Showing papers in "Transcultural Psychiatry in 2006"
TL;DR: The ‘new cross-cultural psychiatry’ heralded by Kleinman in 1977 promised a revitalized tradition that gave due respect to cultural difference and did not export psychiatric theories that were themselves culture bound, but in the ensuing years the view of culture within anthropology has continued to change.
Abstract: The ‘new cross-cultural psychiatry’ heralded by Kleinman in 1977 promised a revitalized tradition that gave due respect to cultural difference and did not export psychiatric theories that were themselves culture bound. In the ensuing years, the view of culture within anthropology has continued to change, along with our understanding of the relationship of biological processes to cultural diversity, and the global political economic contexts in which mental health care is delivered. This article considers the implications of these new notions of culture, biology and the context of practice for theory in cultural psychiatry. The future of cultural psychiatry lies in advancing a broad perspective that: (a) is inherently multidisciplinary (involving psychiatric epidemiology, medical anthropology and sociology, cognitive science and social psychology), breaking down the nature/culture dichotomy with an integrative view of culture as a core feature of human biology, while remaining alert to cultural constructio...
290 citations
TL;DR: The rationale, development and application of the McGill Illness Narrative Interview (MINI), a theoretically driven, semistructured, qualitative interview protocol designed to elicit illness narratives in health research, are summarized.
Abstract: This article summarizes the rationale, development and application of the McGill Illness Narrative Interview (MINI), a theoretically driven, semistructured, qualitative interview protocol designed to elicit illness narratives in health research. The MINI is sequentially structured with three main sections that obtain: (1) A basic temporal narrative of symptom and illness experience, organized in terms of the contiguity of events; (2) salient prototypes related to current health problems, based on previous experience of the interviewee, family members or friends, and mass media or other popular representations; and (3) any explanatory models, including labels, causal attributions, expectations for treatment, course and outcome. Supplementary sections of the MINI explore help seeking and pathways to care, treatment experience, adherence and impact of the illness on identity, self-perception and relationships with others. Narratives produced by the MINI can be used with a wide variety of interpretive strategies drawn from medical anthropology, sociology and discursive psychology.
274 citations
TL;DR: The results indicate that having a personality style which conflicts with the values of society is associated with psychiatric symptoms and having an orientation inconsistent with societal values may be a risk factor for poor mental health.
Abstract: Because humans need both autonomy and interdependence, persons with either an extreme collectivist orientation (allocentrics) or extreme individualist values (idiocentrics) may be at risk for possession of some features of psychopathology. Is an extreme personality style a risk factor primarily when it conflicts with the values of the surrounding society? Individualism-collectivism scenarios and a battery of clinical and personality scales were administered to nonclinical samples of college students in Boston and Istanbul. For students residing in a highly individualistic society (Boston), collectivism scores were positively correlated with depression, social anxiety, obsessive-compulsive disorder and dependent personality. Individualism scores, particularly horizontal individualism, were negatively correlated with these same scales. A different pattern was obtained for students residing in a collectivist culture, Istanbul. Here individualism (and especially horizontal individualism) was positively correlated with scales for paranoid, schizoid, narcissistic, borderline and antisocial personality disorder. Collectivism (particularly vertical collectivism) was associated with low report of symptoms on these scales. These results indicate that having a personality style which conflicts with the values of society is associated with psychiatric symptoms. Having an orientation inconsistent with societal values may thus be a risk factor for poor mental health.
174 citations
TL;DR: Results indicate that those Sudanese for whom life in Canada was not what they expected and those who experienced economic hardship as measured by worry over having enough money for food or medicine experienced poorer overall health and reported a greater number of symptoms of psychological distress.
