Asylums and Harm Embodiment.

This article examines iatrogenic harms incurred by closed-ward psychiatric hospitals. In particular, this article considers roles of narrative in one patient's experience of life-encompassing iatrogenic harm from being institutionalized from infancy to age 60 and also emphasizes Italy's comparative success, relative to the United States, in recovering from decades of deinstitutionalization to establish community-based mental health care.

What Does It Mean for a Case to be 'Local'?: the Importance of Local Relevance and Resonance for Bioethics Education in the Asia-Pacific Region.

Contemporary bioethics education has been developed predominately within Euro-American contexts, and now, other global regions are increasingly joining the field, leading to a richer global understanding. Nevertheless, many standard bioethics curriculum materials retain a narrow geographic focus. The purpose of this article is to use local cases from the Asia-Pacific region as examples for exploring questions such as 'what makes a case or example truly local, and why?', 'what topics have we found to be best explained through local cases or examples?', and 'how does one identify a relevant local case?' Furthermore, we consider the global application of local cases to help extend the possible scope of the discussion, opening new avenues for the development of practical bioethics educational materials. We begin with a background description and discussion of why local cases enhance bioethics education, move to an overview of what is currently available and what is not for the region, and then outline a discussion of what it means to be local using example cases drawn from Hong Kong, Australia, Pakistan, and Malaysia. We are not creating a casebook but rather constructing by example a toolbox for designing active and dynamic learning cases using regional diversity as contextualised cases with generalised principles.

Cultural considerations in forgoing enteral feeding: A comparison between the Hong Kong Chinese, North American, and Malaysian Islamic patients with advanced dementia at the end-of-life.

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient-centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision-making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end-of-life care.

Political engagement as an element of social recovery: a qualitative study.

OBJECTIVE: Taking a qualitative approach, this study sought to describe consumer attitudes toward political participation and the association between political engagement and social recovery. METHODS: This study used data from seven focus groups of self-identified consumers of mental health services in the New York City area (N=52). Attitudes and behaviors related to voting and other forms of political engagement were identified and classified according to grounded theory, with a focus on the relationship between political engagement and broader social functioning, participation, and recovery. RESULTS: Participants described the symbolic meaning of voting and political participation in terms of connection to social inclusion versus exclusion. Participants described political participation as a component of empowerment for minority groups in general, including persons who use mental health services and those from racial-ethnic minority groups. CONCLUSIONS: Qualitative studies of the symbolic meanings of political participation are an important component of understanding the broad yet interconnected dimensions of social recovery.

Gender, race-ethnicity, and psychosocial barriers to mental health care: an examination of perceptions and attitudes among adults reporting unmet need.

Though researchers have described psychosocial barriers to mental health care-seeking, limited research has examined ways in which gender and race-ethnicity are associated with individuals' perceptions and attitudes. This study investigates correlates of psychosocial barriers to mental health care in a population of adults reporting unmet need for mental health care, focusing on gender and race-ethnicity. Data are from the 2002 National Survey on Drug Use and Health. Multivariate analyses show that non-Latino white male status is positively associated with stigma avoidance and mistrust/fear of the mental health care system. Persons of lower income or educational status are less likely to report negative attitudes towards care. Findings imply a need to reconsider the roles of gender race-ethnicity, and socioeconomic status within investigations of psychosocial barriers to care. Future research should examine the relationships among social status, help-seeking behaviors, and attitudes toward mental health care.