Unpacking the Placebo Response: Insights from Ethnographic Studies of Healing

This paper selectively reviews cross-cultural studies of healing to identify parallels with the process of responding to placebos in biomedical contexts. Placebo responses involve positive therapeutic effects of symbolic stimuli that may be mediated by changes in cognition and attention as well as psychophysiological mechanisms. Ethnographic studies of healing point to additional social and cultural processes that may mediate and modulate placebo responding, including: (i) the cognitive and social grounding of believed-in-efficacy and expectations; (ii) interpersonal processes of narrating and re-negotiating symptom and illness experience; and (iii) the embedding of healing in cultural ontologies, values and social institutions that define positive health outcomes and that govern the esthetics and rhetorical power of healing interventions. Research on the social-contextual basis of placebo responding can contribute to an integrative theory of healing. Because placebo responding is part of any therapeutic intervention, there is no theoretical or practical justification for the deceptive use of placebos. Strengthening the components of placebo responding inherent in clinical effectiveness will insure maximum benefit for patients and maintain the credibility and fidelity of medical practitioners and institutions

Cultural logics of emotion: Implications for understanding torture and its sequelae

This paper explores the significance of cultural variations in emotion for the meaning and impact of torture, focusing on the dynamics of shame, humiliation, and powerlessness. Forms of physical and psychological pain and suffering share some common neurobiological pathways and regulatory systems that are influenced by social and cultural factors. All forms of torture follow an affective logic rooted both in human biology and in local social and cultural meanings of experience. Understanding the impact of specific forms of torture on individuals requires knowledge of their learning histories, and of the personal and cultural meanings of specific kinds of violence. Exploring cultural meanings requires attention to over-arching discourse, embodied practices, and everyday engagements with an ecosocial environment. Restitution, treatment and recovery can then be guided by knowledge of cultural meanings, dynamics, and strategies for coping with catastrophic threats, injury, humiliation, helplessness and loss

Culture et maladie mentale chez les Inuit du Nunavik

Bien que l'on retrouve dans la population Inuit du Grand Nord du Québec (Nunavik) les troubles psychiatriques majeurs décrits dans la nosologie psychiatrique actuelle, la culture influence de manière importante la symptomatologie et l'évolution de ces troubles ainsi que les réactions qu'ils suscitent. Une revue de la littérature, les réflexions que nous inspire une expérience de consultation psychiatrique en milieu Inuit et les premières données d'une recherche ethnographique, indiquent que le développement de services mieux adaptés et sensibles à la réalité de la culture Inuit doit reposer sur l'étude de l'ethnopsychologie Inuit et des attitudes actuelles envers les malades mentaux.While the major psychiatric disorders described in current nosology can be found among the Inuit of Northern Québec (Nunavik), there are important cultural influences on the symptomatology, social response and course of these disorders. A literature review, consideration of experiences with psychiatric consultation among the Inuit and the preliminary results of ongoing ethnographic research underscore the importance of the study of Inuit ethnopsychology and current attitudes toward the mentally ill in developing culturally sensitive psychiatric care

Integrating Evolutionary, Cultural, and Computational Psychiatry: A Multilevel Systemic Approach

This paper proposes an integrative perspective on evolutionary, cultural and computational approaches to psychiatry. These three approaches attempt to frame mental disorders as multiscale entities and offer modes of explanations and modeling strategies that can inform clinical practice. Although each of these perspectives involves systemic thinking, each is limited in its ability to address the complex developmental trajectories and larger social systemic interactions that lead to mental disorders. Inspired by computational modeling in theoretical biology, this paper aims to integrate the modes of explanation offered by evolutionary, cultural and computational psychiatry in a multilevel systemic perspective. We apply the resulting Evolutionary, Cultural and Computational (ECC) model to Major Depressive Disorder (MDD) to illustrate how this integrative approach can guide research and practice in psychiatry

La folie de la métaphore

La folie de la métaphoreDes travaux récents en sciences cognitives indiquent que les constructions conventionnelles et novatrices de l'expérience sont médiatisées par des concepts métaphoriques. Les métaphores relient les significations sensorielles, affectives et conceptuelles au point que même des concepts abstraits en sont tramés et contribuent aux expériences corporelles et sociales. À travers le cas d'une femme souffrant de sensations de flottement, j'illustre dans cet article comment la theorie de la métaphore intègre les aspects sociaux et corporels de l'expérience de la maladie. Cette approche pourrait lier les explications constructivistes et réalistes de la maladie et situer ainsi les processus symboliques et imaginaires à l'intérieur d'un monde partagé de substance et de sentiment.The Madness of MetaphorRécent work in cognitive science suggest that both conventional and innovative constructions of expérience and mediated by metaphoric concepts. Metaphors bridge sensory, affective and conceptual meaning so that even abstract concepts are grounded in and contribute to bodily and social expériences. Through the example of a woman suffering from sensations of floating, I illustrate how metaphor theory intégrâtes social and bodily aspects of illness expérience. This approach promises to bridge constructivist and realist accounts of illness and so to situate symbolic and Imaginative processes within a shared world of substance and feeling

