Expression Of Psychological Distress Research Articles

Okweraliikirira and Okwenyamira: Idioms of Psychological Distress Among People Living with HIV in Rakai, Uganda.

Introduction : Health and illness experiences are positioned within social and cultural contexts. Understanding the mental health and psychological distress of people living with HIV in highly affected communities is critical to addressing their needs and to ensure programming and interventions are targeted and appropriate. Methods : Grounded in the ethnomedical theoretical perspective, we conducted qualitative interviews to understand the experience and expression of psychological distress by people living with HIV in Rakai, Uganda. Participants included adults living with HIV (n=20), health workers (counselors, peer health workers, nurses, n=10), and key informants (n=12). Interviews were audio recorded, transcribed/translated, coded, and analyzed using thematic analysis. Results: Two idioms of distress, okweraliikirira (worry/apprehension) and okwenyamira (deep/many thoughts/lots of thoughts) were described as impacting people living with HIV. Both idioms were said to be alleviated by social support or counseling, but if left unaddressed could lead to more severe mental health problems and poor ART adherence. Conclusion: People living with HIV understand their psychological distress through culturally specific idioms; such distress can have deleterious impacts on well-being. Incorporating idioms of distress into screening and treatment for people living with HIV may improve identification of individuals in need and overall health services to address this need.

Unlocking asylum seekers' voices: protocol of a mixed-method clinical study on the use of the cultural formulation interview with asylum seekers in Belgium.

Despite a high prevalence of mental disorders among asylum seekers, many barriers to mental healthcare exist. Cultural and contextual factors strongly influence the experience and expression of psychological distress, putting asylum seekers at greater risk of misdiagnosis and inappropriate treatment. The Cultural Formulation Interview (CFI) is a useful tool to map out cultural and contextual factors of mental disorders; however, to the best of our knowledge, it has not yet been investigated in asylum seekers specifically. The primary aim of this study is to evaluate the value of the CFI in the psychiatric assessment of asylum seekers. Second, we will describe the themes relevant to psychiatric distress in asylum seekers that are identified by the CFI. In addition, asylum seekers' experience of the CFI will be evaluated. This cross-sectional, mixed-method clinical study aims to recruit a group of 60-80 asylum seekers (age 15-29) with mental health symptoms. Data will be collected using structured (MINI, PCL-5, HDRS-17, WHOQoL-BREF & BSI) and semi-structured (CFI & CFI-debriefing) questionnaires to assess cultural background, contextual factors, and illness severity. Multidisciplinary case discussions will be held after the completion of interviews, following a methodological stepped approach. Combining qualitative and quantitative research techniques, this study aims to generate reliable knowledge on working with the CFI in asylum seekers. Based on the findings, recommendations for clinicians will be developed. This study addresses the knowledge gap on using the CFI in asylum seekers. Compared to prior studies, it will provide new insights into the use of the CFI in the specific context of working with asylum seekers. Prior research on the CFI in asylum seekers is limited, partly because of their high vulnerability and low access to care. The study protocol has been tailored in close collaboration with several stakeholders and validated after piloting. Ethical approval has already been obtained. Together with the stakeholders, the results will be translated into guidelines and training materials. Recommendations to policymakers will also be provided.

Expressions of psychological distress among students at the Federal University of Tocantins

Resumo A temática deste artigo é o sofrimento psíquico dos alunos no contexto da universidade pública. Trata-se de um assunto em crescente discussão em razão do aumento de casos evidenciado nas estatísticas sobre depressão, suicídio e adoecimento mental entre acadêmicos do ensino superior. O trabalho é pautado pela reflexão teórica interdisciplinar, abrangendo fundamentos da educação e do ensino, com ênfase também em aspectos da comunicação e ainda perspectivas propostas pela medicina. Utilizando ferramentas metodológicas quantitativas e qualitativas como complementares, a pesquisa analisou 342 questionários respondidos por discentes, docentes e servidores técnicos da Universidade Federal do Tocantins com o objetivo de investigar diferentes aspectos do sofrimento dentro da amostragem selecionada. Mediante a análise é possível observar a complexidade da vivência dos sentimentos e relações experimentadas pelo estudante no ambiente universitário e conclui-se que o sofrimento psíquico deve ser considerado uma preocupante realidade acadêmica. Nesse cenário, sugere-se a elaboração e investimento em políticas públicas institucionais de promoção à saúde e qualidade de vida dos discentes e docentes no ensino superior. A discussão é de fundamental importância e pode contribuir com o desenvolvimento de práticas que amenizem o sofrimento no contexto do ensino superior público.

