New Development in Legal Advocacy

Mental health service users are voicing the need for advocacy which is responsive to the social oppression they encounter in their lives, and within services. The Kent Law Clinic provides free, independent legal representation for people with a mental illness or a learning difficulty. This article describes the development of the Clinic and some of its work.     

Markers of Successful Aging Among Vietnamese Refugee Women

This article describes several markers of successful aging for Vietnamese women. These studies suggest that feelings of control have important implications for life satisfaction and mental health of female Vietnamese refugees. Adequate satisfaction with social relationships is a key contributor to successful aging and mental health of elderly Vietnamese refugees who are female. The article concludes by discussing ways in which mental health and health care professionals can assist female elderly refugees cope with family crisis, adaptation, and acculturation issues because they are at the highest risk now and into the future. Key issues were: cultural values surrounding age and gender norms, differential rates of acculturation across generations in the family, cross-cultural differences in mental health and their therapeutic implications.     

Revolutionizing the Clinical Frame

Abstract

In this article, we discuss the role of individual and social advocacy as practices that promote resilience and enhance the ecological relationship between trauma survivors and their communities. Issues of access, comprehension, linguistic and social isolation, cultural disorientation and displacement, and feelings of powerlessness within governmental and non-governmental systems encompass common challenges that trauma survivors experience. We discuss two composite cases that explore what individual advocacy and social action entail, how these activities can change a victim's relationship with, inform and mobilize health-promoting competencies within the larger community that assist in the healing from trauma. Included in the article are guidelines and handouts intended to be useful for service providers who are interested in incorporating advocacy into their work settings.     

Current and Future Education and Practice

SUMMARY

This article describes a national study conducted by the American Occupational Therapy Association Mental Health Special Interest Section to assess the adequacy of mental health content and fieldwork experiences in occupational therapy educational programs preparing graduates for current and future mental health practice. The results of the study indicate that occupational therapists, especially those who practice in mental health settings, must become more “business-oriented.” This orientation includes educating occupational therapy students about reimbursement issues, legal and political systems, marketing strategies, and advocacy roles. Other recommendations are discussed as possible ways to prepare future practitioners more effectively for roles in community-based settings.     

Life satisfaction and competence of Bosnian refugees in Norway

In this study the relative influence of age, gender, locus of control, preferred acculturation strategy, perceived majority members' attitude, and social support on life satisfaction and competence of Bosnian refugees was examined. Hundred and six Bosnians living temporarily in Norway completed a questionnaire. The results showed that persons with a higher internal locus of control had a higher life satisfaction and higher feelings of competence. The acculturation option assimilation was related to the highest life satisfaction, while the integration option was related to the highest feelings of competence. The more positive reactions the respondents received from Norwegians, the higher their life satisfaction and the higher their feelings of competence. Older refugees reported the highest feelings of competence.     

Die verwundbare Analytikerin

The withdrawal of acceptance lies at the centre of the traumatic experience and the disastrous consequences are overwhelming feelings of anxiety and shame relating to the individual’s own existence. Intense feelings in traumatised individuals are accompanied by fundamental shame as they fear once again being inundated by their own emotions and thus yet again becoming helpless and defenceless. Further, the emergence of emotions inevitably demonstrates their roots in the individual personality and it is precisely the withdrawal of recognition as a separate, autonomous being which these individuals have experienced. “When I experience myself as an individual with feelings, then I am but I am not allowed to be” seems to be what these people are unconsciously thinking. Recognition, in the true sense of the word, can only be achieved by the performative act of recognition both of the subjectivity and of the trauma. Such acts of recognition can be performed in the psychoanalytical process when the analyst shows herself as being involuntarily vulnerable and at the same time as a survivor of that vulnerability. This means, however, that the dialectic tension must not only be endured but under certain circumstances also admitted; the tension between the wish to keep all emotions within oneself and the simultaneous unavoidable failure to do so. Only an analyst who is actively alive can, in the last resort, help the traumatised to establish contact with the world of living objects and to feel themselves as being alive.     

Theistic Dissonance Among Religious Jewish Holocaust Survivors: A Psychodynamic Perspective

Coining the term theistic dissonance to capture conflicted attitudes and feelings toward God, this article examines faith-based reactions to the Holocaust. The theological weltanschauung of religious Jewish Holocaust survivors is analyzed, with a particular focus on their attempts to reconcile the notion of a benevolent and caring God with their harrowing experience. Basic religious sources and contemporary literature are presented to elucidate the realm of resolutions of theistic dissonance. It is suggested that elements of defense mechanisms are adapted from the emotional into the cognitive realm, and are used by survivors to facilitate respective interpretations of God’s role during the Holocaust. Dissonance resolution is seen as being informed theologically and experientially for these victims who confronted stark challenges to their religious integrity.     

