The development of the Short Explanatory Model Interview (SEMI) and its use among primary-care attenders with common mental disorders

BACKGROUND: Recent anthropological studies have documented the importance of understanding the relation of culture to the experience of mental illness. The use of interviews that elicit explanatory models has facilitated such research, but currently available interviews are lengthy and impractical for epidemiological studies. This paper is a preliminary report on the development of a brief instrument to elicit explanatory models for use in field work. METHOD: The development of the SEMI, a short interview to elicit explanatory models is described. The interview explores the subject's cultural background, nature of presenting problem, help-seeking behaviour, interaction with physician/healer and beliefs related to mental illness. RESULTS: The SEMI was employed to study the explanatory models of subjects with common mental disorders among Whites, African-Caribbean and Asians living in London and was also used in Harare, Zimbabwe. Data from its use in four different ethnic groups is presented with the aim of demonstrating its capacity to show up differences in these varied settings. CONCLUSIONS: The simplicity and brevity of the SEMI allow for its use in field studies in different cultures, data can be used to provide variables for use in quantitative analysis and provide qualitative descriptions.(Au)

From vice to madness: the semantics of naturalistic and personalistic understanding in Trinidadian local medicine

Whilst the common analytical distinction between `naturalistic' and `personalistic' paradigms of medical knowledge has some immediate heuristic value and may indeed closely resemble the explicit schema elaborated by informants, interpretation of the semantics of bush medicine and madness in creole Trinidad suggests that the two types of knowledge are not incompatible, nor mutually exclusive, nor distinct. The vices of ganja and rum use may be interpreted within the hot-cold classification of bush medicine but, like other vices and like the more `intrapersonal' categories of pressure, grinding, studiation and tabanka, they may be understood as leading to madness. A common idiom of opposition and catharsis unites them, providing a higher level of analytical generality manifest in a range of local social institutions, and one rooted in post-colonial Afro-Caribbean experience and ideology.(AU)

The psychodynamics of demon possession

This paper examines the psychodynamics of demon possession in contemporary Trinidian society. Field observations and interviews with possessed individuals indicate that the incorporation of the local folklore and superstition is the prime prerequisite for the possession complex, but that the reaction per se is triggered by situations of unusual stress or emotional conflict. Although, a consistent clinical picture of psychopathology is not apparent, the four reported case histories consistently reflect a tendency toward hysterical features, sometimes in conjunction with neurotic depression. In all cases, however, possession affords two positive advantages to the individual - direct escape from a conflict situation and dimunition of guilt by projecting blame on to the intruding spirit (Summary)