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Laurence J Kirmayer

Publications and source records attributed to Laurence J Kirmayer.

At least 19 recordsLinked to original sources
PubMed2006

Abnormal illness behaviour: physiological, psychological and social dimensions of coping with distress.

PURPOSE OF REVIEW: Pilowsky introduced the term 'abnormal illness behaviour' to characterize syndromes of excessive or inadequate response to symptoms, including hypochondriasis, somatization, and denial of illness. This review summarizes recent work from sociology, health psychology and psychiatry that contributes to an understanding of the processes that may underlie abnormal illness behaviour. RECENT FINDINGS: Disturbances in the regulation of physiological systems may account for many 'unexplained' symptoms and sickness behaviour. Increased attention to bodily sensations, sensitivity to pain and catastrophizing play important roles in illness behaviour in medical illness. Developmental adversities and parental modelling of illness behaviour in childhood may increase bodily preoccupation and health care utilization. Apparent cross-national differences in illness behaviour may reflect differences in health care systems, but cultural models of illness and social stigma remain important determinants of illness denial and avoidance of mental health services. SUMMARY: Research into illness behaviour is relevant to efforts to rethink the psychiatric nosology of somatoform disorders. The discrete somatoform disorders might well be replaced by a dimensional framework that identifies specific pathological processes in cognition, perception and social behaviour that contribute to bodily distress, impaired coping, inappropriate use of health services, chronicity and disability.

Adaptation, Psychological↗
PubMed2006

The persistence of mind-brain dualism in psychiatric reasoning about clinical scenarios.

OBJECTIVE: Despite attempts in psychiatry to adopt an integrative biopsychosocial model, social scientists have observed that psychiatrists continue to operate according to a mind-brain dichotomy in ways that are often covert and unacknowledged and suggest that the same intuitive cognitive schemas that people use to make judgments of responsibility lead to dualistic reasoning among clinicians. The goal of this study was to confirm these observations. METHOD: Self-report questionnaires were sent to the 270 psychiatrists and psychologists in the Department of Psychiatry at McGill University. In response to clinical vignettes, the participants rated the level of intentionality, controllability, responsibility, and blame attributable to the patients, as well as the importance of neurobiological, psychological, and social factors in explaining the patients' symptoms. RESULTS: A total of 136 faculty members (50.4%) responded, and 127 were included in the analysis. Factor analysis revealed a single dimension of responsibility regarding the patients' illnesses that correlated positively with ratings of psychological etiology and negatively with ratings of neurobiological etiology. Psychological and neurobiological ratings were inversely correlated. Multivariate analyses of variance supported these results. CONCLUSIONS: Mental health professionals continue to employ a mind-brain dichotomy when reasoning about clinical cases. The more a behavioral problem is seen as originating in "psychological" processes, the more a patient tends to be viewed as responsible and blameworthy for his or her symptoms; conversely, the more behaviors are attributed to neurobiological causes, the less likely patients are to be viewed as responsible and blameworthy.

Algorithms↗
PubMed2006

Understanding immigrants' reluctance to use mental health services: a qualitative study from Montreal.

OBJECTIVE: Studies suggest that non-European immigrants to Canada tend to under use mental health services, compared with Canadian-born people. Social, cultural, religious, linguistic, geographic, and economic variables may contribute to this underuse. This paper explores the reasons for underuse of conventional mental health services in a community sample of immigrants with identified emotional and somatic symptoms. METHOD: Fifteen West Indian immigrants in Montreal with somatic symptoms and (or) emotional distress, not currently using mental health services, participated in a face-to-face in-depth interview exploring health care use. Interviews were analyzed thematically to discern common factors explaining reluctance to use services. RESULTS: Across participants' narratives, we identified 3 significant factors explaining their reluctance to use mental health services. First, there was a perceived overwillingness of doctors to rely on pharmaceutical medications as interventions. Second, participants perceived a dismissive attitude and lack of time from physicians in previous encounters that deterred their use of current health service. Third, many participants reported a belief in the curative power of nonmedical interventions, most notably God and to a lesser extent, traditional folk medicine. CONCLUSION: The above factors may highlight important areas for intervention to reduce disparities in immigrant use of mental health care. We present our framework as a model, grounded in empirical data, that further research can explore.

Caribbean Region↗
PubMed2006

Beyond the 'new cross-cultural psychiatry': cultural biology, discursive psychology and the ironies of globalization.