Abstract: As part of a settlement needs assessment of 220 recently arrived Sudanese refugees and immigrants in seven cities, we examined overall health status, indicators of mental distress, economic hardship and expectations of life in Canada. Data were collected in a community-based study using qualitative and quantitative techniques. Results indicate that those Sudanese for whom life in Canada was not what they expected and those who experienced economic hardship as measured by worry over having enough money for food or medicine experienced poorer overall health and reported a greater number of symptoms of psychological distress. After controlling for demographic and related variables, we found that individuals who were experiencing economic hardship were between 2.6 and 3.9 times as likely to experience loss of sleep, constant strain, unhappiness and depression, and bad memories as individuals who do not experience hardship. Healthcare providers should be aware of how postmigration social disadvantages may increase the risk of mental distress particularly among refugees.
145 citations
TL;DR: The complementary use of emic and etic approaches will enhance the psychometric soundness of acculturation scales and the parallel application of qualitative and quantitative methods may be useful for validity studies.
Abstract: This article reviews conceptual and methodological issues in the measurement of psychological acculturation. The major issues involve the question of dimensionality and the assessment of specific domains of cultural change. Bidimensional scales that cover both overt and internal domains are more informative for the assessment of general levels of psychological acculturation. The validity of such scales must be examined in terms of the actual exposure of individuals to and involvement in each culture, and the influence of sociocultural factors on the course of acculturation. The parallel application of qualitative and quantitative methods may be useful for validity studies. The complementary use of emic and etic approaches will enhance the psychometric soundness of acculturation scales.
141 citations
TL;DR: How research concerning (a) the impact of pre-migration trauma; (b) the mental health impact of social resources such as the like-ethnic community, refugee sponsorship programs, and language training; and (c) individual coping strategies such as suppressing the past can contribute both to theory and to improving policy and practice is examined.
Abstract: Canada's relative generosity in admitting refugees and fairness in considering refugee claims has earned this country an enviable reputation. However, having opened its doors to those selected, Canada's resettlement policies and programs fail to provide for their needs, and to promote their optimal adaptation. Based on a decade-long investigation of the resettlement of more than 1300 Southeast Asian refugee--'Boat People'--the current report examines how research concerning (a) the impact of pre-migration trauma; (b) the mental health impact of social resources such as the like-ethnic community, refugee sponsorship programs, and language training; and (c) individual coping strategies such as suppressing the past, can contribute both to theory and to improving policy and practice. The presentation acknowledges the contributions of Dr. Alexander H. Leighton by demonstrating the importance of his insistence on the need for a longitudinal perspective both for conducting research and for planning programs and services.
135 citations
TL;DR: Test the use of case vignettes in exploring the explanatory models of various subtypes of depression, in six individual interviews, and four focus-group discussions, finding that depressive symptoms presented in these vignette seem to be conceptualized as a problem related to cognition rather than emotion.
Abstract: The literature indicates that although depression is highly prevalent, it is rarely recognized as such. The aim was to test the use of case vignettes in exploring the explanatory models of various subtypes of depression, in six individual interviews, and four focus-group discussions. Depressive symptoms presented in these vignettes seem to be conceptualized as a problem related to cognition (thinking too much) rather than emotion (sadness) and the resulting condition is referred to as 'illness of thoughts.' Worrisome thoughts resulting from various socioeconomic problems are seen as important aetiological factors for the illness of thoughts and require no medication as it is believed that there is no medication for thoughts. There are culturally accepted ways of dealing with and healing the condition. Once illness becomes recurrent or chronic, other explanations about causes and a different course of action have to be considered. Further exploration of the relationship between thoughts and emotions among the Baganda may be an important avenue for further research.
91 citations
TL;DR: In this article, the authors reviewed the historical evolution and progress of nosological concepts from exotic psychiatric disorders and culture-bound syndromes to culture-related specific disorders and emphasized the need to be concerned with the impact of culture on every psychiatric disorder to promote culturally competent care for every patient.