Bodily expression of psychological distress in adolescents: a qualitative study

IntroductionThe bodily expression of psychological disorders is one of the leading motives for consultations in adolescent medicine. The diagnostic entity corresponding to DSM-5 "Somatic symptom and related disorders" is sparsely used in the English-language literature, especially for adolescents. Qualitative studies on this topic mostly concern the experiences of healthcare professionals. This study seeks to explore the experience of adolescents expressing psychological distress through their body.MethodsThis exploratory research took place in a Paris hospital department of adolescent medicine. Our sampling method was purposive. For inclusion, patients had to be aged 11–24 years, with a "somatic symptom disorder" meeting the DSM-5 criteria. Semi-directive interviews were proposed with visual narration inspired by photoelicitation. Thematic analysis allowed us to explore the data with an inductive approach.ResultsThirty adolescents were interviewed; they were 14–22 years old and mostly had somatic symptom or functional neurological disorders. Three principal themes emerged from our analysis of the interview contents: the personal, including bodily, experience of the disorder, the experience of relationships, and the question of what is visible through the body.ConclusionThis research allowed us to discuss the reversal of generations, the function of the DSM-5 diagnosis, illuminated by sociology, and finally, cultural pathways. It shows the importance of recognizing the reality of the adolescents' bodily feelings, reassuring them by ruling out serious causes, and supporting their search for meaning. It is important to think about a specific framework of family therapy that can make effective use of this experience of the reversal of generations.

Families With Violence Exposure and the Intergenerational Transmission of Somatization.

Introduction:Adults who have histories of childhood trauma have been noted to display greater somatization, dissociative symptoms and affect dysregulation. What happens in the parent-child relationship when those traumatized children become parents? A potential link to somatization in the child has been suggested by several prior studies. Children who have early attachment disturbances had more physical complaints if their mothers displayed less maternal sensitivity during observed parent-child interactions. Yet, the intergenerational link between maternal and child somatization has not been sufficiently explored in a longitudinal study in order to understand the potential impact of maternal trauma history and related psychopathology on subsequent child somatization and psychopathology.MethodsThis paper examined prospective, longitudinal data of 64 mother-toddler dyads (mean age = 2.4 years, SD = 0.7) who were later studied when children had a mean age of 7 years. Mothers with and without histories of interpersonal violence (IPV; physical/sexual abuse and/or family violence exposure) were included. Mothers with IPV histories were oversampled. Linear and Poisson regression models were used to test the associations between maternal IPV-related post-traumatic stress disorder (PTSD) with maternal somatization severity when children were toddlers, and between maternal somatization and maternal interactive behaviors with child somatization by maternal report and clinician-rated assessment at school-age.ResultsMaternal PTSD severity was significantly associated with increased maternal somatization severity (p = 0.031). Maternal somatization severity during the child's early childhood predicted both maternal report of child somatization (p = 0.011) as well as child thought problems (p = 0.007) when children were school-aged. No association was found between maternal somatization and child-reported psychopathology. The study did not find that maternal alexithymia, caregiving behaviors or child exposure to violence contributed significantly to the model examining the association between maternal and child somatization.ConclusionThe results are in line with the hypothesis of intergenerational transmission of somatization in the context of IPV and related maternal PTSD during formative early development. We interpret this as an expression of psychological distress from mother to child, as maternal trauma and pathology affect the caregiving environment and, thus, the parent–child relationship. The authors conclude with a discussion of implications for parent–infant and early childhood intervention.

