Maurice Eisenbruch | Monash University (original) (raw)
Papers by Maurice Eisenbruch
npj Breast Cancer, 2019
Breast cancer is a common disease partially caused by genetic risk factors. Germline pathogenic v... more Breast cancer is a common disease partially caused by genetic risk factors. Germline pathogenic variants in DNA repair genes BRCA1, BRCA2, PALB2, ATM, and CHEK2 are associated with breast cancer risk. FANCM, which encodes for a DNA translocase, has been proposed as a breast cancer predisposition gene, with greater effects for the ER-negative and triple-negative breast cancer (TNBC) subtypes. We tested the three recurrent protein-truncating variants FANCM:p.Arg658*, p.Gln1701*, and p.Arg1931* for association with breast cancer risk in 67,112 cases, 53,766 controls, and 26,662 carriers of pathogenic variants of BRCA1 or BRCA2. These three variants were also studied functionally by measuring survival and chromosome fragility in FANCM−/− patient-derived immortalized fibroblasts treated with diepoxybutane or olaparib. We observed that FANCM:p.Arg658* was associated with increased risk of ER-negative disease and TNBC (OR = 2.44, P = 0.034 and OR = 3.79; P = 0.009, respectively). In a coun...
A46 Introduction Psychological morbidity and unmet need is high in English-speaking cancer patien... more A46 Introduction Psychological morbidity and unmet need is high in English-speaking cancer patients in Australia. Services are addressing this need to improve psychosocial care. Australia has one of the most culturally diverse populations in the world, yet the needs of culturally and linguistically diverse (CALD) populations are largely unknown. We therefore set out to investigate the needs of Australian CALD populations. Methods CALD cancer patients (and carers) diagnosed within the previous 3 years participated in focus groups/interviews with a facilitator (in their preferred language). Participants were recruited from Cancer councils, hospitals and support groups. Languages included Arabic (n=18, aged 58-70), Cantonese (n=29, aged 30-73), Mandarin (n=24, aged 47-74) and Greek (n=25, aged 31-79). Bilingual researchers translated recorded conversations. Two researchers used standard techniques for qualitative analysis to identify themes and develop a coding frame (using NVivo 7 software). Consumer advisory boards (comprising medical and religious representatives, social workers and consumer advocates) for each cultural group guided the research. Results Patients expressed difficulties in language and communication with health professionals and identified themselves as being culturally isolated. Patients felt they experienced a very different approach to consultations and illness to their home country and expressed unmet information and decision making needs. They described a desire for balance between truth of diagnosis and prognosis versus hope, and a fear about the burden of cancer treatment. Discussion Australian cancer patients from CALD backgrounds often feel isolated when confronted with the differences between their country of origin and their new “home country”. In our study, we found that these CALD cancer patients from CALD backgrounds experienced additional challenges in their healthcare. The next phase of our research involves a quantitative study of the unmet needs, patterns of care, quality of life, anxiety and depression experienced by CALD cancer patients.
Green, Julie, Renzaho, Andre, Eisenbruch, Maurice, Williamson, Lara, Waters, Elizabeth, Lo Bianco... more Green, Julie, Renzaho, Andre, Eisenbruch, Maurice, Williamson, Lara, Waters, Elizabeth, Lo Bianco, Joseph and Oberklaid, Frank 2008, Parent-centred and culturally-competent literacies for health promotion with newly arrived African communities : a literature review Centre ...
Social Psychiatry and Psychiatric Epidemiology, 2018
Objective Acculturation studies conducted with refugees have predominantly concentrated on invest... more Objective Acculturation studies conducted with refugees have predominantly concentrated on investigating the impact of acculturative stress on mental health, and have neglected to investigate the impact of cultural orientations towards the host and ethnic cultures. Furthermore, exposure to traumas is highly prevalent in refugees and strongly associated with mental health outcomes, however, rarely included in investigations of acculturative process of refugees. Method Using structural equation modelling, this study tested an integrated model of the relationship between traumatic exposure, acculturative stress, host and ethnic cultural orientations and posttraumatic stress disorder (PTSD), depression and anxiety symptoms among 138 Bosnian refugees resettled in Australia and Austria. Results The model showed an overall good fit and noteworthy amount of variance indicating that traumatic exposure is the strongest direct and indirect predictor of PTSD, depression and anxiety symptoms. Furthermore, acculturative stress was identified as a significant risk factor influencing host cultural orientation, mediating the effect of traumatic exposure on all mental health outcomes. Conclusion Acculturative stress and cultural and social stressors that are related to acculturation need to be addressed alongside provision of effective psychotherapy, especially since they are significant impediments to host cultural orientation and constructive engagement with mental health services in refugees.
