Explanatory models of mental illness: a qualitative study with Emirati future mental health practitioners

Cultural traits have an influence on the person's interpretation of mental illness, the expression of distress and help-seeking attitudes. UAE has a unique sociological context where Eastern and Western traditions coexist. Given that there is a scarcity of mental health studies and no study on the explanatory models (EM) of mental illness, it is important to examine the connections between Western biomedical approaches and traditional Emirati illness explanations and how those affect the Emirati EM. In order to explore the influence of those connections on Emirati future clinicians, the present study focuses on young Emirati psychology students in a Western-oriented university. In-depth interviews were performed regarding their EM. The results highlighted the influence of cultural traits on the EM formulation, the importance of family in the Emirati society and the impact of the UAE socio-economic and religious reality in forming the participants’ beliefs on mental illness.     

Explanatory models for mental illness endorsed by Christian clergymen: The development and use of an instrument in Singapore

Researchers have attempted to elicit the explanatory models used by different populations to understand mental illness, since these models can influence how populations use mental-health treatment. However, little effort has been made to understand the explanatory models used by Christian clergymen. This is despite their important role as providers of mental-health care in many Asian and Western societies. Neither are there suitable instruments to conduct such investigations. This study attempts to present a suitable instrument for such research and explore the belief structure of this population by administering a modified version of the Opinions about Psychological Problems to a representative sample of Singaporean Christian clergymen. Factor-analytic techniques revealed five factors which were explained as (1) a Traditional Christian and (2) a Deliverance etiology, both models implicating religious causes for mental illness, (3) a Poor Coping and (4) Internal Conflicts etiology, essentially being psychological explanations and an (5) Organic etiology model. The Traditional Christian model received the greatest endorsement, followed by the Poor Coping model, while the Organic model had the least acceptance. The belief structure used by nearly half of the respondents was noted to be complex, involving a combination of religious, psychological, and organic explanations.     

Service in the Gulf War and Significant Health Problems: Focus on the Central Nervous System

The consensus of several studies on health among Gulf War (GW)-deployed veterans is that they have elevated symptom complaints. Central nervous system (CNS) symptoms among these veterans have been assessed in several investigations. Studies have disagreed as to whether there are neuropsychological deficits in GW-deployed veterans relative to controls. When differences between these groups have been found, they have often been attributed to stress or psychiatric factors, although exposures to neurotoxic substances present in the GW theatre have also been indicted as possible explanations. A review of the existing literature as well as the 5 papers contained in this issue of Journal of Psychopathology and Behavioral Assessment suggests that the neuropsychological and health symptom sequelae of GW zone service are multidetermined and cannot easily be explained on the basis of simplistic models of causation. Psychological, historical, and exposure parameters must be considered in the scientific evaluation of this problem.     

Bewitchment, biology, or both: the co-existence of natural and supernatural explanatory frameworks across development

Three studies examined the co-existence of natural and supernatural explanations for illness and disease transmission, from a developmental perspective. The participants (5-, 7-, 11-, and 15-year-olds and adults; N = 366) were drawn from 2 Sesotho-speaking South African communities, where Western biomedical and traditional healing frameworks were both available. Results indicated that, although biological explanations for illness were endorsed at high levels, witchcraft was also often endorsed. More important, bewitchment explanations were neither the result of ignorance nor replaced by biological explanations. Instead, both natural and supernatural explanations were used to explain the same phenomena, and bewitchment explanations were highest among adults. Taken together, these data provide insight into how diverse, culturally constructed belief systems about illness co-exist across development.     

Children's concepts of illness: Towards an alternative to the “Stage” approach

Abstract

Research concerned with the development of children's beliefs about health and illness has practical implications for educating children about their illness, treatment and hospital admission. Previous research has suggested that beliefs about health and illness develop through a series of systematic stages, and that children are unable to understand explanations in advance of their own cognitive level. Alternative theories which give greater emphasis to the role of experience are considered, and some implications for clinical practice drawn.     