Social representations of coronavirus/COVID-19 in Italy: Psychosocial anchoring to conspiracy beliefs, vaccine hesitancy, and the psychological dimension

From the societal approach of the Theory of Social Representations, this study aimed to investigate the social representations of coronavirus/COVID-19 among the Italian population. By means of an online questionnaire, 599 individuals participated in the research, with a mean age of 38.09 years (SD = 14.44), 62.1% being women. The instrument was composed of sociodemographic questions, free association technique for the inductive term “coronavirus/COVID-19” and scales on conspiracy beliefs, vaccine hesitancy, and psychological dimension. The results allowed us to identify four social representations: “Citizens driven by Social Representations anchored to factual Covid-19 pandemic data,” with lower vaccine hesitancy and conspiracy beliefs, and greater faith in science; “Citizens with low confidence in anti-pandemic preventive measures by government,” with lower agreement with restriction measures; “Emotional people,” with higher agreement with restriction measures and expression of psychological distress; and “Minority group of Citizens driven by denial of Covid-19,” with higher vaccine hesitancy and conspiracy beliefs. We discuss the different social representations identified from the psychological and psychosocial anchoring processes in the context of the COVID-19 pandemic.

Prisoners’ Voices

Frederic Rzewski composed Coming Together and Attica in response to the 1971 uprising at the Attica Correctional Facility. The texts for the works draw upon testimonies of two men who participated in the riot: Samuel Melville and Richard X. Clark, respectively. Rzewski condemns the government crackdown on the uprising through representations of both prisoners and prison. In these and other works, the prisoner is a figure of suffering. Both Melville and Clark suffer through efforts to raise a voice about the hardships of incarceration only to have that voice break apart into fragments and silence. Prison emerges as a space of increasing confinement, conveyed by rigorous compositional schemes that tightly link individual sections and close them off in a larger sealed structure. The musical evocation of confinement along with the expression of psychological distress in the texts creates scenes of suffering. Through these scenes, Rzewski brings out the infliction of pain that scholars have viewed as a fundamental aspect of incarceration. The interaction between the critiques of incarceration and the compositional schemes in Coming Together and Attica is an example of how artists at the time (Steve Reich and sculptor Melvin Edwards) drew upon abstract idioms and materials in works that comment on contemporary political developments.

Migrations, trauma and mental health: A literature update on psychological assessment

IntroductionMigrants and refugees often face potentially traumatic events and post-migratory stressors. Upon arrival in the host country, they can be referred to mental health services to assess the impact of their previous experiences. These cross-cultural clinical encounters may raise questions, particularly regarding the assessment of mental health using models based on Western conceptions of psychopathology. Objectives and methodThe objective of the present non-systematic review of the literature is to discuss the psychological evaluation of post-traumatic reactions in migrants and refugees. More specifically, we present current research on psychopathology, resilience and post-traumatic development (PTG) among the migrant and refugee population. We also examine the cross-cultural validity of concepts such as Post-Traumatic Stress Disorder, resilience and PTG. Finally, we describe the most frequently used tools in cross-cultural psychological assessment and briefly reflect on the question of cultural sensitivity of mental health professionals. A bibliographic search was carried out using the databases: PILOTS, Pubmed, APA PsycNET, and Google Scholar using the following keywords: “migrants”, “refugees”, “posttraumatic stress disorder”, “mental health”, “Psychopathology”, “risk factors”, “protection factors”, “posttraumatic growth” and “resilience”. We have also reviewed the reference lists of articles encountered from database searches. ResultsResponses to a potentially traumatic situation are multiple. Regarding the migrant and refugee population, the reviewed articles studied different post-traumatic reactions such as resilience, post-traumatic development, and psychopathologies. The most studied psychopathological responses were depression, anxiety and Post-traumatic Stress Disorder. After reviewing these studies, we asked the following question: considering the complexity of the migration process, what are the factors associated with the development of these different post-traumatic responses? Indeed, several individual and social factors before, during and after migration influence the mental health of individuals in a migration situation. Among the most cited risk factors identified were: to be a victim of or witness to violence in the country of origin and, after migration, to face post-migration difficulties such as asylum denial, to be in a precarious situation with regard to housing and work, as well as the difficulties linked to adaptation to the new culture. We have also described protective factors for the mental health of this population, such as: social support, psychological support, and a good quality of life in the host country. The reviewed articles also describe an important influence of cultural aspects on mental health, such as the perception of an event as traumatic. Although the authors of the reviewed articles accept this influence of culture on post-traumatic responses, most of the tools used to assess the mental health of migrants and refugees were created in a Western context. Studies show a growing concern with these cultural aspects, and certain tools that allow a more culturally sensitive evaluation, such as the “Cultural Formulation Interview”, are being developed. Discussion and conclusionEven if the concern with the sensitivity of the tools used in cross-cultural assessment seems to be more present in the international literature, researchers seem to encounter difficulties in better understanding the effects of culture on the mental health of individuals. With increasingly diverse societies, new research should not be based on participants’ geographic or ethnic origins, but rather try to “unpack” culture with, for example, the exploration of the relationships between certain values or orientations and the different expressions of psychological distress. Finally, given the still lacking development in the field of cross-cultural research, certain practices, such as the participation of interpreters, the supervision of cultural mediators or the use of culturally sensitive tools, can help the clinician to maintain good practices with patients from different cultures in the diagnostic and psychotherapeutical processes.

