Beyond Critique: Rethinking Roles for the Anthropology of Mental Health

The current supremacy of the ‘bio-bio-bio’ model within the discipline of psychiatry has progressively marginalized social science approaches to mental health. This situation begs the question, what role is there for the anthropology of mental health? In this essay, I contend that there are three essential roles for the anthropology of mental health in an era of biological psychiatry. These roles are to (i) provide a meaningful critique of practices, beliefs, and movements within current psychiatry; (ii) illuminate the socio-cultural, clinical, and familial context of suffering and healing regarding emotional distress/mental illness; and (iii) act as a catalyst for positive change regarding healing, services and provisions for people with emotional distress/mental illness. My argument is unified by my contention that a credible anthropology of mental health intending to make a societal contribution should offer no opposition without proposition. In other words, any critique must be counter-balanced by the detailing of solutions and proposals for change. This will ensure that the anthropology of mental health continues to contribute critical knowledge to the understanding of mental suffering, distress, and healing. Such social and cultural approaches are becoming especially important given the widespread disenchantment with an increasingly dominant biological psychiatry.     

A Point in the Heart: Concepts of Emotional Distress Among Albanian-Speaking Immigrants in Switzerland

Cultural variability regarding concepts of distress for common mental disorders (CMD) has been reported extensively in cultural clinical psychology across the globe. However, little is known about illness narratives in social communities from Southeast Europe. The purpose of this paper is to identify cultural concepts of distress (CCDs) among Albanian-speaking immigrants in Switzerland and to integrate the findings into literature from other parts of the world. Twenty semi-structured qualitative interviews were conducted using the Barts Explanatory Model Inventory (BEMI). A set of concepts was described through content analysis and semantic network analysis. The results show complex expressions of distress, which are mainly associated with post-migration living difficulties. Social problems and life-changing events mark the onset of the most common symptoms. Self-management and social support were described as the most important coping behaviors. Participants expressed trust in physical health care but little belief in psychotherapy. There is indication that mental illnesses are stigmatized in this population. It is therefore important to use non-stigmatizing terms in health communication. Moreover, individuals from this community consider suffering to be part of life, and they assume that this suffering must be endured with patience. It is vital to address these beliefs in psychological interventions.

     

'Positive biology' as a new paradigm for the medical sciences. Focusing on people who live long, happy, healthy lives might hold the key to improving human well-being