Cultural affordances : scaffolding local worlds through shared intentionality and regimes of attention

Abstract: In this paper we outline a framework for the study of the mechanisms involved in the engagement of human agents with cultural affordances. Our aim is to better understand how culture and context interact with human biology to shape human behavior, cognition, and experience. We attempt to integrate several related approaches in the study of the embodied, cognitive, and affective substrates of sociality and culture and the sociocultural scaffolding of experience. The integrative framework we propose bridges cognitive and social sciences to provide (i) an expanded concept of ‘affordance’ that extends to sociocultural forms of life, and (ii) a multilevel account of the socioculturally scaffolded forms of affordance learning and the transmission of affordances in patterned sociocultural practices and regimes of shared attention. This framework provides an account of how cultural content and normative practices are built on a foundation of contentless basic mental processes that acquire content through immersive participation of the agent in social practices that regulate joint attention and shared intentionalit

GPs' strategies in intercultural clinical encounters

Background. In North America and Europe, patients and physicians are increasingly likely to come from non-Western cultural backgrounds. The expectations of these patients may not match those of physicians. Objective. To identify strategies used by GPs with patients from cultures other than their own. Methods. We conducted a qualitative inductive study based on 25 semi-structured interviews with family physicians practising in Montreal, Canada. We elicited physicians' strategies when dealing with patients from a cultural background different from their own. We began by asking physicians to describe an encounter they found difficult and one they found easy. Results. Physicians reported three types of strategies: (i) insistence on patient adaptation to local beliefs and behaviours; (ii) physician adaptation to what he or she assumed patients wanted; and (iii) negotiation of a mutually acceptable plan. Individual physicians did not adopt the same strategy in all situations. Their choice of strategy depended on the topic. When dealing with issues they felt deeply about, such as the autonomy of women, many physicians insisted on patient adaptation. Physicians used a patient-centred model of care, but had no framework to elicit information about patients' culture. Conclusions. A patient-centred model of care enables physicians to consult effectively despite a wide range of cultural differences between themselves and their patients. However, their lack of a conceptual framework for addressing cultural difference prevents systematic data collection and consideration of challenges to respect for individual autonomy. Physician training should include the provision of an explicit conceptual framework for approaching patients from a different cultur

Taming troubled teens: The social production of mental morbidity amongst young mothers in Pelotas, Brazil

Copyright @ 2011 Elsevier Ltd. This is a post-print version of the article. The published version of the article can be viewed at the link below.Explanations for the association between teen-childbearing and subsequent mental morbidity vary considerably, from those based on neurological theories of development to those investigating underlying social and economic determinants. Based on longitudinal epidemiological and ethnographic sub-studies of the 1982 Pelotas birth cohort study, this paper explores the hypothesis that teen childbearing and subsequent mental morbidity have become associated through the interplay of culture, society, and biology in situations where teen pregnancy has become a stigmatised object of scientific and public health attention. Results show that the effect of teen childbearing on subsequent mental morbidity remained significant in the multivariate analysis. Ethnographic analysis, together with epidemiological effect modification analyses, suggest that this association is partially accounted for by the fact that it is more pronounced amongst a specific subgroup of women of low socio-economic status who, being more politicised about societal injustice, were also more critically engaged with – and thus troubled by – the inequitable institutionalisation of life-cycle transitions. With time, these women became highly critical of the institutionalised identification of early childbearing as a key violation of life-cycle norms and the differential class-based application of scientific knowledge on its causes and consequences. Public health campaigns should consider how the age-based institutionalisation of developmental norms has enabled the stigmatisation of those identified as transgressors.The 1982 cohort study has been funded by The Wellcome Trust, the World Health Organisation, the PanAmerican Health Organisation, the European Union, the Programa Nacional para Centros de Excelência (PRONEX), the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), the Brazilian Ministry of Health, and the Fundação de Amparo à Pesquisa do Rio Grande do Sul (Fapergs). D Béhague received support from a US National Science Foundation Doctoral Fellowship and a Postdoctoral Training Fellowship from The Wellcome Trust (Grant no. GR077175MA)