Probe as needed (e.g., ”What other sources of help has he/she used .7 ")t
Clarify the individual’s experience and regard for previous help.
13. Often, people also look for help from many different sources, including different kinds of doctors, helpers, or healers. In the past, what kinds of treatment, help, advice, or her [PROBLEM]?
FULNESS OF HELP RECEIVED:
What types of help or treatment were most useful? Not useful?
Clarify the role ofsocial barriers to help—seeking, access to care, and problems engaging in previous treatment.
Probe details as needed (e.g., ”What got in the way?").
14. Has anything prevented [INDIVIDUAL] from getting the help he/she needs?
PROBE AS NEEDED:
For example, money, work or family com— mitments, stigma or discrimination, or lack guage or background?
expectations ofhelp, broadly defined, from the point of view of the informant.
Probe if informant lists only one source of help (e.g., ”What other kinds of help would be useful to [INDIVIDUAL] at this time?").
Focus on the views of the social network regarding help seeking.
Now let’s talk about the help [INDIVID-
UAL] needs.
15. What kinds of help would be most useful to
LEM]?
16. Are there other kinds of help that [INDI-
VIDUAL’S] family, friends, or other people her now?
Elicit possible concerns about the clinic or the clini— cian—patient relationship, including perceived rac— ism, language barriers, or cultural differences that may undermine goodwill, communication, or care delivery.
Probe details as needed (e.g., "In what way?”).
Address possible barriers to care or concerns about the clinic and the clinician-patient relationship raised previously.
stand each other because they come from expectations.
17. Have you been concerned about this, and is there anything that we can do to provide [INDIVIDUAL] with the care he/she needs?
Cultural Concepts of Distress
Cultural concepts of distress refers to ways that cultural groups experience, understand, and communicate suffering, behavioral problems, or troubling thoughts and emotions. Three main types of cultural concepts may be distinguished. Cultural syndromes are clusters of symptoms and attributions that tend to co-occur among individuals in specific cultural groups, communities, or contexts and that are recognized locally as coherent patterns of experience. Cultural idioms of distress are ways of expressing distress that may not involve specific symptoms or syndromes, but that provide collective, shared ways of experiencing and talking about personal or social concerns. For example, everyday talk about ”nerves” or ”depression” may refer to widely varying forms of suffering without mapping onto a discrete set of symptoms, syndrome, or disorder. Cultural explanations or perceived causes are labels, attributions, or features of an explanatory model that indicate culturally recog- nized meaning or etiology for symptoms, illness, or distress.
These three concepts—syndromes, idioms, and explanations—are more relevant to clinical practice than the older formulation culture-bound syndrome. Specifically, the term culture-bound syndrome ignores the fact that clinically important cultural differences often involve explanations or experience of distress rather than culturally distinctive configura- tions of symptoms. Furthermore, the term culture-bound overemphasizes the local partic- ularity and limited distribution of cultural concepts of distress. The current formulation acknowledges that all forms of distress are locally shaped, including the DSM disorders.
From this perspective, many DSM diagnoses can be understood as operationalized proto- types that started out as cultural syndromes, and became widely accepted as a result of their clinical and research utility. Across groups there remain culturally patterned differ- ences in symptoms, ways of talking about distress, and locally perceived causes, which are in turn associated with coping strategies and patterns of help seeking.
and emotional distress, and they may also reﬂect the inﬂuence of biomedical concepts.