Attitudes of psychiatry residents toward a strike by nursing staff : a case report.

A study of the attitudes of psychiatry residents and attending psychiatrists toward a strike by nurses and mental health workers in a psychiatric teaching hospital was performed. All residents (n = 20) and 47 (83% of the attending psychiatrists) completed a questionnaire within 4 weeks after the strike. The responses to the questionnaire indicated that resident's behavior in response to the strike was significantly different from the behavior of the attendings: 20% of the residents volunteered service during the strike compared with 66% of the attendings (p ≤ 0.0001). The attending psychiatrists, when asked what action they would have taken if they were residents, indicated somewhat less of an inclination to volunteer; 16.7% changed their position about volunteering (NS). When asked what they would have done if they were attendings, 55% (p ≤ 0.008) of the residents indicated they would have volunteered service. The significance of these findings is that residents identify themselves more with the "frontline" mental health workers engaged in the strike than with the faculty/attending psychiatrists who serve as their professional role models.

Developing instruments for cross-cultural psychiatric research.

The growth of cross-cultural psychiatry is now occurring at a time when psychiatry in general is emphasizing diagnostic clarity and the use of quantifiable and reliable methods of collecting clinical and research data. It is now imperative that cross-cultural psychiatry also examine its methods for developing instruments for use in cross-cultural research. This paper outlines a method for developing instruments designed in one culture for use in a second, and particular attention is given to cross-cultural validity or equivalence. Five types of equivalence are enumerated and defined: content, semantic, technical, criterion, and conceptual equivalence. These concepts are illustrated by examples from the authors' experience in research on internal migrants in Peru.

The process of acculturation: theoretical perspectives and an empirical investigation in Peru.

World-wide migratory patterns have led to an increasing interest in acculturation processes and their psychosocial and psychiatric sequelae. This paper reviews alternative theoretical approaches to the study of acculturation and identifies gaps in the current knowledge base. We then present empirical research on acculturation processes experienced by both Indian rural to urban migrants and White-Mestizo non-migrants in Lima, Peru. The study examined overall acculturation and five sub-dimensions: language use, customs, sociability, perceived discrimination and ethnic identity. The data show that second generation migrants are more highly acculturated across sub-areas and perceive less ethnic discrimination than first generation migrants. The first generation varied in acculturative level across sub-dimensions as a function of their age at the time of migration. Contrasts between the migrant and dominant group depicted a two-way process of culture change, but a process characterized by an inequality in the content exchanged in each direction. Socio-demographic correlates of acculturation were also found. These results are discussed in terms of the potential psychological consequences of alternative acculturative adaptations within the Peruvian social-structural context.

Folk healing: a description and synthesis.

All societies have developed ways of dealing with physical and mental illness, defined as folk healing systems. The authors review the systems of folk healing that have evolved in different cultural groups in the United States. They describe the faith healing practices of fundamentalist Christian groups, the belief in rootwork among white and black people in the southeastern United States, curanderismo among Mexican-Americans, and espiritismo among Americans from Puerto Rico. Most believers in folk healing also go to physicians for medical care. The authors argue that physicians should familiarize themselves with patients' folk healing beliefs in order to serve them more effectively.

Perceived statutory applicability versus clinical desirability of emergency involuntary hospitalization.

The authors used a questionnaire survey conducted by mail in 1975 to assess psychiatrists' perceptions of the applicability of two jurisdictions' statutes for emergency involuntary hospitalization and the desirability of such hospitalization in four case vignettes. The great majority of the 287 respondents agreed that the statutes were applicable and hospitalization was desirable for individuals who were at risk for suicide and who were psychotic. Most of them also agreed that such hospitalization was neither legally applicable nor desirable for nonpsychotic, nonsuicidal people. Their perceptions of applicability versus desirability differed, however, regarding people who were nonsuicidal but psychotic or nonpsychotic but suicidal.

"Folk" explanations of mental illness in rural laos.

To obtain "folk" explanations of specific cases of mental illness the authors interviewed 35 baa(insane) Laotian individuals and their relatives and neighbors. They obtained 54 explanations; 15 focused on supernatural causes, 15 on physical causes, 14 on social problems, and 10 on psychological states. Although 31 theories (57%) focused on etiologic factors familiar to clinical psychiatrists, many self-evident factors (such as familial prevalence) were not mentioned. Except for 3 cases, responsibility for the illness was attributed to factors outside the subject's control. This view of mental illness absolves the baa person from blame and ensures support from the social group.

"Folk" criteria for the diagnosis of mental illness in rural Laos: on being insane in sane places.

"Folk" criteria for identifying the mentally ill, as distinguished from folk theories about the causes of mental illness, have been comparatively neglected in cultural psychiatry. The authors describe the criteria by which villagers in Laos labeled 35 subjects as baa (insane). Unprovoked assaultive or destructive behavior, social isolation, self-endangerment due to neglect of personal needs, nonviolent but socially disruptive or inappropriate behavior, and inability to do productive work were found to be important folk criteria. The authors emphasize that folk criteria for mental illness are determined primarily by the persistence of socially dysfunctional behavior rather than by disturbances in thought and affect.

A review of the relationship between dysphoria, pleasure, and human bonding.

A model is presented which links up recent findings regarding the biochemical substrates of neurological networks mediating pleasure states with the concept of animal behavior relating to bonding. The forms of human bonding (parent-child, kinship, friendship) have analogies in the animal world and appear to be based on a combination of fixed action patterns, learning behaviors supported by endogenous secretion of "pleasure-producing" endorphines, and social reinforcement. The implications of this model for psychiatric treatment and rehabilitation are discussed.

Psychiatrists' familiarity with legal statutes governing emergency involuntary hospitalization.

The authors sent out questionnaires regarding knowledge of statutes governing emergency involuntary hospitalization to psychiatrists in Connecticut and in the District of Columbia. Fifty-five percent (N=207) of the sample in Connecticut and 25% (N=87) of the sample in the District of Columbia responded. The responses showed that few of these psychiatrists had a thorough familiarity with the legal statutes governing emergency involuntary hospitalization in their jurisdictions. The most frequently cited criterion was the dangerousness standard, especially in the District of Columbia sample, and many psychiatrists were not sure of the nature of their statutory authority when their patients met the criteria for emergency hospitalization.

Foreign medical graduates who return home after U.S. residency training: the Peruvian case.

With few exceptions, reports on foreign medical graduates (FMGs) are concerned with their academic, clinical, and adaptational problems during their training at American hospitals and universities. This report, part of a study of FMGs from Peru who have completed postgraduate training in the United States in the past 10 years, is concerned with the psychosocial and professional stresses of adaptation experienced by a group of 21 Peruvian doctors who have returned home to practice. The authors discuss the "push" factors and "pull" factors that motivated these physicians to return to Peru to pursue careers in academic medicine, private practice, and government service in contrast to many of their colleagues who have remained in the United States.