Transculturality. When Anthropology meets Psychology.

In lieu of an abstract, here is a brief excerpt of the content:The Cultural Context of Post-traumatic Stress DisorderCarolyn Smith-Morris (bio)Keywordspost-traumatic stress disorder (PTSD), culture, medical anthropology, fight-or-flight responseIn his Clinical Anecdote, Dr. Christopher Bailey gamely imagines the evolutionary underpinnings of his patient's distressing lack of war wounds. As part of a careful and engaged discussion of care for his suffering patient, Dr. Bailey suggests that our evolved fight-or-flight response to the alarms of the African savannah may (...) be at work in Colin's distress. The fight-or-flight response is something of great interest to anthropologists, who rely on Darwin's theory of evolution to explain much in human experience. According to Dr. Bailey's application of the theory, Colin's visceral response to threat is protective in the presence of danger, but destructive (particularly to his mental health) in the absence of such challenges. So Dr. Bailey considers whether we may have an evolved “need” for threat, and that Colin's trauma is in part related to the lack of such threat in his wartime experience.According to Darwin's ideas, evolved traits may be adaptive but may also simply be random appearances that have not yet produced cause for evolutionary eradication. The fight-or-flight response, or any of the hypothalamic–pituitary–adrenal axis events initiated under either acute or chronic stress, is therefore occurring in Colin's reactions to everyday frustrations, to wartime exposures, and even during the stressful nontrauma of feeling “wimpy.” Dr. Bailey's idea about an evolved need for threat is tautological. That need is not biological, but cultural.Although post-traumatic stress disorder is medically real, it is an event that develops in a particular place and time. Likewise, gender roles that demand scar battles and trophies of a certain form are culturally determined. Culture is central to this anecdote: a culture-specific occurrence of post-traumatic stress disorder and culturally driven gender roles for men, especially warriors. Stress is indeed present in Colin's life: our postindustrial culture's separation from everyday death and violence make episodes like war and combat all the more shocking or traumatic; the lack of social recognition for his service also seems to be one of Colin's stressors. Both the shock of warfare and the trauma of his social invisibility are as vivid to his evolutionarily informed body as is the presence of a crouching lioness in the room. So it is the host of cultural expectations, and his inability to mobilize social and cognitive resources to respond to them, that is wounding Colin. Talk therapy should draw out these cultural details [End Page 235] and, as Dr. Bailey has already begun to do, emplot Colin into a more heroic (his)story of his service to our nation.Related ArticlesFeature Article: Clinical Anecdotes: A Painful Lack of WoundsCommentary: The Nature of Proof in PsychiatryCommentary: Truth and Healing a Veteran's DepressionCommentary: Inappropriate RegretCommentary: The Cultural Context of Post-traumatic Stress DisorderCommentary: Explication or Explanation?Commentary: The Importance of What Psychiatrists Care AboutCommentary: Mourning or MelancholiaResponse: A Painful Lack of ConnectionCarolyn Smith-Morris Carolyn Smith-Morris is an Associate Professor in the Department of Anthropology at Southern Methodist University in Dallas, Texas. Her work focuses on chronic disease and the health impacts of culture change and acculturative stress in North America. She is engaged in several research programs among migrating Mexican workers, among poor African-Americans in Dallas, and for the Gila (pronounced Hee-la) River Indian Community of Southern Arizona, a tribe that suffers from the highest recorded rates of type 2 diabetes in the world. She also holds a research fellowship with the Foundation for Community Empowerment, serves on the Board of the Society for Medical Anthropology, and is a fellow in the Society for Applied Anthropology. She published Diabetes Among the Pima in 2006 and has several articles detailing her applied research on diabetes, reproduction, health care ethics, and end-of-life care. She can be contacted via e-mail at: csmorris@mail.smu.eduReferenceBailey, C. 2009. A painful lack of wounds. Philosophy, Psychiatry, & Psychology 16, no. 3:223–224. [End Page... (shrink)

IntroductionWe aimed to study post-traumatic stress disorder symptoms in breast cancer patients during the coronavirus disease pandemic.Materials and methodsWe included BC patients receiving medical treatment during the first COVID-19 lockdown in France. PTSD symptoms were evaluated using the Impact of Event Scale-Revised questionnaire. Quality of life [Functional Assessment of Cancer Therapy-General ], cognitive complaints [Functional Assessment of Cancer Therapy–Cognitive Function ], insomnia [Insomnia Severity Index ], and psychosocial experiences during lockdown were also evaluated. Multivariable logistic regression was used (...) to identify clinical factors and psychosocial factors associated with PTSD symptoms.ResultsAmong the 253 included BC patients, 46% had metastatic cancer and 52% were treated by chemotherapy alone. COVID-19-induced adjustments in medical oncology practices were experienced by 27% of patients. No case of COVID-19 was reported; 23% of BC patients had PTSD symptoms. Compared to other patients, patients with PTSD symptoms had more fears relative to COVID-19 infection, had more feeling of isolation, and had more prescription or increased use of psychotropic drugs. In the multivariable model adjusted for clinical factors, fears relative to COVID-19 and increased use of psychotropic drugs were independently associated with PTSD symptoms. Besides, patients with PTSD symptoms had poor quality of life, and more cognitive complaints and insomnia.ConclusionPost-traumatic stress disorder symptoms were observed in 23% of BC patients during the first COVID-19 lockdown in France. Psychological supports are needed for patients treated during the COVID-19 pandemic. (shrink)

The fact that young people from Nigeria and Asia make up the largest populations of illegal immigrants overseas is no longer news. The rationale for illegal migration is structural injustice and individual decision-making. Migration has led to increased cultural variety but has also contributed to segregation, racism, and cultural disputes. Stress on the infrastructure, sadness, and anxiety in the host community, and the resurfacing of violence-related post-traumatic disorder attributed to illegal migration. The typical methods for limiting illegal immigration (...) have been nationwide border closures and the repatriation of illegal immigrants. These methods failed to address the issue. Using the method of philosophical analysis, this study maintains that migration has strengthened the economies of many nations and promoted global citizenship and cosmopolitanism, but has led to the deaths of many young Nigerians. The Indigenous Moral Theory of Native-Centric Ethics (togetherness) will be applied to advance and comprehend the causes of illegal immigration as well as potential solutions. Native-centric ethics is the moral of togetherness based on the principles of reciprocity, mutual respect, and working towards the common good. This study concludes that Native-centric ethics should be used by policymakers so that citizens can have faith in their leaders. Of course, this would aid in lowering international unlawful migration. (shrink)

