Primum non nocere. The case for a critical approach to global mental health.

The Movement for Global Mental Health (MGMH) argues that there is a moral imperative that psychiatric treatments should be made available to all communities across the world. But psychiatric theories, categories and interventions emerged in the Western world are based on a set of assumptions about the nature of the self and society, nature and the supernatural, health and healing that are not universally accepted. In this paper we argue that there is a stronger moral case for caution with regard to the export of psychiatric thinking. Without a critical interrogation of such thinking the MGMH is at risk of doing a great deal of harm to the diverse, and sometimes fragile, systems of care that already exist across the world.

Post-modernity and post-traumatic stress disorder.

The after effects of trauma have assumed a central role in the discourses of psychiatry and psychology in recent years. Most commentators have looked for an explanation of this explosion of interest in trauma, to developments within psychiatry and psychology. However, it is argued here that important cultural changes in the Western world have produced the conditions in which this interest has come about. The advent of post-modernity has witnessed an undermining of social stability and coherence and a systematic weakening of those cultural institutions which provide meaning and order for individuals. Following trauma, the development of the characteristic symptoms of post-traumatic stress disorder (PTSD) is currently understood to arise from a breakdown of meaning within the victim's world. I seek to establish an association between PTSD and the culture of post-modernity. I argue that this connection has important implications with regard to our understanding of the relationship between trauma and culture more generally.

Antibodies to tyvelose exhibit multiple modes of interference with the epithelial niche of Trichinella spiralis.

Infection with the parasitic nematode Trichinella spiralis is initiated when the L1 larva invades host intestinal epithelial cells. Monoclonal antibodies specific for glycans on the larval surface and secreted glycoproteins protect the intestine against infection. Protective antibodies recognize tyvelose which caps the target glycan. In this study, we used an in vitro model of invasion to further examine the mechanism(s) by which tyvelose-specific antibodies protect epithelial cells against T. spiralis. Using cell lines that vary in susceptibility to invasion, we confirmed and clarified the results of our in vivo studies by documenting three modes of interference: exclusion of larvae from cells, encumbrance of larvae as they migrated within epithelial monolayers, and inhibition of parasite development. Excluded larvae bear cephalic caps (C. S. McVay et al., Infect. Immun. 66:1941-1945, 1998) of immune complexes that may physically block invasion or may interfere with sensory reception. Monovalent Fab fragments prepared from a tyvelose-specific antibody also excluded larvae from cells, demonstrating that antibody binding can inhibit the parasite in the absence of antigen aggregation and cap formation. In contrast, encumbered larvae caused extensive damage to the monolayer yet were not successful in establishing a niche, as reflected by their failure to molt. These results show that antibodies to tyvelose exhibit multiple modes of inhibitory activity, further implicating tyvelose-bearing glycoproteins as mediators of invasion and niche establishment by T. spiralis.

The rehabilitation of child soldiers: defining needs and appropriate responses.

There is growing international concern that large numbers of children are being recruited to military forces in situations of conflict around the globe, despite the fact that there are principles established in international law specifically directed against the use of children as soldiers. It has been assumed that military experience will have negative psychological effects on children, and several projects aimed at the rehabilitation of such children have been developed. We have had opportunities to examine the situation of child soldiers in Uganda, Liberia and Sierra Leone. In this article we draw attention to some of the conceptual and practical problems involved in this rehabilitative work.

The rehabilitation of child soldiers: defining needs and appropriate responses

There is growing international concern that large numbers of children are being recruited to military forces in situations of conflict aroound the globe; desp[ite the fact that there are principles established in international law specifically directed aginst the use of children as soldiers. it has been assumed that military experience will have negative psychological effects on children; and several projects aimed at the rehabilitation of such children have been developed. We have had opportinities to examine the situation of child soldiers in Uganda; Liberia and Sierra leone. In this article we draw attention to some of the conceptual and practical probelms involved in this rehabilitative work

Psychological responses to war and atrocity: the limitations of current concepts.

Because of the prevalence of wars, political violence and other forms of man-made disaster in Third World countries many individuals and communities suffer prolonged and often multiple traumas. In Western psychiatry certain conceptions of the response to violence and trauma have been developed, including the widely used category of post-traumatic stress disorder (PTSD). We argue that because concepts such as PTSD implicitly endorse a Western ontology and value system, their use in non-Western groups should be, atmost, tentative.

Post-empiricism and psychiatry: meaning and methodology in cross-cultural research.

Methodological disputes in psychiatry have usually been framed in terms of a positivist-interpretivist paradigm conflict. While traditional cross-cultural psychiatry does indeed endorse a positivist medical model the author argues that a post-empiricist philosophy of science is best able to 'ground' the 'new' cross-cultural approach.

Donated organ as a source of cytomegalovirus in orthotopic liver transplantation.

The importance of the donated organ as a source of CMV was assessed in 120 patients following orthotopic liver transplant and the CMV infections that developed in these patients were graded by severity. Forty-four recipients were CMV antibody negative pre-transplant. Eighteen of these received organs from CMV antibody positive donors and 15 (83%) developed primary CMV infections, 13 (87%) of which were symptomatic. Twenty-six received organs from CMV antibody negative donors and only 2 (8%) became CMV positive post transplant (P less than 0.001). These data suggest that there would be a considerable advantage in matching CMV antibody negative recipients with negative donors. Forty-five percent of secondary infections were asymptomatic compared with 12% of primary infections, and only 11% became disseminated compared with 53% of primary infections. The secondary infections that followed transplantation of an organ from a CMV antibody positive donor were more likely to be symptomatic and were more severe than those in patients who received seronegative livers.

Helping victims of violence in Uganda.

We report on a project to assist victims of war and violence in Uganda. The original aim of this project, set up by the Medical Foundation for the Care of Victims of Torture, was to establish a centre for the assessment and treatment of torture victims who had suffered during previous regimes in that country. We found, however, that a specialist centre was not the most appropriate response in a country like Uganda. We argue for the need to respect local initiatives and systems of support and against the notion that there is a single model of care which is universally relevant. Following much investigation and involvement with local personnel, we have developed a programme of training and discussion for health workers, and a service to reach the many women who have suffered rape, and whose suffering has continued, largely ignored.

Helping victims of violence in Uganda

We report on a project to assist victims of war and violence in Uganda. The original aim of this project; set up by the Medical Foundation for the Care of Victims of Torture; was to establish a centre for the assessment and treatment of torture victims who had suffered during previous regimes in that country. We found; however; that a specialist centre was not the most appropriate response in a country like Uganda. We argue for the need to respect local initiatives and systems of support and against the notion that there is a single model of care which is universally relevant. Following much investigation and involvement with local personnel; we have developed a programme of training and discussion for health workers; and a service to reach the many women who have suffered rape; and whose suffering has continued; largely ignored

Helping victims of violence in Uganda

We report on a project to assist victims of war and violence in Uganda. The original aim of this project; set up by the Medical Foundation for the Care of Victims of Torture; was to establish a centre for the assessment and treatment of torture victims who had suffered during previous regimes in the country. We found; however; that a specialist centre was not the most appropriate response in a country like Uganda. We argue for the need to respect local initiatives and systems of support; this is against the notion that there is a single model of care which is universally relevant. Following much investigation and involvement with local personnel; we have developed a programme of training and discussion for health workers; and a service to reach the many women who ahve suffered rape; and whose suffering has continued largely ignored