Abstract: This article reviews the historical evolution and progress of nosological concepts from exotic psychiatric disorders and culture-bound syndromes to culture-related specific syndromes. Approaches to classification and subgrouping these disorders are disccused and an argument offered for finding a place for culturally unique syndromes in the existing classification system. The characteristics of various syndromes are elaborated and suggestions are made for future research. Finally, emphasis is given to the need to be concerned with the impact of culture on every psychiatric disorder, not only culture-specific syndromes, to promote culturally competent care for every patient.
74 citations
TL;DR: Evidence suggests that rates of schizophrenia (and probably other disorders) among immigrant groups are low compared with native-born populations when sending and receiving populations are socially and culturally similar.
Abstract: Psychiatric studies of immigrants have yielded contradictory findings regarding rates of mental illness. Current evidence suggests that rates of schizophrenia (and probably other disorders) among immigrant groups are low compared with native-born populations when sending and receiving countries are socially and culturally similar. The rates for immigrants are higher when sending and receiving countries are dissimilar, probably because of multiple social problems faced by immigrants in the receiving country. Refugees who flee their own country because of fears of violence or starvation often have had extremely traumatic experiences, which may result in PTSD and sometimes chronic impairment. Asylum seekers who arrive illegally to seek refuge in a foreign country also may have multiple traumas and experience further distress from their uncertain residency and legal status. Although much is known about the effects of migration, competent culturally sensitive services for migrants remain inadequate to meet the need.
69 citations
TL;DR: Yearning for the home country, perceived discrimination and unemployment in the host country seem to be possible explanations for the higher levels of distress among Kurdish immigrants to Sweden.
Abstract: This study explores the association between ethnicity and poor self-reported health and psychological distress, sleeping difficulties, and use of psychotropic drugs among immigrant Kurdish men and native Swedish men, based on data from the first Swedish National Survey of Immigrants and the Swedish Level-of-Living Surveys collected in 1996 by Statistics Sweden. The age-adjusted odds of poor self-reported health and sleeping difficulties among Kurdish men was about 3.5 times higher than among Swedish men. The odds ratio decreased to 2.1 and 2.7 respectively in a model adjusted for age and the other explanatory variables. Yearning for the home country, perceived discrimination and unemployment in the host country seem to be possible explanations for the higher levels of distress among Kurdish immigrants to Sweden.
54 citations
TL;DR: There is a great deal of promise for future enhancement of the study of religion and spirituality in psychiatric education, research, and clinical care.
Abstract: Cultural psychiatry has been an important contributor to the enhanced dialogue between psychiatry and religion in the past couple of decades. During this time, religion and spirituality have become more prominent in mainstream psychiatry in a number of areas of study and clinical care, including refugee and immigrant health, trauma and loss, psychotherapy, collaboration with clergy, bioethics, and psychiatric research. In looking towards the future, there is a great deal of promise for future enhancement of the study of religion and spirituality in psychiatric education, research, and clinical care.
TL;DR: The results suggest that the self-discipline and hypercontrol of anorectic patients are related to a temperament prone to angry feelings in subjects with a fear of becoming adult and with a trait of pathologic perfectionism.
Abstract: This study investigated the personality and clinical correlates of asceticism in 154 anorectic patients. Multiple linear regression models showed that asceticism was related to angry temperament, high control over anger, perfectionism, maturity fears, and number of vomiting episodes per week. These results suggest that the self-discipline and hypercontrol of anorectic patients are related to a temperament prone to angry feelings in subjects with a fear of becoming adult and with a trait of pathologic perfectionism.
TL;DR: ANOVA of somatic distress by BDI-level revealed that the High BDI Japanese group reported 26 somatic symptoms with significantly higher means when compared with the low BDI group, with implications for primary and mental health care.
