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

• Published in: Culture, medicine and psychiatry Vol. 40; no. 4; pp. 570 - 619
• Main Authors: Hinton, Devon E., Barlow, David H., Reis, Ria, de Jong, Joop
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2016; Springer Nature B.V
• Subjects: Anthropology; Anxiety; Asian culture; Cambodia; Cambodia - ethnology; Causality; Clinical Psychology; Cognition; Cultural factors; Culture; Emotional disorders; Ethnopsychology; Headaches; Humans; Illnesses; Insomnia; Localization; Medicine; Mental depression; Mental Disorders - ethnology; Migraine; Models, Psychological; Multiculturalism & pluralism; Ontology; Original Paper; Psychiatry; Psychological distress; Psychological Trauma - ethnology; Psychopathology; Public Health; Refugees; Refugees - psychology; Science; Social factors; Social Sciences; Sociocultural factors; Sociology; Spirit possession; Stress; Survivor; Symptoms; Thinking; Trauma; New York; United States > US; Netherlands; Thinking a lot; Rumination; Cross-cultural psychiatry; Idioms of distress; Cultural concepts of distress; Thinking too much
• ISSN: 0165-005X; 1573-076X
• DOI: 10.1007/s11013-016-9489-4

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-cultural context. The article shows that Cambodian trauma survivors have a locally specific illness reality that centers on dynamic episodes of “thinking a lot,” or on what might be called the “thinking a lot” causal network.