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REVIEW ARTICLES: DINESH BHUGRA and ANASTASIA MASTROGIANNI Globalisation and mental disorders: Overview with relation to depression The British Journal of Psychiatry 2004; 184: 10-20 [Abstract] [Full text] [PDF]

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Somatisation & Stigma

Dr Ramanathan Raguram, Dr Mitchell Weiss   (24 March 2004)

Somatisation & Stigma 24 March 2004
Dr Ramanathan Raguram, Professor of Psychiatry Faculty of Medicine & Health Sciences, United Arab Emirates University, Al Ain, UAE, Dr Mitchell Weiss Send letter to journal: Re: Somatisation & Stigma raguram{at}uaeu.ac.ae Dr Ramanathan Raguram, et al.	Dear Sir, In their exhaustive review of the impact of globalization and culture on depression, Bhugra & Mastrogianni (2004) highlight the role of somatisation in many parts of the world, where it often accounts for “common presenting features of depression” (p.16). Emphasising both the ubiquity and cultural aspects of somatisation, they cite an earlier characterization of common mental disorders that refers to the “black box of somatisation” (Bhui 1999). In doing so, however, they miss an important explanatory feature of this process with substantial practical and clinical significance—that is, the role of stigma. Despite increasing availability of effective treatments, many people with depression (perhaps even a majority) do not seek professional help because of the stigma associated with the illness. Efforts to clarify the impact of stigma are crucial for explaining cultural aspects of illness-related experience and meaning, and highly relevant for planning interventions that are culturally appropriate and locally effective. As one effort towards elucidating the experience of depression, our study of depressed patients in Bangalore, India, examined the role of self-perceived stigma (Raguram et al., 1996). Assessing both quantitative and qualitative dimensions of stigma, we found that greater severity of depression was associated with higher stigma scores, but more somatisation was associated with less stigma. Through qualitative analysis of patients’ narratives, we also demonstrated that patients viewed depressive, but not somatic, symptoms as socially disadvantageous. Somatic symptoms were considered to be less stigmatizing since they resembled illness experiences that most persons could expect to have from time to time. Consequently, studying the work of culture clarifies the nature of somatisation. From a Western vantage point somatization may appear enigmatic, but attention to stigma helps to illuminate the internal structure of the black box. References Bhugra, D. & Mastrogianni, A. (2004) Globalisation and mental disorders: overview with relation to depression. British Journal of Psychiatry, 184, 10-20. Bhui, K. (1999) Common mental disorders among people with origins in or immigrant from India and Pakistan. International Review of Psychiatry, 11, 136-144. Raguram, R., Weiss, M.W. & Channabasavanna, S.M. (1996) Stigma, somatisation and depression—a report from South India, American Journal of Psychiatry, 153, 1043-1049. Thanking you, Dr Ramanathan Raguram Professor of Psychiatry National Institute of Mental Health & Neurosciences Bangalore 560 029 INDIA & Dr Mitchell Weiss Professor & Head Department of Public Health & Epidemiology Swiss Tropical Institute Socinstrasse 49 Basel Switzerland