Metaphor, magic, and mental disorder: Poetics and ontology in Mexican (Purépecha) curanderismo

This article offers an epistemological, poetic, and ontological reading of the ways of knowing regarding mental disorders that are characteristic of the traditional healers ( curanderas and curanderos) of an Indigenous group in Mexico. The study is based on ethnographic interviews with traditional Purépecha (Tarascan) healers in rural Michoacan. Interviews focused on local conceptions of emotional and mental illness, especially Nervios, Susto, and Locura (nerves, fright, and madness). We discuss the conceptual structure of these Indigenous illness notions, the nature of the associated imagery and notions of the soul, as well as the general sense of meaningfulness and reality implicit in Purépecha curanderismo. The highly metaphorical modes of understanding characteristic of these healers defy analysis in purely structuralist terms. They do, however, have strong affinities with the Renaissance “episteme” or implicit framework of understanding described in The Order of Things, Michel Foucault's classic study of modes of knowing and experiences of reality in Western thought—a work profoundly influenced by Heidegger's interest in the historical and cultural constitution of what Heidegger termed “Being.” After examining the individual illness concepts, we explore both the poetic and the ontological dimension (the foundational sense of reality or of Being) that they involve, with special emphasis on supernatural concerns.

Belief in Brua among psychiatric patients from Aruba, Bonaire, and Curaçao: Results from an explorative study in the Netherlands

Brua is an Afro-Caribbean religion and healing tradition predominantly practised on the ABC islands of the former Netherlands Antilles. It is grounded in oral tradition and shrouded in strict social taboos. Existing literature suggests that the majority of people on and from the islands are familiar with Brua and that it plays a substantial role in shaping their illness conception and idioms of distress. A lack of knowledge of Brua may therefore lead biomedically trained health professionals to misdiagnose these patients. This article discusses how religious beliefs related to Brua influence the illness concepts and idioms of distress of psychiatric patients originating from the ABC Islands, based on semi-structured interviews with former islanders receiving treatment at a psychiatric institute in the Netherlands. We found that of the 29 interviewees, 93.1% knew what Brua involved, 72.4% believed in it, 48.2% had first-hand experience with Brua practices, and 34.5% attributed their mental illness to Brua with greater or lesser certainty. However, only one patient had previously discussed her belief in Brua with her psychiatrist and only when asked to do so. The role of psychoactive substances in the context of Brua practices was negligible. Thus, the present study indicates that the majority of psychiatric patients from the ABC islands are familiar with Brua, but feel reluctant to discuss their concerns in this area with mental health professionals. Recommendations for clinical practice and further research are provided, including the need for a culture-sensitive approach and integrative care.

Illness concepts among patients with benign and malignant mammary tumors

The paper reports variants of subjective illness perception in patients with benign and malignant mammary tumors. The study included 100 patients followed-up in the Vladimirsky Moscow Regional Research Cinical Institute (MONIKI) (50 patients with stage II–III breast cancer and 50 patients with fibrocystic breast changes). The study provided data on subjective illness concept variants for patients of both groups which defined the illness behavior of patients, including the non-compliant behavior. The results obtained may be used for development of disease prevention programs (primary and secondary prevention).

Comparison of Illness Concepts and Coping Strategies among Cancer Patients of Turkish and German Origin

Background: The aim of this study was to compare illness concepts and coping strategies among native German cancer patients and those with a Turkish migration background. Methods: Guideline-based, semi-structured interviews were conducted with 11 German (♂: 8, ♀: 3) and 11 Turkish (♂: 2, ♀: 9) cancer patients. The transcripts were evaluated using a qualitative content analysis in accordance with Mayring. Results: We identified eight categories of illness concepts: stressful life events, environmental influences, the will of God, medical factors, fate, trauma, health behaviour, and psychological causes. German patients frequently attributed their illness to environmental influences, persistent stress, or medical factors, whereas Turkish patients blamed persistent stress, the will of God, or trauma. The last two categories are not found among German patients. We classified the coping strategies into 11 main categories: social support, activity, patient competence, fighting spirit/positive thinking, use of health services/alternative healing methods, lifestyle, emotional coping, cognitive coping, religious coping, spiritual coping, and culture-specific methods for patients of Turkish origin. For German patients, activities as well as social support played primary roles in coping. Turkish patients also often used social support. However, in contrast to the German patients, they are less active and use much more religious coping and culture-specific means. In addition, negative emotions occur more often when processing the illness than in the German patients. Conclusion: Common illness representations and coping strategies could be found for Turkish and German patients, but also specific ones for the respective group. It is particularly noticeable that German patients attach more importance to medical factors and try more actively to cope with the illness. For Turkish patients, cultural and religious factors play an important role, which should also be considered in treatment.