Expressions of psychological distress in Sierra Leone: implications for community-based prevention and response.

Over recent decades there has been considerable mental health research in Sierra Leone but little on local conceptualisations of mental health conditions. Understanding these is crucial both for identifying the experienced needs of the population and utilising relevant community-based resources to address them. This study took a grounded approach to identify the ways in which adults in Sierra Leone express psychological distress. Rapid ethnographic methods deployed included 75 case study interviews with community members, 12 key informant (KI) pile sorts and 55 KI interviews. Thematic analysis of data was supported by frequency analysis and multi-dimensional scaling. Thirty signs of distress were identified. The only consistent 'syndrome' identified with respect to these was a general concept of crase, which referred to psychosis-related presentation but also a wide range of other signs of distress. We did not find consensus on locally defined concepts for mild-moderate forms of mental disorder: people use multiple overlapping signs and terms indicating psychological distress. Analysis supports calls to view mental health problems as a 'continuum of distress' rather than as discrete categories. This framing is coherent with opportunities for prevention and response in Sierra Leone which do not focus primarily on formal healthcare service providers but rather involve a range of community-based actors. It also enables attention to be paid to the identification of milder signs of distress with a view to early response and prevention of more severe mental health problems.

Expression of Psychological Distress on Instagram Using Hashtags in Russian and English: A Comparative Analysis

People have been using images to express ideas, share stories, and communicate since early history. The advent of social media has made sharing images an important part of everyday life. Among other things, social networks can be used to express psychological distress; however, research on this topic is limited. The goal of this study was to explore representations of psychological distress in the Russian-speaking segment of Instagram. The study involved contrasting images labeled with hashtags in Russian with images marked by analogous Anglophone hashtags in a data set of 1,512 images. Quantitative content analysis revealed significant differences between images labeled with Russian and Anglophone hashtags. Images containing depictions of texts were significantly less frequent among images with Russian hashtags, while inanimate object depictions were more prevalent. Hashtags for fear in both languages were related not to psychological distress but to the “scary” in popular culture. Images of alcohol were associated with stress hashtags in both languages and with hashtag for depression in Russian only. Images of food were significantly more prevalent among images with Russian hashtag for stress. Current study highlights the need for culturally and linguistically appropriate online mental health interventions.

