Religion and Spirituality in Psychiatry

Models of Mental Illness and Its Treatment 271disease. Patients tend to be quite selective in whatthey learn from their doctor. This information isused to fill in gaps in their previous knowledgeand to normalize at a higher level the understandingthey have of their disease. As for therest, they would simply stick to their daily andtraditional interpretations of the disease. (13)Also, the patients’ understanding is multifacetedand dynamic. Indeed, patients change theirunderstandings quite rapidly, and sometimesthey can use several explanatory models at thesame time, under the influence of the events takingplace in their lives and of the changing societythey live in. (14) Williams compared severalexplanatory models of depression among threecategories of population: the general community,people in the process of being diagnosedwith depression, and people who already had anestablished diagnosis of depression. These threepopulations had different understandings of thedisorder and of its treatment. These perspectivesmay evolve differently as illness is taking holdof the patient. Indeed, community surveys inWestern societies tend to point to an explanatorymodel of mental health problems that is primarilysocial rather than biological. (15–17) On theother hand, most people today diagnosed withdepression tend to consider it biological. (18)Perceptions of cause are also reflected in beliefsabout the appropriateness of particular treatments.Out of a healthy community, less than25 percent of the patients ( 16 , 17 ) might benefitfrom an antidepressant treatment and morethan half of them from talking therapies (16)whereas for more than two-thirds of the peoplediagnosed with depression, antidepressant treatmentis necessary. (19) The data suggest thereforethat a reformulation of beliefs and a transition intherapeutic perspectives may take place amongpeople who develop mental disorders. Someresearchers suggest that in the early stages of themental disorder, there is a moment when changeis most likely to take place. Indeed, Leventhaland Nerenz (1985) have suggested that whenan individual faces a problematic psychologicalor physiological experience (or simply changesstates), he will construct an understanding ofthe problem based on five dimensions. Theseare identity (label), perceived cause, time line(how long it will last), consequences (physical,psychological, and social), and curability/controllability.(20) Such understandings may drawon explanatory models of diseases specific tothe various cultures and societies. Those peoplefacing a mental health problem for the first timein their life actively attempt to make sense of it.In doing so, individuals may explore and choosebetween a complex set of beliefs. However, suchbeliefs should not be regarded as taking the formof a coherent explanatory model but rather as amap of possibilities, providing a framework forthe ongoing process of making sense and seekingmeaning.3. MENTAL DISORDERS IN DEVELOPINGCOUNTRIESClinicians meet patients with mental disorderswho are embedded into various cultural/religiousbackgrounds. In many developing countries,there is a different approach to the understandingof the disease, as compared to that found indeveloped areas. In larger cities, we are increasinglydealing with patients belonging to migrantpopulations. In this context, it is important for theclinician to understand the perception patientshave of their own disorder and to be aware ofelements of their culture such as the understandingsof disease, the body, and indigenous healingsystems. Compared with Western societies, peoplein developing countries seem to attach moreimportance to the symbolic and spiritual side ofthe illness. (21) Empirical knowledge of the diseaseis influenced by a quasicompulsive searchof the reason for the disease (the meaning of thedisease). Generally speaking, the mental diseaseis not the result of a situation involving individualsin their personal organization. The environment,which historically helps determine thesick person’s personality, is not concerned withthe origin of the disease. Disease comes fromsomewhere else. Irrespective of ethnic groupsor religious systems, mental disorders are consideredto be the result of an aggression against