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Am J Psychiatry 1992; 149:9-21
Copyright © 1992 by American Psychiatric Association
The meaning of expressed emotion: theoretical issues raised by cross- cultural research
JH Jenkins and M Karno
Department of Anthropology, Case Western Reserve University, School of Medicine, Cleveland, OH 44106.
The finding that expressed emotion is associated with the course of
psychiatric disorder has generated a great deal of clinical and research
interest in expressed emotion as an important risk factor. Theoretical
elucidation of the construct of expressed emotion has lagged considerably
behind this interest, however. The authors contribute to a dialogue on what
is inside the "black box" called expressed emotion. They argue that
cross-cultural research can provide an empirical basis for the theoretical
grounding of expressed emotion factors. A comparative approach reveals that
the construct of expressed emotion is essentially cultural in nature. The
constellation of emotions, attitudes, and behaviors that are indexed by the
expressed emotion method represent cross-culturally variable features of
family response to an ill relative. Questions surrounding the cultural
validity of the construct of expressed emotion, the qualitative dimensions
of expressed emotion, and statistically significant cross- cultural
variations in expressed emotion profiles are discussed. Finally, the
authors provide an outline of diverse (cultural, psychobiological,
social-ecological) features of expressed emotion. Anthropological analysis
of expressed emotion reveals that although expressed emotion indexes a
Pandora's box of diverse features, culture provides the context of
variation through which these factors are most productively analyzed.
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