Journal of Clinical Oncology, 2013
6556 Background: Poor prognosis is difficult to impart, particularly across a cultural divide. Th... more 6556 Background: Poor prognosis is difficult to impart, particularly across a cultural divide. This study is the first to compare prognostic communication with immigrants (with and without interpreters) versus native–born patients in audio-taped oncology consultations. Methods: Ten oncologists, 78 patients (31 Australian-born, 47 immigrants) and 115 family members participated. The first two consultations after diagnosis of incurable disease were audiotaped, transcribed and coded. 142 consultations were included in the analysis. Results: Fifty percent of doctor and 59% of patient prognostic speech units were notinterpreted or interpreted non-equivalently when an interpreter was present. Immigrant status predicted few, and oncologist characteristics no, prognostic facts disclosed. Oncologists were significantly less likely to convey hope to immigrants, and more likely to use medical jargon (p = 0.009) than with Australian-born patients. Incurable disease status and a limited life spa...
Journal of Clinical Nursing, 2010
Aims and objectives: This paper describes cultural competence issues within the scientific and sc... more Aims and objectives: This paper describes cultural competence issues within the scientific and scholarly discourse surrounding cardiac rehabilitation (CR). Background: CR is an important secondary prevention strategy, improving health-related outcomes and reducing the risks of subsequent cardiovascular events. Internationally, it is widely accepted as a discrete health service model and is endorsed by government and professional bodies. Over past decades, low participation rates in CR remain a concern, particularly among minority groups and culturally and linguistically diverse populations. Conclusions: Few studies to date have described cultural competence in CR service design and as a consequence, there are minimal data to assist CR professionals and policy makers in tailoring health service delivery models. The limited scholarly debate and discussion regarding cultural competence in the CR literature limits the development and evaluation of culturally appropriate interventions.
eisenbruch.com
Civil war and ruthless experiments in social engineering have created terror for decades in Cambo... more Civil war and ruthless experiments in social engineering have created terror for decades in Cambodia. The population was largely uprooted and displaced, one in four Cambodians died, and when the worst of the conflict was over, 20 more years of low-intensity warfare ...
Journal of Psychiatric Education, 1984
The development of video techniques in child psychiatry is reviewed. Application of techniques to... more The development of video techniques in child psychiatry is reviewed. Application of techniques to teaching the principles of development in child psychiatry as part of the pediatric term for fifth-year medical students is detailed, with utilization of edited tape footage of children of various developmental stages. Reference is made to the use of videotapes in postgraduate training in developmental psychiatry and child psychiatry. An approach toward use of a “videotest” in evaluation of psychiatric learning is described. The use of videotaped clinical interviews in forming an archive for behavioral analysis in research on depressed mothers and their children is reported.
Medical Journal of Australia, 1989
Australian medical education has not kept pace with Australia's increasingly multicultural so... more Australian medical education has not kept pace with Australia's increasingly multicultural society. Feedback from ethnic community organizations suggests that medical students and specialist trainees in medicine are not learning how to understand, to interact with and to treat patients in culturally appropriate ways. The first part of this paper reviews the problem and considers some perspectives in transcultural medicine and clinically applied medical anthropology. The second part proposes some areas in which medical schools can take the initiative in developing interdisciplinary teaching programmes at undergraduate and graduate levels. These programmes should provide minimal standards to enable any medical graduate to practise with patients of any cultural background and, in addition, will encourage some students to pursue more specialized studies in transcultural medicine and medical anthropology. It is suggested that new developments should be integrated with appropriate university departments such as anthropology.
Psychiatric Clinics of North America, 1990
The large number of refugees in the world must cope with the loss of family and homeland. This pa... more The large number of refugees in the world must cope with the loss of family and homeland. This paper proposes a new concept of cultural bereavement and presents a framework for its identification in the clinical interview with refugees. The cultural bereavement interview explores reactions to personal losses and to losses of both the social systems and the cultural meanings. Eleven areas are systematically explored, the first nine are indicators of bereavement and the tenth and eleventh are "antidotes" to cultural bereavement. The cultural bereavement interview can provide a clinical framework for exploring the patient's personal and cultural bereavement, clarify the "structure" of the patient's reactions to loss, complement the currently used psychiatric diagnostic categories, acknowledge the cultural system of meaning held by the patient, and provide information to be used in planning social supports or interventions.
