Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-09T22:17:10.632Z Has data issue: false hasContentIssue false

10 - Explanatory models in psychiatry

from Part II - Culture and mental health

Published online by Cambridge University Press:  11 August 2009

Mitchell G. Weiss
Affiliation:
Department of Public Health and Epidemiology Swiss Tropical Institute Socinstrasse 57 CH-4002 Basel Switzerland
Daryl Somma
Affiliation:
Department of Public Health and Epidemiology Swiss Tropical Institute Socinstrasse 57 CH-4002 Basel Switzerland
Dinesh Bhugra
Affiliation:
Institute of Psychiatry, London
Kamaldeep Bhui
Affiliation:
Barts & The London, Queen Mary School of Medicine and Dentistry
Get access

Summary

EDITORS' INTRODUCTION

Similar experiences of illness or distress are seen as being caused by different elements across different cultures. Feeling gutted and sinking heart are idioms of distress which are remarkably different across cultures, but their implications at an individual level are very similar. Furthermore, the causation of the distress will be seen as remarkably different. It is evident that, in traditional cultures, the locus of control may be seen as external which may be coloured by cultural expectations, whereas in others the locus of control may be internal. Within each culture, however, individuals may carry their own explanations which may or may not be strongly influenced by individual's culture. From a clinical perspective, it is crucial that clinicians are aware of explanatory models that patients bring to the therapeutic encounter so that engagement can begin.

