Explanatory models in psychiatry

Bhui & Bhugra (2002) rightly identify the importance of eliciting patient explanatory models in routine clinical psychiatric practice. Also, they highlight the difficulties in applying this socio-anthropological perspective in routine clinical practice and mental health research. The reductionistic nature of psychiatric classifications, the inherent diversity within diagnostic categories, the fact that choice of therapy is not category-specific but is based on clinical presentation and symptoms, and the variability of outcomes demand the individualisation of care (Jacob, 1999). Bhui & Bhugra attempt to address this complex reality related to mental illness by taking a pragmatic approach.

I agree with Bhui & Bhugra that the transition from illness experience to disorder is determined by social decision points rather than biomedically determined levels of disorder. This is conceptually sound from a socio-anthropological point of view which has approached the issues from a sociocultural perspective. Hitherto, medical anthropologists and sociologists viewed individuals' explanatory models as alternatives to the biomedical model. This would be an oversimplified application of an anthropological perspective in psychiatric practice. Although individual explanatory models are arguably more appropriate, they are not alternatives. Given the incomplete understanding of mental illness by the scientific community, it is not clear whether explanatory models alone are able to capture the complex mental health needs of patients across cultures.

As Bhui & Bhugra mentioned, in many cases the clinical reality is that individual explanatory models and biomedical diagnostic categories are not mutually exclusive but complementary. Medical/biological perspectives and cultural/anthropological views in isolation are inadequate for the understanding of mental disorders (Jacob, 1999). Examining the interconnection between the biomedical model and the individual explanatory model will produce a comprehensive assessment schedule that will be both internationally and locally valid and can form the basis of culturally appropriate modes of treatment that take into account the effect of culture, as well as individual differences, on courses and outcomes. This attempt may furnish the clinician with an opportunity to consider how best to help the patient.