The nearly exclusive focus on understanding and treating chronic disease might not be the most efficient way to improve public health, especially as an effective alternative strategy exists.On 27 April 2009, during a speech at the National Academy of Sciences, US President Barack Obama pledged to invest more than 3% of US GDP in scientific research and development—the amount represented the largest ever investment in research and innovation. However, even a financial investment of such magnitude does not ensure that science is ''well-ordered'' [1], in the sense that the scientific research that is prioritized aspires to address the most significant challenges and problems for humanity.Among the many issues facing society that research must address, improving human health and tackling disease rank high, if not first, on the agenda. Accordingly, a huge fraction of research funding is spent on basic and applied research to further our understanding of the causes of disease and to find new cures and therapies. But is this focus on pathology the most efficient way to conduct research with the aim to improve human health and well-being?…a huge fraction of research funding is spent on basic and applied research to further our understanding of the causes of disease and to find new cures and therapiesMost of today''s medical research could be called ''negative biology''. It is conducted in an intellectual framework that presumes that the most important question to answer is: what causes pathology? Disease is its central focus and this explains why medical research and research funding is mainly concerned with trying to understand, prevent and treat specific diseases. The design of the US National Institutes of Health, which is largely composed of individual institutes dedicated to specific diseases such as cancer, mental illness or infectious diseases, reflects this prevalence of pathology-oriented negative biology.Positive biology, by contrast, focuses on a different set of questions and priorities. Rather than making pathology and disease the central focus of intellectual efforts and financial investments, positive biology seeks to understand positive phenotypes: why do some individuals live more than a century without ever suffering from the chronic diseases that afflict most humans much earlier in their lives? Why are some individuals more happy, optimistic, talented, or have a better memory than most people? The paradigm of positive biology is based on the insight that the process of evolution by natural selection does not create a perfect organism in terms of life expectancy, resistance to disease or other abilities. Observations of exceptional longevity or superior cognition therefore present fascinating puzzles for positive biology: which biological mechanisms would explain these exemplars of health and well-being? The goal of understanding positive phenotypes is that such knowledge might lead to new interventions that generally improve human well-being. This might be achieved by modulating the rate of ageing or by increasing opportunities for play and joy at all stages of the human lifespan, or by developing pharmaceuticals that safely enhance cognition or positive emotions, and so on.The goal of understanding positive phenotypes is that such knowledge might lead to new interventions that generally improve human well-beingThis is distinct from negative biology, which focuses on the proximate causes of specific diseases, rather than on the evolutionary causes of positive phenotypes. It presumes that health, survival and happiness are the default states and aims to explain the deviations: why do we develop cancer? Why do we suffer from depression? Why do we develop hypertension? Negative biology therefore faces the laudable but insurmountable task of trying to prevent or cure all disease. This is a costly and ultimately futile endeavour. Eliminating all types of cancer would increase life expectancy in the USA by approximately only three years [2]. Even eliminating cancer as a cause of death would not prevent any of the other chronic diseases of ageing—cardiovascular disease, Alzheimer and Parkinson disease, diabetes and so on—from afflicting the elderly. Moreover, the more than 40 years of ''war against cancer'' has not defeated a single type of cancer: we still have a long way to go before we can realistically expect to reap the three-year increase in life expectancy that eliminating all cancers could yield.In fact, negative biology has not yet developed a single cure for any one of the hundreds of chronic diseases that afflict millions of people living today. Of course, it has made significant advances to help prevent and treat chronic disease, but the fixation on pathology has meant that other potential avenues for research have been neglected.Indeed, a better understanding of exemplars of health and happiness—the goal of positive biology—could create more benefits for humans more quickly and more easily. A drug that would safely mimic the effects of caloric restriction, for instance, might delay, simultaneously, most diseases and afflictions of ageing. It would generate a much greater health dividend for ageing populations than defeating any one specific disease of ageing because slowing down the rate of ageing by seven years would reduce the age-specific risk of death, frailty and disability by about half at every age [3].Scientists are already making good progress on the project of positive biology, even if the intellectual framework is not yet clearly defined and their topics are rather piecemeal. Richard Miller, for example, a professor of pathology at Michigan University, USA, studies the genetics of ageing in mice and participates in the National Institute of Aging''s multi-institutional programme that evaluates the effects of drugs and nutriceuticals on the ageing process in mice. David Sinclair from Harvard University, USA, and others found that the plant compound resveratrol, which is found in the skin of grapes, can modulate the ageing process. Nir Barzilai and colleagues at the Albert Einstein School of Medicine in New York, USA, have conducted genetic research on more than 500 healthy elderly people between the ages of 95 and 112 years. Michael Rose from the University of California, Irvine, USA, has quadrupled the lifespan of fruit flies by delaying the age of reproduction. Finally, the biologist Cynthia Kenyon demonstrated that in Caenorhabditis elegans, a single gene can control the ageing process. Any of these research projects could eventually lead to the development of a new drug that retards the ageing process and diminishes the onslaught of chronic diseases that typically afflict humans after their sixth decade of life.Similarly, a lot of