The Explanatory Model

Theories of Patient/Doctor Interaction and Illness behaviorHoward WaitzkinArthur KleinmanHoward Leventhal

Howard Waitzkin Structuralistic approachMedical system as an agent of control, focussing on two issues:Medicine defines the ability to work and therefore supports the system of production.Medicine supports the system of biological reproduction to produce workforce.

Arthur KleinmanThe Medical SystemDisease/Illness dichotomyThe Explantory Model

Arthur KleinmanThe medical systemThe popular sectorThe folk sectorThe professional sector

The health care system itsself has a healing effect, not only the healer.

Disease/Illness Dichotomy"Sickness" is what is happening to the patient. Listen to him. Disease is what is happening to science and to populations. (Weed 1978) Illness includes all the secondary personal and social responses to a primary malfunctioning (disease). (Kleinman 1980)

Arthur KleinmanThe Explantory ModelExplanatory Models are the notions about an Episode of sickness and its treatment that are employed by all those engaged in the clinical process. (Kleinman 1980)

Arthur KleinmanThe Explanatory ModelExplanatory Models contain the following elements:Etiologytime and mode of onset of symptoms pathophysiologycourse of sicknesstreatment

Arthur KleinmanThe Explanatory ModelThe specific EM is constituted in a semantic illness networkLay / Professional EMsTheoretical / clinical EMsPsychsomatic / Physical EMsdomain-specifity hypotheses / cross-domain hypotheses

Arthur KleinmanThe Explanatory ModelA study conducted among taiwanese parents about their EMs concerning the etiologiy of the autism of their children found a coexistance of biomedical and supernatural causes, that where integrated in one model without apparent conflict (Shyu, Tsai and Tsai 2010).

Howard LeventhalThe common sense model of illnessheuristic device to assist understanding individuals responses to the threat of an illnessCSM focus is nearly entirely on the patients model

Howard LeventhalThe common sense model of illnessIncludes 5 components:(a) identity: a label of the illness and the symptoms associated with it; (b) cause: factors leading to the onset of the illness;(c) consequences: both long and short term effects;(d) time line: moment of onset, expected duration and periodicity (acute, cyclic, or chronic).(e) later added: cure or control (how one recovers)

ReferencesWaitzkin, H. (1984) The micropolitics of medicine: a contextual analysis. Int J Health Serv, 14, 339-78 Kleinman, A. 1980. Patients and healers in the context of culture : an exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley: University of California Press Diefenbach, M. & H. Leventhal (1996) The common-sense model of illness Shyu, Y. I., J. L. Tsai & W. C. Tsai (2010) Explaining and Selecting Treatments for Autism: Parental Explanatory Models in Taiwan. J Autism Dev Disord.Weed LL. Your health care and how to manage it . Rev . ed . EssexJunction, VT : Essex Publishing, 1978

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