The 'new cross-cultural psychiatry' heralded by Kleinman in 1977 promised a revitalized tradition that gave due respect to cultural difference and did not export psychiatric theories that were themselves culture bound. In the ensuing years, the view of culture within anthropology has continued to change, along with our understanding of the relationship of biological processes to cultural diversity, and the global political economic contexts in which mental health care is delivered. This article considers the implications of these new notions of culture, biology and the context of practice for theory in cultural psychiatry. The future of cultural psychiatry lies in advancing a broad perspective that: (a) is inherently multidisciplinary (involving psychiatric epidemiology, medical anthropology and sociology, cognitive science and social psychology), breaking down the nature/culture dichotomy with an integrative view of culture as a core feature of human biology, while remaining alert to cultural constructions of biological theory; (b) attends to psychological processes but understands these as not exclusively located within the individual but as including discursive processes that are fundamentally social; and (c) critically examines the interaction of both local and global systems of knowledge and power. Globalization has brought with it many ironies for cultural psychiatry: Transnational migrations have resulted in cultural hybridization at the same time as ethnicity has become more salient; the call for evidence-based medicine has been used to limit the impact of cultural research; and cultural psychiatry itself has been co-opted by pharmaceutical companies to inform marketing campaigns to promote conventional treatments for new populations. Cultural psychiatry must address these ironies to develop the self-critical awareness and flexibility needed to deliver humane care in shifting contexts.

Biology↗
PubMed2006

The McGill Illness Narrative Interview (MINI): an interview schedule to elicit meanings and modes of reasoning related to illness experience.

This article summarizes the rationale, development and application of the McGill Illness Narrative Interview (MINI), a theoretically driven, semistructured, qualitative interview protocol designed to elicit illness narratives in health research. The MINI is sequentially structured with three main sections that obtain: (1) A basic temporal narrative of symptom and illness experience, organized in terms of the contiguity of events; (2) salient prototypes related to current health problems, based on previous experience of the interviewee, family members or friends, and mass media or other popular representations; and (3) any explanatory models, including labels, causal attributions, expectations for treatment, course and outcome. Supplementary sections of the MINI explore help seeking and pathways to care, treatment experience, adherence and impact of the illness on identity, self-perception and relationships with others. Narratives produced by the MINI can be used with a wide variety of interpretive strategies drawn from medical anthropology, sociology and discursive psychology.

Anthropology, Cultural↗
PubMed2005

Breastfeeding and the cultural configuration of social space among Vietnamese immigrant woman.

This study aimed to identify cultural factors involved in the abandonment of breastfeeding amongst Vietnamese immigrant women in Canada. Qualitative interviews were conducted with 19 mothers, exploring their perinatal experience from Vietnam to Canada. The results suggest that the decision to bottle-feed was not related to acculturation to local practices as has been claimed in previous studies but to conflicts between Vietnamese cultural practices and the configuration of the new social space in Canada. Living in Canada did not allow specific family members to conduct postnatal traditional rituals thus jeopardizing mothers' perceived health and the quality of their milk. Culturally appropriate strategies to promote breastfeeding among migrants must consider the social and spatial organization of cultural practices.

Adult↗
PubMed2005

Somatoform disorders: time for a new approach in DSM-V.

OBJECTIVE: DSM-III introduced somatoform disorders as a speculative diagnostic category for somatic symptoms "not explained by a general medical condition." Although retained and enlarged in DSM-IV, somatoform disorders have been the subject of continuing criticism by both professionals and patients. The extended period of preparation for DSM-V offers an important opportunity to reconsider the category of somatoform disorders. METHOD: Exploration of the diverse aims of a diagnostic classification indicates that the authors must not only address the conceptual and practical problems associated with this category but also reconcile it with the parallel medical descriptive classification of functional symptoms and syndromes. RESULTS: The existing somatoform disorders categories require modification. The authors favor the radical option of the abolition of the categories. Diagnoses currently within somatoform disorders could be redistributed into other groupings, and the disorders currently defined solely by somatic symptoms could be placed on axis III as "functional somatic symptoms and syndromes." Greater use could be made of "psychological factors affecting medical condition" on axis I. The authors suggest supplementing the diagnosis of functional somatic symptoms with a multiaxial formulation. CONCLUSIONS: The authors promote a classification of somatic symptoms in DSM-V that is compatible with that used in general medicine and offers new opportunities both for research into the etiology and treatment of symptoms and for the greater integration of psychiatry into general medical practice.

Attitude of Health Personnel↗
PubMed2005

The role of Afro-Canadian status in police or ambulance referral to emergency psychiatric services.