pioneering work is being undertaken in the burgeoning field of ''positive psychology''. Rather than studying why people suffer from mental illnesses such as depression, schizophrenia or ADHD (attention deficit hyperactivity disorder), positive psychology is primarily interested in how to improve the happiness of the ''average'' person. Martin Seligman, a psychologist at the University of Pennsylvania, USA, and a pioneer in the field of positive psychology, distinguishes different kinds and levels of happiness [4]. Hedonists who pursue immediate rewards such as the pleasure of buying something or receiving a compliment seek momentary happiness or what Seligman calls ''the pleasant life''. But these pleasures fade quickly and do not leave a lasting impact on subjective well-being. Enduring happiness, by contrast, is realized when we lead a meaningful life. After years spent studying what makes people happy, Seligman contends that it is rooted in attachment to something larger, and the larger the entity to which you attach yourself, the more meaning your life has [4].Eliminating all types of cancer would increase life expectancy in the USA by approximately only three yearsThis is clearly illustrated by the role of wealth. People often assume that being richer will mean being happier, yet surveys in many countries indicate that global levels of life satisfaction or happiness have not changed much during the past four decades despite large increases in real income per capita [5]. Most disposable income is spent on consumer goods that do little to actually enhance our well-being.In a recent study of the daily behaviour of happy people, researchers used an electronically activated recorder to record, and then later classify, participants'' daily conversations with others as either ''small talk'', that is banal conversations, and ''substantive talk'', where meaningful information was exchanged. They found that higher well-being was associated with less small talk and more substantive conversations [6]. While such a study does not establish the truth of Socrates'' famous claim that “the unexamined life is not worth living”, it does suggest that our need to feel attached to something larger is important to our happiness and well-being. This hypothesis is supported by recent studies on how people spend their money. Researchers from the University of British Columbia and Harvard Business School found that when individuals spend more money on prosocial goals, such as charity, they actually experience greater happiness than when they spend money on consumer products for themselves [7]. Similarly, the psychologist Barbara Fredrickson''s research on positive emotions—joy, serenity and gratitude—suggests that these expand cognition and behavioural tendencies [8].Finally, research on exemplars of resilience, that is, the ability of some people to cope and manage with tragic and traumatic events, could lead to the development of drugs that would increase people''s resilience. Avshalom Caspi and colleagues found that individuals with one or two copies of the short allele of the promoter of the 5-HTT serotonin receptor experience more depressive symptoms, diagnosable depression and suicidal thoughts in response to stressful events compared with individuals who are homozygous for the long allele [9].Cognitive functioning is another central topic of positive biology. What are the genetic and environmental determinants of high IQ, exceptional memory or social intelligence? Barbara Sahakian and colleagues found that the analeptic drug modafinil significantly enhanced performance tests of digit span, visual pattern recognition memory, spatial planning and stop-signal reaction time in healthy volunteers [10]. These findings of positive biology will eventually give us a better understanding of our human nature than the very limited focus on disease and pathology of negative biology and might then lead to new interventions, environments and attitudes that improve human well-being and happiness.Negative biology dominates medical research, from the questions research scientists tackle to the education of physicians and government regulation of health interventions. The dominance of this approach to the medical sciences presumes that the most important questions concern the causes of pathology rather than the causes of exemplar health and happiness. Positive biology takes a different approach: it does not limit the moral duty to apply knowledge and technology to improve human welfare to only treating specific diseases or impairments. Rather, it works under the assumption that if knowledge and research can improve people''s lives, there is a moral duty to advance that knowledge and promote well-being. Nor is positive biology predicated on a sharp distinction between therapy and enhancement. Instead, as the bioethicist John Harris has argued, “the overwhelming moral imperative for both therapy and enhancement is to prevent harm and confer benefit. Bathed in that moral light, it is unimportant whether the protection or benefit conferred is classified as enhancement or improvement, protection or therapy” [11].Generally, the medical system as a whole could be much more efficient if it concentrated its efforts on making people healthier and happier in the first place instead of its current focus on understanding and treating disease. Advancing the paradigm of positive biology should therefore help the medical sciences transcend the limited perspectives and aspirations of negative biology. Such a paradigm could help the world''s population to reap the benefits that new knowledge and technologies can offer in terms of making people healthier and happier. Societies and individuals already seek to achieve these goals: we educate our children to eat healthily and exercise and to develop their social goals to find fulfilment in life. The paradigm of positive biology simply encourages us to make use of the full range of options to realize these goals.…the medical system as a whole could be much more efficient if it concentrated its efforts on making people healthier and happier in the first place…In conclusion, positive biology is not contrary to the goals and aspirations of negative biology. Indeed the two paradigms are often complementary. For example, understanding why some high-risk individuals, such as sex workers, seem to have an intrinsic resistance to HIV-1 might spur the development of an HIV vaccine [12]. Similarly, understanding human brains with exceptional cognitive functioning might lead to new avenues for developing drugs and therapies against severe cognitive impairment. Understanding exemplars of health could create real benefits for those who are more vulnerable to disease and disability.     

