title: A Transcultural Model of the Centrality of "Thinking a Lot" in Psychopathologies Across the Globe and the Process of Localization: A Cambodian Refugee Example.
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-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.
authors.affiliation: Center for Anxiety and Traumatic, Massachusetts General Hospital, Harvard Medical School, Stress Disorders, One Bowdoin Square, 6th Floor, Boston, MA, 02114, USA. devon_hinton@hms.harvard.edu.
authors.forename: Devon E
authors.initials: DE
authors.lastname: Hinton
authors.affiliation: Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Barlow
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.|Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.|The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
authors.forename: Ria
authors.initials: R
authors.lastname: Reis
authors.affiliation: Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.|Boston University School of Medicine, Boston, MA, USA.
authors.forename: Joop
authors.initials: J
authors.lastname: de Jong
mesh_terms: D002160:Cambodia / Q000208:ethnology; D005008:Ethnopsychology; D006801:Humans; D001523:Mental Disorders / Q000208:ethnology*; D008960:Models, Psychological; D000067073:Psychological Trauma / Q000208:ethnology*; D012036:Refugees / Q000523:psychology*; D013850:Thinking
keywords: Cross-cultural psychiatry; Cultural concepts of distress; Idioms of distress; Rumination; “Thinking a lot”; “Thinking too much”