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

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 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

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

Suicide Among Aboriginal People in Canada

This report looks at the complex issues that surround Aboriginal suicide in Canad

Pathways to first-episode care for psychosis in African-, Caribbean-, and European-origin groups in Ontario

Objective: To compare the pathways to care and duration of untreated psychosis (DUP) for people of Black-African, Black-Caribbean, or White-European origin with first-episode psychosi(FEP). Methods: We recruited a sample of 171 patients with FEP of Black-African, Black-Caribbean, and White-European origin from hospital-and community-based early intervention services (EIS) in the cities of Toronto and Hamilton. We compared the 3 groups on DUP and key indicators of the pathway to care. Results: We observed differences in pathways to care across the 3 groups. Black-Caribbean participants had an increased odds of referral from an inpatient unit to EIS (OR 3.33; 95% CI 1.46 to 7.60) and a decreased odds of general practitioner involvement on the pathway to care (OR 0.17; 95% CI 0.07 to 0.46), as well as fewer total contacts (exp[β] 0.77; 95% CI 0.60 to 0.99) when compared with White-European participants. Black-African participants had an increased odds of contact with the emergency department at first contact (OR 3.78; 95% CI 1.31 to 10.92). The differences in the DUP between groups were not statistically significant. Conclusions: Our findings suggest that there are significant differences in the pathways to EIS for psychosis for people of African and Caribbean origin in our Canadian context. It is essential to gain a comprehensive understanding of the pathways that different population groups take to mental health services, and the reasons behind observed differences, to inform the development of equitable services, targeting patients in the critical early stages of psychotic disorder

Culture et santé mentale en Haïti : une revue de littérature

Cet article passe en revue et résume l’ensemble de la littérature sur la santé mentale et les services de santé mentale en Haïti. Ce compte rendu a été rédigé à la suite du tremblement de terre qui a frappé Haïti en janvier 2010. Nous avons effectué des recherches dans Medline, Google Scholar et d’autres bases de données disponibles en vue de recueillir la littérature scientifique pertinente sur la santé mentale en Haïti. La consultation d’ouvrages de référence et de la littérature grise sur Haïti a complété les recherches. La première partie décrit les principales données historiques, économiques, sociologiques et anthropologiques qui permettent de comprendre sommairement Haïti et sa population. La démographie, la structure familiale, l’économie haïtienne et la religion y sont abordées. La deuxième partie est axée sur la santé mentale et les services de santé mentale. L’épidémiologie élémentaire des maladies mentales, les croyances au sujet des maladies mentales, les modèles explicatifs, les idiomes de détresse, les comportements de recherche d’aide, la configuration des services de santé mentale et l’étude des relations entre la religion et la santé mentale y sont examinés.This paper reviews and summarizes the available literature on Haitian mental health and mental health services. This review was conducted in light of the Haitian earthquake in January 2010. We searched Medline, Google Scholar and other available databases to gather scholarly literature relevant to mental health in Haiti. This was supplemented by consultation of key books and grey literature relevant to Haiti. The first part of the review describes historical, economic, sociological and anthropological factors essential to a basic understanding of Haiti and its people. This includes discussion of demography, family structure, Haitian economics and religion. The second part of the review focuses on mental health and mental health services. This includes a review of factors such as basic epidemiology of mental illness, common beliefs about mental illness, explanatory models, idioms of distress, help-seeking behavior, configuration of mental health services and the relationship between religion and mental health.Este artículo revisa y resume la literatura sobre la salud mental y los servicios de salud mental en Haití. Este informe fue redactado después del terremoto que sacudió a Haití en enero de 2010. Realizamos búsquedas en Medline, Google Scholar y otras bases de datos disponibles a fin de recopilar la literatura científica pertinente acerca de la salud mental en Haití. La investigación fue completada con obras de referencia y literatura gris acerca de Haití. La primera parte describe los principales datos históricos, económicos, sociológicos y antropológicos que permiten comprender someramente a Haití y a su población. Se abordan la demografía, la estructura familiar, la economía haitiana y la religión. La segunda parte se centra en la salud mental y los servicios de salud mental. Se examinan la epidemiología elemental de las enfermedades mentales, las creencias con respecto a las enfermedades mentales, los modelos explicativos, las expresiones de angustia, los comportamientos de búsqueda de ayuda, la configuración de los servicios de salud mental y el estudio de las relaciones entre la religión y la salud mental.Este artigo passa em revista e resume a literatura sobre a saúde mental e os serviços de saúde mental no Haiti. Este resumo foi redigido após o tremor de terra que atingiu o Haiti em janeiro de 2010. Realizamos pesquisas no Medline, no Google Scholar e em outros bancos de dados disponíveis visando reunir a literatura científica pertinente sobre a saúde mental no Haiti. A consulta de obras de referência e da literatura “cinzenta” sobre o Haiti completou as pesquisas. A primeira parte descreve os principais dados históricos, econômicos, sociológicos e antropológicos que permitem entender sumariamente o Haiti e sua população. São abordadas a demografia, a estrutura familiar, a economia haitiana e a religião. A segunda parte trata da saúde mental e dos serviços de saúde mental. São examinados: a epidemiologia elementar das doenças mentais, as crenças sobre as doenças mentais, os modelos explicativos, as demonstrações de desespero, os comportamentos de busca de auxílio, a configuração dos serviços de saúde mental e o estudo das relações entre a religião e a saúde mental

"Now he walks and walks, as if he didn't have a home where he could eat": food, healing, and hunger in Quechua narratives of madness

In the Quechua-speaking peasant communities of southern Peru, mental disorder is understood less as individualized pathology and more as a disturbance in family and social relationships. For many Andeans, food and feeding are ontologically fundamental to such relationships. This paper uses data from interviews and participant observation in a rural province of Cuzco to explore the significance of food and hunger in local discussions of madness. Carers’ narratives, explanatory models, and theories of healing all draw heavily from idioms of food sharing and consumption in making sense of affliction, and these concepts structure understandings of madness that differ significantly from those assumed by formal mental health services. Greater awareness of the salience of these themes could strengthen the input of psychiatric and psychological care with this population and enhance knowledge of the alternative treatments that they use. Moreover, this case provides lessons for the global mental health movement on the importance of openness to the ways in which indigenous cultures may construct health, madness, and sociality. Such local meanings should be considered by mental health workers delivering services in order to provide care that can adjust to the alternative ontologies of sufferers and carers