Raymond Massé

THE STRUCTURE OF MENTAL HEALTH: HIGHER-ORDER CONFIRMATORY FACTOR ANALYSES OF PSYCHOLOGICAL DISTRESS AND WELL-BEING MEASURES

This paper addresses the question of whether psychological distress and subjective well-being are the opposite poles of the same axis of mental health or independent constructs that should be measured on two independent axes. The measures used in this study originate from a preliminary ethnosemantic study and the content analysis of narratives of psychological distress and well-being episodes experienced by a random sample of francophone Quebecers (Canada). Two scales were produced: a Psychological Distress Manifestation Scale (PDMS) based on 23 items and four factors (Anxiety/Depression, Irritability, Self-Depreciation, and Social Disengagement), and a Psychological Well-Being Manifestation Scale with 25 items and six factors (Self-Esteem, Social Involvement, Mental Balance, Control of Self and Events, Sociability, and Happiness). Structural equation modeling analyses confirm that these 10 factors can be viewed as components of two correlated dimensions (psychological distress and well-being) (r = −0.65) of a two-dimensional latent construct which reflects a higher-order concept of mental health. We conclude that assessment of mental health in general populations should use concomitant measures of psychological distress and well-being.

Qualitative and Quantitative Analyses of Psychological Distress: Methodological Complementarity and Ontological Incommensurability:

Rigorous qualitative and quantitative methodologies have been used for the development of a multidimensional scale dedicated to the measurement of psychological distress. A comparison between the idioms of distress or the cultural forms through which French Quebecois express their distress (qualitative constructs) and the nonorthogonal factors derived from explanatory and higher order factorial analyses (quantitative constructs) illustrates the possibilities of complementarity between qualitative and quantitative approaches. The comparison shows that these two operationalizations of the concept of psychological distress are founded on incommensurable representations of distress. This article concludes that this representational dilemma of distress as a lived language or as an empirical reified entity leads to an ontological and a teleological incommensurability.

The limitations of a negotiation model for perimenopausal women

The clinical negotiation model proposed by Katon and Kleinman (1981) puts culture at the very heart of the patient-doctor relationship. As opposed to the asymmetric model that stresses an unequal power relationship between a dominant physician and a powerless patient, this transactional model suggests that we view the clinical encounter as the locus of a negotiation that takes place between two kinds of knowledge (lay and professional), and between two agendas: the doctor’s and the patient’s. According to such a model, the doctor is taught to listen to the patient’s own explanatory model of disease. Using an in-depth analysis of clinical encounters between perimenopausal women and female physicians, and of separate interviews with individual doctors and patients concerning their respective explanatory models, this pilot study puts emphasis on both the limitations of a transactional model and on the strategies deployed by doctors for enhancing the credibility of hormonal replacement therapy.

Gadè deceptions and lies told by the ill: The Caribbean sociocultural construction of truth in patient-healer encounters.

A constructivist approach in medical anthropology suggests that the boundary between lies and truth in sickness narratives is thin. Based on fieldwork in the French (Martinique) and English (Saint-Lucia) Carribbean with gadé and quimboiseurs (local folk healers), this paper addresses the gap between naïve romanticism and radical cynicism in the anthropological analysis of patient-healer encounters. Is the sick person lying when she accuses evil spirits for her behaviour or sickness? Is the quimboiseur who is building a meaningful explanation or diagnosis simply a liar taking advantage of his clients credulity? The challenge for anthropology is not to determine whether or not a person is lying when attributing their ill fortune to witchcraft. Instead, in this paper, the author approaches lying as a language-game played by both patients and folk healers. Concepts of lying as games, tactical lies, pragmatic creativity, and constructive lies are introduced here as a perspective for a reconsideration of lying as a pertinent research object.

Lay people's interpretation of ethical values related to mass vaccination; the case of A(H1N1) vaccination campaign in the province of Quebec (French Canada)

Pandemic influenza ethics frameworks are based on respect of values and principles such as regard for autonomy, responsibility, transparency, solidarity and social justice. However, very few studies have addressed the way in which the general population views these moral norms.

Les marqueurs de la dépression selon le DSM et le diagnostic populaire : une analyse de concordance chez les Québécois

Objective To query the universality of affective disorder markers, particularly the level of consistency between DSM diagnostic criteria and the criteria implicit in popular diagnoses. Method Utilization of data from the Santé Québec (1987) survey to compare depression markers reported by respondents who identified themselves or were identified by a member of their household as “suffering from depression” and markers underlying DSM-III diagnostic criteria. Results A popular diagnosis of depression is implicitly different from a psychiatric diagnosis considering an inter-diagnosis similarity of 9.5%. Conclusion It is therefore important to become more knowledgeable about the markers underlying diagnosis of affective disorders.