Fatal violence – from trauma to offence: A case study in forensic psychotherapy and trauma therapy with a migrant patient

Abstract

That persons who are objects of violence and traumatisation become offenders themselves is a typical feature of ill-fated cycles of violence in countries torn by fierce political, ethnic, and religious conflicts. Some refugees and migrants with this background present a challenge to forensic psychotherapy when they continue such patterns of physical force and criminal behaviour in a host country like Germany, and are found to be either not responsible or of diminished responsibility for their criminal acts by reason of mental disorders or addictions. Their offences create a critical legal situation for them, since they are threatened with deportation. At the same time, their clinical condition is critical, for they were possibly subjected to traumatic experiences by authorities in their past; their cooperation in the treatment can seriously affect their legal status. Finding a way out of these complications has to take these special factors into account. Our paper focuses on the case study of a refugee from North Africa, illustrating a model of cooperation in forensic inpatient treatment, special trauma therapy (narrative exposure therapy), and expert testimony.     

The admissibility of expert testimony regarding malingering and deception

This article discusses the legal admissibility of expert testimony and the ability of mental health professionals to detect malingering and deception among defendants. A legal analysis of the admissibility of expert testimony regarding malingering and deception in formal legal proceedings is presented. Some guidelines are provided to help mental health professionals and attorneys determine the admissibility of evidence they intend to introduce. Although psychologists and psychiatrists currently have a limited ability to identify accurately malingering and deception, expert testimony about the genuineness of a defendant's mental illness is likely to be held admissible for both practical and evidentiary reasons. In contrast, evidence about a witness' credibility is rarely admissible. In addition, psychologists are ethically obliged to recognize their limitations in making representations about their skills.     

Post-Traumatic Stress Disorder Among Salvadoran Women:

Previous research has documented post-traumatic stress disorder among Salvadoran refugees in this country, but information on refugees living in El Salvador is not available. This study investigated the patterns of psychological distress and documented the existence of PTSD in Salvadoran refugee women in El Salvador. A team of U.S. mental health workers traveled to a refugee camp in El Salvador to interview women about their traumatic experiences and current symptoms of distress. This study provides strong evidence that many refugee women in El Salvador have developed PTSD and that many others show significant signs of distress. Data from this study also provided insight into clinical issues for Salvadoran women experiencing PTSD. In response to requests from Salvadoran mental health providers, a treatment program was developed to help Salvadoran women reduce their distress. Goals of the treatment included associating distress with the trauma as a normal reaction to a very abnormal event, reducing feelings of loss of control, reducing "survivor guilt," and lessening anxiety and high arousal level. These goals were accomplished using cognitive-behavioral and community-oriented strategies.     

Suicide survivors' perceptions of the treating clinician

Seventy-one suicide survivors were surveyed about their perceptions of the clinicians who were treating their loved one at the time of death. Survivors provided information regarding their perceptions and attitudes toward clinician behaviors before and after the suicide and their perceptions of helpful and troubling aspects of clinician behaviors. Results indicated that survivors share a number of common opinions regarding the mental health care providers treating their loved ones. Several differences existed between survivors who consider lawsuits against mental health care providers versus those who do not. The implications of these findings for clinical practice, legal issues, surviving suicide, and future research are discussed.     

Citizen Advocacy Observed: Tool or Tokenism?

Citizen advocacy, where a volunteer works in partnership with a vulnerable person, compliments self- and legal advocacy. In the context of mental health services, citizen advocacy is a tool for enabling and empowering people who use these services, and is founded on the recognition that mental health service users are frequently socially oppressed and disadvantaged. This article describes the development of a Citizen Advocacy service for people with mental health difficulties, and also the problems they brought to this service. The problems encountered in sustaining the service are noted and lessons are drawn for the future.     

Healthy Migrants in an Unhealthy City? The Effects of Time on the Health of Migrants Living in Deprived Areas of Glasgow

This paper examines the healthy immigrant effect in Glasgow, a post-industrial city where the migrant population has more than doubled in the last decade. Using data from a community survey in 15 communities across the city, the paper compares four health outcomes for the following three groups: British-born, social and economic migrants and asylum seekers and refugees. Migrants were found to be healthier than the indigenous population on all four measures, particularly in the case of adult households in both migrant groups and for older asylum seeker and refugee households. Health declines for social and economic migrants with time spent in the UK, but there is no clear pattern for asylum seekers and refugees. Health declined for refugees according to time spent awaiting a decision, whilst their health improved after a leave-to-remain decision. Indigenous and social and economic migrant health declines with time spent living in a deprived area; this was true for three health indicators for the former and two indicators for the latter. Asylum seekers and refugees who had lived in a deprived area for more than a year had slightly better self-rated health and well-being than recent arrivals. The study’s findings highlight the role of destination city and neighbourhood in the health immigrant effect, raise concerns about the restrictions placed upon asylum seekers and the uncertainty afforded to refugees and suggest that spatial concentration may have advantages for asylum seekers and refugees.     

