Past research on idioms of distress among U.S. Latinos has revealed that ataque de nervios and altered perceptions, such as hearing and seeing things when alone, are independent markers of higher morbidity and mental health utilization despite having no one-to-one relationships with any single psychiatric diagnosis. It has been proposed that the idioms exert this effect because they are signs of distressing dissociative capacity associated with traumatic exposure. This study examines the relationships in an ethnically diverse Latino psychiatric outpatient sample (N = 230) among interpersonal trauma, posttraumatic stress disorder (PTSD), major depressive disorder, dissociative capacity and four cultural idioms of distress associated with the popular overall category of nervios. We particularly explore how these relationships change with varied measures of traumatic exposure, including trauma severity and timing or persistence of trauma. A series of adjusted bivariate regressions assessed the matrix of associations between the idioms and the clinical variables. In this highly traumatized population, we identified a strong ‘nexus’ of associations between dissociation and three of the idioms: currently being ill with nerves, ataque de nervios and altered perceptions. These idioms were largely independent from PTSD and depression and were associated with trauma persistence and severity. A fourth idiom, being nervous since childhood, was not associated with any other variable and may represent a personality trait rather than a diagnosable condition. Our results validate the clinical utility of the construct of nervios as a set of specific idioms associated with dissociation that are useful markers of mental health need among Latinos independently of their association with clinical diagnoses.
Fiction films offer unexplored opportunities of rehabilitation for schizophrenia and other psychoses. Schizophrenia produces deficits y distortions in the perception and comprehension of reality, also expressed in the perception and comprehension of films. After a year of an “ad hoc” experience, the following technique was developed:Selecting a fiction film for its narrative, affective, cognitive and social cognitive contentBriefly presenting of the film to a group of 8-16 patients with diverse psychosis.Screening of the film to the patients and the therapeutic team.Summarizing of the plot by a patient. Group correcting of distortions and deficits caused by problems of attention and working memory, as well as positive, negative, affective and social cognitive symptoms (emotional perception, theory of mind, attributive style)Selecting 1-2 sequences by each patient, and group commenting using the same technique.Field recording of all the commentaries obtained.Second screening of the film two days after, repeating points 2 to 6.Comparing both field records.An experimental study using this technique is presented. 8 patients with schizophrenia and other psychoses watched 4 fiction films (“The 39 Steps”, “Charade”, “M”, “The General”). The differences founded in both viewings by two external evaluators (using CGI and analogical scales of the main variables) are presented and commented. An evaluation of the perceived usefulness and satisfaction of the participants was included.
Background“Rite of passage” is an etnographic concept developed by VanGennep that defines the vital transition of an individual between two different status. It is divided in three stages: separation, liminal/threshold and aggregation. Turner described the liminal phase, and the terms of “communitas” and “liminoid” (structure of a rite without religious/spiritual elements). One widely-known Rite of Passage is the initiation of the shamans.ObjetivesStudy the elements of a rite of passage present in Psychiatric Trainning.MethodField study (observational, descriptive, non-experimental).Preliminary Sample=10trainees (5man+5women); last year of Psychiatric Trainning.“ad hoc” semi-structured interview (21items subdivided in open questions). 10interviews (average duration=75mins). Permanent register:digital recorder.Summary and analysis of the answers. Review of the literature.ResultsPsychiatric Trainning shared the elements and tri-phasic structure of VanGennep's “rite of passage” conceptTrainees saw themselves as more empathic(7/10) and humanistic(8/10) than other specialties colleagues. Stigma towards mental illness(8/10) and fear of suicide(9/10) were also considered as their distinctives.The collective behaved as a communitas(10/10)No spiritual elements(0/10): liminoid processResemblances of the ancestral shamans' Initiation: Despite bloody practices were over, suffering was also present(7/10), but was seen as necessary(6/10) and well tolerated(7/10).Trainees felt that they grew spiritual and mentally(7/10) during the trainning yearsConclusionsResults suggest that Psychiatric Trainning has stable phenomena that:are compatible with the Rite of Passage schemaAre considered exclusive of Psychiatry by traineesHave not been systematically studied as a whole, which could help to improve the training.
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