In the conventional view of bipolar disorder, life-long treatment with pharmaceuticals is assumed. This paper presents an overview of 24 narratives from people in the author's practice who have successfully managed and thrived without pharmacological treatment. For comparison purposes, 24 patients who could not manage without medication (even though some tried) were selected from the author's practice and matched for age, sex, socioeconomic status, and years of illness. Comparisons between the stories reveal that recovery without medication requires more substantial life change than does management with medication. Such non-medicated recovery becomes an all-encompassing life project. The patients who follow this path make major life changes and maintain them. The worldview of non-medicated bipolar patients differs, in that their struggle for recovery provides them with meaning and purpose, which is, in itself, healing. These patients avoid health practitioners who would criticize their alternative approach. They are compared to patients who do not manage well without medication who nevertheless try to manage their condition with herbs or vitamins or other alternative therapies and are unable to do so. Accurate appraisal of illness versus denial of illness emerges as the guiding theme. It may be important to recognize a successful strategy for living without medication compared with strategies of denial or flights into herbs and/or vitamins that will ultimately not succeed. Indigenous (or aboriginal) people, in particular, may reject the conventional psychiatric model in favor of a more holistic approach more congruent with their cultural healing paradigms.
First Nations and Inuit youth who abuse solvents are one of the most highly stigmatized substance-abusing groups in Canada. Drawing on a residential treatment response that is grounded in a culture-based model of resiliency, this article discusses the cultural implications for psychiatry's individualized approach to treating mental disorders. A systematic review of articles published in The Canadian Journal of Psychiatry during the past decade, augmented with a review of Canadian and international literature, revealed a gap in understanding and practice between Western psychiatric disorder-based and Aboriginal culture-based approaches to treatment and healing from substance abuse and mental disorders. Differing conceptualizations of mental health and substance abuse are discussed from Western psychiatric and Aboriginal worldviews, with a focus on connection to self, community, and political context. Applying an Aboriginal method of knowledge translation-storytelling-experiences from front-line workers in a youth solvent abuse treatment centre relay the difficulties with applying Western responses to Aboriginal healing. This lends to a discussion of how psychiatry can capitalize on the growing debate regarding the role of culture in the treatment of Aboriginal youth who abuse solvents. There is significant need for culturally competent psychiatric research specific to diagnosing and treating First Nations and Inuit youth who abuse substances, including solvents. Such understanding for front-line psychiatrists is necessary to improve practice. A health promotion perspective may be a valuable beginning point for attaining this understanding, as it situates psychiatry's approach to treating mental disorders within the etiology for Aboriginal Peoples.
a The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences , UiT, the Arctic University of Norway , Tromsø , Norway.
People with Sami and Norwegian background are frequent users of traditional folk medicine (TM). Traditional healing, such as religious prayers of healing (reading) and the laying on of hands, are examples of commonly used modalities. The global aim of this study is to examine whether health personnel's knowledge, attitudes and experiences of traditional healing affect their clinical practice. Semi-structured individual interviews (n=32) and focus group interviews (n=2) were conducted among health personnel in two communities in Northern Norway. The text data was transcribed verbatim and analysed based on the criteria for content analysis. Six themes were identified. The participants had acquired their knowledge of traditional healing through their childhood, adolescence and experience as health personnel in the communities. They all expressed that they were positive to the patients' use of traditional healing. They justified their attitudes, stating that "there are more things in heaven and earth" and they had faith in the placebo effects of traditional healing. The health personnel respected their patients' faith and many facilitated the use of traditional healing. In some cases, they also applied traditional healing tools if the patients asked them to do so. The health personnel were positive and open-minded towards traditional healing. They considered reading as a tool that could help the patients to handle illness in a good way. Health personnel were willing to perform traditional healing and include traditional tools in their professional toolkit, even though these tools were not documented as evidence-based treatment. In this way they could offer their patients integrated health services which were tailored to the patients' treatment philosophy.
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