Weiss and Somma examine the concepts of the explanatory model framework, its appeal to health professionals and social scientists as well as its limitations. The illness explanatory framework deals with notions about an episode of illness and its treatment by all who are engaged in the clinical process and understanding these models means that patients' views on their conditions are being acknowledged. Weiss and Somma emphasize that the model must be distinguished from other ways the term is used which may refer to the nature of health and other problems in general. They explain three formulations of illness explanatory models and describe conceptual underpinning of the illness explanatory framework. In the beginning of the illness explanatory model framework provided a means of bring cultural differences between patients and clinician (especially when they came from different ethnic and cultural backgrounds) in multicultural settings.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aidoo, M. and Harpham, T. (2001). The explanatory models of mental health amongst low-income women and health care practitioners in Lusaka, Zambia. Health Policy and Planning. 16, 206–213.Google Scholar
Alarcón, R. D., Alegria, M., Bell, C. C. et al. (2002). Beyond the funhouse mirrors: research agenda on culture and psychiatric diagnosis. In: A Research Agenda for DSM-V, ed. Kupfer, D. G., First, M. B., and Regier, D. A.. Washington, DC: American Psychiatric Association.
Alarcón, R. D., Westermeyer, J., Foulks, E. F. and Ruiz, P. (1999). Clinical relevance of contemporary cultural psychology. Journal of Nervous and Mental Disease, 187, 465–471.Google Scholar
Bennegadi, R. (1996). Clinical medical anthropology and immigrant's mental health in France. Médecine Tropicale, 56, 445–452.Google Scholar
Betancourt, J. R. (2004). Cultural competence – marginal or mainstream movement?New England Journal of Medicine, 351, 953–955.Google Scholar
Bhui, K. and Bhugra, D. (2002). Explanatory models for mental distress: implications for clinical practice and research. British Journal of Psychiatry, 181, 6–7.Google Scholar
Bhui, D., Bhugra, D. and Goldberg, D. (2002). Causal explanations of distress and general practitioners' assessments of common mental disorder among Punjabi and English attendees. Social Psychiatry and Psychiatric Epidemiology, 37, 38–45.Google Scholar
Blumhagen, D. W. (1981). On the nature of explanatory models. Culture, Medicine and Psychiatry, 5, 337–340.Google Scholar
Brendel, D. H. (2003). Reductionism, eclecticism and pragmatism in psychiatry: the dialectic of clinical explanation. Journal of Medicine and Philosophy, 28, 563–580.Google Scholar
Callan, A. and Littlewood, R. (1998). Patient satisfaction: ethnic origin or explanatory model?International Journal of Social Psychiatry, 44, 1–11.Google Scholar
Carrillo, J. R., Green, A. R. and Betancourt, J. R. (1999). Cross-cultural primary care: a patient-based approach. Annals of Internal Medicine, 130, 829–834.Google Scholar
Chan, B. and Parker, G. (2004). Some recommendations to assess depression in Chinese people in Australasia. Australian and New Zealand Journal of Psychiatry, 38, 141–147.Google Scholar
Daie, N., Witztum, E., Mark, M. and Rabinowitz, S. (1992). The belief in the transmigration of souls: psychotherapy of a Druze patient with severe anxiety reaction. British Journal of Medical Psychology, 65, 119–130.Google Scholar
Daley, T. C. (2005). Beliefs about treatment of mental health problems among Cambodian American children and parents. Social Science and Medicine, 61, 2384–2395.Google Scholar
Eisenberg, L. (1977). Disease and illness: distinctions between professional and popular ideas of sickness. Culture, Medicine and Psychiatry, 1, 9–23.Google Scholar
Eisenbruch, M. (1990). Classification of natural and supernatural causes of mental distress: development of a Mental Distress Explanatory Model Questionnaire. Journal of Nervous and Mental Disease, 178, 712–719.Google Scholar
Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196, 129–136.Google Scholar
Fabrega, H. Jr. (1975). The need for an ethnomedical science. Science, 189, 969–975.Google Scholar
Fabrega, H. Jr. (1990). A plea for a broader ethnomedicine. Culture, Medicine and Psychiatry, 14, 129–132.Google Scholar
Fox, N., Ward, K. and O'Rourke, A. (2005). Pro-anorexia, weight-loss drugs and the internet: an ‘anti-recovery’ explanatory model of anorexia. Sociology of Health and Illness, 27, 944–971.Google Scholar
Good, B. (1977). The heart of what's the matter: the semantics of illness in Iran. Culture, Medicine and Psychiatry, 1, 25–58.Google Scholar
Group for the Advancement of Psychiatry (2002). Cultural Assessment in Clinical Psychiatry. GAP Publication, #145. Committee on Cultural Psychiatry. Washington, DC: American Psychiatric Press.
