The Dividual Self: Ethno-Psychology, Idioms of Distress and Explanatory Models of Mental Illness in Karachi, Pakistan

Abstract

Research on cultural manifestations of distress, by examining ethno-psychology, idioms of distress and explanatory models of mental illness in indigenous populations, is essential to develop culturally sensitive mental health screening tools and interventions. This exploratory study used qualitative methods to understand the cultural manifestations of distress in a population of mental health practitioners, patients and laypeople (N=30) in Karachi, Pakistan. We used a phenomenological approach to conduct 30 in-depth interviews followed by thematic analysis. The ethno-psychology revealed a sense of self that is ‘dividual’; composed of many parts (physical, mental, emotional, social, and spiritual) and influenced by the external environment. Idioms of distress and explanatory models of mental illness revolved around these parts of the self. Idioms of distress pertaining to the ‘heart’ and ‘mind-brain’ constructs were observed, the most salient of which was tension. The most common explanatory models were those attributing mental illness to adverse social experiences. Idioms of distress and explanatory models also showed somatization, spiritualization and socialization of distress, as opposed to the psychological manifestation prominent in Western cultures. Significant differences were observed in the use of idioms and explanatory models between different demographic groups. The younger more educated participants espoused more Western conceptualizations of illness.