A Transcultural Model of the Centrality of "Thinking a Lot" in Psychopathologies Across the Globe and the Process of Localization: A Cambodian Refugee Example

Cult Med Psychiatry (2016) 40:570619

DOI 10.1007/s11013-016-9489-4

ORIGINAL PAPER

Devon E. Hinton1 David H. Barlow2 Ria Reis3,4,5

Joop de Jong4,6

Published online: 16 April 2016 Springer Science+Business Media New York 2016

Abstract We present a general model of why thinking a lot is a key presentation of distress in many cultures and examine how thinking a lot plays out in the Cambodian cultural context. We argue that the complaint of thinking a lot indicates the presence of a certain causal network of psychopathology that is found across cultures, but that this causal network is localized in profound ways. We show, using a Cambodian example, that examining thinking a lot in a cultural context is a key way of investigating the local bio-cultural ontology of psychopathology. Among Cambodian refugees, a typical episode of thinking a lot begins with ruminative-type negative cognitions, in particular worry and depressive thoughts. Next these negative cognitions may induce mental symptoms (e.g., poor concentration, forgetfulness, and zoning out) and somatic symptoms (e.g., migraine headache, migraine-like blurry vision such as scintillating scotomas, dizziness, palpitations). Subsequently the very fact of thinking a lot and the induced symptoms may give rise to multiple catastrophic cognitions. Soon, as distress escalates, in a kind of looping, other negative cognitions such as trauma memories may be triggered. All these processes are highly shaped by the Cambodian socio-

& Devon E. Hinton [e-mail]

1 Center for Anxiety and Traumatic, Massachusetts General Hospital, Harvard Medical School,

Stress Disorders, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA

2 Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA

3 Leiden University Medical Center, Leiden, The Netherlands

4 Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands

5 The Childrens Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa

6 Boston University School of Medicine, Boston, MA, USA

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cultural context. The article shows that Cambodian trauma survivors have a locally specic illness reality that centers on dynamic episodes of thinking a lot, or...