Transcultural psychiatry, 2017
This paper reports an ethnographic study of mass fainting among garment factory workers in Cambod... more This paper reports an ethnographic study of mass fainting among garment factory workers in Cambodia. Research was undertaken in 2010-2015 in 48 factories in Phnom Penh and 8 provinces. Data were collected in Khmer using nonprobability sampling. In participant observation with monks, factory managers, health workers, and affected women, cultural understandings were explored. One or more episodes of mass fainting occurred at 34 factories, of which 9 were triggered by spirit possession. Informants viewed the causes in the domains of ill-health/toxins and supernatural activities. These included "haunting" ghosts at factory sites in the wake of Khmer Rouge atrocities or recent fatal accidents and retaliating guardian spirits at sites violated by foreign owners. Prefigurative dreams, industrial accidents, or possession of a coworker heralded the episodes. Workers witnessing a coworker fainting felt afraid and fainted. When taken to clinics, some showed signs of continued spirit ...
Social Science & Medicine, 1999
Social Science & Medicine, 2004
Hereditary cancer is about families, and clinicians and genetic counsellors need to understand th... more Hereditary cancer is about families, and clinicians and genetic counsellors need to understand the cultural beliefs of patients and families about cancer and inheritance. In the light of their kinship patterns Chinese-Australians were chosen for the present study, which aims to determine the explanatory models of inheritance, cancer, and inherited cancer, with a view to identifying the relationship between these culture-specific lay attributions and help-seeking behaviour, and to identify possible barriers to genetic counselling and testing. Qualitative ethnographically informed methodology involving semi-structured interview was used as a method to uncover latent beliefs held by the families who are represented by the subjects. In-depth interviews were conducted with 16 informants of Chinese ethnicity, who had been recruited through two major Sydney familial cancer clinics. We report the attributions of cancer in general, then on inheritance, kinship, genes and genetics and then focus on the way in which these beliefs come together around hereditary cancer. The majority of informants, despite high acculturation and belief in biomedical explanations about hereditary cancer, also acknowledged the influence of traditional family Chinese beliefs, where 'inheritance' and 'genetics' were related to retribution for ancestral misdeeds and offending ancestors. Extensive mismatch of attributes and beliefs were identified in those who attended the clinic and senior family members, creating barriers to optimal service utilisation. Three traditional patterns of beliefs were identified: (a) father and mother contributed in equal share to one's genetic makeup, linked to the ying-yang theory; (b) the dominance of life force (yang chi) and the shaping of genes were transmitted through the paternal line; and (c) natural and…
Psychological Medicine, 2005
Background. Studies of depression in the Chinese have long identified low rates and a greater lik... more Background. Studies of depression in the Chinese have long identified low rates and a greater likelihood of somatization, findings which could reflect cultural influences or real differences. We report a study from a western region examining the impact of acculturation on depression to clarify the role of cultural factors.Method. In a Sydney-based study, Chinese subjects (n=385) and a matched control group of 143 non-Chinese subjects completed either a Chinese or English questionnaire assessing state and lifetime depression, attributional style, depression recognition and help-seeking. The impact of acculturation was examined by several strategies.Results. Any tendency by the Chinese to somatize depression appeared to be attenuated by acculturation. State depression levels countered the view that Chinese necessarily deny depression. Lifetime depression rate differences were also attenuated by acculturation, with Chinese subjects being less likely than controls to judge episodes as a...
L'Homme, 1997
Le pouvoir de guerir par simple dissolution du mal est une quete ancienne de l'humanite. Chez... more Le pouvoir de guerir par simple dissolution du mal est une quete ancienne de l'humanite. Chez les Hmong du Laos et de la Thailande, ce pouvoir est exerce par des chamanes, chez les Khmers du Cambodge par des maitres-guerisseurs. Considere comme un phenomene holistique dans ces cultures, ce traitement de la guerison offre un champ d'observation unique. La principale opposition reside dans l'inversion des moyens. A la transformation de l'image du corps du chamane hmong par laquelle il etablit son pouvoir de guerison correspond la transformation de l'image du corps du malade par le guerisseur khmer. Cela indiquerait-il que, quel que soit le systeme therapeutique en cause, l'acte de guerison consiste fondamentalement dans la communication qui s'instaure entre medecin et malade et la prise de possession par le premier de la sphere de souffrance ou le second est isole ?
Journal of Traumatic Stress, 2004
The collaborative program of the Transcultural Psychosocial Organization (TPO) provides a communi... more The collaborative program of the Transcultural Psychosocial Organization (TPO) provides a community-oriented and culturally sensitive public health response to the psychosocial problems of refugees and victims of organized violence. This paper describes the 9-step model that TPO has developed as a blueprint for each new intervention. Beneficiaries participate in determining priorities and there is an orientation toward culturally competent training, capacity-building, and sustainability. Two cases, one related to Sudanese refugees in Uganda and the other to internally displaced persons and returnees in postwar Cambodia, show how the TPO intervention protocol is adapted to local settings. The paper provides preliminary evaluative comments on the model's performance.
