Claudewell S. Thomas

Migration and Mental Health among the Peoples of the Caribbean, 1948-1980

A body of literature suggests that the rates of mental illness among immigrant groups greatly exceed those of the population of their countries of origin [1]. Schizophrenia, in particular, has been found to be associated with migration [1-4]. Some studies have also reported high rates of mental disorders among refugees and exiles [5,6]. The purposes of this paper are severalfold: (1) to review the salient findings in the literature for 1948-1980 dealing with migration and mental health among the peoples of the Caribbean; (2) to highlight some of the important theoretical problems inherent in research on migration and mental health; and (3) to increase awareness of an array of questions that should be raised and of some of the theoretical and methodological issues involved.

A cross-cultural study of confidentiality.

SummaryAlthough increasing attention is being paid to confidentiality in the clinician-patient relationship, there is a notable paucity of empirically grounded research addressing the problem. The authors present data, which are an extension of research carried out in the United States, which compare the handling of confidentiality among American, Egyptian, and Israeli psychiatrists, and American and Israeli psychologists and internists. The data support the view that no significant differences exist between practitioners of the same professional groups practicing in different countries while also showing significant and parallel between-group differences. The limitations and implications of the findings are discussed.

An attempt to examine the perception of self and hospital among chronically ill mental patients.

AS new programs are formulated emphasizing community rehabilitation of the mentally ill, increasing attention must be paid to the large numbers of &dquo;chronically ill&dquo; who make up part of our present in-patient population. One important question to be answered is: What characteristics of these patients must be taken into account as we seek to restore them to some level of community functioning? Some studies have already suggested that a marked deterioration of social skills,’ lack of motivation,9 and sense of alienation from societyg are some of the factors with which any new rehabilitation program must cope.

Emergency Planning: the Practical and Theo Retical Backdrop To an Emergency Treatment Unit

IN many of the major cities of the United States (the Eastern Seacoast is most striking) an interesting and challenging phenomenon which has major medical and social consequences is taking place. We are experiencing an exodus to suburbia of the relatively more affluent in search of privacy, greenery, and better living conditions, leaving a core city population of so-called ethnic minority and lower-class origin.’ 1 The population pattern of 50-100 years ago, which saw medical center complexes of the great cities arise in proximity to middle-class settings has been radically altered, and such centers as the Yale-New Haven Medical Center, The Columbia Presbyterian Medical Center, The University of Chicago Medical Center, and The Johns Hopkins Medical Complex, to name but a few, stand essentially at the periphery of modern slums. The residual core city population of these slums differs significantly in its use of medical facilities from its predecessor, in that it uses the emergency services of available general hospitals in place of private practitioners of medicine. The use of psychiatric facilities is likewise different. It is largely polarized between the local State Hospital on the one hand, and the Emergency Room on the other; indeed, often using the latter as a way station to the former. This reflects the lack of an alternative facility, in turn indicative of insufficient professional concern with the specific needs of a poverty class. Psychiatric problems are perceived differently by professionals and by lay individuals, depending on age, education, social class, etc. of the latter. It follows logically that what is done or not done in the way of problem solving depends very much on the individual and group perception of the problem. The lower socio-economic class (Hollingshead’s Class V Group)2 has been thought to be the least accessible to psychiatric help. In particular, this groups’ involvement in psychotherapy has been singled out as being particularly poor, by virtue of nonpsychological-mindedness, distrust of authority and impulsivity, among other characteristics. Conflicting frames of reference between psychiatrist and client seem responsible for the failure of engagement in a treatment contract rather than especially deviant psychological processes. The patient’s insistence on a physical frame of reference rather than an inner psychological frame may reflect only the central problem of engagement rather than a

Mobility and Mental Health.

Mobility and Mental Health is an outstanding collection of articles stemming from the Fifth Annual Conference on Community Mental Health Research held at the Social Science Institute of Washington University in 1963. The book is divided into two parts; the first part contains original research papers from a number of disciplines directed toward several aspects of mobility. The second part of the book consists of three short discussion papers and a summary statement. The aspects of mobility covered are migration and social mobility. Migration is related to the major mental disorders, as discussed by H. B. M. Murphy in a review of pertinent data from several countries. W. E. Henry discusses social mobility from the standpoint of the social learning involved, identifying sociological criteria for successful social mobility, tying these to individual motivation and to group supported values in an interesting and thought provoking manner. George A. DeVos presents some