Culture and Psychosis: A Case Study

Background: Multiple descriptive studies utilizing disease vignettes called short explanatory model interviews (SEMI) were undertaken in a rural district of Tamil Nadu, India to explore regional disease models of psychosis. Among community health workers, 87% attributed SEMIs to non-medical explanations. A similar study found community members believed social and financial problems resulted from violence, self-destructive behavior, sadness and alcoholism while possessions, hallucinations, irrelevant talk and bizarre behavior resulted from spirits, witchcraft and magic. Overwhelmingly, they believed violence/aggression required intervention which could be administered at a hospital or religious center. A study among a cohort of schizophrenic patients found that 70% attributed their situation to spiritual or mystical factors; only 22% attributed it to a disease model. Case Presentation: Our patient was a 60 year-old Hindi speaking man with a history of hypertension, diabetes mellitus and alcohol dependence presenting with command auditory hallucinations (CAH), visual hallucinations (VH) and suicidal ideation (SI). Clinical interviews were conducted through an in-person translator who also served as a cultural broker assisting interpretation of our patient’s beliefs. Our patient immigrated 22 years ago from rural India. He reported that his wife had affairs with family members after he came to the US. CAH were of his wife and in-laws instructing him to commit suicide, bequeathing them his property. VH were family members poisoning his food. He started drinking 1/4 L of alcohol daily at age 16. He reports AH before drinking; as the voices increased he coped with increased drinking. He was sober for 1.5 years, during which time hallucinations continued. He lost his job due to drinking. He did not interpret CAH/VH as depression (Hamilton-D score: 13) or as illness but felt this bad luck was due to black magic perpetrated by his family. He wants the hallucinations to stop and believes they impair daily functioning by necessitating drinking. Discussion: It is important to highlight the emic perspective of diagnosis and assess psychosis against cultural standards. Black magic is a commonly held belief in India but it is general, not directed at individuals. Therefore, belief of personal black magic persecution, as held by our patient, is an abnormal thought process. Conclusion: Given our patient’s disordered beliefs of personal black magic persecution and his CAH/VH, outside the context of alcoholism, which impaired functioning, he was diagnosed with paranoid schizophrenia. This case highlights the importance of culturally competent care and considering culturally appropriate disease models in diagnosis

Testimonial Psychotherapy in Immigrant Survivors of Intimate Partner Violence: A Case Series

© The Author(s) 2018. Testimonial psychotherapy is a therapeutic ritual for facilitating the recovery of survivors of human rights violations that focuses on sharing the trauma narrative. Originally developed in Chile as a method for collecting evidence during legal proceedings, testimonial therapy has been widely applied transculturally as a unique treatment modality for populations that are not amenable to traditional Western psychotherapy. In this case report, we first review the literature on testimonial therapy to this date. We go on to describe how testimonial therapy has been specifically adapted to facilitate recovery for immigrant survivors of intimate partner violence (IPV). We present three Latin American women who underwent testimonial psychotherapy while receiving psychiatric treatment at a Northern Virginia community clinic affiliated with the George Washington University. The therapy consisted of guided trauma narrative sessions and a Latin- American Catholic inspired reverential ceremony in a Spanish-speaking women\u27s domestic violence group. In this case series we provide excerpts from the women\u27s testimony and feedback from physicians who observed the ceremony. We found that testimonial psychotherapy was accepted by our three IPV survivors and logistically feasible in a small community clinic. We conceptualize testimonial psychotherapy as a humanistic therapy that focuses on strengthening the person. Our case report suggests testimonial psychotherapy as a useful adjunct to formal psychotherapy for post-traumatic stress symptoms

Testimonial Psychotherapy in Immigrant Survivors of Intimate Partner Violence: A Case Series.

© The Author(s) 2018. Testimonial psychotherapy is a therapeutic ritual for facilitating the recovery of survivors of human rights violations that focuses on sharing the trauma narrative. Originally developed in Chile as a method for collecting evidence during legal proceedings, testimonial therapy has been widely applied transculturally as a unique treatment modality for populations that are not amenable to traditional Western psychotherapy. In this case report, we first review the literature on testimonial therapy to this date. We go on to describe how testimonial therapy has been specifically adapted to facilitate recovery for immigrant survivors of intimate partner violence (IPV). We present three Latin American women who underwent testimonial psychotherapy while receiving psychiatric treatment at a Northern Virginia community clinic affiliated with the George Washington University. The therapy consisted of guided trauma narrative sessions and a Latin- American Catholic inspired reverential ceremony in a Spanish-speaking women\u27s domestic violence group. In this case series we provide excerpts from the women\u27s testimony and feedback from physicians who observed the ceremony. We found that testimonial psychotherapy was accepted by our three IPV survivors and logistically feasible in a small community clinic. We conceptualize testimonial psychotherapy as a humanistic therapy that focuses on strengthening the person. Our case report suggests testimonial psychotherapy as a useful adjunct to formal psychotherapy for post-traumatic stress symptoms

Teaching the Fundamentals of the Risk Assessment Interview to Clinicians

© SLACK Incorporated. The ability to predict a person’s risk of acute suicide is one of the most important skills in the practice of psychiatry. This article reviews the essential components of suicide assessment in a concise format meant to be learned and taught to psychiatrists at various levels of training. Strategies for assessing a person’s existential state, imminent warning signs, lethality of planned suicide attempts, and protective factors in an empathetic, collaborative approach are reviewed. Finally, a brief overview of the Chronological Assessment of Suicide Events (CASE) approach, a well-validated approach to obtaining a thorough and empathetic suicide assessment that is useful in cases where suicidality is not obviously apparent, is given

Teaching the fundamentals of the risk assessment interview to clinicians

© SLACK Incorporated. The ability to predict a person’s risk of acute suicide is one of the most important skills in the practice of psychiatry. This article reviews the essential components of suicide assessment in a concise format meant to be learned and taught to psychiatrists at various levels of training. Strategies for assessing a person’s existential state, imminent warning signs, lethality of planned suicide attempts, and protective factors in an empathetic, collaborative approach are reviewed. Finally, a brief overview of the Chronological Assessment of Suicide Events (CASE) approach, a well-validated approach to obtaining a thorough and empathetic suicide assessment that is useful in cases where suicidality is not obviously apparent, is given