The Journal of Nervous and Mental Disease, 2007
Depression measurement tools in cross-cultural research require careful design and thorough valid... more Depression measurement tools in cross-cultural research require careful design and thorough validation to ensure that cognitive concepts in one culture can be appropriately translated and applied to a differing culture. The aim of this study was to validate the Chinese version of a screening measure of state depression, the 10-item Depression in Medically Ill (DMI-10), and we report three interdependent studies. An initial bilingual test-retest study identified four (of the 10) items as having poor cross-cultural validity. A second study involved focus groups participants exploring the meaning of translated items with Chinese speakers. The third study repeated the bilingual test-retest analyses on the modified DMI-10 form and demonstrated improved correlation coefficients on all items and an excellent overall correlation (r=0.87) between the Chinese and English versions. The Chinese DMI-10 should prove useful as a tool in cross-cultural research to understand the Chinese experience of depression. The findings of this study have methodological implications for cross-cultural research on depression.
npj Breast Cancer, 2019
Breast cancer is a common disease partially caused by genetic risk factors. Germline pathogenic v... more Breast cancer is a common disease partially caused by genetic risk factors. Germline pathogenic variants in DNA repair genes BRCA1, BRCA2, PALB2, ATM, and CHEK2 are associated with breast cancer risk. FANCM, which encodes for a DNA translocase, has been proposed as a breast cancer predisposition gene, with greater effects for the ER-negative and triple-negative breast cancer (TNBC) subtypes. We tested the three recurrent protein-truncating variants FANCM:p.Arg658*, p.Gln1701*, and p.Arg1931* for association with breast cancer risk in 67,112 cases, 53,766 controls, and 26,662 carriers of pathogenic variants of BRCA1 or BRCA2. These three variants were also studied functionally by measuring survival and chromosome fragility in FANCM−/− patient-derived immortalized fibroblasts treated with diepoxybutane or olaparib. We observed that FANCM:p.Arg658* was associated with increased risk of ER-negative disease and TNBC (OR = 2.44, P = 0.034 and OR = 3.79; P = 0.009, respectively). In a coun...
A46 Introduction Psychological morbidity and unmet need is high in English-speaking cancer patien... more A46 Introduction Psychological morbidity and unmet need is high in English-speaking cancer patients in Australia. Services are addressing this need to improve psychosocial care. Australia has one of the most culturally diverse populations in the world, yet the needs of culturally and linguistically diverse (CALD) populations are largely unknown. We therefore set out to investigate the needs of Australian CALD populations. Methods CALD cancer patients (and carers) diagnosed within the previous 3 years participated in focus groups/interviews with a facilitator (in their preferred language). Participants were recruited from Cancer councils, hospitals and support groups. Languages included Arabic (n=18, aged 58-70), Cantonese (n=29, aged 30-73), Mandarin (n=24, aged 47-74) and Greek (n=25, aged 31-79). Bilingual researchers translated recorded conversations. Two researchers used standard techniques for qualitative analysis to identify themes and develop a coding frame (using NVivo 7 software). Consumer advisory boards (comprising medical and religious representatives, social workers and consumer advocates) for each cultural group guided the research. Results Patients expressed difficulties in language and communication with health professionals and identified themselves as being culturally isolated. Patients felt they experienced a very different approach to consultations and illness to their home country and expressed unmet information and decision making needs. They described a desire for balance between truth of diagnosis and prognosis versus hope, and a fear about the burden of cancer treatment. Discussion Australian cancer patients from CALD backgrounds often feel isolated when confronted with the differences between their country of origin and their new “home country”. In our study, we found that these CALD cancer patients from CALD backgrounds experienced additional challenges in their healthcare. The next phase of our research involves a quantitative study of the unmet needs, patterns of care, quality of life, anxiety and depression experienced by CALD cancer patients.
Green, Julie, Renzaho, Andre, Eisenbruch, Maurice, Williamson, Lara, Waters, Elizabeth, Lo Bianco... more Green, Julie, Renzaho, Andre, Eisenbruch, Maurice, Williamson, Lara, Waters, Elizabeth, Lo Bianco, Joseph and Oberklaid, Frank 2008, Parent-centred and culturally-competent literacies for health promotion with newly arrived African communities : a literature review Centre ...