Visiting parents in times of COVID-19: The impact of parent-adult child contacts on the psychological health of the elderly

Using the 8th wave of the SHARE and the SHARE Corona Survey, we investigated whether the disruption of parent–adult child contacts due to social distancing restrictions increased the symptoms of depression among old age individuals during the first wave of the COVID-19 pandemic. We model the relationship between the disruption of parent–adult child contacts and the mental health of the elderly using a recursive simultaneous equation model for binary variables. Our findings show that the likelihood of disruption of parent–adult child contacts was higher with adult children who do not live with or close to their parents (i.e., in the same household or in the same building) for whom contact disruption increases about 15 %. The duration of restrictions to movement and lockdowns also has a positive and significant effect on parent-child contact disruption: an additional week of lockdown significantly increases the probability of parent-child contact disruption, by about 1.5 %. The interventions deemed essential to reduce the spread of the pandemic, such as the “stay-at-home” order, necessarily disrupted personal parent–child contacts and the social processes that facilitate psychological well-being, increasing the probability of suffering from a deepening depressed mood by about 17 % for elderly parents.     

Paying attention to pigs: negotiating equity and equality in global environmental governance in Suau,Papua New Guinea

The idea of ‘equity’, largely grounded in Western legal tradition, has come to permeate evaluations of what is fair and just within environmental governance programmes. But what constitutes equity in climate change and conservation projects? And does everyone affected by such projects see equity as desirable? Local encounters with global environmental governance interventions in Suau, Milne Bay Province of Papua New Guinea, provide an entry point to explore these questions. Drawing on ethnographic fieldwork with communities implicated in the Central Suau Reducing Emissions from Deforestation and Forest Degradation (REDD+) Pilot Project and in Save the Forest conservation projects, we examine tensions around conceptions of equity and equality between project proponents and local communities, as well as between individuals within those communities. By paying attention to talk about pigs in Suau, and tracing the intersections between reciprocity and trade, we explore how people negotiate equity and equality. We emphasize that this negotiation is central to Suau ideas of fairness. While the REDD+ and Save the Forest projects work to ensure ‘equitable’ distribution of benefits among supposedly equivalent actors, we show how this may actually close down possibilities for negotiation of outcomes that local people consider fair.     

Medical Student Attitudes Towards People with Mental Illness in China: A Qualitative Study

Stigma towards people with mental illness is a worldwide concern. A five-nation survey of medical student attitudes towards people with mental illness recently reported far lower levels of social acceptance among Chinese medical students compared to those from the US, Brazil, Ghana, and Nigeria. This qualitative study presented recent Chinese medical school graduates with probes based on questions used in the aforementioned cross-national study to elicit their views of factors underlying the negative attitudes towards social acceptance of people with mental illness. One-hour interviews were conducted with twenty psychiatry residents in June, 2016. Of 241 coded responses concerning negative attitudes, 51.5% were coded as reflecting fear of violent behavior, 22.8% as loss of face (i.e. shame from interpersonal associations), 17.0% lowered social status, 4.98% nonconforming social behavior, and 3.73% the heritability of mental illness. Low levels of social acceptance of individuals with mental illness among medical students in China are largely related to fears of violence of and loss of face. Understanding the attitudes of medical students may inform efforts to reduce stigma through educational initiatives targeted at both medical students and the general public.     

I Gave My Child Life but I Also Gave Her Death

The capacity for a complex inner life—encompassing inner speech, imaginative reverie and unarticulated moods—is an essential feature of living with illness and a principal means through which people interpret, understand and manage their condition. Nevertheless, as Nigel Rapport has pointed out in a recent edition of The Australian Journal of Anthropology (2008: 19 (3)), interiority largely remains a ‘terra‐incognita’ for social science, while anthropology lacks a generally accepted theory or methodological framework for understanding how interiority relates to people’s public actions and expressions. Moreover, as conventional social‐scientific methods are often too static to understand the fluidity of perception among people living with illness or bodily instability, I argue we need to develop new, practical approaches to knowing. By placing the problem of interiority directly into the field and turning it into an ethnographic, practice‐based question to be addressed through fieldwork in collaboration with informants, this article works alongside women living with HIV/AIDS in Uganda with the aim of capturing the unvoiced but sometimes radical changes in being, belief and perception that accompany terminal illness.     

Explanatory Models and Mental Health Treatment: Is Vodou an Obstacle to Psychiatric Treatment in Rural Haiti?

