| Research suggests that heart disease is sensitive to biologic and psychosocial variables, and that depression contributes to heart disease mortality. Few studies, however, probe the role of culture in these conditions. The research presented here was conducted in Berlin, Germany, where an East-West health gradient (especially in terms of heart disease) exists, one favoring the West. The research asked: To what degree does social change (defined as the post-socialist transformation) influence health? Building on previous research into culture and hypertension, and culture and depression, this work examines the processes influencing the expression of heart disease, depression, and their comorbidity, and elucidates the linkages between body, health, and society.; The study consisted of three phases: (1) a community-based cultural study of the political-economic transition and the psychosocial stressors associated with post-transition life; (2) a community-based cultural study of cardiac and mental health; (3) a clinic-based appraisal of cultural factors among patients expressing heart disease, or comorbid heart disease and depression.; Ethnographic findings reveal that East and West Berliners share two kinds of explanatory models for heart disease, which include: (1) non-modifiable risk factors, such as genetics; and, (2) pathological lifestyle factors, such as smoking or overeating. East Berliners cite an additional and unique model, which semantically links heart disease to experiences of post-socialism, such as economic instability, unemployment, and prejudice. Explanatory models for depression, across East and West participants, reveal similar themes of social stress. In addition, a depression scale and a cultural stress measure were administered to cardiac patients. Findings show that in terms of depression alone, East and West participants are similarly distressed. However, incorporation of the cultural stress measure reveals that different cultural stressors shape the expression of comorbid heart disease and depression among East and West participants.; The dissertation outlines the strategies used to investigate culture, illness, and meaning in a changing social context, discusses the application of integrative methods to the task of studying the linkages between illness and culture, and comments on the implications of the findings for the development of medical and social remedies pertaining to heart disease and depression. |
