La part de l’analyse phénoménologique dans l’étude de cas singulier

We argue that clinical psychiatry oscillates between two epistemological poles: inference and perception. The inferential approach categorises illnesses bottom up, from visible symptoms to the pathological category supposedly causing them. In doing so, psychiatry moves away from the possible instantaneous perception of a patient, as well as from illness as a changing, evolving, phenomenon. From a phenomenological point of view, the perceptive approach enables the therapist, within an encounter, to experience the emergence of an impression of a patient’s overall bearing, or attitude. Thanks to épochè, a sense of form, Gestalt will emerge. The clinical case, nevertheless, is always a construction, an intersubjective narrative about illness, recounted by the patient. Creating a library of clinical cases leads to the development of case types, each becoming a reference to which future clinical cases can be compared and categorised as belonging to a clinical family; it is the participant with respect to Plato’s eidos. Phenomenology contributes to clinical experience in that it makes possible the link between perception and inference, between subjective experience and intersubjective narrative, and between person and case type.     

Asperger’s Syndrome,Subjectivity and the Senses

Situated at the intersection of anthropological work on illness narratives and research on the anthropology of autism, this paper is a close reading of an autobiographical narrative recounted by Peter, a young man diagnosed with Asperger’s Syndrome, a type of autism spectrum disorder (ASD). Responding to Solomon’s (2010a:252) call for phenomenologically grounded accounts of “the subjective, sensory, and perceptual experiences of autism … based on personal narratives and practices of being and self-awareness,” this paper calls into question key assumptions in the clinical and popular literature about ASD relating to theory of mind, empathy, capacity for metaphorical thinking, and ASD as a life-long condition.     

“Traveling Pains”: Embodied Metaphors of Suffering Among Southern Sudanese Refugees in Cairo

This paper presents the results of a larger study conducted among Southern Sudanese refugees in Cairo, Egypt. "Illness talk" and body metaphors are the focus of the present work, which is based mainly on an analysis of the illness narratives of people attending a church-run medical clinic. The findings suggest that refugees use certain narrative styles in discussing their illnesses that highlight the interconnection of bodily ills and refugee-related trauma. The refugees narrated the histories of their illnesses in terms consistent and coterminous with their refugee histories, and articulated illness causes in terms of threatening assaults on their sense of self as human beings and as part of a distinct community and culture. The use of embodied metaphors to understand and cope with their current and past traumatic experiences was echoed in narratives that were nonillness related. Metaphors such as "the heart," "blood," and "body constriction" were consistently used to discuss social and cultural losses. Understanding the role that the body plays in experience and communication within a given cultural context is crucial for physicians and others assisting refugees.     

Innovative Training with Virtual Patients in Transcultural Psychiatry: The Impact on Resident Psychiatrists’ Confidence

Background

Virtual patients are now widely accepted as efficient and safe training tools in medical education, but very little is known about their implementation in psychiatry, especially in transcultural clinical care of traumatized refugee patients.

Objective

This study aimed at assessing the impact of training with a virtual patient on confidence in providing clinical care for traumatized refugee patients.

Methods

The authors developed an educational tool based on virtual patient methodology portraying the case of “Mrs. K”, a traumatized refugee woman with symptoms of PTSD and depression. A group (N=32) of resident psychiatrists tested the system and their confidence in different aspects of providing clinical care for this patient group was evaluated pre- and post-test by using a validated confidence questionnaire. Cronbach’s α was calculated for all clusters. Changes between pre- and post-test were compared by using the matched-pair t-test, binomial distribution for exact significance test and a calculation of effect sizes (Cohen’s d).

Results

A statistically significant improvement was exhibited in overall confidence (mean Δ: 0.34; p<0.0001; d: 0.89) as well as in four more specific domains of clinical care, with the area of identifying and evaluating trauma-related diagnoses and disability showing the most prominent improvement (mean Δ: 0.47; p<0.0001; d: 1.00).

Conclusions

This VP-system can lead to physicians’ improvement of confidence in providing transcultural clinical care for traumatized refugee patients. Further research is required to investigate improvement in actual performance and cognitive outcomes with several VPs and in a long-term effect perspective.     

Resettlement challenges and dilemmas: An in‐depth case study of Bhutanese refugee women in Australia

In this paper, the perceptions of Bhutanese refugee women were explored in relation to their changing identity and their behavioural responses in the use of preventive health services following resettlement. Interviews with 30 Bhutanese refugee women in Melbourne revealed resettlement drivers, challenges and dilemmas. There was no option for women other than resettlement, women wanted to escape from bad conditions and hopes for a better future for their children was critical in their thinking. Resettlement introduced new unexpected challenges including cultural discontinuity, changed dependency and a sense of not belonging. Dilemmas were apparent in their experiences including: despondency and contentment, gratitude and regret; and identifying as either Australian or refugee. Motherhood was important to women in this study and was challenged by changed dependency with their children in resettlement. Challenges of cultural discontinuity included the impact of communication difficulties and illiteracy and the absence of social connections with neighbours. A better understanding of how changing identities of women interact should lead to more effective strategies including tailored programs and activities.     