OBJECTIVE: This study tested the hypothesis that among patients admitted to a hospital with psychosis, Afro-Canadian patients would be more likely than Euro-Canadian or Asian-Canadian patients to be brought to emergency services by police or ambulance. METHODS: Data on psychotic patients admitted to the psychiatry ward in 1999 were extracted from records of a general hospital in Montreal. Logistic regression models examined the relationship between being Afro-Canadian and being brought to the emergency service by police or ambulance, while controlling for age, gender, marital status, and number of psychotic symptoms. RESULTS: Of the 351 patients with psychosis, 59 percent were Euro-Canadian, 11 percent were Afro-Canadian, and 18 percent were Asian Canadian. Most Afro-Canadian patients in the study were immigrants from the Caribbean and Africa. Being Afro-Canadian was independently and positively associated with police or ambulance referral to emergency services. CONCLUSIONS: Afro-Canadians admitted to the hospital with psychosis are overrepresented in police and ambulance referrals to emergency psychiatric services.

Adult↗
PubMed2005

Inuit interpretations of sleep paralysis.

Traditional and contemporary Inuit concepts of sleep paralysis were investigated through interviews with elders and young people in Iqaluit, Baffin Island. Sleep paralysis was readily recognized by most respondents and termed uqumangirniq (in the Baffin region) or aqtuqsinniq (Kivalliq region). Traditional interpretations of uqumangirniq referred to a shamanistic cosmology in which the individual's soul was vulnerable during sleep and dreaming. Sleep paralysis could result from attack by shamans or malevolent spirits. Understanding the experience as a manifestation of supernatural power, beyond one's control, served to reinforce the experiential reality and presence of the spirit world. For contemporary youth, sleep paralysis was interpreted in terms of multiple frameworks that incorporated personal, medical, mystical, traditional/shamanistic, and Christian views, reflecting the dynamic social changes taking place in this region.

Adult↗
PubMed2005

Religious practice and psychological distress: the importance of gender, ethnicity and immigrant status.

The present study examined the relationship between religious practice and psychological distress in a culturally diverse urban population to explore how religious affiliation, gender, ethnicity, and immigrant status affect this relationship. Data were drawn from a study of health care utilization in Montreal. A stratified community sample of 1485 yielded four religious groups: Protestant (n = 205), Catholic (813), Jewish (201), and Buddhist (150), and a group with no declared religion (116). The sample was composed of five ethnocultural groups: Anglophone Canadian-born, Francophone Canadian-born, Afro-Caribbean, Vietnamese, and Filipino immigrants. Psychological distress was assessed with the 12-item version of the General Health Questionnaire (GHQ). Religious involvement was measured with three items: 1) declared religion; 2) frequency of attendance at religious meetings; and 3) frequency of religious rituals performed at home. Multiple regression models examined the relationship of religious practice to distress, controlling for sociodemographic variables including ethnicity. Overall, attendance at religious services was associated with a lower GHQ score. Attendance at religious services also was inversely related to psychological distress for females, Protestants, Catholics, Filipinos, and Afro-Caribbeans; but not for males, Buddhists or Jews. Religious practice at home was not associated with level of distress for any group. The 'no declared religion' group had the highest mean GHQ score of all the groups. Results confirm the association between attendance at religious services and lower levels of distress, but reveal ethnospecific and gender effects indicating the need to understand the impact of religious practice on mental health in social and cultural context.

Adolescent↗
PubMed2004

Research ethics and the plight of refugees in detention.

Health researchers may have a strategic role to play in confronting the predicament of refugee detainees because they can lend their analytic skills and authority to document the personal cost and impact of this practice. The justification for such 'subversive' research comes from the discrepancy between the sources of legitimacy and legality for government action. The practice of detention may be legal but illegitimate, judged against the standards of international human rights. Hence, research to explore the consequences of this policy is both morally and politically legitimate. Morally, it reflects a commitment to uncover and oppose unjustified violence against others; politically, it represents an attempt to identify and challenge abuses of power by the state. However, doing research without official approval or with the use of deception raises concerns for the safety of detainees as vulnerable research subjects as well as the credibility of researchers and the research enterprise. Researchers also may face sanctions that will limit their future effectiveness. An international network of researchers working on issues of human rights and the health of asylum seekers can provide an institutional basis to support work that challenges local practices.

Australia↗
PubMed2004

Perceived stigma in functional somatic syndromes and comparable medical conditions.

OBJECTIVE: To determine if patients with functional somatic syndromes (FSS) perceive greater levels of stigma than patients with comparable medical conditions that have a clear medical pathology. METHODS: Patients with chronic fatigue syndrome (CFS), fibromyalgia (FM), or irritable bowel syndrome (IBS) were compared to multiple sclerosis (MS), rheumatoid arthritis (RA), and inflammatory bowel disease (IBS), respectively. RESULTS: There were greater levels of perceived stigma in the combined group of FSS compared to the medical control group. When each FSS was compared to its matched control group, only CFS had a higher level of perceived stigma. These results remained when controlling for other variables relevant to stigma. CONCLUSIONS: The higher level of perceived stigma in CFS may be due to the ambiguity of its status as a medical condition. The absence of this effect in FM and IBS is consistent with a greater level of acceptance of these disorders as medical illnesses.