AimThe Coronavirus 2019 pandemic represents one of the most catastrophic events of recent times. Due to the hospitals’ emergency situation, the population of healthcare workers was the most affected. Healthcare workers who were exposed to COVID-19 patients are most likely to develop psychological distress and post-traumatic stress disorder. The present study aimed at investigating PTSD in a sample of Italian healthcare workers during this outbreak and to evaluate the effectiveness of the Eye Movement Desensitization and Reprocessing Therapy with (...) this population.MethodsA total of 744 healthcare workers were included. 587 healthcare workers were treated with EMDR, while the other 157 were not treated. Participants were asked to provide sociodemographic information; the post-traumatic symptomatology was evaluated through Impact of Event Scale-Revised and to investigate the level of intensity of emotional activation was used The Emotion Thermometer at two time points.ResultsThe results obtained between EMDR treatment and non-EMDR treatment were evaluated on only 2 hospitals. Treatment group n = 68 vs. waitlist non-treatment group n = 157. All scores pre- and post-EMDR decreased significantly showing an evident effect of EMDR. The differences between pre- and post-treatment of the IES-R scores of subjects in which EMDR was performed as compared to the scores pre- and post-12 weeks of waiting list subjects in which it was not performed were significantly different.LimitationThe emergency situation did not provide an opportunity to explore further aspects that would have been important for research. One limitation is the use and analysis of only two standardized tests. In addition, other psychopathologies were not investigated as outcome measures. A limitation is the comparison of subjects treated online and de visu. Although the protocol used was the same, the mode of intervention may have influenced the results. In addition, the effectiveness of EMDR treatment was only evaluated at two time points with no possibility of follow-up and the lack of a control group.Discussion/conclusionThe findings of the present study suggest that healthcare workers were at high risk of developing PTSD when confronted with COVID-19 outbreak and suggest the importance of psychological support during this humanitarian emergency. (shrink)

This study aimed to investigate the status and risk factors of post-traumatic stress disorder in patients with acute myocardial infarction after emergency percutaneous coronary intervention in acute and convalescence phases. A longitudinal study design was used. Two questionnaire surveys were conducted in the acute stage of hospitalization, and 3 months after onset in patients. Logistic regression was used to analyze the risk factors for PTSD in AMI patients. The incidence of PTSD was 33.1 and 20.4% in acute and (...) convalescent patients, respectively. The risk factors related to PTSD were door-to-balloon time, left ventricular ejection fraction, smoking, anxiety, and depression. AMI patients after PCI had PTSD in the acute and convalescent stage. The findings indicate that tailored measures should be developed and carried out to prevent PTSD and improve the mental health of patients with AMI after undergoing PCI. (shrink)

In this paper, we will attempt to describe an integrative model that links stress, trauma, and post-traumatic health disorders through biological, psychological, and behavioral mechanisms of influence. Each of these phenomena has its specificities but also shares common characteristics (sources, symptoms, and consequences) related to health and an individual’s functioning. Prolonged stress and sudden experiences can lead to trauma, and repeated experiences of trauma over time can result in the development of post-traumatic stress disorder (PTSD). This (...) key mechanism illustrates how long-term stress and trauma can lead to severe health impairment. A review of the literature on this topic, along with our many years of experience and research in these areas, reveals that the majority of authors in their research primarily focus on one of these topics, usually stress. There are fewer studies that provide a comprehensive representation of both stress and trauma. We have not come across any research that unifies all three topics in their presentation, highlighting the common elements as well as the specificities and differences. The aim of this paper is to demonstrate, through an integrative approach, the combined impact of these three phenomena on health and an individual’s functioning. First, we will describe each of these phenomena along with their respective specifications. Finally, we will attempt to integrate the knowledge of physiological and psychological mechanisms for dealing with stress, trauma, and post-traumatic stress disorder. Although challenging, we will also touch upon prevention strategies towards the end. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical Anecdotes: A Painful Lack of WoundsChristopher Bailey (bio)Keywordsdepression, post-traumatic stress disorder (PTSD), evolution, fight-or-flight, veteran (treatment of)Colin came to me complaining of depression, which started after he got back from Iraq in 2005. Although he had served in the National Guard, he volunteered absolutely nothing about his time in Iraq as we spoke, instead focusing on other factors, like problems at his job and a family (...) history of depression.Colin's depression seemed serious but not severe. He had been functioning fairly well at work and was not suicidal, although his home life had begun to suffer. As the interview proceeded, I myself fell into Colin's blind spot, all but forgetting his tour of duty as I forged ahead with my list of questions. My avoidance was conscious at first, a deliberate reluctance to come across as one more morbidly curious onlooker recklessly inflaming the wounds of war.When Colin complained of irritability, however, and being kept awake by sinister, shadowy “flashes” at night, I knew I had to ask about Iraq. He was probably suffering from post-traumatic stress disorder, I decided, and was thus trying to avoid the very memories that were haunting and hunting him. And for fear of retraumatizing him (if not suffering second-hand trauma myself), I had colluded in his denial.So when I finally got around to asking about Iraq, I fully expected to hear horror stories, half-articulated perhaps, but all the more grisly for the graininess of their images. Instead, Colin surprised me. He had not experienced anything he considered traumatic. No bombs, bloodshed, or shattered bodies. And in fact, he felt like a “wimp” for having been assigned to a noncombat detail where he missed what might have been his last, best chance “to be a hero.”Most of us would consider this a good thing, but in Colin's case, it had left him feeling somehow uninitiated, like he had not done his part or proven his manhood. Contrary to my assumption, it was the lack of trauma that seemed to trigger his depression upon returning from Iraq. In a relatively safe homeland, rife with middle-class comforts and lacking all but metaphorical rites of passage, perhaps we all feel this way at some level.I pointed out to Colin that people have been dying everywhere in Iraq and under all different circumstances, not just combat. From my stateside perspective, just being there is brave. Although I meant to honor him, he seemed to take my offering as more evidence of his failure, reassuring me that nothing he did could ever compare with the unspeakable horrors endured by veterans of Viet Nam and World War II.Now, as a civilian, he questions whether or not he would respond with sufficient ferocity if, say, he had to defend his family against an attacker. Although powerfully built, Colin (to his credit) has never been a brawler or a bully. Nonetheless, [End Page 223] I have no doubt he could do whatever it took to protect his family. What concerns me more is the opposite: That in trying to prove himself, he might unwittingly put himself and his family in harm's way, if not hurt someone who was never really a threat to begin with.With a new family member, I too feel the burden of hypervigilance. But although terrorists, serial killers, and gangs grab headlines, activating our visceral alarm systems, data from the Centers for Disease Control and Prevention suggest that a sedentary lifestyle still exacts a higher death toll among white American men, like Colin and myself. Although the effect of inertia on the body has been discussed extensively, its impact on mental health has received relatively little attention. Maybe for a creature who evolved on the African savannah, competing over territory and trying not to get eaten, the absence of a visceral challenge can be as debilitating as too much of one.Colin seemed receptive to my concerns, which I took to be a good sign. Although insecure men are quick to fear emasculation, Colin did not seem to be the least bit threatened when I suggested a course... (shrink)

