Historically health, illness and healing operated through a single medium, or idiom, within relatively culturally encapsulated societies. Our increasingly porous societies now present us with a plethora of cultural explanations for our states of ‘being’. Health ‘seekers’ can now turn to a variety of health ‘providers’. The complexities of this situation are illustrated by reviewing research from Africa on cognitive tolerance. In many western societies the clinician is also faced with the challenge of having to work with a plurality of complex ideas about health and illness, which he or she may be unfamiliar with. The Problem Portrait Technique (PPT) is presented as a means of assisting practitioners (and researchers) to assess the interplay of culture and health. It is argued that health psychology should cultivate pluralism both by acknowledging the influence of culture on health and by embracing the diversity of methodological and conceptual perspectives within itself.
Ader, R., & Cohen, N. (1985). CNS–immune system interactions: Conditioning phenomena. Behavioural & Brain Sciences, 8, 379–395.
2.
Ager, A., Carr, S. C., MacLachlan, M., & Kaneka-Chilongo, B. (1996). Perceptions of tropical health risk in Mponda, Malawi: Attributions of cause, suggested means of risk reduction and preferred treatment. Psychology & Health, 12, 23–31.
3.
Airhihenbuwa, C. O. (1995). Health and culture: Beyond the western paradigm. Thousand Oaks, CA: Sage.
4.
Berry, J. W. (1990). Psychology of acculturation. In J. Berman (Ed.), Cross-cultural perspectives: Nebraska Symposium on Motivation. Lincoln: University of Nebraska Press.
5.
Berry, J. W. (1997). Immigration, acculturation and adaptation.Applied Psychology: An International Review, 46, 5–68.
6.
Blane, D., Brunner, E., & Wilkinson, R. (1996). (Eds.). Health and social organisation: Towards a health policy for the 21st century. London: Routledge.
7.
Carr, S. C., & MacLachlan, M. (1997). Motivational gravity. In D. Munroe, J. F. Schumaker, & S. C. Carr (Eds.), Motivation and culture. New York: Routledge.
8.
Carr, S. C., McAuliffe, E., & MacLachlan, M. (1998). Psychology of aid. London: Routledge.
9.
Davis, W. (1999). Vanishing cultures: The issue is whether ancient cultures will be free to change on their own terms. National Geographic, 196(2), 62–89.
10.
Elliot, E, Pirrs, M., & McMaster, J (1992). Nurses’ views of parasuicide in a developing country. International Journal of Social Psychiatry, 38, 273–279.
11.
Ensink, K., & Robertson, B. (1999). Patient and family experiences of psychiatric services and African indigenous healers. Transcultural Psychiatry, 36(1), 23–43.
12.
Festinger, L. (1954). A theory of social comparison processes. Human Relations, 1, 117–140.
13.
Furnham, A., & Vincent, C. (2000). Promoting health through complementary medicine. In M. MacLachlan (Ed.), Cultivating health: Cultural perspectives on promoting health. Chichester: Wiley.
14.
Helman, C. (1994). Culture, health and illness: An introduction for health professionals (3rd Ed.). London: Butterworth-Heinemann.
15.
Hermans, H. J. M., & Kempen, H. J. C. (1998). Moving cultures: The perilous problems of cultural dichotomies in a globalising society. American Psychologist, 53(10), 1111–1120.
16.
Hubble, M. A., Duncan, B. L., & Miller, S. D. (1999). The heart and soul of change: What works in psychotherapy. Washington: American Psychological Association.
17.
Ingram, H., & Desombre, T. (1999). Teamwork in health care: Lessons from the literature and from good practice around the world. Journal of Management in Medicine, 13(1), 51–58.
18.
Kleinman, A. (1980). Patients and healers in the context of culture. Berkeley: University of California Press.
19.
Landrine, H., & Klonoff, E. A. (1992). Culture and health-related schemas: A review and proposal for interdisciplinary integration. Health Psychology, 11(4), 267–276.
20.
MacLachlan, M. (1997). Culture and health. Chichester: Wiley.
21.
