China's importation of Western psychiatry: Cultural relativity and mental disorders

As one aspect of China's modernization, the importation of Western psychiatric ideas poses a mystery. How are such ideas integrated with traditional assumptions? The apparently wholesale adoption of Western psychiatric categories runs counter to the fact that the Chinese have been generally reluctant to define problems in highly individualized psychiatric terms. Our lack of knowledge as to how the Chinese and Western medical models interface raises questions about the cross-cultural applicability of psychiatric theory. Ironically, the very conceptual categories intended to facilitate professional discourse obscure cultural, political, and epistemological differences between Chinese and Western thought. This paper focuses on certain incongruities in psychiatric theory and practice in order to underscore many unresolved issues that still exist with respect to our cross-cultural understandings of ‘mental illness’. Insofar as the trend has been towards standardizing methodology, taxonomies have been generated without a corresponding development in textured comparison. Originating from Western theoretical frameworks, comparative analyses have been otherwise devoid of culture-specific knowledge. The goal of this paper is to show that these categorical assumptions are still premature, and that examining the meaning of current ‘rates of mental illness’ in China specifically raises more questions than it answers. Hopefully, this discussion will stimulate a renewed interest in ethnographic methods that would uncover locally-based understandings and thereby create the basis for a more sophisticated epidemiological comparison.     

The mental functioning axis of the psychodynamic diagnostic manual: an adolescent case study

We describe the assessment of a troubled adolescent boy to demonstrate the use of the Shedler-Westen Assessment Profile for Adolescents (Westen, Dutra, & Shedler, 2005) and the Social Cognition and Object Relations Scale-Global (Westen, 1995) to formulate the Mental Functioning for Children and Adolescents Axis (MCA) of the Psychodynamic Diagnostic Manual (PDM Task Force, 2006). The assessment made possible a meaningful psychodynamic therapy.     

Clinical psychologists' theory-based representations of mental disorders predict their diagnostic reasoning and memory

The theory-based model of categorization posits that concepts are represented as theories, not feature lists. Thus, it is interesting that the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) established atheoretical guidelines for mental disorder diagnosis. Five experiments investigated how clinicians handled an atheoretical nosology. Clinicians' causal theories of disorders and their responses on diagnostic and memory tasks were measured. Participants were more likely to diagnose a hypothetical patient with a disorder if that patient had causally central rather than causally peripheral symptoms according to their theory of the disorder. Their memory for causally central symptoms was also biased. Clinicians are cognitively driven to use theories despite decades of practice with the atheoretical DSM.     

Some reflections on spirituality,religion and mental health

For both religion and psychiatry context is becoming more important. Object relations theory, and especially the concept of a transitional object, may be a means of linking religious thinking and psychoanalysis together. The distinction between religion and spirituality is important, though not absolute. Two factors emerge from this engagement: 1) critical questioning at the boundary of each discipline; and 2) both spirituality and mental health are related to life in a specific society. The link between religion and irrational behaviour is important, religion being a primary means of acknowledging the irrational facets of everyday life. But delusion must not be confused with illusion: between these two imagination, art and religion flourish. Each of these is dangerous, since they connect the ‘normal’ with the ‘riskily marginal’. In a multicultural society behaviour which may be acceptable in one context may in another be regarded as a sign of illness. This is particularly true of religious behaviour. Three key issues are examined: 1) the social function of spirituality and religion; 2) the idea of personal wholeness; and 3) the link between external and internal validation of the individual's spirituality. The boundary between psychotic and religious behaviour is a difficult one to discern. Yet neither medical nor spiritual explanations alone seem sufficient. There is a complementary mapping of the complications of human experience.     

The triumph of American psychiatry: How it created the modern therapeutic state

Over the past 170 years, American psychiatry has progressively asserted its authority over a larger segment of the American population. From the mid-1800s to the end of World War II, psychiatry had authority over the asylum population, which markedly increased in the first half of the twentieth century due to the influence of eugenics, an ideology that argued the ‘mentally ill’ had to be segregated from society. After the war, American psychiatry adopted Freudian conceptions of mental disorders, which enabled it to begin treating people in the community who were ‘neurotic’ in some way, which dramatically expanded its influence in society. Then, in the 1970s, when many in American society were questioning psychiatry’s legitimacy as a branch of medicine, the American Psychiatric Association (APA) responded by adopting a disease model for diagnosing mental disorders, which it set forth in the third edition of its Diagnostic and Statistical Manual. There were no scientific discoveries that led to this new model, but soon the APA was informing the American public that mental disorders were diseases of the brain, and that psychiatric drugs helped fix those diseases, ‘like insulin for diabetes.’ The APA, in concert with pharmaceutical companies, has successfully exported this belief system to much of the developed world. In order to break free of this ‘therapeutic state,’ the public needs to understand the history of how it came to be, and see the social injury it has caused.     

