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Global Mental Health and Idioms of Distress: The Paradox of Culture-Sensitive Pathologization of Distress in Cambodia.
Cult Med Psychiatry. 2019 Jun; 43(2):211-235.CM

Abstract

Efforts to provide culturally appropriate global mental health interventions have included attention to local idioms of distress. This article critically examines the potential gap between lay ethnopsychological understandings of the Cambodian idiom of baksbat (broken courage) on the one hand and clinical conceptualizations of the idiom as a potential indicator of posttraumatic stress disorder. Ethnographic semi-structured interviews with trauma survivors reveal resistance to current clinical translations and hybrid Euro-Western and Khmer treatment interventions. While the notion of idioms of distress is intended to draw attention to everyday non-pathologizing forms of discourse, the creation of hybrid assessment and treatment constructs linking idioms to trauma-related pathology may obscure the pragmatic communicative functions of the idiom, making them subordinate to an existing model of psychiatric disorder and pathologizing everyday modes of coping. Participants' narratives highlight self-perceived connections between stressors that determine the trajectory and outcome of distress and shared cultural worldviews that together uniquely shape their meaning. These observations point to the dilemmas of linking idioms of distress with co-morbid illness constructs in ways that may pathologize normal emotional responses. Results have implications for efforts to develop effective models of post-conflict trauma care in global mental health.

Authors+Show Affiliations

Department of Anthropology, University of Haifa, Mt. Carmel, Haifa, Israel. ckidron@soc.haifa.ac.il.Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30515681

Citation

Kidron, Carol A., and Laurence J. Kirmayer. "Global Mental Health and Idioms of Distress: the Paradox of Culture-Sensitive Pathologization of Distress in Cambodia." Culture, Medicine and Psychiatry, vol. 43, no. 2, 2019, pp. 211-235.
Kidron CA, Kirmayer LJ. Global Mental Health and Idioms of Distress: The Paradox of Culture-Sensitive Pathologization of Distress in Cambodia. Cult Med Psychiatry. 2019;43(2):211-235.
Kidron, C. A., & Kirmayer, L. J. (2019). Global Mental Health and Idioms of Distress: The Paradox of Culture-Sensitive Pathologization of Distress in Cambodia. Culture, Medicine and Psychiatry, 43(2), 211-235. https://doi.org/10.1007/s11013-018-9612-9
Kidron CA, Kirmayer LJ. Global Mental Health and Idioms of Distress: the Paradox of Culture-Sensitive Pathologization of Distress in Cambodia. Cult Med Psychiatry. 2019;43(2):211-235. PubMed PMID: 30515681.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Global Mental Health and Idioms of Distress: The Paradox of Culture-Sensitive Pathologization of Distress in Cambodia. AU - Kidron,Carol A, AU - Kirmayer,Laurence J, PY - 2018/12/6/pubmed PY - 2019/12/4/medline PY - 2018/12/6/entrez KW - Cambodia KW - Cultural competence KW - Global mental health KW - Idioms of distress KW - Khmer KW - Trauma SP - 211 EP - 235 JF - Culture, medicine and psychiatry JO - Cult Med Psychiatry VL - 43 IS - 2 N2 - Efforts to provide culturally appropriate global mental health interventions have included attention to local idioms of distress. This article critically examines the potential gap between lay ethnopsychological understandings of the Cambodian idiom of baksbat (broken courage) on the one hand and clinical conceptualizations of the idiom as a potential indicator of posttraumatic stress disorder. Ethnographic semi-structured interviews with trauma survivors reveal resistance to current clinical translations and hybrid Euro-Western and Khmer treatment interventions. While the notion of idioms of distress is intended to draw attention to everyday non-pathologizing forms of discourse, the creation of hybrid assessment and treatment constructs linking idioms to trauma-related pathology may obscure the pragmatic communicative functions of the idiom, making them subordinate to an existing model of psychiatric disorder and pathologizing everyday modes of coping. Participants' narratives highlight self-perceived connections between stressors that determine the trajectory and outcome of distress and shared cultural worldviews that together uniquely shape their meaning. These observations point to the dilemmas of linking idioms of distress with co-morbid illness constructs in ways that may pathologize normal emotional responses. Results have implications for efforts to develop effective models of post-conflict trauma care in global mental health. SN - 1573-076X UR - https://www.unboundmedicine.com/medline/citation/30515681/Global_Mental_Health_and_Idioms_of_Distress:_The_Paradox_of_Culture_Sensitive_Pathologization_of_Distress_in_Cambodia_ L2 - https://doi.org/10.1007/s11013-018-9612-9 DB - PRIME DP - Unbound Medicine ER -