Taking post-traumatic stress disorder (PTSD) as an example, we present a concept for transdisciplinary cooperation between life sciences and humanities. PTSD is defined as a long-term persisting anxiety disorder after severe psychological traumata. Initially recognized in war veterans, PTSD also appears in victims of crime and violence or survivors of natural catastrophes, e.g., earthquakes. We consider PTSD as a prototype topic to realize transdisciplinary projects, because this disease is multifacetted from different points of view. Based on physiological and (...) molecular biological research to understand the causes of this disease, conventional academic medicine (to Western medicine) and pharmacology can offer a panel of drugs for treatment, albeit only with limited success. Hence, other treatment options are indispensable. Chinese medicine is frequently regarded as alternative to complement Western medicine. In fact, Chinese medicine offers a large array of both pharmacological and non-pharmacological treatments for PTSD patients. Narrative therapy represents a non-pharmacological approach combating PTSD both in Western medicine as well as in Chinese medicine to improve quality of life of affected patients. Narratives on traumatic experiences form a new genre of life writing in Asian American literature, whose excitement is considerably fueled by the tension between fictitious and very personal narratives taken from reality. Systematic academic reflections on narratives from PTSD patients in the field of Asian American studies may support the improvement of narrative therapy in medical practice. Chinese medicine has a strong philosophical background and may, therefore, serve as junction between life sciences with their strong rational and reductionistic way to generate new knowledge and more holistic approaches in traditional medicines and humanities. In this regard, Chinese medicine may represent a missing link between life science and life writing. (shrink)

Background: Post-traumatic stress disorder is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy, are effective in treating PTSD, although a fair proportion of individuals show limited benefit from such treatments. CPT requires cognitive demands such as encoding, recalling, and implementing new information, resulting in behavioral change that may improve PTSD symptoms. Individuals with PTSD show worse cognitive functioning than those without PTSD, particularly in acquisition of verbal memory. Therefore, memory dysfunction may limit treatment (...) gains in CPT in some individuals with PTSD. Methods and Analysis: Here, we present a protocol describing the Cognition and PsychoTherapy in PTSD study, a prospective, observational study examining how cognitive functioning affects treatment response in CPT for PTSD. The study aims to recruit 105 outpatient veterans with PTSD between the ages of 18 and 70 years. Prior to beginning 12 sessions of CPT, Veteran participants will have standardized assessments of mood and functioning and complete a comprehensive neurocognitive battery assessing episodic learning, attention and speed of processing, language ability, executive control, and emotional functioning. This study aims to fill gaps in the current literature by: examining the specificity of memory effects on treatment response; exploring how baseline cognitive functioning impacts functional outcomes; and examining potential mechanisms, such as memory for treatment content, that might explain the effects of baseline memory functioning on PTSD symptom trajectory. Discussion: If successful, this research could identify clinically relevant neurocognitive mechanisms that may impact PTSD psychotherapy and guide the development of individualized treatments for PTSD. (shrink)

ObjectiveTo examine the effect of family and perceived organizational support on the relationship between nurse adaptability and their experience with COVID-related PTSD (post-traumatic stress disorder) symptoms in frontline nurses working on COVID-19 units.BackgroundProximity to and survival of life-threatening events contribute to a diagnosis of PTSD, which is characterized by avoidance of reminders of trauma, intrusive thoughts, flashbacks of events, sleep disturbances, and hypervigilance. Using the job-demands and resource model, we examined the effect of adaptability, family support, and perceived (...) organizational support on PTSD symptoms for nurses during the COVID-19 pandemic. Specifically, we tested whether perceptions of environmental supports—i.e., family and organizational support—moderated the relationship between nurse adaptability and COVID-related PTSD symptoms.MethodsA sample of frontline nurses working on COVID-19 units during the COVID-19 pandemic in Texas (N= 277) participated in this cross-sectional, observational study. Frontline Nurses reported demographic information and completed surveys designed to measure adaptability, perceived organizational support, family support, and COVID-related PTSD symptoms.ResultsAdaptability was significantly positively correlated (medium effects) to perceived organizational and family support (r= 0.51 and 0.56, respectively,p< 0.01). Adaptability and perceived organizational support were also negatively correlated with COVID-related PTSD symptoms (medium effects). Adaptability was negatively correlated with COVID-related PTSD symptoms, supporting Hypothesis 1 (r= −0.43,p< 0.01). Perceived organizational support was also significantly negatively correlated with COVID-19-related PTSD symptoms (r= −0.30,p< 0.01). Family support was not significantly correlated with COVID-related PTSD but was positively related to experiencing COVID-related PTSD after other variables were accounted for.ConclusionFindings suggest that individual adaptability and organizational support may reduce PTSD severity in frontline nurses working during a crisis; however, family support may increase PTSD symptoms. We provide suggestions for strengthening individual adaptability and healthcare leadership including remaining highly engaged to show support by providing rapid communication, remaining calm during difficult circumstances, and maintaining a consistent, physical presence during difficult times. Moreover, our results suggest additional support for nurses with families to adapt to crisis. (shrink)

I discuss why one critical aspect of the process of political reconciliation involves the restoration of mutual respect for the rule of law and suggest that psychological research on post-traumatic stress disorder (PTSD) provides valuable resources for understanding how successfully to restore such mutual respect.

This paper discusses the political implications of the British military's Trauma Risk Management (TRiM) approach to personnel suffering from combat-related mental debilities such as post-traumatic stress disorder. Drawing on narratives that emerged from qualitative interviews with trained TRiM practitioners and military welfare workers, I tease out some of the assumptions and beliefs about mental health and mental illness that underpin this mental health intervention programme. I explore TRiM as a biopolitical strategy targeted towards the construction of a particular (...) conceptualisation of mental wellness and militarised masculine personhood. As a biopolitical strategy, I argue that TRiM plays an important role in the construction of ideas around mental well-being and mental frailty that best enable the operation of military power in the contemporary British context. I discuss the narrative of transformation in militarised models of masculinity that emerge from discussions of TRiM, and highlight the important political function that this plays in enabling and legitimating militarism. Finally, I draw attention to the ways in which the focus on individual and cultural factors, rather than war as the primary cause of difficulties for servicemen experiencing psychological distress, functions to neutralise the potential trouble that could be instigated for the British military by the bodies of servicemen psychologically damaged by their experiences of conflict. (shrink)