Vodou as an explanatory framework for illness has been considered an impediment to biomedical psychiatric treatment in rural Haiti by some scholars and Haitian professionals. According to this perspective, attribution of mental illness to supernatural possession drives individuals to seek care from houngan-s (Vodou priests) and other folk practitioners, rather than physicians, psychologists, or psychiatrists. This study investigates whether explanatory models of mental illness invoking supernatural causation result in care-seeking from folk practitioners and resistance to biomedical treatment. The study comprised 31 semi-structured interviews with community leaders, traditional healers, religious leaders, and biomedical providers, 10 focus group discussions with community members, community health workers, health promoters, community leaders, and church members; and four in-depth case studies of individuals exhibiting mental illness symptoms conducted in Haiti's Central Plateau. Respondents invoked multiple explanatory models for mental illness and expressed willingness to receive treatment from both traditional and biomedical practitioners. Folk practitioners expressed a desire to collaborate with biomedical providers and often referred patients to hospitals. At the same time, respondents perceived the biomedical system as largely ineffective for treating mental health problems. Explanatory models rooted in Vodou ethnopsychology were not primary barriers to pursuing psychiatric treatment. Rather, structural factors including scarcity of treatment resources and lack of psychiatric training among health practitioners created the greatest impediments to biomedical care for mental health concerns in rural Haiti.     

Has psychology “found its true path”? Methods,objectivity, and cries of “crisis” in early twentieth-century French psychology

This article explores how French psychologists understood the state of their field during the first quarter of the twentieth century, and whether they thought it was in crisis. The article begins with the Russian-born psychologist Nicolas Kostyleff and his announcement in 1911 that experimental psychology was facing a crisis. After briefly situating Kostyleff, the article examines his analysis of the troubles facing experimental psychology and his proposed solution, as well as the rather muted response his diagnosis received from the French psychological community. The optimism about the field evident in many of the accounts surveying French psychology during the early twentieth century notwithstanding, a few others did join Kostyleff in declaring that all was not well with experimental psychology. Together their pronouncements suggest that under the surface, important unresolved issues faced the French psychological community. Two are singled out: What was the proper methodology for psychology as a positive science? And what kinds of practices could claim to be objective, and in what sense? The article concludes by examining what these anxieties reveal about the type of science that French psychologists hoped to pursue.     

Suicidal ideation and reported suicide attempts in Greece during the economic crisis

The financial crisis in Greece is largely impinging on the health and mental health of the population, raising concerns about a potential rise in suicide rates. The aim of this study was to explore changes in suicidal ideation and reported suicide attempts between 2009 and 2011 in a representative sample of the population and in several population subgroups. The socio‐economic predictors of suicidal ideation and suicide attempts in 2011 were also investigated. Two nationwide cross‐sectional telephone surveys were conducted in 2009 and 2011 using the same methodology. A random and representative sample of 2192 and 2256 people, respectively, took part in the surveys. Between 2009 and 2011, there was a substantial increase in the prevalence of suicidal ideation and reported suicide attempts. People suffering from depression, men, married individuals, people experiencing financial strain, people with low interpersonal trust, and individuals with a history of suicide attempts were particularly vulnerable.     

Physical healthcare of people with severe mental illness: everybody's business!

Aim People with severe mental illness are at higher risk of physical health problems. Guidelines recommend annual monitoring. An audit cycle was completed on individuals with severe mental illness under the care of an early interventions in psychosis (EIP) service to evaluate and improve physical health monitoring practice.Methods The number of patients who had undergone a physical health check in the previous year, and those having a record of it in their EIP notes, was examined. Interventions made between baseline audit and re-audit included improving awareness within the multidisciplinary EIP mental health team about the importance of physical health monitoring of people with severe mental illness and liaison with primary care health services.Results The number of patients undergoing at least one annual physical health check increased from 20% to 58%. Among patients who had undergone a physical health check at re-audit, a record of some or all the checks was available in the notes for 75% of patients.Clinical implications There is a need to improve awareness among mental health professionals about the importance of the physical health of people with severe mental illness and to make appropriate organisational changes.     