A Systematic Review of the Literature Exploring Illness Perceptions in Mental Health Utilising the Self-Regulation Model

Psychologists have utilised a range of social cognition models to understand variation in physical health and illness-related behaviours. The most widely studied model of illness perceptions has been the Self-Regulation Model (SRM, Leventhal, Nerenz, & Steele, 1984). The illness perceptions questionnaire (IPQ) and its revised version (IPQ-R) have been utilised to explore illness beliefs in physical health. This review examined 13 quantitative studies, which used the IPQ and IPQ-R in mental health in their exploration of illness perceptions in psychosis, bipolar disorder, eating disorders, depression and adolescents experiencing mood disorders. Across these studies the SRM illness dimensions were largely supported. Mental illnesses were commonly viewed as cyclical and chronic, with serious negative consequences. Perceptions regarding chronicity, controllability and negative consequences were associated with coping and help seeking, while engagement with services and help seeking were also related to illness coherence beliefs. Treatment adherence was linked to beliefs that treatment could control one’s illness. Whilst a major limitation of the reviewed studies was the use of cross-sectional designs, overall the applicability of the SRM to mental health was supported. The IPQ and IPQ-R were shown to be valuable measures of illness perceptions in mental health, offering implications for clinical practice.     

Psychological correlates of negative self-assessed health

The recent growth in the area now subsumed under the title health psychology can be seen to reflect real changes in the societal pre-occupation with health promotion. Established models within health psychology have tended to focus on the interface between the individual and the health care system. Moreover, as a consequence of employing the tripartite model of health, illness and sick-role behaviour as separate entities, research has tended to construct barriers between these behaviours. In is necessary to develop psychological models within health psychology rather than use the education model of the medical orthodoxy. This study explored the distinguishing features of a sub-group of women within the sample who were identified as having relatively negative self-assessed health. Data was obtained on their experience of health and illness, their involvement in health-related behaviours (HRB) and their health beliefs. It was shown that this group was more likely to be involved in damaging HRB, but involvement in positive HRB did not differ from the main sample. They tended to anticipate an improvement over time from their present health status which they felt had been influenced by their own behaviour and by their experience of motherhood.     

Day-to-Day Physical Symptoms: Individual Differences in the Occurrence, Duration, and Emotional Concomitants of Minor Daily Illnesses

Even minor illnesses represent significant events in the ongoing lives of most people. As such, daily event methodologies could be applied to the study of ongoing health and illness. When daily health is considered as a temporal process, it is possible to expand our formulation of the relation between personality and day-to-day health. We used a daily event approach to model three temporal parameters of day-to-day health: the occurrence rate of symptoms, the duration of symptoms, and the covariation of symptoms and moods over time. We then examine whether these three models of day-to-day health are related to personality variables commonly used in health psychology research. The occurrence of illness related most strongly to neuroticism, the duration of illness related most strongly to the trait of aggressive responding, and Type A behavior related to less unpleasant affect reported during episodes of respiratory infection, aches, and depressive symptoms. Results are discussed in terms of how alternative models of health/illness are made possible by the daily event perspective.     

Health practices and hardiness as mediators in the stress-illness relationship

Two stress and illness models that include the joint mediating effects of health practices and hardiness were tested prospectively over a 2-month period. At the beginning of one academic quarter, 60 female and 26 male undergraduate students completed five subscales indexing hardiness. Stress, health practices, and illness for the prior month were assessed at this time as well as 1 and 2 months later. Stress was measured by the number of negatively rated stressors reported on the Life Experiences Survey. Health practices were measured by the Self Care Inventory. In the first model, illness was measured by the severity of physical symptoms reported on the Seriousness of Illness Rating Scale; in the second model, it was measured by the number of symptoms reported. Correlations between all measures of stress and illness were typical for life events research (r = .22 to .29). In both models, path analyses revealed that stress acted directly to affect illness as well as indirectly by changing health practices. Hardiness also had a direct effect on illness as well as in indirect effect through health practices. Hardiness did not appear to have a stress-buffering effect on illness; rather, its effects on illness appeared to be independent of its effects on stress. Implications for life events research are discussed.     