Abstract: The present study examined the relationship between common somatic symptoms and depression in samples of Japanese and American college students. Fifty Japanese and 44 American women completed the Beck Depression Inventory (BDI) and rated 56 somatic-distress items for 7 days. Japanese had higher levels of somatic distress than Americans. ANOVA of somatic distress by BDI-level revealed that the High BDI Japanese group reported 26 somatic symptoms (including stomach ache, dizziness, and shoulder pain) with significantly higher means when compared with the low BDI group. High BDI Americans had a significantly higher mean for joint pain compared to the Low BDI group. The importance of the body in transcultural psychiatry is explored, and implications for primary and mental health care are discussed.
TL;DR: A model of the process of ritual healing that is focused on the core components of spiritual transformation, relatedness and empathy is proposed and some implications of aspects of the model of healing process that support the claim that it is widely applicable are explored.
Abstract: Based on studies of spirit healing, this article proposes a model of the process of ritual healing that is focused on the core components of spiritual transformation, relatedness and empathy. It describes the central role of spiritual transformation in healers from which emerges their capacity for relation and empathy. Many spirit healers, following a spiritual transformation, begin to exercise 'radical empathy,' in which individual differences between healer and sufferer are melded into one field of feeling and experience. The model is compared and contrasted with aspects of healing processes in some psychotherapeutic and analytic therapies. These comparisons are offered in the light of the growing interest in incorporating spirituality into psychological and medical treatments.A concluding section briefly explores some implications of aspects of the model of healing process that support the claim that it is widely applicable and identifies foundational components.
TL;DR: Creolization has the lightening speed of interaction among its elements; the awareness of awareness; the reevaluation of the various elements brought into contact; unforeseeable results.
Abstract: ‘I call creolization the meeting, interference, shock, harmonies and disharmonies between the cultures of the world . . . [it] has the following characteristics: the lightening speed of interaction among its elements; the awareness of awareness: thus provoked in us; the reevaluation of the various elements brought into contact (for creolization has no presupposed scale of values); unforeseeable results. Creolization is not a simple cross breeding that would produce easily anticipated results.’ (Edouard Glissant, 1997)
TL;DR: It is suggested that ethnicity per se may not ‘protect’ against the development of disordered eating attitudes and behaviours in nonwestern black populations and these findings remain tentative until future survey studies employ interviews to confirm eating disorder diagnosis.
Abstract: We examined the presence and severity of disordered eating attitudes and behaviours in a group of 895 South Africans. The Eating Attitude Test-26 (EAT-26), the Bulimic Investigatory Test, Edinburgh (BITE) and the Rosenberg Self-esteem Scale (RSE), were administered to high-school and college students (515 White, 126 Black, and 254 'Coloured'). There were few differences between these three groups on measures of eating disorder pathology and self-esteem. A small number of participants (3.5%) were identified as at 'high risk' for an eating disorder as shown by scores in the clinical range for both the EAT-26 and BITE. Weight, self-esteem and age were predictors for this subgroup. This study suggests that ethnicity per se may not 'protect' against the development of disordered eating attitudes and behaviours in nonwestern black populations. These findings remain tentative until future survey studies employ interviews to confirm eating disorder diagnosis.
TL;DR: The causes underlying low utilization of mental health services by Vietnamese immigrants in Australia are examined and the importance of education for ethnic communities regarding available mental health facilities and treatments offered, as well as specific information on mental illness to help remove stigma is suggested.
Abstract: This article examined the causes underlying low utilization of mental health services by Vietnamese immigrants in Australia. Study 1 examined cases of Vietnamese patients who had attended an anxiety disorders clinic, while Study 2 surveyed Vietnamese people in the community on their knowledge and attitudes towards common mental problems. Results from Study 1 showed that Vietnamese patients had significantly higher attrition rates, and presented with a larger number of nonanxiety disorders than their Australian-born counterparts. Study 2 results indicated that many Vietnamese people did not differentiate clearly between the terms 'stress', 'anxiety' and 'depression'. Additionally, many participants felt that there was a generally negative cultural attitude towards people suffering from these problems and the mental health system itself. These outcomes suggest the importance of education for ethnic communities regarding available mental health facilities and treatments offered, as well as specific information on mental illness to help remove stigma.