ObjectivePost-traumatic stress disorder may affect individuals exposed to adversity. Eye Movement Desensitization and Reprocessing is an evidence-based trauma-focused psychotherapy for PTSD. There is still some debate whether the eye movements are an effective component of EMDR. The primary aim of this study was to investigate the effectiveness of Eye Movement Desensitization treatment in reducing PTSD symptoms compared to a retrieval-only active control condition. We also investigated whether PTSD symptom reduction was associated with reductions in depression and anxiety, and improvements (...) in quality of life.MethodologyAdult PTSD patients were recruited at public psychological services in Jakarta, Bandung and Cimahi, Indonesia. PTSD was diagnosed with the Structured Clinical Interview for DSM-5 disorders. Participants were randomized into: EMD or retrieval-only. EMD consisted of clinical history and treatment planning, preparation, assessment, EMs, closure, whereas retrieval-only consisted of the same elements except EMs. Data were collected at baseline, 1-week post-treatment, 1-month follow-up, and 3-months follow-up. Outcome measures included the PTSD Checklist for DSM-5, Hopkins Symptoms Checklist-25, and the World Health Organization Quality of Life–BREF. Data were analyzed with linear mixed model analysis in R Statistics.ResultsAlthough there were main effects of time indicating reductions for both EMD and retrieval-only in PCL-5 and HSCL-25 scores, and improvements in WHOQoL-BREF scores at T1, T2, and T3, no significant differences in PCL-5, HSCL-25, and WHOQoL-BREF total scores between the EMD and retrieval-only groups at T1, T2, and T3 were found.ConclusionWithin a clinical sample of PTSD patients in Indonesia, both EMD and retrieval-only was associated with reductions in symptoms of PTSD, anxiety and depression, and improvements in quality of life, although EMs did not add to the efficacy of the treatments. Further research to examine the underlying mechanisms of EMDR’s effective treatment elements in clinical samples is needed.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [ISRCTN55239132]. (shrink)

Traumatic experiences and post-traumatic stress are highly prevalent in people with psychosis, increasing symptom burden, decreasing quality of life and moderating treatment response. A range of post-traumatic sequelae have been found to mediate the relationship between trauma and psychotic experiences, including the “traditional” symptoms of post-traumatic stress disorder (PTSD). The International Classification of Diseases-11th Edition recognizes a more complex post-traumatic presentation, complex PTSD (cPTSD), which captures both the characteristic symptoms of PTSD (...) alongside more pervasive post-traumatic sequelae known as ‘disturbances in self-organization’ (DSOs). The prevalence and impact of cPTSD and DSOs in psychosis remains to be explored. In the first study of this kind, 144 participants with psychosis recruited from North West United Kingdom mental health services completed measures assessing trauma, PTSD and cPTSD symptoms and symptoms of psychosis. Forty-percent of the sample met criteria for cPTSD, compared to 10% who met diagnostic criteria for PTSD. PTSD and DSOs mediated the relationship between trauma and positive symptoms, controlling for dataset membership. Both PTSD and DSOs mediated the relationship between trauma and affective symptoms but did not explain a significant proportion of variance in negative symptoms. Cognitive and excitative symptoms of psychosis did not correlate with trauma, PTSD or DSO scores. These findings indicate the possible value of adjunct therapies to manage cPTSD symptoms in people with psychosis, pending replication in larger epidemiological samples and longitudinal studies. (shrink)

Self-compassion is a mechanism of symptom improvement in post-traumatic stress disorder, however, the underlying neurobiological processes are not well understood. High levels of self-compassion are associated with reduced activation of the threat response system. Physiological threat responses to trauma reminders and increased arousal are key symptoms which are maintained by negative appraisals of the self and self-blame. Moreover, PTSD has been consistently associated with functional changes implicated in the brain’s saliency and the default mode networks. In this paper, (...) we explore how trauma exposed individuals respond to a validated self-compassion exercise. We distinguish three groups using the PTSD checklist; those with full PTSD, those without PTSD, and those with subsyndromal PTSD. Subsyndromal PTSD is a clinically relevant subgroup in which individuals meet the criteria for reexperiencing along with one of either avoidance or hyperarousal. We use electroencephalography alpha-asymmetry and EEG microstate analysis to characterize brain activity time series during the self-compassion exercise in the three groups. We contextualize our results with concurrently recorded autonomic measures of physiological arousal, parasympathetic activation and self-reported changes in state mood and self-perception. We find that in all three groups directing self-compassion toward oneself activates the negative self and elicits a threat response during the SC exercise and that individuals with subsyndromal PTSD who have high levels of hyperarousal have the highest threat response. We find impaired activation of the EEG microstate associated with the saliency, attention and self-referential processing brain networks, distinguishes the three PTSD groups. Our findings provide evidence for potential neural biomarkers for quantitatively differentiating PTSD subgroups. (shrink)

BackgroundWeChat is the main social platform in China, characterized by its versatility and ease of communication. This study aimed to explore the effect of a WeChat-platform-based education and care program on relieving anxiety, depression, and post-traumatic stress disorder in parents of pediatric and adolescent patients with osteosarcoma.MethodsIn total, 48 patients and 86 parents were enrolled in this randomized, controlled study and then assigned to the WBEC program and the usual education and care program for 6 months as a (...) 1:1 ratio.ResultsParents in the WBEC group had lower Hospital Anxiety and Depression Scale for anxiety scores at M3 and M6 when compared to the UEC group, while anxiety rate was only decreased at M3 in the WBEC group. Meanwhile, parental HADS for depression scores were reduced at M3 and M6 in the WBEC group when compared with the UEC group; while depression rate remained the same. Parental Impact of Event Scale-Revised scores were slightly reduced among the WBEC group at M6 when compared with the UEC group [12.0 : 10.0–20.8] vs. 15.0 ], but not statistically significant.ConclusionWeChat-platform-based education and care is considered a feasible intervention to reduce anxiety and depression in parents of pediatric and adolescent patients with osteosarcoma, while also providing mild relief from PTSD. (shrink)

The aim of the research is to investigate the effect of eye movement desensitization and reprocessing therapy on post-traumatic stress disorder levels of individuals who can be defined as high-risk groups during the pandemic. Therefore, the online EMDR R-TEP Protocol was applied to a total of 154 individuals working with coronavirus patients, frontline professionals, relatives of coronavirus patients, coronavirus patients, and relatives of someone who died from coronavirus and the PTSD symptom level before, after, and 1 month after (...) therapy was measured and examined. A personal information form and impact of events scale were used to collect data. Analyses showed that EMDR therapy was effective in reducing the PTSD level in all groups. The PTSD levels of frontline professionals continued to decrease until the follow-up test but remained the same in the other groups. (shrink)

A multifaceted, holistic approach to identifying potential predictors is needed to eradicate workplace bullying. The current study investigated the impact of an unfavourable organisational climate that plays a role in breeding workplace bullying. The present study also postulated that individual personality differences mediate between a caring climate and workplace bullying. Similarly, the interaction between workplace bullying and personality impacts PTSD. We also checked the role of workplace bullying as a mediator between a caring climate and PTSD. This research tested all (...) the proposed hypotheses, and the study was conducted in Pakistan. The data is analysed using the two-step partial least square structural equation modelling procedure. The first part assesses the measurement model, while in the second step, the structural model is evaluated. The results supported all the proposed hypotheses of this study. Type A behaviour moderated the caring climate—person-related bullying relationship, whereas it did not moderate the caring climate—work-related bullying in the suggested direction. Type A behaviour is moderated for both types of bullying and PTSD. Results also show significant indirect effects of a caring climate on PTSD through workplace bullying. This study will contribute theoretically to filling the literature gap on studies of climate-bullying and bullying-stress using contingency factors. (shrink)