Jurors' Decisions in Trials of Battered Women Who Kill: The Role of Prior Beliefs and Expert Testimony1

The present research explored the influence of four factors on mock jurors' decisions in a homicide trial involving a battered woman who killed her abusive husband: (a) jurors' preexisting beliefs about wife abuse, (b) the presence of expert testimony on the battered woman syndrome, (c) jurors' beliefs in a just world, and (d) gender. Mock jurors listened to a trial involving a woman who had killed her abuser, which either contained expert testimony or did not, and then rendered various judgments about the case. Results indicated that those individuals who were more informed about the dynamics of abuse and those exposed to the expert testimony, compared to their respective counterparts, were more believing of the battered woman's account of what occurred. In general, weak believers in a just world were more lenient in their judgments, with verdicts of not guilty being associated with weaker beliefs in a just world than guilty verdicts. Weak believers in a just world also felt that the expert testimony applied more to the defendant than did strong believers. Finally, women who were weak believers in a just world were less likely to hold the defendant responsible for the events and to be more informed about the dynamics of abuse following the experiment.     

Group therapy for refugees and torture survivors: treatment model innovations

The paper discusses varieties of group therapies with refugees and torture survivors and the logic behind enhancing traditional group therapies to fit the unique experiences of refugees and torture survivors. It discusses some lessons learned from practice and from empirical research and some recommended adaptations. Finally, it discusses the Center for Torture and Trauma Survivors' therapy group model for torture survivors and describes two of its variants: The Bashal group for African and Somali women and the Bhutanese multi-family therapy group. Group therapies, in this model, extend to community healing. One of the essential and innovative features of the model is that it focuses not only on treating individual psychopathology but also extends to community healing by promoting the development of social clubs and organizations that promote the values and culture of the graduates of the therapy group and the continuation of social support. New graduates from the group join the club and become part of the social advocacy process and of group and community support and healing. This model adds an ecological dimension to the traditional group therapy.     

Off the stage,on the page: on the relationship between advocacy and scholarship

When and how should scholars of religion draw a line between advocacy and research activities? In what ways does advocacy contribute to or cut against scholarly credibility? Addressing these questions from the intersection of the academic study of religion and Indigenous Studies, this article opens by asserting that both fields are frequently hampered by deferential treatments of their subject matter, a problem that is potentially exacerbated when scholars in these fields engage in forms of political advocacy. Problematizing this narrative, the author turns to his ethnographic experiences in Hawai'i with regard to burial-protection struggles in order to describe ways his theoretical commitments and advocacy activities stand in tension and how he has attempted to navigate these competing but sometimes complementary elements of his scholarly life. In this context, a heuristic definition of advocacy is advanced in order to sketch a spectrum of forms, ranging from direct advocacy (e.g., physical action, legal testimony, or publication) to indirect advocacy (e.g., sharing documents, brainstorming about pending issues, or providing transportation to a meeting). The article concludes with reflections on advocacy and changing institutional demands upon scholars in the humanities and social sciences with reference to perceived public relevance.     

PROFESSIONALIZING SURVIVAL: THE POLITICS OF PUBLIC MEMORY AMONG HOLOCAUST SURVIVOR-EDUCATORS IN MONTREAL

The majority of Holocaust survivors never speak publicly about their experiences, but those who do tend to find themselves at the centre of commemorative work in their communities. As Holocaust scholars, Holocaust education institutions, and members of the general public become increasingly interested in how to ethically universalize the lessons of the Holocaust, the public Holocaust survivor's role has broadened. It is no longer enough to recount one's own experience; survivors are expected to speak to current human rights abuses and genocides.In Montreal, Canada, a city which once claimed the third largest survivor population in the world, public survivors do a great deal of work. They give testimony in schools and at commemorative events, organize book clubs, write plays, direct films, teach, act as museum docents, and assume roles as community spokespeople. Given their dedication to this work, and a push to get them to speak beyond their personal experiences, we argue that there is a major shift taking place: the act of giving public Holocaust testimony is being professionalized. This professionalization raises unique questions about how people who lived through the Holocaust conceptualize themselves and their identities as survivors. By treating testimony as professional work, survivors contemplate, on a daily basis and in an applied manner, their stances on big questions regarding hierarchies of suffering, comparability, the connection between the personal and the political, blame and forgiveness, as well as many other relevant themes that are central to Holocaust and memory scholarship. All of this plays out in their testimonies.     

Post‐traumatic factors and resilience: the role of shelter management and survivours' attitudes after the earthquakes in El Salvador (2001)

A participatory research action was undertaken in the two largest shelters established after the earthquakes in El Salvador (2001). One hundred fifteen semi‐structured interviews were carried out among refugees, which later formed the basis for a self‐managed community plan. Comparisons between the two shelters—which differed primarily in whether the grouping of tents was made to reflect the community of origin of the survivors (shelter Santa Gertrudis) or not (shelter El Cafetalón)—showed that refugees in Santa Gertrudis participated more often in community activities, and had more positive emotional memories, fewer feelings of having been humiliated and less emotional discomfort than refugees in El Cafetalón. The results suggest that forms of organisation and management which consider elements of dignity, participation and respect for the capacity of the victims to control their own lives are relevant factors for effective individual and community coping after a catastrophe. Copyright © 2005 John Wiley & Sons, Ltd.