TL;DR: In this paper, a flexible approach for defining boundaries in mental health professionals working with groups from diverse cultures is proposed. But the authors do not consider the cultural factors for clinicians to consider.
Abstract: Behavioral health professionals are constantly faced with the dilemma of how to define boundaries in their relationships with clients. When working with groups from diverse cultures, defining boundaries becomes even more complex. This article urges a flexible approach, using the graded-risk model (Martinez, 2000) and a list of cultural factors for clinicians to consider. Possible benefits of reaching out to clients in concrete ways, as well as risks, are emphasized. Clients' notions of appropriate boundaries must be considered in the decision-making process. Case examples from a refugee mental health clinic are used to elucidate a flexible approach to boundary decisions.
TL;DR: An MMPI-2 scale designed to assess features of the Korean culture-bound syndrome, Hwa-Byung (HB), created via rational item selection and psycho-metric refinement applied well to both Korean men and women, but not to an American sample.
Abstract: This study documents the development of an MMPI-2 scale designed to assess features of the Korean culture-bound syndrome, Hwa-Byung (HB). An American research team and psychiatric practitioners in Korea created an 18-item HB scale via rational item selection and psycho-metric refinement. Principal components analysis of scale items revealed four components, reflecting content domains of general health, gastrointestinal symptoms, hopelessness, and anger. This four-component solution applied well to both Korean men and women, but not to an American sample. Although some findings were encouraging, future studies employing clinical samples are needed to provide further validation of this scale.
TL;DR: Anthropology has long recognized the inadvertent polluting power of the male and female genitals but only a few others have recognized the aggressive use of female genital power.
Abstract: Anthropology has long recognized the inadvertent polluting power of the male and female genitals. In his important discussion of Yoruba beliefs in female power and witchcraft, Raymond Prince (1961) recognized that African women know very well that they can direct the power that can emanate from their own genitals, and in some extreme situations their threats to loosen this power are strongly persuasive. Only a few others have recognized the aggressive use of female genital power. Further research in this area has important implications for understanding African ideas of sexuality.
TL;DR: The famous Stirling County Study is contextualized by suggesting that a hitherto unrecognized shaping role was played by William Henry Welch of Johns Hopkins and The Rockefeller Foundation, especially so through the example of Hopkins's epidemiological ‘demonstration areas'.
Abstract: What is the relationship between sociocultural environment and psychiatric disorder? In particular, what is 'social disintegration', its characteristics, dangers and possible remediation? Alexander Hamilton Leighton and Jane Murphy's interdisciplinary contributions derive from those consuming concerns. This article contextualizes the famous Stirling County Study by suggesting that a hitherto unrecognized shaping role was played by William Henry Welch of Johns Hopkins and The Rockefeller Foundation, especially so through the example of Hopkins's epidemiological 'demonstration areas'. The article then details the Stirling County Study itself, including its relations with Dalhousie University and Canadian psychiatry. The concluding section identifies and assesses a wider set of achievements and contributions forming Leighton and Murphy's legacy to our several but interdependent fields of cross-cultural endeavour.
TL;DR: This article reviews recent trends in cultural epidemiology, and especially the emergence of the EMIC (Explanatory Model Interview Catalogue) as a quantitatively oriented tool designed to assess culture.
Abstract: Alexander Leighton's seminal work has clearly demonstrated how ethnographic experience provides the rich cultural context in which epidemiological data are best interpreted. This article reviews recent trends in cultural epidemiology, and especially the emergence of the EMIC (Explanatory Model Interview Catalogue) as a quantitatively oriented tool designed to assess culture. It is suggested that such efforts do not reflect more recent trends in culture theory, and tend to view 'cultures' as easily bounded and largely homogenous units to facilitate the generation of quantitative data. It is argued that cultural epidemiologists should take a step back and ask, 'what is the culture in question here?' and 'how do I know if it is appropriate to place any given member of my sample into a specific cultural category?' before proceeding with any 'culturally appropriate' instrument. The answer to these questions begins with a return to ethnography as a means to elucidate and describe culture within the context in which it is being presented and studied.