The paper proposes a theoretical analysis of A Pale View of Hills, using a psycho-literary approach to the themes of Japaneseness-Englishness, displacement, and the hybrid individual as they emerge from Kazuo Ishiguro’s novel. Etsuko’s pidgin identity results from the main character’s existential migration, which, in turn, stems from her experiencing and witnessing gender inequality, domestic abuse, and war trauma along with the gaping rift between generations. In line with Freud and Jung’s oneiric theories, the paper investigates Etsuko’s post-traumatic (...) stress disorder in order to explain why the protagonist fails to face the suicide of her elder daughter, Keiko, whose avoidant-insecure behaviour might have worsened after her forced uprooting and immigration to England. Although the middle-aged expatriate Etsuko is willing to find new motivation for living, based on the unusual habit of the subconscious to get used to repetitive traumas, her pidgin identity, impossible to recalibrate, may affect her ability to heal. (shrink)

IntroductionFrontline healthcare workers have faced significant plight during the ongoing Coronavirus disease 2019 pandemic. Studies have shown their vulnerabilities to depression, anxiety disorders, post-traumatic stress, and insomnia. In a developing country like India, with a rising caseload, resource limitations, and stigma, the adversities faced by the physicians are more significant. We attempted to hear their “voices” to understand their adversities and conceptualize their resilience framework.MethodsA qualitative approach was used with a constructivist paradigm. After an initial pilot, a socio-demographically (...) heterogeneous population of 172 physicians working in COVID-designated centers were purposively sampled from all over India. Following in-depth virtual interviews using a pre-formed semi-structured guide, the data was transcribed and translated verbatim. The interview was focused on their challenges, needs, and processes of coping and support. Charmaz’s grounded theory was used for analysis supplemented by NVivo 10 software.ResultsFear of infection, uncertainty, stigma, guilt, and social isolation emerged as the main challenges. Simultaneously, their “unmet needs” were flexible work policies, administrative measures for better medical protection, the sensitivity of media toward the image of HCW, effective risk communication for their health, and finally, social inclusion. Their resilience “framework” emerged as a process while navigating these adversities and consisted of three facets: forming a “resilient identity,” managing the resilience, and working through the socio-occupational distress. The role of mental well-being, social network, peer support, problem negotiation, and self-care emerged as the key coping strategies.ConclusionThe study findings support the global call for better psychosocial health and quality of life of the frontline HCWs. Their “unheard voices” explored in the study can anchor subsequent resilience-enhancing interventions and policies. Guidelines focusing on the psychological wellbeing of frontline HCWs need to be grounded in their unmet needs and lived experiences. (shrink)

BackgroundIn many Western countries like Germany, the social integration of children with an immigrant background has become an urgent social tasks. The probability of them living in high-risk environments and being disadvantaged regarding health and education-related variables is still relatively higher. Yet, promoting language acquisition is not the only relevant factor for their social integration, but also the support of earlier developmental processes associated with adequate early parenting in their first months of life. The Emotional Availability Scales measure the quality (...) of caregiver-child-interactions as an indicator of the quality of their relationship and thus of such early parenting, focusing on mutual and emotional aspects of their interaction.MethodThis pilot study examined in a randomized controlled trial the effects of the prevention project First Steps regarding the hypothesis that the Emotional Availability improved to a greater extent in “difficult-to-reach” immigrant mother-child dyads in a psychoanalytically oriented early intervention compared to a usual care intervention offered by paraprofessionals with an immigrant background. A sample of N = 118 immigrant women in Germany from 37 different countries and their children was compared with regard to the parental EA-dimensions sensitivity, structuring, non-intrusiveness and non-hostility and the child dimensions responsiveness to and involvement of the caregiver in the pre-post RCT design.Results and ConclusionDifferent from what was expected, repeated ANOVAs revealed no significant pre-post group differences for the parental dimensions. For the child dimensions the effect of time of measurement was highly significant, which can be interpreted as mostly natural developmental effects. Still, on the level of simple main effects for each intervention, only in the FIRST STEPS groups child responsiveness significantly improved. When controlled for confounding variables, a significant interaction effect for maternal sensitivity in favor of the FIRST STEPS intervention was found. The systematic group differences indicate that the more extensive and professional intervention, focusing on the individual needs of the participants, is more suitable to support the quality of the mother-child-relationship amongst immigrant mother-child dyads than usual care. The results are discussed taking into account the context of the maternal migration process and potential maternal traumatization.Clinical Trial Registration[https://clinicaltrials.gov], identifier [DRKS00004632]. (shrink)

Funding: Research funded by Canadian Institutes of Health Research, NNF 80045, States of Mind: Emerging Issues in Neuroethics. While there are those who object to the prospective use of propranolol to prevent or treat post-traumatic stress disorder (PTSD), most obstreperous among them the President’s Council on Bioethics, the use of propranolol can be justified for patients with severe PTSD. Propranolol, if effective, will alter the quality of certain memories in the brain. But this is not a serious threat (...) to the self understood in terms of narrative identity. A narrative identity framework acknowledges that memory is always being subtly altered or modified. For severe cases of PTSD propranolol may help victims who don’t respond to any other therapy or therapy combination regain their authentic self-narrative and engage once more in life activities. For those whose symptoms are not so severe the potential risks and side-effects of the drug may outweigh the benefits. Patients and family members should be allowed to decide, in consultation with their physician, whether this drug is appropriate in their case. (shrink)

Alexithymia, psychological distress, and posttraumatic stress disorder (PTSD) are highly related constructs. The ongoing debate about the nature and relationship between these constructs is perpetuated by an overreliance on cross-sectional research. We examined the longitudinal interactive relationship between alexithymia, psychological distress, and PTSD. We hypothesised that there is an interactive relationship between the three constructs. Military personnel (N = 1871) completed the Toronto Alexithymia Scale, the Kessler 10 and a PTSD Checklist (PCL-C) at pre-deployment, post-deployment, and at 3–4 years (...) following the post-deployment assessment. We initially tested whether psychological distress is either a moderator or mediator in the relationship between alexithymia and PTSD across the time points. General psychological distress was a partial mediator of total PTSD severity and hyperarousal symptomology at all three time points. Psychological distress fully mediated re-experiencing and avoidance symptomology at all three time points. Our results suggest that those with alexithymia are at longitudinal risk of developing more severe PTSD symptomology and experiencing hyperarousal irrespective of temporal proximity to traumatic exposure. Further, vulnerability to the emergence of re-experiencing and avoidance symptomology for those with alexithymia is increased when one experiences greater distress. Our results show that alexithymia is a persistent risk factor for PTSD symptomology. (shrink)