When "humanitarianism" becomes "development": the politics of international aid in Syria's Palestinian refugee camps

In recent years, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has attempted to go beyond its role as a provider of relief and basic services in Palestinian refugee camps and emphasize its role as a development agency. In this article, I focus on the Neirab Rehabilitation Project, an UNRWA-sponsored development project taking place in the Palestinian refugee camps of Ein el Tal and Neirab in northern Syria. I argue that UNRWA's role as a relief-centered humanitarian organization highlights the everyday suffering of Palestinian refugees, suffering that has become embedded in refugees’ political claims. I show that UNRWA's emphasis on “development” in the refugee camps is forcing Palestinian refugees in Ein el Tal and Neirab to reassess the political narrative through which they have understood their relationship with UNRWA.     

Property as sovereignty in micro: the state/property nexus and the Cyprus Problem

This article shows that landed property can be an exercise of state sovereignty in micro. I argue that property tightly relates to statehood and that the concept of ‘community’ offers us a lens with which to investigate that relation. Property's ‘communal’ character in Cyprus often transcends individual rights to ownership. A house belongs not to an individual, but to persons in their capacity as members of either the Greek-Cypriot or Turkish-Cypriot constitutional communities of the Republic. Focusing on the moral and political claims that ensue from this premise, I show how refugee Cypriots encounter and rearticulate the state in a variety of institutions as they lay claims to property (periousia) – their own or others’. Consequently, I argue that thinking through ‘community’ contributes to understandings of the linkage between property and statecraft (what I call the state/property nexus). In turn, this allows us to better comprehend statehood in post-conflict domains.     

CBL教学模式在细胞研究进展教学中的应用效果

目的:探讨案例式教学(CBL)教学模式在细胞研究进展教学中的应用效果。方法:选择我校2013~2015级选修"细胞研究进展"的学生80人为研究对象,按选修课程时间的不同分为实验组及常规组各40例。常规组实施传统的教学模式(LBL),实验组实施CBL教学模式,调查两组学生的教学效果并比较两组学生考试得分情况。结果:实验组学生分析问题的能力、临床思维的建立、课堂积极性及教学满意度得分均高于常规组,差异均有统计学意义(P0.05)。实验组学生临床案例分析及临床操作能力得分均高于常规组,差异均有统计学意义(P0.05)。结论:对选修细胞研究进展课程的学生采用CBL模式进行教学,有助于其建立临床思维,提高临床操作能力,提高学生对教学的满意度。     

The ‘successful’ return: Caribbean narratives of migration,family, and gender

Research on female migrant caregivers has tended to focus upon the emotional and social problems they encounter working abroad, given women's traditional role as caregivers for their own families. This article analyses how Caribbean women who have returned after a period abroad as domestic workers inscribe their migration experiences within the gendered narrative of the good relative who migrates to help the family left behind and therefore deserves social recognition in the community of origin. It argues that this narrative allows the women to both affirm and reinterpret local family and gender roles within the context of migration. This analysis points to the close connection between narrative structures, accounts of migration experiences, and self‐presentations and suggests that narratives about family and gender roles not only reflect people's lives, but are also a malleable resource that can be (re)shaped to validate a variety of life‐courses.     

The state construction of affect: Political ethos and mental health among Salvadoran refugees

This essay seeks to extend current anthropological theorizing on emotion. Although anthropologists have convincingly established the specifically cultural status of emotion, recognition also of state (including sociopolitical institutions of nation-states) constructions of affect has been slow in coming. The present essay seeks to expand the emerging scholarly discourse on the emotions by examining the nexus among the role of the state in constructing a political ethos, the personal emotions of those who dwell in that ethos, and the mental health consequences for refugees. This analysis is intended as a bridge between analyses of the state construction of affect, on the one hand, and the phenomenology of those affects, on the other. To illustrate, I examine the state construction of affect and its traces in the narrative and clinical presentations of Salvadoran refugees in North America. The saliency of fear and anxiety among a group of psychiatric out-patients is framed by bodily experience, knowledge of illness, and the ethnopsychology of emotion within the context of chronic political violence and poverty. Distinctions between terror and torture, distress and disease are proposed as essential to an account of refugee experience. Future directions for the study of the state construction of affect are suggested.     