Headland, T. N., Pike, K. L. and Harris, M., eds. (1990). Emics and Etics: The Insider/Outsider Debate. Newbury Park, CA: Sage.
Helman, C. (2004). Culture, Health, and Illness, 4th edn. London: Hodder Arnold.
Ho, T. P. and Luk, C. (1997). Comparison of child psychiatric patients in hospital and community clinics in Hong Kong. General Hospital Psychiatry, 19, 362–369.Google Scholar
Hollifield, M., Katon, W., Spain, D. and Pule, L. (1990). Anxiety and depression in a village in Lesotho, Africa: a comparison with the United States. British Journal of Psychiatry, 156, 343–350.Google Scholar
Joel, D., Sathyaseelan, M., Jayakaran, R., Vijayakumar, C., Muthurathnam, S. and Jacob, K. S. (2003). Explanatory models of psychosis among community health workers in South India. Acta Psychiatrica Scandinavica, 108, 66–69.Google Scholar
Kleinman, A. (1977a). Culture, and illness: a question of models. Culture, Medicine and Psychiatry, 1, 229–231.Google Scholar
Kleinman, A. (1977b). Depression, somatization and the ‘new cross-cultural psychiatry’. Social Science and Medicine, 11, 3–10.Google Scholar
Kleinman, A. (1978a). Clinical relevance of anthropological and cross-cultural research: concepts and strategies. American Journal of Psychiatry. 135, 427–431.Google Scholar
Kleinman, A. (1978b). What kind of model for the anthropology of medical systems?American Anthropologist, 80, 661–665.Google Scholar
Kleinman, A. (1980). Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. Berkeley: University of California Press.
Kleinman, A. (1981). On illness meanings and clinical interpretation: not ‘rational man,’ but a rational approach to man the sufferer/man the healer. Culture, Medicine, and Psychiatry, 4, 373–377.Google Scholar
Kleinman, A. (1986). Social Origins of Distress and Disease: Depression, Neurasthenia and Pain in Modern China. New Haven: Yale University Press, p. 84.
Kleinman, A. (1988a). The Illness Narratives: Suffering, Healing and the Human Condition. New York: Basic Books.
Kleinman, A. (1988b). Rethinking Psychiatry: From Cultural Category to Personal Experience. London: Free Press.
Kleinman, A. (1995). Writing at the Margin of Discourse between Anthropology and Medicine. Berkeley: University of California Press.
Kleinman, A., Eisenberg, L. and Good, B. (1978). Culture, illness and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88, 251–258.Google Scholar
Larsen, J. A. (2004). Finding meaning in first episode psychosis: experience, agency and the cultural repertoire. Medical Anthropology Quarterly, 18, 447–471.Google Scholar
Lee, S. (1995). Self-starvation in context: towards a culturally sensitive understanding of anorexia nervosa. Social Science and Medicine, 41, 25–36.Google Scholar
Lemelson, R. B. (2004). Traditional healing and its discontents: efficacy and traditional therapies of neuropsychiatric disorders in Bali. Medical Anthropology Quarterly, 18, 48–76.Google Scholar
Lewis-Fernandez, R. (1996). Cultural formulation of psychiatric diagnosis. Culture, Medicine and Psychiatry, 20, 133–144.Google Scholar
Littlewood, R. (1990). The new cross-cultural psychiatry. British Journal of Psychiatry, 157, 775–776.Google Scholar
Lloyd, K. R., Jacob, K. S., Patel, V., St Louis, L., Bhugra, D. and Mann, A. H. (1998). The development of the Short Explanatory Model Interview (SEMI) and its use among primary-care attenders with common mental disorders. Psychology and Medicine, 28, 1231–1237.Google Scholar
McCabe, R. and Priebe, S. (2004). Explanatory models of illness in schizophrenia: comparison of four ethnic groups. British Journal of Psychiatry, 185, 25–30.Google Scholar
McGorry, P. D. and McConville, S. B. (1999). Insight in psychosis: an elusive target. Comprehensive Psychiatry, 40, 131–142.Google Scholar
Mezzich, J. E., Kirmayer, L. J., Kleinman, A.et al. (1999). The place of culture in DSM-IV. Journal of Nervous and Mental Disease, 187, 457–464.Google Scholar
Niehaus, D. J., Oosthuizen, P., Lochner, C.et al. (2004). A culture-bound syndrome amafufunyana and a culture-specific event ukuthwasa: differentiated by a family history of schizophrenia and other psychiatric disorders. Psychopathology, 37, 59–63.Google Scholar
Nutini, H. G. (1965) Some considerations on the nature of social structure and model building: a critique of Claude Levi-Strauss and Edmund Leach. American Anthropologist, 67, 707–731.Google Scholar
Pang, K. Y. (1998). Symptoms of depression in elderly Korean immigrants: narration and the healing process. Culture, Medicine and Psychiatry, 22, 93–122.Google Scholar
Patel, V. (1995). Explanatory models of mental illness in sub-Saharan Africa. Social Science and Medicine, 40, 1291–1298.Google Scholar
