The cultural experience of depression amongst white Britons in London

This thesis reviews the cultural history of western depressive symptoms and critically examines the epidemiology of Neurotic Depression world wide. It argues that such studies and vocabularies are deeply embedded within "white British and western European" institutions, and predicated on a western epistemology. This is followed by an overview of major research methods to study folk models of mental disorders. Using established clinical anthropological methods, a clinical ethnographic instrument, the EMIC, initially developed in India, is culturally adapted for white Britons in London (the UK EMIC for Depression). 47 white Britons with a diagnosis of Neurotic Depression (ICD-9), attending psychiatric services for the first time, are interviewed for their experience of illness: presenting idioms of distress, perceived seriousness and outcome, experience of stigma, ideas of causation, and help seeking. The study also examines the relationship between such personal meaning of suffering with objective professional biomedical assessments. Results reveal that the expression of illness features, including symptoms, are governed by both popular and professional ideas of depression. Women present considerably later for help, with predominant somatic symptoms whilst men report more psychological idioms. 55 discrete models of causation are elicited. Although there is considerable stability of causal explanations over time, subjects hold multiple contradictory and overlapping ideas of causation suggesting a high degree of pluralism. These results challenge the current methodology of national public mental health campaigns. The development of a culturally sensitive stigma scale is an additional result of this study. Idioms of sadness together with psychological explanations are associated with high stigma, those of anxiety together with somatic explanations with less stigma. The thesis concludes that the concept of a universal psychopathological model for Neurotic Depression is problematic