CULTURE AND SOMATIZATION - CLINICAL, EPIDEMIOLOGIC, AND ETHNOGRAPHIC PERSPECTIVES

Objectives: The cross-cultural prevalence of somatization and the limi tations of current nosology and psychiatric theory for interpreting cu ltural variations in somatization are reviewed. Method: Selective revi ew was conducted of recent research literature and research findings f rom an epidemiological survey and ethnographic study of help-seeking a nd health care utilization of a random sample of 2246 residents in a C anadian urban multicultural milieu. Results: Somatization is common in all ethnocultural groups and societies studied to date. However, sign ificant differences in somatization across ethnocultural groups persis t even where there is relatively equitable access to health care servi ces. Analysis of illness narratives collected from diverse ethnocultur al groups suggests that somatic symptoms are located in multiple syste ms of meaning that serve diverse psychological and social functions. D epending on circumstances, these symptoms can be seen as an index of d isease or disorder, an indication of psychopathology, a symbolic conde nsation of intrapsychic conflict, a culturally coded expression of dis tress, a medium for expressing social discontent, and a mechanism thro ugh which patients attempt to reposition themselves within their local worlds. Conclusion: Major sources of differences in somatization amon g ethnocultural groups include styles of expressing distress (''idioms of distress''), the ethnomedical belief systems in which these styles are rooted, and each group's relative familiarity with the health car e system and pathways to care. Psychological theories of somatization focused on individual characteristics must be expanded to recognize th e fundamental social meanings of bodily distress.