Cultural experience of depression among white Britons in London

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Cultural pluralism that characterises many major urban centres, especially London, underscores needs for research in cultural psychiatry to identify distinctive needs for mental health services and clinical treatment. Such questions motivated development of this study of the cultural experience and meaning of depression amongst white Britons in London, involving development of a British EMIC interview for depression by adapting an earlier version of the EMIC used in Bangalore, India. Steps in the process involved historical and ethnographic study of depression, and extensive pilot testing. This report focuses on the experience of depression with reference to patterns of distress and its meaning with reference to perceived causes. A wide range of contradictory, overlapping and linked explanations, consistent with reports from previous studies of Indian and other non-Western cultures, were notable among white Britons, whose illness concepts are likely to appear as diverse and inconsistent to an outside observer as findings from research in South Asia may be for a Western medical anthropologist. Furthermore, somatic idioms of depression, although not spontaneously reported, were frequently reported when specifically probed, raising questions about the distinctiveness of depressive and somatoform disorders as discrete diagnostic headings. The range of perceived causes are reviewed, considering the relationship between coded categories and narrative accounts that specify the interrelationship of categories in a causal web. The discussion considers the utility of the EMIC for cultural study and reflections on methodological issues arising in its adaptation and use that may help other researchers wishing to apply the framework and use the tools of cultural epidemiology.