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 EM‘s
Theoretical / clinical EM‘s
Psychsomatic / Physical EM‘s
domain-specifity hypotheses / crossdomain hypotheses
Arthur Kleinman
The Explanatory Model
A study conducted among taiwanese
parents about their EM’s 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
Vielen Dank für die Aufmerksamkeit!