The cost of good fortune: when positive life events produce negative health consequences

Previous research regarding the effects of positive life events on physical health has been inconclusive. We tested the hypothesis that positive life events have a detrimental effect on health only among people with negative self-views. This prediction derives from an identity disruption model of stress, which holds that an accumulation of life events that are inconsistent with the self-concept leads to physical illness. To test the hypothesis, we conducted two prospective studies in which positive life events and self-esteem were used to predict the development of illness over time. In accordance with predictions, both studies showed that desirable life changes were associated with increases in illness only among subjects with low self-esteem; among subjects with high self-esteem, positive life events were linked to better health. Implications for understanding the manner in which life events affect health are considered.     

Categorical reasoning from multiple diagrams.

Syllogistic reasoning from categorical premise pairs is generally taken to be a multistep process. Quantifiers (all, no, some, some ... not) must be interpreted, representations constructed, and conclusions identified from these. Explanations of performance have been proposed in which errors may occur at any of these stages. The current paper contrasts (a) representation explanations of performance, in which errors occur because not all possible representations are constructed, and/or mistakes are made when doing so (e.g., mental models theory), and (b) conclusion identification explanations, in which errors occur even when information has been correctly and exhaustively represented, due to systematic difficulties that people may have when identifying particular conclusions, or in identifying conclusions in particular circumstances. Three experiments are reported, in which people identified valid conclusions from diagrams analogous to Euler circles, so that the first two stages of reasoning from premise pairs were effectively removed. Despite this, several phenomena associated with reasoning from premise pairs persisted, and it is suggested that whereas representation explanations may account for some of these phenomena, conclusion identification explanations, which have never previously been considered, are required for others.     

Du modèle transactionnel à une approche dyadique en psychologie de la santé

In the context of chronic disease, models and studies in health psychology have first focused on the patients’ adjustment. Research conducted with the Transactional Model of Stress and Coping (Lazarus and Folkman, 1984) and the Transactional Integrative and Multifactorial Model (Bruchon-Schweitzer, 2002) have shown that individuals’ social relations, and especially family support, are associated to patients’ outcomes. Recently, studies have taken more attention to the “significant others”, most often the partners. In fact, relatives are also affected indirectly by the disease and its changes on daily life. Moreover, they often play a crucial role by helping the patient to face the disease. These models are focused on the individual and are not relevant to study dyads. An evolution of these models can be proposed by integrating a systemic and dyadic approach. In fact, the way the patient and the relative face the disease, the quality of their relation but also the way they face the disease together, as a dyad, have to be considered. The first part of this article presents the Transactional Model of Stress and Coping and the Transactional Integrative and Multifactorial Model and their evolutions. The second part shows how it is possible to develop a dyadic approach based on these models. It presents the Family System-Illness Model (Rolland, 1987), the Developmental-Contextual Model of couples coping with chronic illness across the adult life span (Berg and Upchurch, 2007) and a Systemic and Transactional Model of Dyads, which help to take more completely into account the adjustment processes of patients and relatives to a chronic illness.     

Examining Explanatory Biases in Young Children's Biological Reasoning

Despite the well-established literature on explanation in early childhood, little is known about what constrains children's explanations. State change and negative outcomes were examined as potential explanatory biases in the domain of naïve biology, extending upon previous work in the domain of naïve physics. In two studies, preschool children (N = 70, 3- to 5-year-olds) were informed of the distinct health outcomes of characters in four between-subjects conditions (i.e., becoming ill, recovering from illness, continuous health, and continuous illness) and were asked to provide explanations. Whereas children in both studies provided relevant information for health outcomes, they more often explained outcomes that included a salient health-state change. Presence of a state change also influenced the interpretation of potentially relevant information and improved memory for health outcomes. We discuss how biases in children's explanations constrain children's reasoning and may exacerbate difficulties with reasoning about important health-related topics such as illness prevention.     

