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      A cultural-ecosocial systems view for psychiatry

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          Abstract

          While contemporary psychiatry seeks the mechanisms of mental disorders in neurobiology, mental health problems clearly depend on developmental processes of learning and adaptation through ongoing interactions with the social environment. Symptoms or disorders emerge in specific social contexts and involve predicaments that cannot be fully characterized in terms of brain function but require a larger social-ecological view. Causal processes that result in mental health problems can begin anywhere within the extended system of body-person-environment. In particular, individuals’ narrative self-construal, culturally mediated interpretations of symptoms and coping strategies as well as the responses of others in the social world contribute to the mechanisms of mental disorders, illness experience, and recovery. In this paper, we outline the conceptual basis and practical implications of a hierarchical ecosocial systems view for an integrative approach to psychiatric theory and practice. The cultural-ecosocial systems view we propose understands mind, brain and person as situated in the social world and as constituted by cultural and self-reflexive processes. This view can be incorporated into a pragmatic approach to clinical assessment and case formulation that characterizes mechanisms of pathology and identifies targets for intervention.

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          Network analysis: an integrative approach to the structure of psychopathology.

          In network approaches to psychopathology, disorders result from the causal interplay between symptoms (e.g., worry → insomnia → fatigue), possibly involving feedback loops (e.g., a person may engage in substance abuse to forget the problems that arose due to substance abuse). The present review examines methodologies suited to identify such symptom networks and discusses network analysis techniques that may be used to extract clinically and scientifically useful information from such networks (e.g., which symptom is most central in a person's network). The authors also show how network analysis techniques may be used to construct simulation models that mimic symptom dynamics. Network approaches naturally explain the limited success of traditional research strategies, which are typically based on the idea that symptoms are manifestations of some common underlying factor, while offering promising methodological alternatives. In addition, these techniques may offer possibilities to guide and evaluate therapeutic interventions.
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            Responses to depression and their effects on the duration of depressive episodes.

            I propose that the ways people respond to their own symptoms of depression influence the duration of these symptoms. People who engage in ruminative responses to depression, focusing on their symptoms and the possible causes and consequences of their symptoms, will show longer depressions than people who take action to distract themselves from their symptoms. Ruminative responses prolong depression because they allow the depressed mood to negatively bias thinking and interfere with instrumental behavior and problem-solving. Laboratory and field studies directly testing this theory have supported its predictions. I discuss how response styles can explain the greater likelihood of depression in women than men. Then I intergrate this response styles theory with studies of coping with discrete events. The response styles theory is compared to other theories of the duration of depression. Finally, I suggest what may help a depressed person to stop engaging in ruminative responses and how response styles for depression may develop.
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              Theories for social epidemiology in the 21st century: an ecosocial perspective.

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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                13 April 2023
                2023
                : 14
                : 1031390
                Affiliations
                [1] 1Division of Social and Transcultural Psychiatry, McGill University , Montreal, QC, Canada
                [2] 2Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital , Montreal, QC, Canada
                Author notes

                Edited by: Michael Finn, Independent Psychology Practice, United States

                Reviewed by: Laura Noll, Northern Arizona University, United States; Patrick Bieler, Humboldt University of Berlin, Germany; Felix Tretter, Bertalanffy Center for the Study of Systems Science (BCSSS), Austria; Michael Moutoussis, University College London, United Kingdom

                *Correspondence: Ana Gómez-Carrillo, ana.gomez-carrillo@ 123456mcgill.ca

                This article was submitted to Psychopathology, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2023.1031390
                10133725
                37124258
                b0c7287e-cc46-49d9-a0b8-7b04837ad23d
                Copyright © 2023 Gómez-Carrillo and Kirmayer.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 29 August 2022
                : 08 March 2023
                Page count
                Figures: 2, Tables: 1, Equations: 0, References: 283, Pages: 20, Words: 19494
                Categories
                Psychiatry
                Hypothesis and Theory

                Clinical Psychology & Psychiatry
                multilevel explanation,embodiment,enactment,ecosocial,looping effects,cultural psychiatry,clinical case formulation,systems theory

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