The Explanatory Model

Theories of Patient/Doctor Interaction and

Illness behavior
Howard

Waitzkin
Arthur Kleinman
Howard Leventhal

Howard Waitzkin
Structuralistic approach
Medical system as an agent of control,
focussing on two issues:
1. Medicine defines the ability to work and
therefore supports the system of
production.
2. Medicine supports the system of
biological reproduction to produce
workforce.

Arthur Kleinman
The

Medical System
Disease/Illness dichotomy
The Explantory Model

Arthur Kleinman
The medical system
The

popular sector
The folk sector
The professional sector
The health care system itsself has a
healing effect, not only the healer.

Disease/Illness Dichotomy
"Sickness"

is what is happening to the

patient. Listen to him. Disease is what is
happening to science and to populations.
(Weed 1978)
Illness includes all the secondary personal
and social responses to a primary
malfunctioning (disease). (Kleinman 1980)

Arthur Kleinman
The Explantory Model
Explanatory

Models are the notions about

an Episode of sickness and its treatment
that are employed by all those engaged in
the clinical process. (Kleinman 1980)

Arthur Kleinman
The Explanatory Model
Explanatory Models contain the following
elements:
Etiology
time and mode of onset of symptoms
pathophysiology
course of sickness
treatment

Arthur Kleinman
The Explanatory Model
The

specific EM is constituted in a
semantic illness network
Lay / Professional EMs
Theoretical / clinical EMs
Psychsomatic / Physical EMs
domain-specifity hypotheses / crossdomain hypotheses

Arthur Kleinman
The Explanatory Model
A study

conducted among taiwanese

parents about their EMs concerning the
etiologiy of the autism of their children
found a coexistance of biomedical and
supernatural causes, that where
integrated in one model without apparent
conflict (Shyu, Tsai and Tsai 2010).

Howard Leventhal
The common sense model of illness
heuristic

device to assist understanding

individuals responses to the threat of an
illness
CSM focus is nearly entirely on the
patients model

Howard Leventhal
The common sense model of illness

Includes 5 components:
(a) identity: a label of the illness and the symptoms
associated with it;
(b) cause: factors leading to the onset of the illness;
(c) consequences: both long and short term effects;
(d) time line: moment of onset, expected duration and
periodicity (acute, cyclic, or chronic).
(e) later added: cure or control (how one recovers)

References

Waitzkin, H. (1984) The micropolitics of medicine: a

contextual analysis. Int J Health Serv, 14, 339-78
Kleinman, A. 1980. Patients and healers in the context of
culture : an exploration of the borderland between
anthropology, medicine, and psychiatry. Berkeley:
University of California Press
Diefenbach, M. & H. Leventhal (1996) The commonsense model of illness
Shyu, Y. I., J. L. Tsai & W. C. Tsai (2010) Explaining and
Selecting Treatments for Autism: Parental Explanatory
Models in Taiwan. J Autism Dev Disord.
Weed LL. Your health care and how to manage it . Rev .
ed . EssexJunction, VT : Essex Publishing, 1978

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