Naturally Occurring Peer Support through Social Media: The Experiences of Individuals with Severe Mental Illness Using YouTube

Increasingly, people with diverse health conditions turn to social media to share their illness experiences or seek advice from others with similar health concerns. This unstructured medium may represent a platform on which individuals with severe mental illness naturally provide and receive peer support. Peer support includes a system of mutual giving and receiving where individuals with severe mental illness can offer hope, companionship, and encouragement to others facing similar challenges. In this study we explore the phenomenon of individuals with severe mental illness uploading videos to YouTube, and posting and responding to comments as a form of naturally occurring peer support. We also consider the potential risks and benefits of self-disclosure and interacting with others on YouTube. To address these questions, we used qualitative inquiry informed by emerging techniques in online ethnography. We analyzed n = 3,044 comments posted to 19 videos uploaded by individuals who self-identified as having schizophrenia, schizoaffective disorder, or bipolar disorder. We found peer support across four themes: minimizing a sense of isolation and providing hope; finding support through peer exchange and reciprocity; sharing strategies for coping with day-to-day challenges of severe mental illness; and learning from shared experiences of medication use and seeking mental health care. These broad themes are consistent with accepted notions of peer support in severe mental illness as a voluntary process aimed at inclusion and mutual advancement through shared experience and developing a sense of community. Our data suggest that the lack of anonymity and associated risks of being identified as an individual with severe mental illness on YouTube seem to be overlooked by those who posted comments or uploaded videos. Whether or not this platform can provide benefits for a wider community of individuals with severe mental illness remains uncertain.     

Nest Building as an Indicator of Health and Welfare in Laboratory Mice

The minimization and alleviation of suffering has moral and scientific implications. In order to mitigate this negative experience one must be able to identify when an animal is actually in distress. Pain, illness, or distress cannot be managed if unrecognized. Evaluation of pain or illness typically involves the measurement of physiologic and behavioral indicators which are either invasive or not suitable for large scale assessment. The observation of nesting behavior shows promise as the basis of a species appropriate cage-side assessment tool for recognizing distress in mice. Here we demonstrate the utility of nest building behavior in laboratory mice as an ethologically relevant indicator of welfare. The methods presented can be successfully used to identify thermal stressors, aggressive cages, sickness, and pain. Observation of nest building behavior in mouse colonies provides a refinement to health and well-being assessment on a day to day basis.     

We don't make WEIRD faces: A brief history of emotion expression research in small-scale societies

Research in the social sciences has largely relied on Western, Educated, Industrialized, Rich, and Democratic (WEIRD) participants, yet scholars tend to use findings from such WEIRD samples to draw conclusions about human psychology at large. There is, however, one prominent area of psychological science drawing on evolutionary theory that marks a major exception to this trend: research on the nonverbal expression of emotion. We briefly review the major findings from this literature, highlighting the ways in which researchers have effectively used participant samples from “maximally divergent populations” to address questions about universality and, in turn, the evolutionary basis of nonverbal displays.     

The Psychotropic Self/Imaginary: Subjectivity and Psychopharmaceutical Use Among Heroin Users with Co-Occurring Mental Illness

Many people diagnosed with mental illnesses struggle with illicit drug addiction. These individuals are often treated with psychiatric medications, yet little is known about how they experience this treatment. Research on the subjective experience of psychiatric medication use highlights the complex, contradictory, and ambiguous feelings often associated with this treatment. However, for those with mental illness and addiction, this experience is complicated by the need to manage both psychiatric medication and illicit drug use. Using ethnographic data from a study of heroin use in Northeast Ohio, we explore this experience by expanding the pharmaceutical self/imaginary (Jenkins, Pharmaceutical Self: The Global Shaping of Experience in an Age of Psychopharmacology, School for Advanced Research Press, Santa Fe, NM, 2010b) to include psychopharmaceuticals and illicit drugs, what we call the psychotropic self/imaginary. Through this lens we explore the ways participants interpret and manage their psychotropic drug use in relation to sociocultural, institutional, and political–economic contexts. This analysis reveals how participants seek desired effects of legally prescribed and illicit drugs to treat mental illness, manage heroin addiction, and maintain a perceived “normal” self. Participants manage their drug use using active strategies, such as selective use of psychiatric medications, in the context of structural constraints, such as restricted access to mental health care, and cultural contexts that blur distinctions between “good” medicines and “bad” drugs.     