Die Posttraumatische Belastungsstörung (PTBS) ist ein schwerwiegendes psychisches Krankheitsbild, das Betroffene nach dem Erleben traumatisierender Situationen entwickeln. Im Zusammenhang mit den Auslandseinsätzen der Bundeswehr ist die PTBS bei Soldaten in den letzten Jahren verstärkt in den Fokus der deutschen Öffentlichkeit gerückt. Auch zivile Traumata bergen ein großes PTBS-Risiko. Seit einigen Jahren werden Methoden zur medikamentösen Prävention der PTBS erforscht. Die beiden wichtigsten Ansätze, die Prävention mit zentralnervös wirkenden Betablockern und Glukokortikoiden, basieren auf der Idee, durch den Eingriff in neuroendokrine Stressachsen (...) Einfluss auf die Art und Weise zu nehmen, in der die Erinnerung im Gedächtnis konsolidiert wird. Durch eine Entemotionalisierung und Abschwächung entsprechender Gedächtnisspuren soll das spätere Auftreten einer PTBS verhindert werden. Beide Ansätze zeigen in Pilotstudien vielversprechende Ergebnisse. Angesichts der herausragenden Bedeutung des Gedächtnisses für Individuum und Gesellschaft sollten Ansätze zur medikamentösen Gedächtnismodifikation (MGM) unter neuroethischen Gesichtspunkten diskutiert und bewertet werden. Der Text beleuchtet die MGM zur PTBS-Prävention entlang von fünf Problemachsen: 1) der Einflussnahme von MGM auf den Prozess der normalen psychischen Verarbeitung traumatischer Erlebnisse, 2) der Gefahr einer Entkopplung von Erinnerung und Realität, 3) der Bedeutung von emotionaler Erinnerung für die Moral, 4) der sozialen, juristischen und historischen Relevanz einer wahrhaftigen Erinnerungskultur und 5) der potenziellen Förderung eines gesellschaftlichen Medikalisierungsprozesses. Trotz ernsthaft zu diskutierender ethischer Bedenken ist – vor dem Hintergrund der Schwere des Krankheitsbilds – aus unserer Sicht eine MGM zur PTBS-Prävention grundsätzlich begrüßenswert, sollte jedoch derzeit nur im Rahmen klinischer Studien erfolgen. Hierfür stellen wir acht forschungsethische Aspekte zur Diskussion, die bei solchen Studien zu berücksichtigen sind. (shrink)

Background. In some organisations, traumatic events via direct or indirect exposure are routine experiences. A NICE review (2005; updated in December 2018) of Post-Traumatic Stress Disorder (PTSD) management in primary and secondary care did not address early interventions for trauma in emergency response organisations. Aims. This scoping review was designed to identify previous research which evaluated the use of early interventions following exposure to primary or secondary trauma, to report on the effectiveness of early interventions models. Method. (...) A scoping review was conducted to examine early interventions for trauma with staff in roles potentially exposed to trauma including: emergency response, military and humanitarian aid. Relevant data was extracted from included studies and outcomes were assessed using meta-ethnography. Results. Fifty studies of mixed quality met the inclusion criteria for this review. Synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they: are delivered in a manner that respects distinct organisational culture; are supported by organisations and senior management, and; harness existing social cohesion and peer support systems within teams. Conclusions. This review demonstrates that early interventions support emergency responders following exposure to trauma when: tailored to the needs of the population, are supported by the host organisation, and harness existing social cohesion and peer support processes within a team or unit. We identify a number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organisations. (shrink)

The National Institute of Mental Health reports that approximately 5.2 million Americans experience post-traumatic stress disorder each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias put forth by (...) the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry. (shrink)

This study discusses the potential of virtual reality therapy to treat traumatic experiences. It considers the main advantages of exposure therapy through virtual reality in comparison with traditional exposure therapy. In order to explain the effectiveness of using virtual reality to treat trauma, the main research question that was asked was how to conceptualize it. It was assumed that the trauma was a deviation from the normal narrative that people create for a particular crisis event. The results of the (...) empirical research prove that virtual reality therapy can be considered a powerful tool for treating traumatic experiences, as cyberspace allows reformulation of self-images, experimenting and practicing coping skills, creating a new life story, and finding meaning in certain crisis events. (shrink)

The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias (...) put forth by the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry. (shrink)

Healthcare workers who are on the front line of coronavirus disease 2019 and are also undergoing shift schedules face long work hours with few pauses, experience desynchronization of their circadian rhythm, and an imbalance between work hours effort and reward in saving lives, resulting in an impact on work capacity, aggravated by the lack of personal protective equipment, few resources and precarious infrastructure, and fear of contracting the virus and contaminating family members. Some consequences are sleep deprivation, chronic insomnia, stress-related (...) sleep disorders, and post-traumatic stress disorder. These sleep alterations critically affect mental health, precipitating or perpetuating anxiety, stress, and depression, resulting in the inability to regulate positive and negative emotions. Pre-existing sleep disorders are an important risk factor for the development and maintenance of PSTD when individuals are exposed to an important stressor such as a COVID-19 pandemic. At the same time, how an individual regulates the emotion associated with worries during daytime functioning impacts nighttime sleep, precipitating and perpetuating difficulties in sleeping. All of these changes in sleep and emotional regulation also alter the immune system. Sleep deprivation is commonly associated with chronic inflammatory diseases, due to the desynchronizations in circadian rhythms, causing possible psychophysiological disorders and impaired neuroimmune-endocrine homeostasis. From this perspective, we clarify in this article how sleep disorders affect the immune system and emotional regulation, explaining their phenomenological and neurobiological mechanisms, and discussing elements of cognitive and behavioral coping for health professionals to adopt and manage a healthier sleep pattern in the COVID-19 outbreak. (shrink)

ObjectiveSome people experience post-traumatic growth, entailing positive changes such as a greater appreciation of life following traumatic events. We examined PTG in the context of the negative consequences of the COVID-19 pandemic, notably working from home and social distancing. We aimed to assess whether distinct sub-groups of individuals experiencing PTG could be identified by how they appraised and coped with the COVID-19 pandemic.MethodFor this cross-sectional study, we used convenience sampling. In total, 951 participants from the general population (...) completed an online questionnaire with items focusing on primary and secondary appraisal, positive reappraisal, rumination, and coping flexibility. For the latent profile analysis, we selected a sample of 392 individuals who had experienced moderate degrees of pandemic-related PTG, reporting at least two of the 10 positive changes in the PTG Inventory-Short Form.ResultsWe identified two distinct profiles among people experiencing PTG. The first was characterised by low levels of primary appraisal and stressfulness and higher levels of secondary appraisal, increased coping flexibility and greater use of positive reappraisal. The second was characterised by higher levels of stressfulness and primary appraisal and greater use of rumination.ConclusionThe two sub-groups evidently appraised and coped with the COVID-19 pandemic differently. Therefore, future research should account for these different profiles of people experiencing PTG. (shrink)