Psychologists' perspectives on the diagnostic classification of mental disorders: Results from the WHO‐IUPsyS Global Survey

This study examined psychologists' views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD‐11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD‐10 used most frequently by 51% and DSM‐IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD‐11 development and dissemination are discussed.     

Perimenopausal mental disorders: epidemiology and phenomenology

Perimenopause, the interval of irregular menstrual activity which directly precedes menopause, is characterized by widely fluctuating hormone levels amidst a large-scale decline in circulating estrogen. This phase in a woman's life is typically accompanied by physical discomforts including vasomotor symptoms, such as headaches, insomnia, and hot flushes, as well as genital atrophy. Not surprisingly, studies suggest a significant increase in mood lability for women during this time. While some evidence points toward an exacerbation of bipolar mood symptoms and an increase in schizophrenic psychosis during perimenopause, the majority of research conducted on perimenopausal mental disorders has focused on unipolar depression. Studies vary widely in methodology, definitions of menopausal status, and degrees of depression among subjects; however, the majority of findings indicate an increased susceptibility to depression during the perimenopausal transition. This greater susceptibility may be due to neuroendocrine effects of declining estrogen levels, the subjective experience of somatic symptoms resulting from this hormonal decline, and/or the more frequent occurrence of "exit" or "loss" events for women during this stage of life. At this time, more research is needed to address questions of prevalence, risk, and etiology for depression and other major mental disorders as related to the physiological and psychosocial changes associated with perimenopause.     

The soul of psychoanalysis in the modern world reflections on the work of Christopher Bollas

The paper begins with the claim that psychoanalysis faces a dilemma in locating itself in a contemporary world that devalues experiences of interiority, depth, and embeddedness in personal history. Psychoanalysis's coming to terms with this modern world—reflected in contemporary relational paradigms and emphases on interaction, authority, and epistemology—is essential yet tends to replace an outdated conformity with an updated one, in which what is offered to analysands may become limited and the soul of psychoanalysis lost.

Bollas's work attempts to reinspire psychoanalysis. This paper explores his contributions and the tensions within them and develops several points about how psychoanalysis can maintain a worthwhile self—for itself and for its analysands—in the modern world. Among the issues discussed are the sense in which an endogenous motivational core associated with an emphasis on interiority may be compatible with a relational paradigm and how the notion of personal idiom is a rich and fruitful one, but that the cultural field deserves a more fundamental place than it is given by Bollas. The problem of authority and exploitation, within and outside the consulting room, is also taken up, and it is argued that psychoanalysis should be conceived as a moral discourse in which the analyst's self‐subverting (but not diminished) authority is essential.     

The detection of feigned mental disorders on specific competency measures

Psychologists have standardized competency-to-stand-trial (CST) assessments through the development of specialized CST measures. However, their research has largely neglected the possibility that CST measures may be stymied by feigning mental disorders and concomitant impairment. The current study is the first systematic examination of (a) how feigned mental disorders may affect CST measures and (b) which scales are effective at identifying feigned cases. Bona fide patients (n = 65) were compared with suspected malingerers (n = 22) on 3 CST measures: the Georgia Court Competency Test (GCCT), the MacArthur Competence Assessment Tool--Criminal Adjudication, and the Evaluation of Competency to Stand Trial--Revised (ECST-R). Results indicated that these CST measures are vulnerable to feigning. The development of specialized GCCT and ECST-R scales yielded moderately effective screens for feigned mental disorders in the context of CST evaluations.     

Divergences in American psychiatry during the Depression: somatic psychiatry, community mental hygiene, and social reconstruction

The differences between somatic psychiatrists and mental hygienists, already apparent earlier, became much more pronounced during the Depression years, partly as a consequence of their different perspectives on this social crisis. Somatic psychiatrists, emboldened by the apparent success of new medical treatment methods, reasserted the central position of the mental hospital within psychiatry, attempted to improve the discipline's position within medicine, and promoted basic research. Mental hygienists, following the ideal of prevention, proposed far-reaching programs of community mental hygiene to alleviate widespread mental distress. A small group of mental hygienists embraced socialism and advocated measures of radical social reconstruction.