Social Psychiatry and Psychiatric Epidemiology, 2018
Objective Acculturation studies conducted with refugees have predominantly concentrated on invest... more Objective Acculturation studies conducted with refugees have predominantly concentrated on investigating the impact of acculturative stress on mental health, and have neglected to investigate the impact of cultural orientations towards the host and ethnic cultures. Furthermore, exposure to traumas is highly prevalent in refugees and strongly associated with mental health outcomes, however, rarely included in investigations of acculturative process of refugees. Method Using structural equation modelling, this study tested an integrated model of the relationship between traumatic exposure, acculturative stress, host and ethnic cultural orientations and posttraumatic stress disorder (PTSD), depression and anxiety symptoms among 138 Bosnian refugees resettled in Australia and Austria. Results The model showed an overall good fit and noteworthy amount of variance indicating that traumatic exposure is the strongest direct and indirect predictor of PTSD, depression and anxiety symptoms. Furthermore, acculturative stress was identified as a significant risk factor influencing host cultural orientation, mediating the effect of traumatic exposure on all mental health outcomes. Conclusion Acculturative stress and cultural and social stressors that are related to acculturation need to be addressed alongside provision of effective psychotherapy, especially since they are significant impediments to host cultural orientation and constructive engagement with mental health services in refugees.
Journal of Clinical Oncology, 2013
6556 Background: Poor prognosis is difficult to impart, particularly across a cultural divide. Th... more 6556 Background: Poor prognosis is difficult to impart, particularly across a cultural divide. This study is the first to compare prognostic communication with immigrants (with and without interpreters) versus native–born patients in audio-taped oncology consultations. Methods: Ten oncologists, 78 patients (31 Australian-born, 47 immigrants) and 115 family members participated. The first two consultations after diagnosis of incurable disease were audiotaped, transcribed and coded. 142 consultations were included in the analysis. Results: Fifty percent of doctor and 59% of patient prognostic speech units were notinterpreted or interpreted non-equivalently when an interpreter was present. Immigrant status predicted few, and oncologist characteristics no, prognostic facts disclosed. Oncologists were significantly less likely to convey hope to immigrants, and more likely to use medical jargon (p = 0.009) than with Australian-born patients. Incurable disease status and a limited life spa...
Journal of Clinical Nursing, 2010
Aims and objectives: This paper describes cultural competence issues within the scientific and sc... more Aims and objectives: This paper describes cultural competence issues within the scientific and scholarly discourse surrounding cardiac rehabilitation (CR). Background: CR is an important secondary prevention strategy, improving health-related outcomes and reducing the risks of subsequent cardiovascular events. Internationally, it is widely accepted as a discrete health service model and is endorsed by government and professional bodies. Over past decades, low participation rates in CR remain a concern, particularly among minority groups and culturally and linguistically diverse populations. Conclusions: Few studies to date have described cultural competence in CR service design and as a consequence, there are minimal data to assist CR professionals and policy makers in tailoring health service delivery models. The limited scholarly debate and discussion regarding cultural competence in the CR literature limits the development and evaluation of culturally appropriate interventions.
eisenbruch.com
Civil war and ruthless experiments in social engineering have created terror for decades in Cambo... more Civil war and ruthless experiments in social engineering have created terror for decades in Cambodia. The population was largely uprooted and displaced, one in four Cambodians died, and when the worst of the conflict was over, 20 more years of low-intensity warfare ...
Journal of Psychiatric Education, 1984
The development of video techniques in child psychiatry is reviewed. Application of techniques to... more The development of video techniques in child psychiatry is reviewed. Application of techniques to teaching the principles of development in child psychiatry as part of the pediatric term for fifth-year medical students is detailed, with utilization of edited tape footage of children of various developmental stages. Reference is made to the use of videotapes in postgraduate training in developmental psychiatry and child psychiatry. An approach toward use of a “videotest” in evaluation of psychiatric learning is described. The use of videotaped clinical interviews in forming an archive for behavioral analysis in research on depressed mothers and their children is reported.
Medical Journal of Australia, 1989
Australian medical education has not kept pace with Australia's increasingly multicultural so... more Australian medical education has not kept pace with Australia's increasingly multicultural society. Feedback from ethnic community organizations suggests that medical students and specialist trainees in medicine are not learning how to understand, to interact with and to treat patients in culturally appropriate ways. The first part of this paper reviews the problem and considers some perspectives in transcultural medicine and clinically applied medical anthropology. The second part proposes some areas in which medical schools can take the initiative in developing interdisciplinary teaching programmes at undergraduate and graduate levels. These programmes should provide minimal standards to enable any medical graduate to practise with patients of any cultural background and, in addition, will encourage some students to pursue more specialized studies in transcultural medicine and medical anthropology. It is suggested that new developments should be integrated with appropriate university departments such as anthropology.
Psychiatric Clinics of North America, 1990
The large number of refugees in the world must cope with the loss of family and homeland. This pa... more The large number of refugees in the world must cope with the loss of family and homeland. This paper proposes a new concept of cultural bereavement and presents a framework for its identification in the clinical interview with refugees. The cultural bereavement interview explores reactions to personal losses and to losses of both the social systems and the cultural meanings. Eleven areas are systematically explored, the first nine are indicators of bereavement and the tenth and eleventh are "antidotes" to cultural bereavement. The cultural bereavement interview can provide a clinical framework for exploring the patient's personal and cultural bereavement, clarify the "structure" of the patient's reactions to loss, complement the currently used psychiatric diagnostic categories, acknowledge the cultural system of meaning held by the patient, and provide information to be used in planning social supports or interventions.