Revisiting the imaginary audience and personal fable constructs of adolescent egocentrism: a conceptual review

Adolescents are thought to believe that others are always watching and evaluating them, and that they are special and unique, labeled the imaginary audience and the personal fable, respectively. These two constructs have been fixtures in textbooks on adolescent development, and have been offered as explanations for self-consciousness and risk-taking. However, their characterization of adolescent social cognition as biased has not been supported empirically, the measures used to assess them lack construct validity, and alternative explanations for both ideation patterns have not been explored. Despite these issues, the imaginary audience and personal fable constructs continue to be considered prototypical representations of social cognitive processes during adolescence. This paper (1) reviews theoretical models of the imaginary audience and the personal fable, and the empirical data pertaining to each model, (2) highlights problems surrounding the two most commonly used measures, and (3) outlines directions for future research, so that a better understanding of the imaginary audience and personal fable, and their roles in adolescent development, may be achieved.     

Psychoanalytic and biological approaches to mental illness: schizophrenia.

Biological psychiatrists tend to look upon the phenomena of mind and meaning, which are the data of psychoanalysis, as meaningless epiphenomena, and propose reductive explanations of complex mental states, whereas psychoanalysts tend to ignore the proliferation of neurobiological data indicating the importance of constitutional factors in mental illness. Interactive models which confuse biological causes and psychological consequences, or vice-versa, are theoretically unsound. A scientific model hierarchy is proposed, along with some principles for coexistence and collaboration between neurobiology and psychoanalysis. The problem is illustrated with schizophrenia, a condition whose probable biological underpinnings are now generally considered to remove it from the realm of psychoanalysis. Schizophrenia-vulnerable phenotypes consistent with organic findings and clinical observations are hypothesized, and some ideas about their development in the context of early object relations, leading to pathological forms of symbiosis, are elaborated. A neurobiological rationale for the psychoanalytic treatment of schizophrenia is presented, and special problems related to the biological and symbiotic substrate are examined.     

Conceptualising mental health in the United Arab Emirates: the perspective of traditional healers

Substantial investments in health-care have ensured the widespread availability of allopathic medical services across the United Arab Emirates (UAE). However, in spite of this accessibility traditional healers (Mutawa) continue to play a significant, albeit, unofficial role in the UAE's health sector. Citizens routinely consult traditional healers for problems that might, from a western biomedical perspective, be considered psychiatric conditions. This qualitative study explores traditional healers' conceptualisations of mental health problems, discussing their perspectives on phenomenology, aetiology, intervention and outcome. Notably, traditional healers distinguished between biomedical illness and states they attributed to demonological or metaphysical causes. The Islamic spiritual narrative was central to discussions of aetiology, intervention and outcome. Greater integration of traditional healers within the UAE's mental health-care services would, in many cases, improve patient experience and outcomes.     

Parental illness,attachment dimensions,and health beliefs: testing the cognitive-behavioural and interpersonal models of health anxiety

The cognitive-behavioral and interpersonal models of health anxiety propose that parental illness could be a contributory factor to the development of health anxiety but through different mechanisms. The cognitive-behavioral model suggests that exposure to parental illness may lead to health beliefs that could increase health anxiety. In contrast, the interpersonal model proposes that parental illness may contribute to the development of an insecure attachment pattern and consequently health anxiety. To assess the additive value of the models, 116 emerging adults (i.e. aged 18–25) who had a parent diagnosed with a serious medical illness (e.g. cancer, multiple sclerosis) completed measures of health anxiety, adult attachment dimensions, and health beliefs. Attachment anxiety, attachment avoidance, health beliefs, and death of the ill parent were statistically significant predictors of health anxiety. The results provide support for both models of health anxiety. Theoretical implications and directions for future research are discussed.