Penka, S., Krieg, S., Hunner, Ch. and Heinz, A. (2003). Different explanatory models ofr addictive behavior in Turkish and German youths in Germany: significance for prevention and treatment. Nervenarzt, 74, 581–586.Google Scholar
Pike, K. L. (1967). Etic and emic standpoints for the description of behavior. In: ed. Language and Thought: An Enduring Problem in Psychology, Hildum, D. C., Princeton: Van Nostrand.
Rodrigues, M., Patel, V., Jaswal, S. and Souza, N. (2003). Listening to mothers: qualitative studies on motherhood and depression from Goa, India. Social Science and Medicine, 57, 1797–1806.Google Scholar
Sayre, J. (2000). The patient's diagnosis: explanatory models of mental illness. Qualitative Health Research, 10, 71–83.Google Scholar
Sheikh, S. and Furnham, A. (2000). A cross-cultural study of mental health beliefs and attitudes towards seeking professional help. Social Psychiatry and Psychiatric Epidemiology, 35, 326–334.Google Scholar
Stern, L. and Kirmayer, L. J. (2004). Knowledge structures in illness narratives: development and reliability of a coding scheme. Transcultural Psychiatry, 41, 130–142.Google Scholar
Swartz, L. (1987). Illness negotiation: the case of eating disorders. Social Science and Medicine, 24, 613–618.Google Scholar
Thomas, A. (1978). Discussion on Arthur Kleinman's paper. Social Science and Medicine, 12, 95.Google Scholar
Weiss, M. G. (1997). Explanatory Model Interview Catalogue: framework for comparative study of illness experience. Transcultural Psychiatry, 34, 235–263.Google Scholar
Weiss, M. G. (2001). Cultural epidemiology: an introduction and overview. Anthropology and Medicine, 8, 5–29.Google Scholar
Weiss, M. G., Sharma, S. D., Gaur, R. K., Sharma, J. S., Desai, A. and Doongaji, D. R. (1986). Traditional concepts of mental disorder among Indian psychiatric patients: preliminary report of work in progress. Social Science and Medicine, 23, 379–386.Google Scholar
Weiss, M. G., Doongaji, D. R., Siddhartha, S.et al. (1992). The Explanatory Model Interview Catalogue (EMIC). Contribution to cross-cultural research methods from a study of leprosy and mental health. British Journal of Psychiatry, 160, 819–830.Google Scholar
Weiss, M. G., Raguram, R. and Channabasavanna, S. M. (1995). Cultural dimensions of psychiatric diagnosis. A comparison of DSM-III-R and illness explanatory models in South India. British Journal of Psychiatry, 166, 353–359.Google Scholar
Williams, B. and Healy, D. (2001). Perceptions of illness causation among new referrals to a community mental health team: explanatory model or exploratory map?Social Science and Medicine, 53, 465–476.Google Scholar
Wong, S. S., Lee, S. and Wat, K. H. (1999). A preliminary communication of an insight scale in the assessment of lithium non-adherence among Chinese patients in Hong Kong. Journal of Affective Disorders, 44, 241–244.Google Scholar
Young, A. (1981). When rational men fall sick: an inquiry into some assumptions made by medical anthropologists. Culture, Medicine and Psychiatry, 5, 317–337.Google Scholar
Young, A. (1982). The anthropologies of illness and sickness. Annual Review of Anthropology, 11, 257–285.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Explanatory models in psychiatry
    • By Mitchell G. Weiss, Department of Public Health and Epidemiology Swiss Tropical Institute Socinstrasse 57 CH-4002 Basel Switzerland, Daryl Somma, Department of Public Health and Epidemiology Swiss Tropical Institute Socinstrasse 57 CH-4002 Basel Switzerland
  • Edited by Dinesh Bhugra, Institute of Psychiatry, London, Kamaldeep Bhui
  • Book: Textbook of Cultural Psychiatry
  • Online publication: 11 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511543609.012
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Explanatory models in psychiatry
    • By Mitchell G. Weiss, Department of Public Health and Epidemiology Swiss Tropical Institute Socinstrasse 57 CH-4002 Basel Switzerland, Daryl Somma, Department of Public Health and Epidemiology Swiss Tropical Institute Socinstrasse 57 CH-4002 Basel Switzerland
  • Edited by Dinesh Bhugra, Institute of Psychiatry, London, Kamaldeep Bhui
  • Book: Textbook of Cultural Psychiatry
  • Online publication: 11 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511543609.012
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Explanatory models in psychiatry
    • By Mitchell G. Weiss, Department of Public Health and Epidemiology Swiss Tropical Institute Socinstrasse 57 CH-4002 Basel Switzerland, Daryl Somma, Department of Public Health and Epidemiology Swiss Tropical Institute Socinstrasse 57 CH-4002 Basel Switzerland
  • Edited by Dinesh Bhugra, Institute of Psychiatry, London, Kamaldeep Bhui
  • Book: Textbook of Cultural Psychiatry
  • Online publication: 11 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511543609.012
Available formats
×