Diagnostic Utility of the Impact of Event Scale–Revised in Two Samples of Survivors of War

The study aimed at examining the diagnostic utility of the Impact of Event Scale-Revised (IES-R) as a screening tool for post-traumatic stress disorder (PTSD) in survivors of war. The IES-R was completed by two independent samples that had survived the war in the Balkans: a sample of randomly selected people who had stayed in the area of former conflict (n = 3,313) and a sample of refugees to Western European countries (n = 854). PTSD was diagnosed using the MINI International Neuropsychiatric Interview. Prevalence of PTSD was 20.1% in the Balkan sample and 33.1% in the refugee sample. Results revealed that when considering a minimum value of specificity of 0.80, the optimally sensitive cut-off score for screening for PTSD in the Balkan sample was 34. In both the Balkan sample and the refugee sample, this cut-off score provided good values on sensitivity (0.86 and 0.89, respectively) and overall efficiency (0.81 and 0.79, respectively). Further, the kappa coefficients for sensitivity for the cut-off of 34 were 0.80 in both samples. Findings of this study support the clinical utility of the IES-R as a screening tool for PTSD in large-scale research studies and intervention studies if structured diagnostic interviews are regarded as too labor-intensive and too costly.     

Asymptomatic Malaria in Refugees Living in a Non-Endemic South African City

Background

Asymptomatic malaria infection in refugees is both a threat to the lives of the individuals and the public in the host country. Although South Africa has been experiencing an unprecedented influx of refugees since 1994, data on malaria infection among refugees is lacking. Such information is critical since South Africa is among the countries that have planned to eliminate malaria. The objective of this study was to determine prevalence of asymptomatic malaria infection among a refugee population living in a city of KwaZulu-Natal province, South Africa.

Methods and Findings

A survey was conducted on adult refugee participants who attended a faith-based facility offering social services in a city of KwaZulu-Natal province, South Africa. The participants were screened for the presence of malaria using rapid diagnostic tests and microscopy. Demographic data for the participants were obtained using a closed ended questionnaire. Data was obtained for 303 participants consisting of 51.5% females and 47.5% males, ranging from 19 to 64 years old. More than 95% of them originated from sub-Saharan African countries. Two hundred and ninety participants provided a blood sample for screening of malaria. Of these, 3.8% tested positive for rapid diagnostic test and 5.9% for microscopy. The majority of malaria infections were due to Plasmodium falciparum.

Conclusions

The study confirms the presence of asymptomatic malaria infections among a refugee population residing in a city of KwaZulu-Natal province that is not endemic for malaria. The results have important implications for both public health and malaria control in South Africa, particularly since the country has decided to eliminate malaria by 2018. To achieve this goal, South Africa needs to expand research, surveillance and elimination activities to include non-endemic areas, particularly with high refugee populations. We further recommend use of powerful diagnostic tests such as PCR for these interventions.     

Chemoembolization in the treatment of hepatic malignancy.

Numerous factors must be taken into account to best provide for the health and well-being of refugee patients in developed countries. One issue that is rarely considered is the awful and not uncommon occurrence of political torture. Large numbers of refugees and other displaced persons are survivors of political torture, and health care professionals must be prepared for this possibility when treating refugee patients. The effects of torture are pervasive, and we provide some practical considerations for health professionals who care for survivors of torture. Specific challenges include problems relating to exile and resettlement, somatic symptoms and pain, and the "medicalization" of torture sequelae.     

The Play is Now Reality: Affective Turns, Narrative Struggles, and Theorizing Emotion as Practical Experience

Discursive approaches to subjectivity have been critiqued most recently for its dismissal of a living body that moves and senses. While identity as performative has proven invaluable to contemporary cultural theory for its dynamic conceptualization of power in everyday practice, the emergence of what some scholars have named an “affective turn” has prompted calls for configuring the body as more than a complex set of significations, but also a vibrant energy field in perpetual emergence. Centered on an enacted story created by two clinical therapists and two South Asian immigrant domestic violence survivors during a therapeutic support group session, this paper brings the affective turn into dialog with narrative theory. I juxtapose two different readings of this clinical “performance.” One interpretation recognizes affect theory’s value for highlighting sensation and the virtual in moments of transformation. Nonetheless I argue it overlooks a lived history. Thus, using a specifically dramatistic approach to narrative, the second analysis stresses the importance of personal experience and meaning-making in strengthening the link between affect and subjectivity. In doing so, the case study also argues for emotion’s critical link to practical and moral experience.     