Transcultural psychiatry, 2017
This paper reports an ethnographic study of mass fainting among garment factory workers in Cambod... more This paper reports an ethnographic study of mass fainting among garment factory workers in Cambodia. Research was undertaken in 2010-2015 in 48 factories in Phnom Penh and 8 provinces. Data were collected in Khmer using nonprobability sampling. In participant observation with monks, factory managers, health workers, and affected women, cultural understandings were explored. One or more episodes of mass fainting occurred at 34 factories, of which 9 were triggered by spirit possession. Informants viewed the causes in the domains of ill-health/toxins and supernatural activities. These included "haunting" ghosts at factory sites in the wake of Khmer Rouge atrocities or recent fatal accidents and retaliating guardian spirits at sites violated by foreign owners. Prefigurative dreams, industrial accidents, or possession of a coworker heralded the episodes. Workers witnessing a coworker fainting felt afraid and fainted. When taken to clinics, some showed signs of continued spirit ...
Social Science & Medicine, 1999
Social Science & Medicine, 2004
Hereditary cancer is about families, and clinicians and genetic counsellors need to understand th... more Hereditary cancer is about families, and clinicians and genetic counsellors need to understand the cultural beliefs of patients and families about cancer and inheritance. In the light of their kinship patterns Chinese-Australians were chosen for the present study, which aims to determine the explanatory models of inheritance, cancer, and inherited cancer, with a view to identifying the relationship between these culture-specific lay attributions and help-seeking behaviour, and to identify possible barriers to genetic counselling and testing. Qualitative ethnographically informed methodology involving semi-structured interview was used as a method to uncover latent beliefs held by the families who are represented by the subjects. In-depth interviews were conducted with 16 informants of Chinese ethnicity, who had been recruited through two major Sydney familial cancer clinics. We report the attributions of cancer in general, then on inheritance, kinship, genes and genetics and then focus on the way in which these beliefs come together around hereditary cancer. The majority of informants, despite high acculturation and belief in biomedical explanations about hereditary cancer, also acknowledged the influence of traditional family Chinese beliefs, where 'inheritance' and 'genetics' were related to retribution for ancestral misdeeds and offending ancestors. Extensive mismatch of attributes and beliefs were identified in those who attended the clinic and senior family members, creating barriers to optimal service utilisation. Three traditional patterns of beliefs were identified: (a) father and mother contributed in equal share to one's genetic makeup, linked to the ying-yang theory; (b) the dominance of life force (yang chi) and the shaping of genes were transmitted through the paternal line; and (c) natural and…
Psychological Medicine, 2005
Background. Studies of depression in the Chinese have long identified low rates and a greater lik... more Background. Studies of depression in the Chinese have long identified low rates and a greater likelihood of somatization, findings which could reflect cultural influences or real differences. We report a study from a western region examining the impact of acculturation on depression to clarify the role of cultural factors.Method. In a Sydney-based study, Chinese subjects (n=385) and a matched control group of 143 non-Chinese subjects completed either a Chinese or English questionnaire assessing state and lifetime depression, attributional style, depression recognition and help-seeking. The impact of acculturation was examined by several strategies.Results. Any tendency by the Chinese to somatize depression appeared to be attenuated by acculturation. State depression levels countered the view that Chinese necessarily deny depression. Lifetime depression rate differences were also attenuated by acculturation, with Chinese subjects being less likely than controls to judge episodes as a...
L'Homme, 1997
Le pouvoir de guerir par simple dissolution du mal est une quete ancienne de l'humanite. Chez... more Le pouvoir de guerir par simple dissolution du mal est une quete ancienne de l'humanite. Chez les Hmong du Laos et de la Thailande, ce pouvoir est exerce par des chamanes, chez les Khmers du Cambodge par des maitres-guerisseurs. Considere comme un phenomene holistique dans ces cultures, ce traitement de la guerison offre un champ d'observation unique. La principale opposition reside dans l'inversion des moyens. A la transformation de l'image du corps du chamane hmong par laquelle il etablit son pouvoir de guerison correspond la transformation de l'image du corps du malade par le guerisseur khmer. Cela indiquerait-il que, quel que soit le systeme therapeutique en cause, l'acte de guerison consiste fondamentalement dans la communication qui s'instaure entre medecin et malade et la prise de possession par le premier de la sphere de souffrance ou le second est isole ?