ФІЛОСОФСЬКІ ПІДХОДИ ДО РОЗУМІННЯ КАТЕГОРІЙ «ЗДОРОВ’Я/ХВОРОБА»

The philosophical fundamentals of categories «health/illness» are analyzed; the genesis of the health concept in philosophical discourse and the basic semantic tinctures of «health/illness» concepts have been researched; the approaches to the understanding of the health in human philosophical doctrines have been analyzed and summarized.

Philosophy of Medicine

This chapter views philosophy of medicine as a domain within philosophy of science as opposed to a province of bioethics. Thus, it first deals with the philosophical analysis of health, disease, and illness concepts and with the scientific nature of medicine. Relative to the second theme, it addresses questions relative to the causes and explanations of disease and the status of theories in biomedical science. A central concern here is the status and nature of proof in medicine and the relationship between theory and practice at the heart of evidence-based medicine. Finally, the chapter focuses on the specific problems raised by causal analysis and experimentation in medicine and on the nature of clinical reasoning.

Exploring the association between depression and shenjing shuairuo in a population representative epidemiological study of Chinese adults in Guangzhou, China

Traditional mental illness concepts remain prevalent in China. Shenjing shuairuo (i.e., neurasthenia), a depressive-like syndrome less favored in Western psychiatric nosology, has a long tradition of acceptance among Chinese lay people. The concept may be more easily accepted in China due to the culturally informed view of the importance of harmony between mind and body and is consistent with Traditional Chinese Medicine. The goals of this study were to estimate the prevalence of shenjing shuairuo, the overlap between shenjing shuairuo and depression, and whether these two disorders share correlates. Data was obtained from 751 Chinese adults using stratified random sampling. Spatial epidemiological methods were utilized with face-to-face interviews conducted in Guangzhou, China. The Patient Health Questionnaire (PHQ-9) and the neurasthenia criteria from ICD-10 measured depression and shenjing shuairuo. The prevalence of depression and shenjing shuairuo were 5.3% and 15.4%, respectively. Participants with depression were nearly six times more likely to have shenjing shuairuo. Women were more likely than men to have comorbid depression and shenjing shuairuo. Poorer health was reported across disorders. Those with shenjing shuairuo were more likely to report medical diagnoses. Longer sleep latency was reported for those with shenjing shuairuo and those with depression reported fewer hours of sleep and lower sleep quality. Those with depression alone reported the poorest sleep. Significant diagnostic overlap and few distinct correlates were observed. Nevertheless, the difference in prevalence and acceptance among non-professionals suggests that shenjing shuairuo is a useful category of distress among Chinese adults in Southern China.

The Importance of the Instructions in the Use of Draw-and-Write Techniques for Understanding Children’s Health and Illness Concepts

AimThe present study aims to test whether different instructions, when using draw-and-write data collection techniques, can be especially suited for understanding specific aspects of children’s conceptions about health and illness.MethodThis is a mixed-method study and participants were 209 schoolchildren, aged 10 to 12 years, who were asked to draw-and-write following one of two different instructions (A or B) that were related to the concepts of health and illness. Texts were examined through content analysis based on a previously validated coding system (inter-rater agreement of 93%).ResultsFindings suggest that the instruction “what does it mean to you to be sick and what does it mean to you to be healthy?” allows a more direct access to experiences and feelings, and that the instruction “draw and write about what a sick person is and what a healthy person is” is more adequate to elicit children’s knowledge and perceptions.ConclusionThe study suggests that to elicit children’s concepts of health and illness, relevant for health education and health promotion interventions, the draw-and-write instructions should be phrased in impersonal general terms. In contrast, for clinical interventions, the instruction should be targeted to the child’s direct experience of being ill.