Culture, Medicine and Psychiatry
Volume 40, Issue 4, 2016, Pages 570-619

A Transcultural Model of the Centrality of “Thinking a Lot” in Psychopathologies Across the Globe and the Process of Localization: A Cambodian Refugee Example (Article)

Hinton D.E.* , Barlow D.H. , Reis R. , de Jong J.
  • a Center for Anxiety and Traumatic, Massachusetts General Hospital, Harvard Medical School, Stress Disorders, One Bowdoin Square, 6th Floor, Boston, MA 02114, United States
  • b Center for Anxiety and Related Disorders, Boston University, Boston, MA, United States
  • c Leiden University Medical Center, Leiden, Netherlands, Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands, The Children’s Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
  • d Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands, Boston University School of Medicine, Boston, MA, United States

Abstract

We present a general model of why “thinking a lot” is a key presentation of distress in many cultures and examine how “thinking a lot” plays out in the Cambodian cultural context. We argue that the complaint of “thinking a lot” indicates the presence of a certain causal network of psychopathology that is found across cultures, but that this causal network is localized in profound ways. We show, using a Cambodian example, that examining “thinking a lot” in a cultural context is a key way of investigating the local bio-cultural ontology of psychopathology. Among Cambodian refugees, a typical episode of “thinking a lot” begins with ruminative-type negative cognitions, in particular worry and depressive thoughts. Next these negative cognitions may induce mental symptoms (e.g., poor concentration, forgetfulness, and “zoning out”) and somatic symptoms (e.g., migraine headache, migraine-like blurry vision such as scintillating scotomas, dizziness, palpitations). Subsequently the very fact of “thinking a lot” and the induced symptoms may give rise to multiple catastrophic cognitions. Soon, as distress escalates, in a kind of looping, other negative cognitions such as trauma memories may be triggered. All these processes are highly shaped by the Cambodian socio-cultural context. The article shows that Cambodian trauma survivors have a locally specific illness reality that centers on dynamic episodes of “thinking a lot,” or on what might be called the “thinking a lot” causal network. © 2016, Springer Science+Business Media New York.

Author Keywords

cross-cultural psychiatry “Thinking too much” “Thinking a lot” Cultural concepts of distress Rumination Idioms of distress

Index Keywords

Models, Psychological psychological model refugee Psychological Trauma psychotrauma ethnology Ethnopsychology Cambodia Mental Disorders cultural psychology mental disease thinking human Humans Refugees psychology
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84963774082&doi=10.1007%2fs11013-016-9489-4&partnerID=40&md5=0312028235704cae3d5b6131847f3d71
DOI: 10.1007/s11013-016-9489-4
ISSN: 0165005X
Cited by: 12
Original Language: English