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   Table of Contents - Current issue
September-December 2019
Volume 1 | Issue 1
Page Nos. 1-89

Online since Friday, September 27, 2019

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World Social Psychiatry: A Dream Coming True, but Miles to Go! p. 1
Roy Abraham Kallivayalil
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Mens sana in societate sana… toward a wholesome world of social psychiatry p. 4
Debasish Basu, Nitin Gupta
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“A person is a person through other persons”:A social psychiatry manifesto for the 21st century Highly accessed article p. 8
Vincenzo Di Nicola
A critical issue for our field is how to define contemporary social psychiatry for our times. In this article, I address this definitional task by breaking it down into three major questions for social psychiatry and conclude with a call for action, a manifesto for the 21st century social psychiatry: (1) What is social about psychiatry? I address definitional problems that arise, such as binary thinking, and the need for a common language. (2) What are the theory and practice of social psychiatry? Issues include social psychiatry's core principles, values, and operational criteria; the social determinants of health and the Global Mental Health (GMH) Movement; and the need for translational research. This part of the review establishes the minimal criteria for a coherent theory of social psychiatry and the view of persons that emerges from such a theory, the social self. (3) Why the time has come for a manifesto for social psychiatry. I outline the parameters for a theory of social psychiatry, based on both the social self and the social determinants of health, to offer an inclusive social definition of health, concluding with a call for action, a manifesto for the 21st century social psychiatry.
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Medicine is medicine through its disciplines p. 22
Norman Sartorius
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The social brain: Wired to connect and belong p. 23
Eliot Sorel
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The Importance of the Social in Psychiatry p. 25
Thomas K J Craig
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Partnerships in global mental health p. 27
Helen Herrman
The United Nations (UN) Sustainable Development Goals set by the UN General Assembly in 2015 include mental health among the targets for health. The mental health professions can play a role in alerting opinion leaders and decision-makers to the importance of equality and social connectedness in combatting problems that stand in the way of social, economic, and personal development. Problems such as child maltreatment and intimate partner violence, safety and security in communities, bullying in schools, and gender, racial, and other forms of discrimination are prevalent in all countries and closely linked with poor mental health and mental ill-health. They need to be tackled through partnerships between community groups and professionals who between them can map out solutions. The solutions necessarily include interventions within health, education, family, and other systems and operate at multiple levels. Among the solutions are the mental health professions engaging directly with people living in adversity as well as helping to mobilize other sources of help that they can be trained to support. The World Social Psychiatry can play an important role by taking an editorial approach that encourages psychiatrists and other mental health professionals to use their expertise to promote participatory approaches and facilitates the mental health work of nonspecialists across the diverse community settings.
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Toward an ecosocial psychiatry p. 30
Laurence J Kirmayer
Social psychiatry is grounded in the recognition that we are fundamentally cultural beings. To advance the field, we need integrative theory and practical tools to better understand, assess, and intervene in the social-ecological cultural systems that constitute our selves and personhood. Cognitive science supports the view that mental processes are intrinsically social, embodied, and enacted through metaphor, narrative, and discursive practices. The circuits of the mind, therefore, extend beyond the brain to include our interactions with others through bodily and verbal communication. This ecosocial view of mind, brain, and culture calls for a shift in perspective from a psychiatry centered on brain circuitry and disorders toward one that recognizes social predicaments as the central focus of clinical concern and social systems or networks as a crucial site for explanation and intervention. The ecosocial perspective insists that we consider the powerful effects of structural violence and social inequality as key determinants of health. Social systems also have their own dynamics which can amplify inequities or provide sources of resilience. These social processes are framed, mediated, and maintained by cultural narratives, models, and metaphors. Hence, cultural analysis and critique must be foundational to social psychiatry. This opens the door to a creative engagement with human diversity in all its forms.
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Social psychiatry: The ethical challenges p. 33
Fernando Lolas
Considerations on the ethical challenges facing social psychiatry are based on the fact that it is an academic and applied endeavor harmonizing different forms of knowledge stemming from diverse sources, with different epistemic traditions. The field requires careful analysis of linguistic uses, distinguishing between public, international, and global health research and practice. Ethical imperatives extend from sound research practices to reasoned application of knowledge, advocacy, and counseling.
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Inequity in mental health: An issue of increasing public health concern p. 36
Marianne C Kastrup
The WHO Alma-Ata Declaration of 1978 aimed to include social and economic sectors within the scope of attaining health. Health is seen as a human right, and a goal was to reduce disparities in health in 2000. Forty years later, we are far from having reached these goals, and inequity in health both between and within countries is still a major problem that receives too little public and political attention. This article discusses the social determinants of mental health and reasons for disparities thereof. To achieve equity is a goal that is beyond reach, but there are many strategies how to reduce the inequity in health, and examples thereof will also be discussed.
