On the surface, Shahins problem is her weight. Her physical health will suffer if she does not attend to her nutritional needs. Yet as with most anorexic clients, Shahin is not as concerned about her physical symptoms as her loved ones are. Her self-deprivation is a sign of internal struggles. When interviewing Shahin, we talked about her perspective as well as her familys. As Kleinman & Benson (2006) suggest, an explanatory model encourages inquiry into fundamental beliefs about health and healing. How Shahin and her parents label the problem, what they feel its causes and effects are, and what they fear most about the condition were focal points of the interview.
What Shahins parents saw in their daughter is the dramatic weight loss. Their focusing on the physical aspects of the condition is common and is not directly related to cultural perspectives because all parents should be worried about the immediate health ramifications of dramatic weight loss. However, culture played a huge role in shaping their reaction to the diagnosis of anorexia nervosa. The condition is uncommon in India, but malnourishment is an issue that is deeply feared and associated with poverty and low social status. To see their daughter grow thinner means much on a psychic level for Shahins parents. They viewed her inability to eat as an affront to their ability to parent her properly. Taking their cultural perspective into account was essential in offering the best quality of care for Shahin. Connected to their sense of responsibility for her illness, her parents truly believed that she could be disciplined into eating more.
Interviews with Shahin showed that she shared her parents core values and beliefs. She denied having a problem during the early phases of the diagnosis and treatment. When she became aware of the physical ramifications of her low body weight, she seemed surprised at first and then guilty for having disappointed her parents.
She believed that the cause of the problem was a combination of her inability to fully assimilate into American society, her desire to look, think, and be like her peers, and her strong need to fulfill her parents wishes. Their pressuring her to enter careers she had no affinity for was also something Shahin noted as psychological root causes for the problem: all significant insights that the explanatory model brought to light and helped offer the best care for the whole family.
Therefore, an explanatory model showed that Shahins personal perspective about anorexia and that of her parents differed only slightly. What her parents feared most included social stigma and the appearance that they had failed as parents. Shahin likewise feared the social stigma of looking different from her peers. She also feared letting down her parents.
Explaining anorexia nervosa within the context of Indian society demands close attention to cultural ideals of beauty and issues related to social class status. The explanatory model used in this mini-ethnography and assessment of one sixteen-year-old girl is one that probed for the differences between Shahin and her parents. Moreover, the explanatory model revealed ways Indian and American societies view social status and the signs that denote personal success. Finally, the stigma of mental illness was one raised during the interview sessions. The explanatory model was designed to explore issues related to seeking help from psychologists and counselors: an act viewed as a sign of weakness or poor social ties in many cultures and not just India.
Kleinman, a. & Benson, P. (2006). Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix it. Retrieved Oct 12, 2008 from PubMed:
Quality and Safety Education for Nurses (QSEN). Web site retrieved oct 12, 2008 at http://qsen.org.