Challenges of interpersonal harm for a theology of freedom and grace -- Karl Rahner's theological anthropology -- The role of freedom and grace in the construction of the human self -- The vulnerable self and loss of agency -- Trauma theory and the challenge to a Rahnerian theology of freedom and grace -- The fragmented self and constrained agency -- Feminist theories as correctives to a Rahnerian anthropology -- Response to the challenge -- Rahner's theology revisited -- Ethical directions -- (...) Implications of a revised theology of freedom and grace. (shrink)

Considering his status as the best fighter on the Trojan side, Hector’s flight in “Iliad” 22.131-7 is unexpected and surprising, even though Hector is never overtly reproached for his reaction. This article proposes a psychological explanation for Hector’s behaviour, drawing on recent insights concerning combat stress reaction (CSR) and post-traumatic stress disorder (PTSD): Hector does not flee from fear of death, but from the “Wind of Hate”, i. e. the terror felt when confronted with direct and personal aggression. (...) An examination of the actions of Achilles in the “Iliad” supports this conclusion, for Achilles exhibits behaviour which would qualify for a diagnosis of antisocial personality disorder. The intense personal hatred of Achilles is sufficient to shock Hector into flight, even if he ultimately recovers and heroically faces Achilles in battle. Thus, the scene bears testimony to the “Iliad”’s understanding of the universal human experiences of warfare and aggression. (shrink)

ObjectiveTo investigate post-traumatic stress disorder, perceived professional benefits and post-traumatic growth status among Chinese nurses in the context of the COVID-19 pandemic and to compare the differences between nurses working inside and outside Hubei.MethodsFrom February 18 to February 25, 2020, the authors constructed the questionnaire using the Questionnaire Star platform, and convenience sampling was used to distribute the questionnaire via WeChat. Nurses who worked at the hospital during the COVID-19 pandemic were the research subjects.ResultsA total of (...) 3,419 questionnaires were received, of which 2,860 nurses were working outside Hubei Province and 559 nurses were working inside Hubei Province. Both groups were exposed to COVID-19. The results indicated that gender, job title, department, average monthly income, the number of night shifts per month, hospital classification, specialization, and previous experience with assisting during disasters were statistically significant. The t-test results showed that the difference in perceived professional benefits scores between the two groups was not statistically significant, and the differences in PTG scores and PTSD scores between the two groups were statistically significant. The chi-square test indicated that the difference in PTSD prevalence between nurses working outside and inside Hubei Province was statistically significant and that the PTSD prevalence of nurses working outside Hubei Province was higher than that of nurses working inside Hubei Province. One-way ANOVA and independent sample t-test results showed that age, job title, job assignment, length of service, average monthly income, number of night shifts per month, number of children, and the Nurses’ Perceived Professional Benefits Scale and post-traumatic growth inventory scores influenced the prevalence of PTSD. Logistic regression showed that the occurrence of PTSD was associated with average monthly income, length of service, number of children, and the PTGI and NPPBS scores.ConclusionDuring the COVID-19 pandemic, nurses working outside Hubei Province reported greater PTSD than those working inside Hubei Province. The occurrence of PTSD was related to average monthly income, length of service, number of children, and the PTGI and NPPBS scores. (shrink)

Emotional disorder symptoms are highly prevalent and a common cause of disability among children and adolescents. Screening and early detection are needed to identify those who need help and to improve treatment outcomes. Nowadays, especially with the arrival of the COVID-19 outbreak, assessment is increasingly conducted online, resulting in the need for brief online screening measures. The aim of the current study was to examine the reliability and different sources of validity evidence of a new web-based screening questionnaire for emotional (...) disorder symptoms, the DetectaWeb-Distress Scale, which assesses mood, anxiety, obsessive–compulsive disorder, post-traumatic stress disorder, suicidality, and global distress. A total of 1,499 participants completed the DetectaWeb-Distress Scale and specific questionnaires for emotional disorder symptoms, suicidal behaviors, and well-being through a web-based survey. Results indicated that a structural model of 10 correlated factors fits reasonably better in comparison to the remaining models; measurement invariance for age and gender; good internal consistency ; and significant positive correlation with other measures of anxiety, depression, PTSD, or distress, and negative correlation with well-being measures, displaying support for convergent-discriminant validity. We also found that girls scored higher than boys on most of the subscales, and children had higher scores for social anxiety, specific phobia, panic disorder, and obsessive–compulsive symptoms, whereas adolescents scored higher on depressive symptoms, suicidality, and generalized anxiety, but the effect sizes were small to medium for all comparisons. The DetectaWeb-Distress Scale is a valid, innovative, and useful online tool for the screening and evaluation of preventive programs for mental health in children and adolescents. (shrink)

Religious leaders face numerous mental health challenges, and prior research suggests that some experience symptoms of post-traumatic stress disorder (PTSD) due to work-related experiences. This study employed a diverse sample of 274 religious leaders to (a) qualitatively describe the types of work-related experiences they identify as particularly stressful or overwhelming, (b) assess the prevalence of PTSD symptoms associated with these experiences, and (c) test hypothesized associations between PTSD symptoms and narcissism. The study found that the stressful experiences reported (...) typically involved relational conflict, having limited resources, or caring for people suffering. Over half of the sample endorsed symptoms that were above the cutoff for a clinical concern for PTSD, and PTSD symptoms were significantly associated with symptoms of both vulnerable narcissism and grandiose narcissism. Practical implications for the ongoing formation and support of religious leaders are discussed. (shrink)

The purpose of this study is to investigate the current state of post-traumatic growth and identify its influencing factors in discharged COVID-19 patients. PTG refers to individual experiences of significant positive change arising from the struggle with a major life crisis. This descriptive cross-sectional study used the convenient sampling method to recruit 140 discharged COVID-19 patients in Hunan, China. The results show that the PTG of the discharged COVID-19 patients was positively correlated with self-esteem, post-traumatic stress (...) disorder, coping style tendency, and social support, but negatively correlated with the time from onset to diagnosis. Our findings could provide guidance on improving the psychological state and well-being of discharged COVID-19 patients. (shrink)

The idea that acquired brain injury (ABI) caused by stroke, hemorrhage, infection or traumatic insult to the brain can result in post-traumatic growth (PTG) for individuals is increasingly attracting psychological attention. However, PTG also attracts controversy as a result of ambiguous empirical findings. The extent that demographic variables, injury factors, subjective beliefs, and psychological health are associated with PTG following ABI is not clear. Consequently, this systematic review and meta-analysis explores the correlates of variables within these four (...) broad areas and PTG. From a total of 744 published studies addressing PTG in people with ABI, eight studies met inclusion criteria for detailed examination. Meta-analysis of these studies indicated that growth was related to employment, longer education, subjective beliefs about change post-injury, relationship status, older age, longer time since injury, and lower levels of depression. Results from homogeneity analyses indicated significant inter-study heterogeneity across variables. There is general support for the idea that people with ABI can experience growth, and that various demographics, injury-related variables, subjective beliefs and psychological health are related to growth. The contribution of social integration and the forming of new identities post-ABI to the experience of PTG is explored. These meta-analytic findings are however constrained by methodological limitations prevalent in the literature. Clinical and research implications are discussed with specific reference to community and collective factors that enable PTG. (shrink)