Regarding the confusion between the population concept and Mayr's "population thinking"

Ernst Mayr said that one of Darwin's greatest contributions was to show scholars the way to population thinking, and to help them discard a mindset of typological thinking. Population thinking rejects a focus on a central representative type, and emphasizes the variation among individuals. However, Mayr's choice of terms has led to confusion, particularly among biologists who study natural populations. Both population thinking and the concept of a biological population were inspired by Darwin, and from Darwin the chain for both concepts runs through Francis Galton who introduced the statistical usage of "population" that appears in Mayr's population thinking. It was Galton's "population" that was modified by geneticists and biometricians in the early 20th century to refer to an interbreeding and evolving community of organisms. Under this meaning, a population is a biological entity and so paradoxically population thinking, which emphasizes variation at the expense of dwelling on entities, is usually not about populations. Mayr did not address the potential for misunderstanding but for him the important part of the population concept was that the organisms within a population were variable, and so he probably thought there should not be confusion between population thinking and the concept of a population.     

Debt revolts: Ecuadorian foreclosed families at the PAH in Barcelona

Can present day grassroots direct actions be considered revolutionary? In this paper, I argue that seemingly “reformist” demands can be considered revolutionary in today’s neoliberal capitalism. At the turn of the twenty-first century, working class Ecuadorian migrants in Barcelona were trying to join the global middle classes via subprime mortgage loans and despite their precarious jobs. Following the collapse of Spain’s housing bubble, unemployed, defaulting on their mortgages, and risking home eviction, they turned to housing activism. They joined the Platform for People Affected by Mortgages (PAH) and became daily protestors for the right to housing and against indebtedness. Looking at PAH approaches that encouraged debt default among low-income families, strategies to reconvert repossessed homes by rescued banks into social housing units, or the effective occupation of buildings that belonged to these banks by the PAH to house evicted families, I claim that these moments represent revolutionary instances of a broader fight against indebtedness taking place globally which can be considered—as many did at the PAH—a fight against capitalism at large. In this paper I illustrate how people who had seldom participated in social mobilization became part of a small Barcelonan movement for the right to housing that grew exponentially throughout Spain succeeding in canceling thousands of mortgage debts and stopping equally as many evictions. PAH’s spaces of encounter and action made possible a cross-class alliance upheld by weekly assemblies and near daily direct actions against financial institutions and a pro-austerity central government. These moments demonstrate the ability of everyday people to reclaim housing, redefine the narrative of indebtedness, and—in the case of Barcelona—it even made possible taking control of City Hall.     

Using indirect methods to understand the impact of forced migration on long-term under-five mortality

Despite the large numbers of displaced persons and the often-lengthy periods of displacement, little is known about the impact of forced migration on long-term under-five mortality. This paper looks at the Brass Method (and adaptations of this method) and the Preceding Birth Technique in combination with a classification of women by their migration and reproductive histories, in order to study the impact of forced migration on under-five mortality. Data came from the Demography of Forced Migration Project, a study on mortality, fertility and violence in the refugee and host populations of Arua District, Uganda and Yei River District, Sudan. Results indicate that women who did not migrate in a situation of conflict and women who repatriated before the age of 15, had children with the highest under-five mortality rates compared with women who were currently refugees and women who repatriated after the age of 15.     

Comparison of the Nutritional Status of Overseas Refugee Children with Low Income Children in Washington State

Introduction

The extent that the dual burden of undernutrition and overnutrition affects refugee children before resettlement in the US is not well described.

Objective

To describe the prevalence of wasting, stunting, overweight, and obesity among refugee children ages 0–10 years at their overseas medical screening examination prior to resettlement in Washington State (WA), and to compare the nutritional status of refugee children with that of low-income children in WA.

Methods

We analyzed anthropometric measurements of 1047 refugee children ages 0–10 years old to assess their nutritional status at the overseas medical screening examination prior to resettlement in WA from July 2012—June 2014. The prevalence estimates of the nutritional status categories were compared by country of origin. In addition, the nutritional status of refugee children age 0–5 years old were compared to that of low-income children in WA from the Center for Disease Control and Prevention’s Pediatric Nutrition Surveillance System.

Results

A total of 982 children were eligible for the study, with the majority (65%) from Somalia, Iraq and Burma. Overall, nearly one-half of all refugee children had at least one form of malnutrition (44.9%). Refugee children ages 0–10 years were affected by wasting (17.3%), stunting (20.1%), overweight (7.6%) and obesity (5.9%). Among children 0–5 years old, refugee children had a significantly higher prevalence of wasting (14.3% versus 1.9%, p<0.001) and stunting (21.3% versus 5.5%, p<0.001), and a lower prevalence of obesity (6.2% versus 12.9%, p<0.001) than low-income children in WA.

Conclusion

The dual burden of under- and over-nutrition among incoming refugee children as well as their overall difference in prevalence of nutritional status categories compared to low-income children in WA provides evidence for the importance of tailored interventions to address the nutritional needs of refugee children.