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Social psychiatry: A global and indian perspective p. 39
Shridhar Sharma
The future germinates in the soil of the present and has its root in the past. In 2019, the World Association of Social Psychiatry (WASP) completes its 55 years. To have any vision for the future of social psychiatry, stock-taking of the past, assessment of the present activities, and a vision for future are warranted. As a past president of the WASP and a Founder Member of the Indian Association for Social Psychiatry (IASP), I present this broad overview of the various historic-political forces behind the movement of social psychiatry (including a forgotten and unpleasant past), trace the development and activities of WASP and IASP, and try to figure out a foreseeable and sustainable future for social psychiatry. The new journal of WASP, the World Social Psychiatry, can play an important role in this by advocacy, research, and dissemination of knowledge.
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Examining the “Social” in social psychiatry: The changing profile of context in the era of globalization and epidemiological transitions, with a special focus on Sub-Saharan Africa p. 43
Oye Gureje, Akin Ojagbemi
Interest in seeking to understand psychopathology in social and cultural contexts has gone through phases. There was a time when the traditional social context in which Africans lived was mystified and exoticized by the West as simple and unsophisticated. While a more liberalized understanding of the diversity of social organizations is now common, a more complex social configuration is nevertheless emerging on the continent. The countries in sub-Saharan Africa are undergoing rapid transitions characterized by epidemiological shifts, urbanization, and a reorganization of family structure. Each of these transitions is, in turn, affected by the pervasive influence of globalization and the prominent impact of information technology, including social media. In this context, the traditional defining features of “social” networks and sociocultural norms and rituals are changing. These changes bring tensions which have consequences for the mental health of populations and how the people who experience mental illness are related to and cared for. Changes that produce lonely elderly in the villages and disaffiliated youths in urban slums challenge us to re-think how we conceptualize the emerging social networks and social interactions and grasp the nexus of syndemics that often develop in those contexts.
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Social psychiatry in the era of sustainable development p. 47
Shekhar Saxena
We currently live in an era when sustainable development is a high priority. Inclusion of mental health and well-being in the United Nation's Sustainable Development Goals presents an unprecedented opportunity to bring mental health out of shadows into the larger arena of development. Social psychiatry can play a large role in ensuring that that these opportunities are utilized fully by working more closely with professionals from other areas within and outside health sectors as well as with communities including people with lived experience.
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The current refugee problem around the world: Implications for social psychiatry p. 50
Eugenio M Rothe, Andres J Pumariega, Rama Rao Gogineni
In the last 3 years, the numbers of forcibly displaced people around the world have reached a record high. Experiences of war, persecution, violence, torture, participating in killing, disruptions of attachments, and emotional losses increase the risk for psychological distress and may contribute to the risk of developing psychiatric disorders, especially in child and adolescent refugees. We briefly review the existing psychiatric literature on refugees, discuss sociological reasons that explain the recent crisis, psychiatric consequences, and long-term prognosis, and discuss the implications for policy, practice, and research.
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Setting the global agenda for social psychiatry: child and adolescent psychiatric perspectives p. 53
Rama Rao Gogineni, Eugenio M Rothe, Andres J Pumariega
History of child psychiatry is interlocked with society, child-rearing, family, and many social psychiatric aspects. Children make up one-third of the world's population and are the most physically, economically, and socially vulnerable group. Mental health problems represent the largest burden of disease among young people. Worldwide, 10%–20% of children and adolescents experience mental disorders. For the last 200 years, understanding of children and adolescents, their vulnerabilities, resilience, and treatments to enhance their mental health has been exploding. As we entered the 21st century with industrialization, urbanization, modernization, and globalization along with many aspects of our lives, children's mental health, and their rights, advocacy for their health has been of intense research and care. In this article, we address some of the most relevant topics – contributions of culture, immigration, digitalization, child maltreatment, discrimination, stigma, changes in the family structure. We also report here the efforts of the United Nations and various countries, with special emphasis on low- and middle-income countries. Finally, we also advocate various ways for children's mental health advancement from a social psychiatric perspective.