Journal of Traumatic Stress, 2004
The collaborative program of the Transcultural Psychosocial Organization (TPO) provides a communi... more The collaborative program of the Transcultural Psychosocial Organization (TPO) provides a community-oriented and culturally sensitive public health response to the psychosocial problems of refugees and victims of organized violence. This paper describes the 9-step model that TPO has developed as a blueprint for each new intervention. Beneficiaries participate in determining priorities and there is an orientation toward culturally competent training, capacity-building, and sustainability. Two cases, one related to Sudanese refugees in Uganda and the other to internally displaced persons and returnees in postwar Cambodia, show how the TPO intervention protocol is adapted to local settings. The paper provides preliminary evaluative comments on the model's performance.
The Journal of Nervous and Mental Disease, 2007
Depression measurement tools in cross-cultural research require careful design and thorough valid... more Depression measurement tools in cross-cultural research require careful design and thorough validation to ensure that cognitive concepts in one culture can be appropriately translated and applied to a differing culture. The aim of this study was to validate the Chinese version of a screening measure of state depression, the 10-item Depression in Medically Ill (DMI-10), and we report three interdependent studies. An initial bilingual test-retest study identified four (of the 10) items as having poor cross-cultural validity. A second study involved focus groups participants exploring the meaning of translated items with Chinese speakers. The third study repeated the bilingual test-retest analyses on the modified DMI-10 form and demonstrated improved correlation coefficients on all items and an excellent overall correlation (r=0.87) between the Chinese and English versions. The Chinese DMI-10 should prove useful as a tool in cross-cultural research to understand the Chinese experience of depression. The findings of this study have methodological implications for cross-cultural research on depression.
Background – People in mainland Southeast Asia have faced numerous
In Cambodia, more than half of all children experience physical violence, a quarter suffers emoti... more In Cambodia, more than half of all children experience physical violence, a quarter suffers emotional violence, and child rape is common. The aim is to provide an understanding of the ways in which Cambodians see the causes and effects of child abuse and to analyse the cultural forces that underpin and shape its landscape. An ethnographic study was carried out with 150 informants including 23 monks and other Buddhist key informants, involving 39 cases of child abuse (12 physical, 15 sexual, 15 emotional and 21 psychological). Child abuse was thought to stem from eight 'cultural attractors': 1 'bad building' or 'blighted endowment' (sɑmnaaŋ mɨn lʔɑɑ) that was determined by deeds in a previous life (kam); 2 early character e.g. boys born with stigmata of lust growing into sexual predators; 3 astrological mishap of the child or their family (krʊəh), with abuse falling at certain times; 4 pre-ordained entanglement of the fate of the child and abuser to meet in this life ensuring that abuse would ensue (kuu kam); 5 'Triple Poison', with sexual abuse fuelled by craving and greed (lobha) and physical abuse by anger and aversion (dosa); 6 'Entering the road to ruin' (apāyamuk) e.g. through alcohol abuse and pornography; 7 loss of judgement (moha); and 8 moral blindness (mo baŋ), the abuser shameless and blameless, his mind in darkness. This paper identifies a cultural epigenesis of child abuse in Cambodia, challenges the assumptions underlying 'Theory of Change' and provides a blueprint that is central to the development of culturally responsive interventions and prevention of child abuse. 2 Epigenesis of child abuse v9 SA-for circulation
Background: Violence against women in Cambodia is alarming, with one in four women a victim of it... more Background: Violence against women in Cambodia is alarming, with one in four women a victim of it. The study aims to provide a comprehensive understanding of the ways in which Cambodians see its causes and effects and to identify and analyse the cultural forces that underpin and shape its landscape. Method: An ethnographic study was carried out with 102 perpetrators and survivors of emotional, physical and sexual violence against women and 228 key informants from the Buddhist and healing sectors. Their views and experiences of it were recorded – the popular idioms expressed and the symptoms of distress experienced by survivors and perpetrators. From these results, the eight cultural forces, or cultural attractors, that propel a person to violence were identified. Results: Violence stemmed from blighted endowment, or 'bad building' (sɑmnaaŋ mɨn lʔɑɑ) determined by deeds in a previous life (kam). Children with vicious character (kmeeŋ kaac or doṣa-carita) might grow to be abusers, and particular birthmarks on boys were thought to be portents. Krʊəh, or mishap, especially when a female's horoscope predicted a zodiac house on the descent (riesəy), explained vulnerability to violence and its timing. Astrological incompatibility (kuu kam) was a risk factor. Lust, anger and ignorance, the 'Triple Poison', fuelled it. 'Entering the road to ruin' (apāyamuk) including alcohol abuse, womanising and gambling, triggered it. Confusion and loss of judgement (moha) led to moral blindness (mo baŋ). These were the eight cultural attractors that shaped the landscape of violence against women. Discussion: The cultural epigenesis of violence against women in Cambodia is an insight which can be used to build culturally responsive interventions and strengthen the primary prevention of violence against women. An understanding of the epigenesis of violence could strengthen the primary prevention of violence against women.