An Integrative Theory-Driven Positive Emotion Regulation Intervention

Over the past fifteen years, positive psychology research has validated a set of happiness enhancing techniques. These techniques are relatively simple exercises that allow happiness seekers to mimic thoughts and behavior of naturally happy people, in order to increase their level of well-being. Because research has shown that the joint use of these exercises increases their effects, practitioners who want to help happiness seekers need validated interventions that combine several of these techniques. To meet this need, we have developed and tested an integrative intervention (Positive Emotion Regulation program – PER program) incorporating a number of validated techniques structured around a theoretical model: the Process Model of Positive Emotion Regulation. To test the effectiveness of this program and to identify its added value relative to existing interventions, 113 undergraduate students were randomly assigned to a 6-week positive emotion regulation pilot program, a loving-kindness meditation training program, or a wait-list control group. Results indicate that fewer participants dropped out from the PER program than from the Loving-Kindness Meditation training. Furthermore, subjects in the PER group showed a significant increase in subjective well-being and life satisfaction and a significant decrease in depression and physical symptoms when compared to controls. Our results suggest that the Process Model of Positive Emotion Regulation can be an effective option to organize and deliver positive integrative interventions.     

How Darwinian reductionism refutes genetic determinism

Genetic determinism labels the morally problematical claim that some socially significant traits, traits we care about, such as sexual orientation, gender roles, violence, alcoholism, mental illness, intelligence, are largely the results of the operation of genes and not much alterable by environment, learning or other human intervention. Genetic determinism does not require that genes literally fix these socially significant traits, but rather that they constrain them within narrow channels beyond human intervention. In this essay we analyze genetic determinism in light of what is now known about the inborn error of metabolism phenylketonuria (PKU), which has for so long been the poster child 'simple' argument in favor of some form of genetic determinism. We demonstrate that this case proves the exact opposite of what it has been proposed to support and provides a strong refutation of genetic determinism in all its guises.     

Modulation of NMDA receptor function as a treatment for schizophrenia

Schizophrenia is a devastating mental illness that afflicts nearly 1% of the world’s population. Currently available antipsychotics treat positive symptoms, but are largely ineffective at addressing negative symptoms and cognitive dysfunction. Thus, improved pharmacotherapies that treat all aspects of the disease remain a critical unmet need. There is mounting evidence that links NMDA receptor hypofunction and the expression of schizophrenia, and numerous drug discovery programs have developed agents that directly or indirectly potentiate NMDA receptor-mediated neurotransmission. Several compounds have emerged that show promise for treating all symptom sub-domains in both preclinical models and clinical studies, and we will review recent developments in many of these areas.     

Transdiagnostic clinical staging in youth mental health: a first international consensus statement

Recognizing that current frameworks for classification and treatment in psychiatry are inadequate, particularly for use in young people and early intervention services, transdiagnostic clinical staging models have gained prominence. These models aim to identify where individuals lie along a continuum of illness, to improve treatment selection and to better understand patterns of illness continuity, discontinuity and aetiopathogenesis. All of these factors are particularly relevant to help‐seeking and mental health needs experienced during the peak age range of onset, namely the adolescent and young adult developmental periods (i.e., ages 12‐25 years). To date, progressive stages in transdiagnostic models have typically been defined by traditional symptom sets that distinguish “sub‐threshold” from “threshold‐level” disorders, even though both require clinical assessment and potential interventions. Here, we argue that staging models must go beyond illness progression to capture additional dimensions of illness extension as evidenced by emergence of mental or physical comorbidity/complexity or a marked change in a linked biological construct. To develop further consensus in this nascent field, we articulate principles and assumptions underpinning transdiagnostic clinical staging in youth mental health, how these models can be operationalized, and the implications of these arguments for research and development of new service systems. We then propose an agenda for the coming decade, including knowledge gaps, the need for multi‐stakeholder input, and a collaborative international process for advancing both science and implementation.     

Erratum: “This is Why you’ve Been Suffering”: Reflections of Providers on Neuroimaging in Mental Health Care

Mental health care providers increasingly confront challenges posed by the introduction of new neurotechnology into the clinic, but little is known about the impact of such capabilities on practice patterns and relationships with patients. To address this important gap, we sought providers’ perspectives on the potential clinical translation of functional neuroimaging for prediction and diagnosis of mental illness. We conducted 32 semi-structured telephone interviews with mental health care providers representing psychiatry, psychology, family medicine, and allied mental health. Our results suggest that mental health providers have begun to re-conceptualize mental illness with a neuroscience gaze. They report an epistemic commitment to the value of a brain scan to provide a meaningful explanation of mental illness for their clients. If functional neuroimaging continues along its projected trajectory to translation, providers will ultimately have to negotiate its role in mental health. Their perspectives, therefore, enrich bioethical discourse surrounding neurotechnology and inform the translational pathway.