Retreating From Life: The Boy Whose Body Experienced His Pain

The expression of psychological distress through somatic symptoms is most prevalent among children. Somatic symptom disorders represent a difficult category of disorders to treat and they are often misdiagnosed due to their physical symptomology and dismissed due to their malingering stigma. The current case report follows the treatment of David, a 10-year-old Caucasian male, admitted into the pediatric psychiatric ward of a general hospital, uncommunicative, showing little signs of responsiveness, and dependent on nursing staff for basic needs. Following a complex treatment protocol which integrated key elements of psychodynamic and cognitive-behavior (CBT) treatment recommendations for somatic disorders, David was discharged after 6 months as an inpatient. This in-depth case study provides a synthesis of the varied research on somatic symptom disorders and an acute understanding of how to combine the understanding of complex family dynamics and individual personality structure with empirically reinforced treatment strategies.

Acute effects of cannabis on breath-holding duration.

Distress intolerance (an individual's perceived or actual inability to tolerate distressing psychological or physiological states) is associated with cannabis use. It is unknown whether a biobehavioral index of distress intolerance, breath-holding duration, is acutely influenced (increased or decreased) by cannabis. Such information may further inform understanding of the expression of psychological or physiological distress postcannabis use. This within-subjects study examined whether smoked marijuana with 2.7%-3.0% delta-9-tetrahydrocannabinol (THC), relative to placebo, acutely changed duration of breath holding. Participants (n = 88; 65.9% male) were nontreatment-seeking frequent cannabis users who smoked placebo or active THC cigarette on two separate study days and completed a breath-holding task postsmoking. Controlling for baseline breath-holding duration and participant sex, THC produced significantly shorter breath-holding durations relative to placebo. There was a significant interaction of drug administration × frequency of cannabis use, such that THC decreased breath-holding time among less frequent but not among more frequent users. Findings indicate that cannabis may exacerbate distress intolerance (via shorter breath-holding durations). As compared to less frequent cannabis users, frequent users display tolerance to cannabis' acute effects including increased ability to tolerate respiratory distress when holding breath. Objective measures of distress intolerance are sensitive to contextual factors such as acute drug intoxication, and may inform the link between cannabis use and the expression of psychological distress. (PsycINFO Database Record

Clinical Approaches to Somatization

Somatization is the experience and expression of psychological distress through bodily symptoms. Somatization can be conceptualized as an emotional state that has not been represented symbolically or as a defense against intolerable emotions and fantasies. Bodily concerns can also function as a means of seeking responsiveness from others. Alexithymia refers to a difficulty identifying and symbolizing emotional states that has been found to be associated with somatization. When functioning as a defense, a focus on the body can be used to avoid frightening or intolerable feelings and fantasies, or to ward off aggressive fantasies by viewing oneself as physically damaged. Systematic studies have demonstrated the presence of the defense of somatization in mood disorders, particularly anxiety and panic disorders. In treating anxiety disorders, the therapist helps the patient to determine the nature of emotions and fantasies that the patient is defending against, particularly fears and conflicts surrounding anger and separation.

Clinical Utility of the Brunel Mood Scale in Screening for Post-Traumatic Stress Risk in a Military Population

Measures of mood states and post-traumatic stress (PTS) symptoms are commonplace in many studies. However, the conventional application of these measures conjointly raises questions whether they actually correlate, and whether mood states have a meaningful role in predicting PTS symptoms. This study aimed to assess the degree to which the Brunel Mood Scale (BRUMS) and the Impact of Event Scale-Revised (IES-R) would be useful in detecting adverse psychological experiences (e.g., PTS). A sample of South African Navy sailors (N = 103) completed the BRUMS during demobilization after a traumatic deployment, and 6 weeks later completed a repeat BRUMS and the IES-R. Significant correlations were found between some BRUMS and IES-R subscales, but the lack of other subscale correlations indicates that the two measures probably tap different expressions of psychological distress following exposure to adverse events. Greater mood distress correlated with more severe PTS. A BRUMS total mood distress score cutoff of ≥24 gave a sensitivity of 100% and specificity of 79% for severe PTS 6 weeks later. Using a BRUMS score of ≥24 at demobilization to assess for possible elevated PTS response later could be useful in the screening of large groups of people.

An update on mindfulness meditation as a self-help treatment for anxiety and depression.