Almost half of Australia's people have non-English speaking backgrounds, but psychotherapy remain... more Almost half of Australia's people have non-English speaking backgrounds, but psychotherapy remains geared to the mainstream and ignorant of the stamp of culture. In this lecture, based on 35 years' experience as a psychotherapist-anthropologist in multicultural Australia and Cambodia, I will consider some of the cultural cornerstones of psychotherapy such as attachment theory, loss and bereavement; sanity and madness; the biological basis of mind such as cultural neurosciencje; excavations of mind, especially dream analysis; local notions of cause and effect such as contagion; structures of emotion such as anger; idioms of distress as seen in dissociative states; the preternatural, shown in possession states and demonology; family therapies withi ancestors; local forms such as traditional healing or religious interventions; and evil as manifested in wholesale violence against women and children. A culturally responsive psychotherapy allows the clinician to identify what matters to the patient as a participant in multicultural Australia and in a global world.
A yantra is a diagram drawn on cloth or engraved on metal or tattooed on the skin by the monk or ... more A yantra is a diagram drawn on cloth or engraved on metal or tattooed on the skin by the monk or healer, and worn or carried as defence or protection against illness. Although the Yantra have been well described in Hindu and Buddhist societies, including Cambodia, the way they work in healing remains a mystery. In this paper, the use of Yantra for prevention and treatment of illness and social conflict is considered. Through participant observation with healers and their patients, and analysis of the magical letters drawn and the geometric arrangement of each design, we have classified the Yantra according to their healing power, mode of action, and clinical use. One group of Yantra draw on Buddhist sources such as the Jina-Siri Buddha, who moved far from violence. The acrostics that stand for the Seven Factors of Enlightenment (Pali: satta bojjhaṅgā) relieve the victim's suffering. Some Yantra feature the Karaṇīyamettā Sutta, the protective Paritta verses that urge malevolent beings to do no harm and champion non-violence. The Yantra that reorganise the body elements restores the mind of those suffering post-traumatic stress as a result of violence. The Yantra of the four Great Elements, Yantra pkum tʰiet, corrects the imbalance between the earth, water, fire and air elements arising from stress. Na = 'water', element derived from mother – soft attributes e.g. love, mercy. Ma = 'earth', derived from father – 'hard' attributes e.g. shielding skin against being broken. Ba = 'fire', to chase out and incinerate evil spirits which emerge from the wild forest. Da = 'wind', to render invisible from predations of Three Vast Plains. Another, the 'Yantra Prachum Thiet', reassembles the 32 body elements and is also known as 'Yantra of Gatha Girimananda', named for the severely ill monk. The healer, in an echo of the meditation system, recites sections of the letters drawn on the Yantra forward and reversed. A heterodox group of Yantra draws on Brahmanic sources, especially on the Siva linga. The Āthabbaṇa Yantra derive their effectiveness from the Ayurvedic legendary healer who can defeat the enemy, and may be tattooed to empower the skin to resist attack or deflect bullets. The Āthabbaṇa Yantra Bɑŋʔap entices with a sex lure to cloud the perpetrator's mind. The Yantra 'to enable to delivery of the Royal baby (from Sanskrit prasūta putra), is drawn with a giant straddling a small figure and helps the victim to evade the clutches of the aggressor, who cannot bind the victim because the knot magically slips off. In the Yantra of Great Induced Abortion (Yantra moha rumluut), person evading attack becames as slippery as a foetus. The Angulimala Yantra, also named 'Pursuing But Never Catching Up With Yantra' (dəɲ pum toan) depicts the story of how the mass murderer could not kill the Buddha and instead became converted to non-violence. The Dharaṇī Yantra, known as Yantra Earth Maiden Goddess (kʊəŋhiiŋ tʰɔɔreaʔni) acts on behalf of downtrodden victims of injustice. The Yantra to ShortCut Across the Three Vast Plains remoralises those facing the threat of conflict and war, hunger, or illness. A group of medicinal Yantra, rather than being lists of ingredients, are instrumental in magically activating the power of the medicine. The 'Zero System' is an algebraic device that uses the 'Nine and Five Sāṃkhya Enumerations' and magically annihilates the perpetrator, making him zero. The Yantras, rather than being inaminate drawings, were alive. Clinical examples included the healer magically under attack and pounding on himself to awaken his tattooed Āthabbaṇa. The salience of the Yantra in modern Cambodia is undiminished. During Millenarian crises, people circulated Buddh Damnaay yantra to ward off helplessness in the face of civil and political violence. Nowadays, mass produced Yantra can be ordered on the internet by people around the world.
