One of the major concerns of health professionals working in the area of psychiatry is understanding the conditions under which patients adhere to prescribed treatments, and this entails having knowledge of
patients' understanding of these treatments. While adherence is linked to some extent to the patients' comprehension of their illness, it is also a function of their social and demographic characteristics, such as age,1 social milieu,2 or sex.3 Another attribute also merits our attention, however: the patient's cultural affiliation and in particular, his or her religious background.
This was the perspective taken by a recent study undertaken in France on the behavior of patients with regard to drugs.4 The study was carried out among 4 groups of patients from different religious backgrounds: Catholic, Protestant, Jewish, and Muslim. The aims of the study were to determine the level of comprehension these subjects had about drugs in general and psychotropic drugs in particular, why they did or did not use them, and what stood in the way of their use.
Subjects were chosen on the basis of their families' religious background and not on their belonging to an organized religious group. The aim of the study was to measure the "imprint" left by culture (and family religious background is part of culture) in patients who were sometimes totally unfamiliar with any religious belief system. The investigators found that religious/cultural heritage passed on through traditional values influenced a person's understanding of psychotropic drugs and the body, and it influenced the person's perception of and relationship with medical authorities.
In accordance with the classical methodology of social anthropology, the data were collected from in-depth interviews and thorough observations of subjects' behavior during medical consultations and at home. For each subject, medical and social histories were obtained and socioeconomic status noted. The research was carried out over a period of 5 years among 186 patients from diverse socioeconomic backgrounds, aged 25 to 75 years. Patients with equivalent socioeconomic status were compared across the 4 cultural groups in order to neutralize the strictly sociologic variable. Study subjects were drawn from groups of patients in treatment for various types of pathologies. Although some of them had never taken psychotropic drugs, all had ideas and perceptions about these drugs.
Perception of psychotropic drugs
An inquiry into the way in which people relate to psychotropic drugs poses questions that are coextensive with this original problem—namely, those concerning a person's beliefs about the body and psychiatric disorders—but also questions concerning relationships with those in medical authority. It was thus necessary to examine the subjects' perceptions of physicians (psychiatrists as well as general practitioners, because in France 85% of psychotropic drug prescriptions are written by general practitioners).
In this article, "psychotropic drugs" refers to neuroleptics, antidepressants, anxiolytics, and hypnotic drugs. Patients tend to group all of these into a single class because they lack thorough knowledge about the differences among these agents. Although psychotropic drugs are reputedly extensively consumed in France—overconsumption that can largely be explained by overprescription--they may provoke considerable reticence on the part of patients, which is linked to various types of fears, including:
- Fear of physiologic or psychological dependence.
- Fear of changes in cognitive abilities.
- Fear of a change in personality or of feeling ill.
In all 4 groups, we found a fear of the uncontrollable effects of psychotropic drugs and of the potential for madness to result from their incorrect consumption. However, some fears were more specific to individual cultural/religious groups under consideration.
Findings from gathered data showed that patients with a Catholic background more easily express their fears about the physical state in which psychotropic drugs may put them and in particular the fact that they "put you to sleep" or that they "knock you out." It is mainly the physical discomfort that
is feared—the disagreeable feeling brought on by the desire to sleep in the middle of the day.
The same reasons are cited by patients of Muslim descent, especially by women. They complain about the physical effects of the drugs and of the sleepiness that results (effects that conflict with obligations linked to the status of a woman in a Muslim family, which entails the necessity of taking care of her family and not giving in to illness or sleepiness).
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