In recent years, complementary and alternative medicine (CAM) treatments have increased in popularity. This is especially true for treatments that are related to exercise and mindfulness-based interventions (MBIs) in the treatment of both mental and physical illness. MBIs, such as Mindfulness-based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR), which are derived from ancient Buddhist and Yoga philosophies, have become popular treatments in contemporary psychotherapy. While there is growing evidence that supports the role of these interventions in relapse prevention, little is known about the role that MBIs play in the treatment of acute symptoms of depression and anxiety. Even less is known about the importance of specific components of MBIs (eg, mindfulness meditation [MM]) and the overall impact that these interventions have on the experience or expression of psychological distress. Moreover, few studies have rigorously evaluated the dose-response relationship that is required to effect positive symptom change and the mechanisms of change that are responsible for observed improvements. This review will define meditation and mindfulness, discuss the relationship between stress and health and how MM relates to therapeutically engaging the relaxation response, and review the empirical findings that are related to the efficacy of MM in the treatment of depression and anxiety symptoms. Given the paucity of research that examines the applications of these treatments in clinical populations, the limitations of applying these findings to clinical samples will be mentioned. A brief review of the issues related to the possible mechanisms of change and the dose-response relationship regarding MBIs, particularly MM, will be provided. Finally, limitations of the extant literature and future directions for further exploration of this topic will be offered.

A life-course and time perspective on the construct validity of psychological distress in women and men. Measurement invariance of the K6 across gender

BackgroundPsychological distress is a widespread indicator of mental health and mental illness in research and clinical settings. A recurrent finding from epidemiological studies and population surveys is that women report a higher mean level and a higher prevalence of psychological distress than men. These differences may reflect, to some extent, cultural norms associated with the expression of distress in women and men. Assuming that these norms differ across age groups and that they evolve over time, one would expect gender differences in psychological distress to vary over the life-course and over time. The objective of this study was to investigate the construct validity of a psychological distress scale, the K6, across gender in different age groups and over a twelve-year period.MethodsThis study is based on data from the Canadian National Population Health Survey (C-NPHS). Psychological distress was assessed with the K6, a scale developed by Kessler and his colleagues. Data were examined through multi-group confirmatory factor analyses. Increasing levels of measurement and structural invariance across gender were assessed cross-sectionally with data from cycle 1 (n = 13019) of the C-NPHS and longitudinally with cycles 1 (1994-1995), 4 (2000-2001) and 7 (2006-2007).ResultsHigher levels of measurement and structural invariance across gender were reached only after the constraint of equivalence was relaxed for various parameters of a few items of the K6. Some items had a different pattern of gender non invariance across age groups and over the course of the study. Gender differences in the expression of psychological distress may vary over the lifespan and over a 12-year period without markedly affecting the construct validity of the K6.ConclusionsThis study confirms the cross-gender construct validity of psychological distress as assessed with the K6 despite differences in the expression of some symptoms in women and in men over the life-course and over time. Findings suggest that the higher mean level of psychological distress observed in women reflects a true difference in distress and is unlikely to be gender-biased. Gender differences in psychological distress are an important public health and clinical issue and further researches are needed to decipher the factors underlying these differences.

Susto and Nervios: Expressions for Stress and Depression

Folk illnesses that are cultural constructions of psychological distress offer a vehicle for the cross-cultural study of stress and stress-related morbidity. This study explores the relationship between the Latin American folk illnesses susto and nervios and mental health. We hypothesize that these folk illnesses are distinct and that there is a stronger association between current levels of stress and depressive symptoms with past experience of nervios than with susto, because the cultural constructions of these folk illnesses reflect chronic and acute concepts of distress, respectively. Interviews were conducted in Guadalajara, Mexico, where participants responded to questions about their socio-demographic characteristics, stress, depressive symptoms, and whether they had experienced susto or nervios. Susto and nervios are very prevalent and occur across sociodemographic subgroups, with the exception that nervios occurred more often in women (p < 0.05). Susto was significantly associated with stress and depressive symptoms (p < 0.05), but nervios had a much stronger association (p < 0.0001), even after controlling for gender. Susto and nervios were expressions of psychological distress; most of those with depression reported susto and/or nervios. This study validates the link between these folk illnesses and stress and depression and may, ultimately, facilitate cross-cultural research on stress.

