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Inuit Concepts of Mental Health and Illness

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Inuit Concepts of Mental Health and Illness TABLE OF CONTENTS Acknowledgment..........................................................................................................4 Summary ........................................................................................................................5 1. Introduction ...............................................................................................................9 1.1 Outline of Report...............................................................................................10 1.2 The Inuit of Nunavik. .......................................................................................10 1.3 Psychiatric Epidemiology Among the Inuit..................................................13 1.4 Traditional Concepts of Illness........................................................................17 1.5 Contemporary Concepts of Mental Health and Illness...............................17 2. Methods......................................................................................................................21 2.1 Ethnographic Studies of the Meaning of Symptoms and Illness...............21 2.2 Study Sites..........................................................................................................22 2.3 Selection of Respondents & Sampling ...........................................................22 2.4 Procedure for Ethnographic Interviews ........................................................25 2.5 Data Analysis.....................................................................................................28 3. Symptoms, Signs and Behaviors of Mental Health and Illness..........................30 3.1 Initial Interviews—Behavioral Registers and Lexicon ................................30 3.2 General Concepts of Mental Illness................................................................31 3.3 Hallucinations and Delusions. ........................................................................36 3.4 Interpersonal Violence......................................................................................37 3.5 Suicide.................................................................................................................39 3.6 Social Withdrawal and Isolation.....................................................................41 3.7 Depression..........................................................................................................44 3.8 Anxiety................................................................................................................45 3.9 Mental Deficiency/Learning Disability.........................................................47 3.10 Seizures and Convulsions..............................................................................48 3.11 Memory Lapses, Immobility and ‘Running Wild’. ....................................48 3.12 Drug, Alcohol and Solvent Abuse................................................................50 3.13 Demon Possession...........................................................................................52 3.14 Other Problems................................................................................................57 3.15 Discussion ........................................................................................................58 4. Ethnopsychology and Causes of Mental Illness...................................................61 4.1 Role of Traditional Food in Well-Being .........................................................61 4.2 Environmental Quality and Mental Health ..................................................63 4.3 Physical or Organic Causes of Mental Illness...............................................64 4.4 Psychological or Emotional Causes of Mental Illness. ................................65 4.5 Spirit Possession and Mental Illness ..............................................................69 4.5.1 Uuttulutaq possession.............................................................................71 4.5.2 Uirsalik/Nuliarsalik ................................................................................72 4.5.3 ‘Satanic’ Possession..................................................................................75 4.6 Impact of Culture Change on Child-Rearing and Mental Health..............76 4.7 Discussion ..........................................................................................................81 2 5. Social Course & Treatment of Mental Illness........................................................84 5.1 Response to the Mentally Ill ............................................................................84 5.2 The Value of Conversation for Mental Health..............................................87 5.3 Views of Biomedicine and Psychiatry............................................................90 5.4 Name-Soul and the Management of Grief ....................................................91 5.5 Discussion ..........................................................................................................95 6. Attitudes Toward Psychiatric Disorders ...............................................................97 6.1 History of Inuit Responses to Deviant Behavior..........................................97 6.2 Social Responses to Deviance..........................................................................98 6.3 Measuring Attitudes Toward Mental Health and Illness ...........................100 6.4 Method of Questionnaire Study of Attitudes ...............................................101 6.5 Results of Questionnaire Study of Attitudes ................................................104 6.6 Discussion ..........................................................................................................111 7. Conclusion..................................................................................................................114 Appendix A. Interview Protocol and Consent Form...............................................120 Appendix B. Glossary of Mental Health Related Terms.........................................123 Appendix C. Attitude Survey Questionnaire ...........................................................131 Appendix D. ‘Concerning Evil Spirits and Fasting’.................................................133 References.......................................................................................................................136 TABLES Table 1-1. Psychosocial Comorbidity with Psychiatric Disorders .........................16 Table 2-1. Distribution of Occupations in the Sample.............................................24 Table 3-1. Behavioral Registers ...................................................................................30 Table 6-1. Vignettes Used in Attitude Survey...........................................................102 Table 6-2. Sociodemographic Characteristics............................................................104 Table 6-3. Descriptive Statistics for Social Distance Scale.......................................105 Table 6-4. Factor Loadings of Social Distance Scale Items......................................106 Table 6-5. Descriptive Statistics for Questions..........................................................106 Table 6-6. Correlations of Sociodemographics and Attitude Scales......................107 Table 6-7. Social Distance Scale by Vignette .............................................................108 Table 6-8. Effects of Vignettes on Social Distance Scale ..........................................109 Table 6-9. Multiple Regression Model of Determinants of Social Distance..........110 Table 6-10. Effects of Vignettes on Recovery Scale...................................................111 FIGURES Figure 1-1. Diagnoses of 100 Consecutive Inuit Psychiatric Consults...................15 Figure 2-1. Distribution of Ethnographic Informants by Age Cohort...................23 Figure 2-2. Distribution of Interview Informants by Years of Education.............24 Figure 2-3. Distribution of Informants’ Frequency of Church Attendance..........25 Figure 3-1. Signs and Symptoms of Mental Health Problems................................35 Figure 6-1. Social Distance Scale by Vignette............................................................108 3 ACKNOWLEDGMENT This research project was supported by grants from the Kativik Regional Board of Health and Social Services and the Conseil québecois de la recherche sociale. We would like to thank our research assistants and interviewers, Melina Auerbach, Clara Aupaluk, Martha Aupaluk, Michel Elie, Annie Kenuayuak, Nuluki Putugu, Annie Sivuarapik, Robert Watt, and Kate Zimmerman. Dr. André Corriveau and the staff of Inuulitsivik Hospital made the study possible by helping with the many logistical problems. Jimmy Mark, Monica Nashak, Charlie Pinguartuk and Robert Watt translated interviews and transcriptions. Harry Okpik re-translated the Inuktitut lexicon of mental health related terms. Professor Louis-Jacques Dorais reviewed the lexicon. Karen Beaulieu, Jennifer Fletcher and Consuelo Quesney assisted with transcription of English and French tapes. Data analysis was conducted by members of the Culture and Mental Health Research Unit of the Department of Psychiatry of the Sir Mortimer B. Davis—Jewish General Hospital. Suzanne Taillefer translated the report summary into French. Laura Freeman, Consuelo Quesney and Louise Veilleux ably assisted with proof reading of the text. This research unit is supported
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