Activities of Daily Living↗
PubMed2004

The cultural diversity of healing: meaning, metaphor and mechanism.

This chapter reviews the great diversity of healing practices found around the world and represented in most urban centres. A general model of healing is presented that includes both the physiological processes central to biomedical theory and practice and the symbolic aspects of healing that have physiological, psychological and social effects. Work on the theory of metaphor in cognitive science provides a way to understand the transformation of experience across levels of sensory, affective and conceptual meaning. Healing rituals and other symbolic action can thus have effects on physiology, experience, interpersonal interaction and social positioning. Complementary medicine and traditional forms of healing are attractive to many individuals both because of the limitations of biomedicine and their metaphoric logic of transformation, which promises wholeness, balance and well-being. Participation in specific healing traditions may also contribute to individual and collective identity.

Attitude to Health↗
PubMed2004

Explaining medically unexplained symptoms.

Patients with medically unexplained symptoms comprise from 15% to 30% of all primary care consultations. Physicians often assume that psychological factors account for these symptoms, but current theories of psychogenic causation, somatization, and somatic amplification cannot fully account for common unexplained symptoms. Psychophysiological and sociophysiological models provide plausible medical explanations for most common somatic symptoms. Psychological explanations are often not communicated effectively, do not address patient concerns, and may lead patients to reject treatment or referral because of potential stigma. Across cultures, many systems of medicine provide sociosomatic explanations linking problems in family and community with bodily distress. Most patients, therefore, have culturally based explanations available for their symptoms. When the bodily nature and cultural meaning of their suffering is validated, most patients will acknowledge that stress, social conditions, and emotions have an effect on their physical condition. This provides an entree to applying the symptom-focused strategies of behavioural medicine to address the psychosocial factors that contribute to chronicity and disability.

Culture↗
PubMed2004

Knowledge structures in illness narratives: development and reliability of a coding scheme.

Illness narratives reflect patients' underlying illness schemas or models of illness as well as efforts to position themselves vis-à-vis a specific interlocutor and social context. Although the literature on illness narratives in medical anthropology has been dominated by the explanatory model perspective, people may use other types of knowledge structures to frame and construct their conceptions of symptoms. For this study, we developed operational definitions and a coding manual for three types of putative knowledge schemas: prototypes, chain complexes, and explanatory accounts. The operationalized definitions were then applied to coding a sample of illness narratives collected in a study of help-seeking in an urban community population. It was found that all three knowledge structures could be reliably identified in these narratives. This method of analysis provides a way to test hypotheses regarding the role of knowledge structures in illness narratives.

Adolescent↗
PubMed2003

Correlates of illness worry in chronic fatigue syndrome.

BACKGROUND: Anxiety about illness leading to restriction of activity and physical deconditioning has been hypothesized to contribute to the chronicity of fatigue. Pathological symptom attributions, personality traits, and depression have all been hypothesized to contribute to illness worry. METHODS: We compared 45 chronic fatigue syndrome (CFS) and 40 multiple sclerosis (MS) outpatients using a battery of psychometric instruments comprising the 12-item Illness Worry scale, the Symptom Interpretation Questionnaire (SIQ), the NEO Five-Factor Inventory (NEO-FFI), and a modified version of the SCL-90R Depression scale. RESULTS: There was no difference between the two diagnostic groups on neuroticism, depressive symptoms, as well as the three scales of the SIQ. On the illness worry index, the CFS group had significantly higher scores than the MS group. This difference was due to items tapping vulnerability to illness and the perception that others are not taking their illness seriously. Somatic attributional style, neuroticism, depressive symptoms, and age were all significant predictors of illness worry in both CFS and MS patients. CONCLUSIONS: Somatic attributions, neuroticism, and depression all contribute to illness worry in chronic illness. However, these factors do not account for the higher levels of illness worry in CFS as opposed to MS, which may be due to other specific cognitive and social interactional processes.

Adult↗
PubMed2003

Cultural consultation: a model of mental health service for multicultural societies.

OBJECTIVES: This paper reports results from the evaluation of a cultural consultation service (CCS) for mental health practitioners and primary care clinicians. The service was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Cultural consultations were based on an expanded version of the DSM-IV cultural formulation and made use of cultural consultants and culture brokers. METHODS: We documented the service development process through participant observation. We systematically evaluated the first 100 cases referred to the service to establish the reasons for consultation, the types of cultural formulations and recommendations, and the consultation outcome in terms of the referring clinician's satisfaction and recommendation concordance. RESULTS: Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up. CONCLUSION: The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture brokers.

Adult↗