Frequent Flyers? Look for Somatization

Somatization is the expression of psychological distress through physical symptoms. In patients with somatoform disorders (e.g., hypochondriasis,

Comorbidity and psychological distress in irritable bowel syndrome (IBS)

We previously' (Gastro 2002,122(Suppl 1):A502) developed and validated the IBS-specific Recent Physical Symptoms Questionnaire (RPSQ) and Comorbid Medical Conditions Questionnaire (CMCQ) based on a systematic literature review We hypothesized that the excess comorhid medical cooditions and non-gastrointestinal symptoms seen in 1BS constitute somatization, that is, expresskm of psychological distress thmugb physieal symptoms (Gastro 2002;122(4):1140-56). Aims: (1) Test the hy'pothesis that comorbidity m IBS is related to anxiety and depression and (2) quantity ' the impact of excess comorbidity on IBS symptom severity, disability, quality of fite and IBScelated health care utilization. Methods: The RPSQ and CMCQ were mchided in a marl survey completed by 1603 patients with functional bowel diagnoses in a large nortfiwestem US. health maintenance organization within 2 weeks of a clinic visit. The survey also included the IBS-QOL (Dig Dis Sci 1998;43:40011), the IBS Seventy Index (Aliment Pharmacol Tber 1997;11:395-402) the Brief Symptom Inventory' -18 (NCS Pearson, Inc.) attd questions about doctor's visits and disability days. Data from the 7g\5 IBS patients who met Rome II criteria were analyzed. Results: RPSQ # of non-gastrointestinal (non-GI) symptoms and CMCQ # of comorbid medical diagnoses were moderately intercorrelated (r= 49, p 1 standard deviation above the sample mean) on either comorbidity scale bad greater quality of li|e impairment, more than 3 times the number of disability days m the past year, and greater overall IBS symptom severity (p<.001 m all comparisons). High number of co-morbid medical diagnoses, but not nonspecific symptoms contributed to more frequent (p<.01) doctors' visits due to bowel symptoms in the past 6 montha Conclusions: Our results support the hypothesis that comorbidity in IBS is an expression of psychological distress. High number of co-morbid diagnoses and non*GI symptoms are related to a substantiaUy greater IBS morbidity, disability and worse quality ot lite. (Supported by RO1 DK31369, ROI HD36069 and a grant fi'om Novartis Pharmaceuticals Corp.)

Witchcraft or Madness? The Amandiki of Zululand, 1894-1914*

In southern Africa today, as elsewhere, expressions of psychological distress elicit a variety of explanatory frameworks and responses that continue to reflect the different discourses and practices of medicine, magic and religion. The assertion that these positions are historically constructed and contingent is an important theme in the study of healing, both of mind and of body. We know relatively little about African conceptions of mental illness in the late nineteenth and early twentieth centuries, but in researching the social history of mental health in Natal and Zululand, investigation of one phenomenon - the 'epidemic' of indiki spirit possession in Zululand from the 1890s to 1914 - has proved particularly illuminating. It shows that African concepts of mental illness were in a state of flux at this time as therapies for psychological distress adapted in the face of the entrenchment of colonialism, Christianity and a cash economy. Furthermore, African mental health strategies were not always as inclusive as has sometimes been suggested by scholars. This had very real consequences for a number of women - known as the amandiki - who were tried by the colonial state for the crime of witchcraft between 1894 and 1914. As the ensuing court cases revealed, colonial psychiatry was not simply or necessarily a blunt tool for social control. Instead, changing Western concepts surrounding, and responses to, criminal responsibility and mental illness posed legal problems for the colonial authorities in their attempts to distinguish between witchcraft, hysteria and spirit possession. An exploration of the histories of women and hysteria elsewhere in the world provides possibilities for a new understanding of the actions of the amandiki as attempts to achieve a state of mental health in the context of changing African healing practices.