TL;DR: The meanings that accrue to illness experience and that produce salient popular disease etiology are grounded in the experience and social construction of the Nova Scotian landscape over time.
Abstract: This article presents a phenomenologically oriented description of the interaction of illness experience, social context, and place. This is used to explore an outbreak of environmental sensitivities in Nova Scotia, Canada. Environmental Sensitivity (ES) is a popular designation for bodily reactions to mundane environmental stimuli that are insignificant for most people. Mainstream medicine cannot support the popular models of this disease process and consequently illness experience is subject to ambiguity and contestation. As an 'equivocal illness', ES generates considerable social action around the nature, meaning and validity of suffering. Sense of place plays an important role in this process. In this case, the meanings that accrue to illness experience and that produce salient popular disease etiology are grounded in the experience and social construction of the Nova Scotian landscape over time. Shifting representations of place are reflected in illness experience and the meanings that arise around illness are emplaced in landscape.
TL;DR: It is suggested that cross-cultural psychotherapy is psychotherapy in which the therapist keeps in mind, both her own and her client's contexts, and an assessment of process as well as content and attention to ‘moments’ rather than longer sequences in the therapy.
Abstract: This article examines the challenges posed by cross-cultural psychotherapy in a creolized world, and the way this intersects with issues faced by the ethnographer. It proposes ‘the relational subject,’ implicit in systemic psychotherapy and social anthropology, as a framework for an understanding of communication. In cross-cultural psychotherapy, this assumption is central to non-discriminatory and equitable treatment. Drawing on Bateson's ethnographic work, the article connects ‘the relational subject’ to what Bateson, following Whitehead, called ‘the fallacy of misplaced concreteness’ and later referred to as ‘context.’ The article examines the choices of ‘context’ first in ethnography and systemic psychotherapy and then in Bateson's own analysis of the Naven ritual. It is suggested that cross-cultural psychotherapy is psychotherapy in which the therapist keeps in mind, both her own and her client's contexts. This means an assessment of process (performative aspects) as well as content (semiotic aspects...
TL;DR: Issues discussed include: establishing trust in the cross cultural context; the use of body language and its interpretation; the psychologist as an authority figure; active participation vs. hidden learning; and working with dreams in such groups.
Abstract: Effective counseling across a cultural divide depends on adaptations or changes of technique to suit the particular intercultural circumstances. The concept of mutual creative space provides a guiding principle for therapists who wish to make such changes. This space is 'negotiated' between the therapist/counselor coming from the 'dominant/mainstream' group within society, and the group participants who arrive from another culture. Mutual creative space consists of the negotiation of power and a process of mutual invention, incorporating the creation, by therapist and participants, of something new that did not exist in either of their cultures of origin. A meaningful encounter and effective group counseling can take place following the negotiation of such a creative space. This is illustrated by the example of intercultural group work with Ethiopian Jewish immigrants in Israel, including an analysis of cultural characteristics of the Ethiopian group and specific ways of negotiating mutual creative space in this case. Issues discussed include: establishing trust in the cross cultural context; the use of body language and its interpretation; the psychologist as an authority figure; active participation vs. hidden learning; and working with dreams in such groups.
TL;DR: This article introduces the special issue of Transcultural Psychiatry in honour of Alexander Leighton, followed by a discussion of the work of his wife, Dr. Jane Murphy, first on St. Lawrence Island, near the Bering Strait, and later as a key figure in the Stirling County project.
