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Parental Magico-Religious Illness Beliefs in an Adolescent Girl With Major Depression and Systemic Lupus Erythematosus

TO THE EDITOR: We report the case of a 15-year-old girl with major depression, which occurred in the course of systemic lupus erythematosus (SLE). We choose here to describe how the understanding of her parents’ illness beliefs has been of therapeutic support in the psychiatric follow-up. Actually, many aspects of psychiatry, as diagnosis, illness behavior, help-seeking, and perceived quality of care, are affected by illness beliefs.¹ This is why medical anthropology and transcultural psychiatry encourage understanding of patients’ own illness experiences.^1,2

Case Report
Ms. A was born in France, near Paris. She lived with her parents who were Muslim and came from Algeria, having left 20 years ago. She had two older brothers. A younger sister died at the age of 3 months from a cardiac malformation when Ms. A was 8 years old. Her oldest brother has had non-Hodgkin’s lymphoma, in remission for 3 years. Her SLE was diagnosed 2 years ago, but began at the age of 10 with a malar rash and arthritis. The treatment, with a favorable outcome, consisted of hydroxychloroquine and prednisone, 10 mg/day.

When she was referred to consultation–liaison psychiatry, Ms. A was troubled by feelings of sadness, insomnia, and worthlessness, without suicidal intent. These symptoms of major depression (by DSM–IV) had appeared several weeks earlier. There was no evidence of SLE activity or neurological symptoms. Ms. A had no history of psychiatric disorders. The outpatient psychiatric follow-up, with a favorable outcome, lasted for 1 years and included individual psychotherapy and psychiatric consultation with her family in our transcultural psychiatric clinic.³

Her parents had cultural explanations that coexisted with biomedical meanings. Ms. A and her parents had been invited to a wedding in Algeria when she was 14. According to them, the malar rash might be interpreted as make-up by the bride’s parents. Ms. A might be perceived as a possible rival to the bride, and someone could have thrown the evil eye on Ms. A and her family in order to neutralize her and protect the bride. Another cultural explanation was sorcery. Her mother had asked herself whether the spirit of Ms. A’s younger sister, who had died of cardiac malformation, could be in Ms. A’s body. Despite these magico-religious beliefs, no traditional help-seeking experiences were described. Ms. A disagreed with her parents’ representations, but she was sensitive to the possible role of her sister’s death.

Discussion
This case illustrates how, in consultation–liaison psychiatry, it is essential to understand patients’ own illness experience, especially in immigrants or in immigrants’ children.³ The most apparent symptom of the disease, the malar rash, supported the construction of one of the parental explanations, the evil eye. Taking into account those ideas and the family conflicts around the important position of Ms. A in the series of family misfortunes (the younger sister’s death, the brother’s lymphoma, and the SLE) was a major issue for psychiatric treatment and was accompanied by progressively more flexibility and a wider range of parental beliefs. The transcultural setting, a group of psychiatrists and psychologists of varying nationalities, with an anthropological training, has allowed the formulation of these illness beliefs. This has helped to minimize the gap between Western healthcare and illness experience, and also between the parents’ and their adolescent’s cultural worlds, by constructing a common sense of what happened.^3,4 Even though these beliefs were not congruent with the disease’s biomedical explanations, Ms. A’s compliance with the medical and psychiatric treatment was excellent. The meaning of illness, with reference to its context, could be a better predictor of clinically significant illness-behavior than whether or not patients’ ideas are consistent with biomedical theory.^4,5 Patients’ beliefs need not be congruent with healers’ for the help they provide to be acceptable and effective. This case demonstrates how an understanding of illness beliefs may enhance utilization of Western healthcare.

REFERENCES

1. Kleinman A: Patients and Healers in the Context of Culture. Berkeley, CA, University of California Press, 1980
2. Littlewood R: From categories to contexts: a decade of the "new cross-cultural psychiatry." Br J Psychiatry 1990; 156:308–327[Abstract/Free Full Text]
3. Moro MR: Parents and infants in changing cultural context: immigration, trauma, and risk. Infant Ment Health J 2003; 24:240–264[CrossRef]
4. Eisenbruch M, Handelman L: Cultural consultation for cancer: astrocytoma in a Cambodian adolescent. Soc Sci Med 1990; 31:1295–1299[Medline]
5. Weiss MG: Cultural epidemiology: an introduction and overview. Anthropol Med 2001; 8:5–29[CrossRef]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Taïeb, O. Articles by Guillevin, L. Search for Related Content PubMed Citation Articles by Taïeb, O. Articles by Guillevin, L. Cross-Cultural Psychiatry Depression Depression Syndromes Secondary to General Medical Disorders

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