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Social psychiatry in the era of cyber age and globalization: Threatened, empowered, or both? p. 62
Rachid Bennegadi
The cyber age and the era of rapid globalization have fundamentally challenged and changed the way human beings communicate, relate, and respond to one another. While these processes of change have undeniably speeded up human transactions and obliterated distances, they have also created unique challenges. Some of these challenges are directly relevant for social psychiatry, which is alternatively seen as either empowered or threatened by these challenges. This article is the result of an ethical reflection on the place of digital era in the different aspects of life (psychosocioanthropological dimension), considering the impact of the digital world on our mind. I propose that even in this era of digital revolution, globalization, and artificial intelligence including big data and machine learning, the fundamentally social nature of all communications and feedback systems will remain valid. I suggest four examples how social psychiatry can be empowered (rather than threatened) by wisely utilizing the technological advances of the cyber era and globalization: webminars (webinars), supervisions via the Internet, mental health apps, and developing “mindwares” for promoting mental and social well-being. I conclude by posing several conceptual, ethical, and practical questions for our reflection and debate.
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Social psychiatry can “Empower” the individuals, families, and communities for mental health p. 67
R Srinivasa Murthy
There is growing awareness of the limitations of the biological model for understanding and treatment of mental disorders, along with increasing evidence of the role of individuals, families, and communities in matters of mental health and mental disorders. By increasing the research into the social origins of mental health and mental disorders and by developing appropriate skills to “empower” individuals, families, and communities, social psychiatry can advance the cause of mental health of the populations.
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Delivery by “trained hospital-based health workers” of “family psychoeducation package” to caregivers of patients with schizophrenia through “task-sharing” strategy p. 70
Shikha Tyagi, Nitin Gupta, BS Chavan, Harneet Kaur, Vikas Sharma
Background: In India, there is an urgent need to evaluate cost-effective methods providing basic awareness on mental illness. Family psychoeducation (FP) for caregivers of patients with severe mental illnesses (SMIs) is one such important intervention. Due to high treatment gap, concepts of “scaling up” and “task sharing” have been advocated; evidence is available through the use of “community lay workers.” However, there is no evidence for the delivery of FP by lay persons in a hospital setting. Objectives: The study had the following objectives, namely (i) to compare the effectiveness of delivery of “FP package” (FPP) to caregivers of persons with schizophrenia using different professionals versus hospital-based health workers (HHWs) and (ii) to see whether FPP brought any change in the level of knowledge, burden, needs, and effect for the caregivers. Methodology: The study was conducted at the Disability Assessment Rehabilitation and Triage Services, Mental Health Institute, Government Medical College Hospital 32, Chandigarh, using the “Service Evaluation Framework.” Twenty-two caregivers of patients with SMI, attending the Family Intervention Services, were divided into three groups and provided FPP (NIMHANS Manual) by pair of psychiatrists, psychiatric social workers (PSWs), and trained HHW, respectively. The three groups were assessed using Assessment Questionnaire (AQ) and then compared across and pre–post intervention as per identified objectives. Results: All the three groups were comparable across relevant socioclinical variables. At baseline, all three groups were comparable on the AQ; post-FPP delivery, they remained comparable. In addition, FPP, as an intervention, did not improve the level of knowledge, burden, needs, and effect for the caregivers in any of the three groups. Conclusions: HHWs, after receiving appropriate and adequate supervision, are able to deliver FPP using “The Manual” as effectively as other mental health professionals (psychiatrists, PSWs). However, this is not able to bring about effective change in the level of knowledge. Nevertheless, this adds to the evidence base of use of “lay workers,” “task-sharing strategy,” and “scaling-up approach” from low- and middle-income countries such as India.
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Social relationships and the association of loneliness with major depressive disorder in the ibadan study of aging p. 82
Akin Ojagbemi, Oye Gureje
Background: Socially disaffiliated elderly Nigerians are at higher risk for major depressive disorder (MDD). It is unclear whether subjective experience of loneliness has independent association with MDD. Methods: A household multistage probability sample of persons who were 65 years or older was drawn from a geographical area with approximately 25 million population. We measured loneliness using the three-item University of California at Los Angeles scale. Poor social engagement, social isolation, and MDD were assessed using the World Health Organization (WHO) Disability Assessment Schedule II and Composite International Diagnostic Interview (WHO), respectively. Results: Of 1704 respondents, 179 (16.7%) were classified as lonely. Lonely respondents were more likely to have poor social engagement (P < 0.001) and social isolation (P < 0.001). While loneliness (adjusted odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.3–4.0) and poor social engagement (adjusted OR = 3.1, 95% CI = 1.6–6.1) were independent correlates of MDD, the association of loneliness with MDD was substantially, but not totally, mediated by poor social engagement. Conclusion: The association of loneliness with late-life depression in this African sample is partly explained by poor social engagement. Interventions for loneliness based on social activity schedules and networking programs can be adapted to reduce loneliness and lower the burden of late-life depression in Africans.
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23rd Congress of the world Association of Social Psychiatry: “Social determinants of mental health and access to care” p. 89
Roy Abraham Kallivayalil
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