Imbalances in the knowledge about infancy: The divide between rich and poor countries

Over 90% of the world's infants are born in low‐income or “developing” countries, and these countries bear a disproportionate burden in terms of health and social problems. In this article we compare the contributions of richer and poorer countries to knowledge about infancy. We surveyed articles on infancy from 12 international journals dealing with psychological aspects of childhood and infancy and found that 94% of articles surveyed were written from Europe or North America. We suggest that the imbalance in knowledge about infancy is serious and that efforts must be made to increase collaborative research between poor and rich countries. ©2003 Michigan Association for Infant Mental Health.     

Effects of involuntary outpatient commitment on subjective quality of life in persons with severe mental illness

Recent evidence suggests that involuntary outpatient commitment (OPC), when appropriately applied, can improve adherence with psychiatric treatment, decrease hospital recidivism and arrests, and lower the risk of violent behavior in persons with severe mental illness. Presumably these are benefits that improve quality of life (QOL); however, insofar as OPC involves legal coercion, the undesirable aspects of OPC could also exert a negative effect on quality of life, thus offsetting clinical benefits. Involuntarily hospitalized subjects, awaiting discharge under outpatient commitment, were randomly assigned to be released or continue under outpatient commitment in the community after hospital discharge, and were followed for one year. Quality of life was measured at baseline and 12 months follow-up. Treatment characteristics and clinical outcomes were also measured.Subjects who underwent longer periods of outpatient commitment had significantly greater quality of life as measured at the end of the 1 year study. Multivariable analysis showed that the effect of OPC on QOL was mediated by greater treatment adherence and lower symptom scores. However, perceived coercion moderated the effect of OPC on QOL. Involuntary outpatient commitment, when sustained over time, indirectly exerts a positive effect on subjective quality of life for persons with SMI, at least in part by improving treatment adherence and lowering symptomatology.     

Counter-narratives in context: The role of the organisation and broader culture in psychic splitting among South African survivors of intimate partner violence

Chronic trauma, shame and psychopathology, as well as the association between them, are acutely understudied, both in South African and internationally. The focus of this article is on chronic trauma of a particular kind, intimate partner violence (IPV) and the development of a specific form or shame-related psychopathology, the splitting of self and how this splitting may be further facilitated or exacerbated by the contexts in which people live. The (counter) narratives of three women are presented. These (counter) narratives demonstrate the presence of both a concealed and shameful authentic self, and the socially conforming projected false self, two polarised parts of the psyche. It is argued that the organisational context, a shelter for survivors of IPV, which has a strong ethos centred around advocacy and human rights and which promotes a strong message of personal empowerment and agency, may unintentionally exacerbate the psychic split in women who have been subjugated at a broader (predominantly patriarchal) cultural level their whole lives. Participants’ resistance narratives were often characterised by inconsistencies and contradictions which oscillated between supporting mainstream cultural narratives and organisationally driven, active resistance against the cultural context from which they came. However, resistance narratives often felt thinly veiled and inauthentic, which is one of the problems with interventions in resource constrained settings which are necessarily time-limited. To fully and completely counter the cultural message that has been the focus of participants’ lifelong gendered socialisation, long-term and in depth interventions at organisational level are needed. These ideas are not only relevant to the South African setting, but have wider application internationally.     

Child,Adolescent and Adult Psychiatric Disorders in Africa: Implications for Psychological Interventions

The authors start by critically discussing some core features of Western psychiatric diagnosis, and present the cultural formulation as one approach to ensure that the cultural aspects of the diagnostic process are addressed, followed by a summary of what is known about the causes of psychiatric disorder. Five arguments are presented that provide support for the importance of psychiatric disorders in Africa: prevalence rates are high; psychiatric disorder is associated with a considerable burden from disability; in most cases, adults with psychiatric disorders experienced the onset of their disorder in childhood or youth; psychiatric disorders are strongly associated with medical conditions; and effective interventions exist for the majority of people suffering from psychiatric disorders. Against this background, current mental health services in Africa are reviewed. Finally, some suggestions are provided for how those providing psychological interventions can contribute to addressing the challenges posed by psychiatric disorders in Africa.     

Mechanisms of hypnotic and nonhypnotic forgetting

Subjects participated in two experimental sessions designed to study laboratory-induced amnesia, one using a standard hypnosis paradigm and one using a non-hypnotic directed-forgetting paradigm. Two independent sources of variation were derived from the hypnotic amnesia data: retrieval inhibition and inhibition release. In the nonhypnotic directed-forgetting procedure, some items were cued to be forgotten shortly after presentation and some were cued to be remembered. At test, the subjects were asked to recall both the to-be-remembered and the to-be-forgotten items. Over 39% of the variance in the recall of the to-be-forgotten items could be accounted for by the inhibition and release constructs obtained with hypnosis. These relations between the two procedures were not mediated by verbal ability or cognitive style (field independence). We concluded that the mechanisms of forgetting involved in laboratory demonstrations of hypnotic and nonhypnotic amnesia are related, and the implication is that some of them are the same, namely, retrieval inhibition and inhibition release. We also argued that the possible demand characteristics that accompany the hypnosis procedure are not apparent with the nonhypnotic procedure. Therefore, the relationships observed in the present results were taken as evidence that hypnotically induced amnesia is not entirely the result of subjects' reactions to demand characteristics.     

Giving In,Giving Up,and Being Blown to Smithereens: A Discussion of “‘When Reparation Is Felt to Be Impossible’: Persecutory Guilt and Breakdowns in Thinking and Dialogue about Race”

In describing the paralysis that encumbers those struggling with persecutory guilt about their white privilege, and suggesting we seek opportunities for meaningful repair within the realm of the ordinary, Caflisch (this issue) is directing us toward an ethic of personal accountability to everyday interaction. This paper explores possible routes toward the “ordinary” reparation Caflisch seeks, and describes several pitfalls that might be encountered along the way.