"Thinking too much"

A systematic review of a common idiom of distress

Bonnie N. Kaiser, Emily Haroz, Brandon A. Kohrt, Paul A Bolton, Judith Bass, Devon E. Hinton

Research output: Contribution to journalArticle

Abstract

Idioms of distress communicate suffering via reference to shared ethnopsychologies, and better understanding of idioms of distress can contribute to effective clinical and public health communication. This systematic review is a qualitative synthesis of "thinking too much" idioms globally, to determine their applicability and variability across cultures. We searched eight databases and retained publications if they included empirical quantitative, qualitative, or mixed-methods research regarding a "thinking too much" idiom and were in English. In total, 138 publications from 1979 to 2014 met inclusion criteria. We examined the descriptive epidemiology, phenomenology, etiology, and course of "thinking too much" idioms and compared them to psychiatric constructs. "Thinking too much" idioms typically reference ruminative, intrusive, and anxious thoughts and result in a range of perceived complications, physical and mental illnesses, or even death. These idioms appear to have variable overlap with common psychiatric constructs, including depression, anxiety, and PTSD. However, "thinking too much" idioms reflect aspects of experience, distress, and social positioning not captured by psychiatric diagnoses and often show wide within-cultural variation, in addition to between-cultural differences. Taken together, these findings suggest that "thinking too much" should not be interpreted as a gloss for psychiatric disorder nor assumed to be a unitary symptom or syndrome within a culture. We suggest five key ways in which engagement with "thinking too much" idioms can improve global mental health research and interventions: it (1) incorporates a key idiom of distress into measurement and screening to improve validity of efforts at identifying those in need of services and tracking treatment outcomes; (2) facilitates exploration of ethnopsychology in order to bolster cultural appropriateness of interventions; (3) strengthens public health communication to encourage engagement in treatment; (4) reduces stigma by enhancing understanding, promoting treatment-seeking, and avoiding unintentionally contributing to stigmatization; and (5) identifies a key locally salient treatment target.

Original languageEnglish (US)
Pages (from-to)170-183
Number of pages14
JournalSocial Science and Medicine
Volume147
DOIs
StatePublished - Dec 1 2015

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ethnopsychology
Ethnopsychology
Health Communication
Psychiatry
Publications
Public Health
public health
Stereotyping
gloss
communication
stigmatization
phenomenology
Post-Traumatic Stress Disorders
epidemiology
Thinking
Systematic Review
Idioms
etiology
Research
Mental Disorders

Keywords

  • Anxiety
  • Cultural concept of distress
  • Depression
  • Ethnopsychology
  • Global mental health
  • Idiom of distress
  • PTSD
  • Transcultural psychiatry

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science

Cite this

"Thinking too much" : A systematic review of a common idiom of distress. / Kaiser, Bonnie N.; Haroz, Emily; Kohrt, Brandon A.; Bolton, Paul A; Bass, Judith; Hinton, Devon E.

In: Social Science and Medicine, Vol. 147, 01.12.2015, p. 170-183.

Research output: Contribution to journalArticle

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