This chapter conceptually analyzes the post-traumatic stress injuries called moral injury, moral fatigue or exhaustion, and broken spirit. It then identifies two puzzles. First, soldiers sometimes sustain moral injury even from doing right actions. Second, they experience moral exhaustion from making decisions even where the morally right choice is so obvious that it shouldn’t be stressful to make it; and even where rightness of decision is so murky that no decision could be morally faulted. The injuries result of (...) mistaken moral self-evaluation. Methods of preventing and treating these injuries are defended, including training in self-forgiveness, moral off-loading of actions and decisions to persons and devices less likely to feel inappropriate guilt, and the use of drugs to prevent such guilt. The foregoing has been about moral injury erroneously resulting from the non-violation of a correct moral code. But the chapter then introduces the concept of moral pseudo-injury—felt moral injury that has in reality resulted from violation of a false moral code, so that no one has really been morally injured. This can be used as a method in warfighting. And since the injuries it produces are illusory, this would be morally superior to physical violence. For it causes less injury to its victims, and should cause less guilt in those who must inflict it. Historical precedents are considered. Finally, our enemies often use moral pseudo-injury against us, in the form of terrorist violence against civilians. Terrorism causes comparatively few harms, yet we mistakenly see it as more morally horrific than conventional combat that causes much worse loss of life among armed forces members. Here we need the nuancing and clarifying power of philosophy to restore a sense of proportion, thence to prevent or therapize the moral pseudo-injury we may experience from these sorts of attacks. (This is a pre-penultimate version of the published version, available from OUP at the external link, which contains minor variances. The paper was earlier known as "PTSD Weaponized: A Theory of Moral Injury"; that now superseded version is archived under "past conferences" on the Center for Ethics and the Rule of Law website.). (shrink)

Over 50,000 youth, mostly between the ages of 13 and 17 years, migrated to the United States without familial accompaniment in the fiscal year 2018. The tripartite process of pre-flight, flight, and resettlement exposes these unaccompanied immigrant children to multiple, and often ongoing, traumatic events that can significantly and adversely impact their mental health into adulthood. However, the ethical considerations for psychologists working with this growing population, with limited exceptions, remain largely unaddressed. As more and more UIC flee their (...) home countries due to violence, abuse, and economic instability only to experience further stressors during the processes of detainment, custodial placement, and acculturative adjustment in the US, there is an increasing need for psychological services; thus, the importance of preparation of mental health providers is increasingly significant. Psychologists must have the requisite skills and knowledge of the complex experiences of UIC, and of how these intersect with salient cultural, developmental, and systemic factors, as a means of providing competent and ethical mental health treatment. The present article highlights several ethical issues that arise when providing psychological services to UIC, with particular consideration paid to the embeddedness of UIC in various organizational entities with which psychologists will likely need to interface when working with this population. Implications and recommendations for practicing psychologists and training programs are discussed. (shrink)

The subject of intercultural exchange is complex and demands that we keep the basic issues that shape our views of the world in mind. And one of these basic issues is what we mean by “European identity.” The ideological concerns over the norms of identity became necessarily entangled in the post-1989 interests and agendas of Europe’s various nations. So the great challenge for us as academics as well as for the policymakers in Brussels and Strasburg is to focus on (...) these dialectics. European identity is too varied to be a unitary and homogenous thing; indeed, one of the battles within it is between the advocates of a unitary identity and those who see the whole as a complex that is irreducible to a unified identity. In this article I explore how the theatre, in the aftermath of the Second World War, served as a laboratory for the investigation, analysis, and constuction of dramatic models that became a means of transcultural communication. As attested by the continuing success of the experimental approaches of Brecht, Grotowski, La Mama, and Suzuki, this endeavour reflected the struggle of people from different cultural backgrounds to understand and accept each other. One of the reasons the theatre continues to have the potentiality to promote transcultural integration is that it deals in concrete particulars with universal resonances. As I will demonstrate with examples from my own work in various countries, the production and directing of plays by these and other dramatists shows that it is only in the performance—by transforming the familiar into the unfamiliar, by making the habitual and customary seem strange and unexpected—that the motives, relationships, and events enclosed in the written play are released so as to stimulate the audience to re-examine their own contemporary realities. Transcultural theatre thus creates dramatic experiences that are adequate and responsive to the changing world of migration and mobility in which both practitioners and audiences actually live. As such it offers the kind of transcultural education that promotes communication and understanding and that fosters an open-eyed and open-hearted attitude to the changing realities of Europe. (shrink)

Intimate partner violence is an important problem that has significant detrimental effects on the wellbeing of female victims. The chronic physical and psychological effects of intimate partner violence are complex, long-lasting, chronic, and require treatments focusing on improving mental health issues, safety, and support. Various psycho-social intervention programs are being implemented to improve survivor wellbeing. However, little is known about the effectiveness of different treatments on IPV survivors' wellbeing. For this purpose, we conducted a systematic review and meta-analysis to assess (...) the effectiveness of interventions on improving outcomes that describe the wellbeing of adult female survivors of IPV. We searched PubMed, PsycINFO, and Cochrane Library. We explored the effectiveness of available interventions on multiple outcomes that are critical for the wellbeing of adult female victims of IPV. To provide a broad and comprehensive view of survivors' wellbeing, we considered outcomes including mental health, physical health, diminishing further violence, social support, safety, self-efficacy, and quality of life. We reviewed 2,770 citations. Among these 25 randomized-controlled-study with a total of 4,683 participants met inclusion criteria. Findings of meta-analyses on interventions indicated promising results in improving anxiety [standardized mean difference −7.15, 95% confidence interval −8.39 to −5.92], depression, safety, violence prevention, health, self-esteem, social support, and stress management at the post-test. We found that empowerment plays a vital role, especially when treating depression and Post-Traumatic Stress Disorder, which are difficult to improve across interventions. We found mixed findings on self-efficacy and quality of life. The effects of IPV are long-lasting and require treatments targeting co-morbid issues including improving safety and mental health issues. (shrink)

This study discusses the issue of emotional crisis and trauma in terms of opportunities to develop and grow. The article seeks to show the complex psychological conditions pertaining to emotional crises, a constructive way of dealing with them, and the possibility of growing and developing thanks to having experienced such a crisis. These issues are usually omitted when describing crises; however, as the author postulates, they constitute a foundation for differentiating — as we surely must do — between emotional crisis (...) and trauma, development and growth through crisis, and the positive adaptive changes observed in cases of post-traumatic disorder. Such changes cannot always be identified as instances of so called post-traumatic growth. The latter is described by the author, with reference to Maslow's theory, as development “resulting from the lack of something”, where this in turn reflects some trauma or other. Moreover, considerations pertaining both to current work in health psychology, and to the distinction between emotional crisis and trauma proposed here, could well prove relevant where practices of intervention are concerned. (shrink)