Explanatory models in psychiatry

Abstract

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 individualS 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 frameuork, its appeal to health professionals and social scientists as well as its limitations. The illness explanatoryframeworkdeals with notions aboutan episode of illness and its treatment by all who are engaged in the clinical process and understanding these models means that patients' uiews on their conditions are being acknowledged. Weiss and Somma emphasize that the model must be distinguishedfrom 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 explanatoryframework. 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. However, Weiss and Somma illustrate that this approach should also be seen as managing concerns about an imbalance over-emphasizing biology in the biopsychosocial model. They are also aware of possible critique of the model. This critique includes the perceived fixed and static nature of the model and that clinical interests do not take into account the injuence of social context. Perhaps the most significant criterion is based on the question of whether too much emphasis on the model in explanatory model exists. Models are important for developing theory and for research. The approach remains a useful one for bridging the interests and experiences of clinicians and their patients.