MacLachlan, M. (1998). Promoting health: Thinking through context. In E. McAuliffe & L. Joyce (Eds.), A healthier future? Managing healthcare in Ireland. Dublin: IPA.
22.
MacLachlan, M. (2000). Cultivating health. In M. MacLachlan (Ed.),Cultivating health: Cultural perspectives on promoting health. Chichester: Wiley.
23.
MacLachlan, M., Banda, D. M., & McAuliffe, E. (1995). Epidemic psychological disturbance in a Malawian secondary school: A case study in social change?Psychology & Developing Societies, 7,79–90.
24.
MacLachlan, M., & Carr, S. C. (1994a). From dissonance to tolerance: Towards managing health in tropical cultures. Psychology & Developing Societies, 6, 119–129.
25.
MacLachlan, M., & Carr, S. C. (1994b). Managing the AIDS crisis in Africa: In support of pluralism. Journal of Management in Medicine, 8(2), 45–52.
26.
MacLachlan, M., Nyirenda, T., & Nyando, C. (1995). Attributions for admission to Zomba Mental Hospital: Implications for the development of mental health services in Malawi. International Journal of Social Psychiatry, 41(2), 79–87.
27.
MacLachlan, M., & O’Connell, M. (2000). (Eds.). Cultivating pluralism: Psychological, social and cultural experiences of minorities in Ireland. Dublin: Oak Tree Press.
28.
Marks, D. F. (1996). Health psychology in context. Journal of Health Psychology, 1(1), 7–21.
29.
Moghaddam, F. M., & Solliday, E. A. (1991). ‘Balanced multiculturalism’ and the challenge of peaceful coexistence in pluralistic societies.Psychology & Developing Societies, 3(1), 51–72.
30.
Mulatu, A., & Berry, J. B. (2000). Cultivating health through multiculturalism. In M. MacLachlan (Ed.), Cultivating health: Cultural perspectives on promoting health. Chichester: Wiley.
31.
Murray, M., & Chamberlain, K. (1997). Qualitative research in health psychology: Developments and directions. Journal of Health Psychology, 3(3), 291–295.
32.
Pangani, D., Carr, S. C., MacLachlan, M., & Ager, A. (1993). Medical versus traditional attributions for psychiatric symptoms in the tropics: Which is associated with greater tolerance?Medical Science Research, 21, 171–171.
33.
Peltzer, K. (1993). Psychology and health in African cultures: Examples of ethnotherapeutic practice. Institut für Psychologie, Universität Klagenfurt, Austria.
34.
Peltzer, K., & MacLachlan, M. (in preparation). Causes and treatments for tuberculosis in South Africa: Exploring pluralism with the Problem Portrait Technique.
35.
Pick, S. (1997). Berry in Legoland. Applied Psychology: An International Review, 46(1), 49–52.
36.
Shaba, B., MacLachlan, M., Carr, S. C., & Ager, A. (1993). Palliative versus curative beliefs regarding tropical epilepsy as a function of medical and traditional attributions.Central African Journal of Medicine, 39, 65–67.
37.
Shweder, R. A. (1991). Thinking through cultures: Expeditions in cultural psychology. Cambridge MA: Harvard University Press
38.
Smyth, K. (1998). Mental health in northern Malawi: patients’ explanations for admission to St John of God Mental Health Services. Paper presented at the American Anthropological Association’s Annual Conference, Philadelphia, 12–16 December.
39.
Stainton Rogers, W. (1994). Explaining health and illness: An exploration of diversity. Hertfordshire: Harvester Wheatsheaf.
40.
Swartz, L. (1998). Culture and mental health: A southern African view. Cape Town: Oxford University Press.
41.
Watters, P. A., Carr, S. C., & MacLachlan, M. (submitted). The cultural dynamics of cognitive tolerance: The mathematics of pluralism.
42.
Weick, K. E. (1984). Small wins: Redefining the scale of social problems. American Psychologist, 39,40–49.
43.
Wilkinson, M. (1992). A mental health handbook for Malawi. Blantyre: Assemblies of God.
