Symptom Attribution in Cultural Perspective *

The explanatory model perspective of medical anthropology emphasizes the cultural shaping of individuals' efforts to make sense of their symptoms and suffering. Causal attribution is a pivotal cognitive process in this personal and social construction of meaning. Cultural variations in symptom attribution affect the pathogenesis, course, clinical presentation and outcome of psychiatric disorders. Research suggests that styles of attribution for common somatic symptoms may influence patients' tendency to somatize or psychologize psychiatric disorders in primary care. At the same time, symptom attributions are used to negotiate the sociomoral implications of illness. Recent work in social psychology and medical anthropology emphasizes the roots of attributional processes in bodily and social processes that are highly context-dependent, and hence, must be understood as part of the construction of a local world of meaning. Symptom attributions then may be understood as forms of positioning with both cognitive and social consequences relevant to psychiatric assessment and intervention.