Causal attribution for mental illness in Cuba: A thematic analysis

Abstract

Explanatory models (EMs) for illness are highly relevant for patients, and they are also important for clinical diagnoses and treatment. EMs serve to capture patients' personal illness narratives and can help reveal how culture influences these narratives. While much research has aimed to understand EMs in the Western hemisphere, less research has been done on other cultures. Therefore, we investigated local causal attributions for mental illness in Cuba because of its particular history and political system. Although Cuban culture shares many values with Latin American cultures because of Spanish colonization, it is unique because of its socialist political and economic context, which might influence causal attributions. Thus, we developed a qualitative interview outline based on the Clinical Ethnographic Interview and administered interviews to 14 psychiatric patients in Havana. We conducted a thematic analysis to identify repeated patterns of meaning. Six patterns of causal attribution for mental illness were identified: (1) Personal shortcomings, (2) Family influences, (3) Excessive demands, (4) Cultural, economic, and political environment in Cuba, (5) Physical causes, and (6) Symptom-related explanations. In our sample, we found general and Cuba-specific patterns of causal attributions, whereby the Cuba-specific themes mainly locate the causes of mental illness outside the individual. These findings might be related to Cubans' socio-centric personal orientation, the cultural value of familismo and common daily experiences within socialist Cuban society. We discuss how the findings may be related to social stigma and help-seeking behavior.

Mental health stigma and professional help-seeking attitudes a comparison between Cuba and Germany

“…Beyond, stigma at work is an often-mentioned burden of mentally ill persons which well fits the German cultural context of professional success being considered a highly self-esteem relevant aspect of everyday life. As opposed to this, in the Cuban socialist economy all citizens are meant to work and to support the society, and even severe mentally ill persons are compelled to work [76,135]. In this way, they remain integrated in work life and may be able to maintain their self-esteem.…”

Learning about mental healthcare in today's Cuba: An interview with the president of the Cuban society of psychology

“…Treatment is seen within the context of the community, the solving of here and now problems, and is not over‐individualized 21 . Psychological assistance is offered in the doctor's office, the polyclinics, and specialty institutes serving individuals with medical illnesses such as cancer, 22 or specific populations, such as forensics 23 . A more recent phenomenon has been the creation of free‐standing community mental health clinics.…”

“…Physicians make less than what hotel workers and taxi drivers make in tips, essentially creating a two‐tiered economic system 5 . In addition, Cubans often live in tight quarters, with multigenerations and many family responsibilities adding its own potential stresses 23 . Nonetheless, human connection in Cuba is strong as was demonstrated by a greater sharing of emotions with others, besides spouses, as compared to Europeans 27 .…”

“…5 In addition, Cubans often live in tight quarters, with multigenerations and many family responsibilities adding its own potential stresses. 23 Nonetheless, human connection in Cuba is strong as was demonstrated by a greater sharing of emotions with others, besides spouses, as compared to Europeans. 27 As an example, family therapy is widely used and practiced in Cuba by also incorporating closely-knit community members that are not related.…”

“…21 Psychological assistance is offered in the doctor's office, the polyclinics, and specialty institutes serving individuals with medical illnesses such as cancer, 22 or specific populations, such as forensics. 23 A more recent phenomenon has been the creation of free-standing community mental health clinics. Cuba has roughly 222 hospitals to serve the general population, of those, 19…”