Abstract: This article introduces the special issue of Transcultural Psychiatry in honour of Alexander Leighton. A sketch of his research career is followed by a discussion of the work of his wife, Dr. Jane Murphy, first on St. Lawrence Island, near the Bering Strait, and later as a key figure in the Stirling County project. A brief conclusion highlights the main aspects of their joint legacy to cultural psychiatry and psychiatric epidemiology.
TL;DR: It was concluded that such a high frequency of conduct problems in adolescence argues for the need for preventive programs in Colombian schools.
Abstract: This study assessed the validity, reliability, and utility of a screening measure for detecting the signs or symptoms of Conduct Disorder in male adolescents from schools in Medellin, Colombia. A f...
TL;DR: A comparison of the theoretical approach of Alexander H. Leighton with that of current work in evolutionary psychology and psychiatry reveals key similarities as discussed by the authors, and evolutionary psychiatrists would benefit greatly from studying Leighton's work, particularly in connection with the hypothesis that psychopathology is a product of our departure from the environments in which we evolved.
Abstract: A comparison of the theoretical approach of Alexander H. Leighton with that of current work in evolutionary psychology and psychiatry reveals key similarities. For both, a core human nature/psychology is assumed to underlie human behavior. Individuals may vary with regard to the salience of components of that core, which in any event are differentially expressed in response to varying cultural/environmental factors. As with many of today's evolutionists, Leighton's research involved natural settings combined with the collection of rigorously analyzed quantitative data. Evolutionary psychiatrists would benefit greatly from studying Leighton's work, particularly in connection with the hypothesis that psychopathology is a product of our departure from the environments in which we evolved.
TL;DR: The authors argue that this question must be answered from within the centre of each discipline rather than from their frontiers or zones of interface.
Abstract: As a mark of gratitude to Alexander Leighton, this article engages him in a dialogue, reopening several debates that were enriched by his research and reflections on ethics, the 'aesthetic dimension' of the research enterprise, the processes that mediate between collective and individual variables, and his strong distrust of theory. The authors discuss some of the features of Leighton's perspective that they have retained and transformed in their own work on community responses to chronic mental illness in rural Quebec, on the course of schizophrenia in India, and on culture and psychosis in clinical settings in Montreal. The challenge remains the one that Leighton identified: how can findings derived from different disciplines be made to co-ordinate? The authors argue that this question must be answered from within the centre of each discipline rather than from their frontiers or zones of interface.
TL;DR: The special issue of Transcultural Psychiatry on Sleep Paralysis (SP) (March 2005) raises awareness about this common phenomenon in which culture-specific explanations and the vocabulary chosen by the person experiencing it can have a significant bearing on how psychiatrists interpret it.
Abstract: The special issue of Transcultural Psychiatry on Sleep Paralysis (SP) (March 2005) marks a significant development for two reasons. First, it raises awareness about this common phenomenon in which culture-specific explanations and the vocabulary chosen by the person experiencing it can have a significant bearing on how psychiatrists interpret it. It also highlights the fact that culture-specific presentations exist in all cultures, western and others. The report on alien abductees (McNally & Clancy, 2005) is a case in point. However, its greater importance lies in the fact that sleep paralysis and hypnic hallucinations (HH) are neglected by the mainstream generalist journals. Notwithstanding the wide prevalence of these phenomena and their potential overlap with psychotic symptoms, very little has been published in the more mainstream journals. In informal (unpublished) surveys of psychiatrists and residents, I have rarely found a colleague who has come across patients experiencing SP/HH. This is probably because we do not routinely consider these phenomena as possible explanations for the patients’ symptoms. SP/HH have been reported in a number of ethnic groups but systematic data have not been published from South Asia, though I have come across a number of patients in psychiatric settings with SP/HH as the basis of their symptoms (Gangdev, 1996). The common terminology used refers to ‘bhoot-pret’ (ghosts), ‘chudel’ (witch), ‘palit’, ‘pishach’, ‘rakshash’, ‘sattarshingha’ and so on (versions of demons) entering the room and