GLOBAL HEALTH & SOCIAL MEDICINE
Weiss’s research has made important contributions in several different fields, including cultural psychiatry and mental health, health social science and public health studies of major global health problems, sociocultural study of suicidal behavior, health-related stigma and vaccine acceptance. Weiss established a cultural epidemiology research group that developed an approach to cultural epidemiology notable for integrating quantitative and qualitative research methods for study of cultural psychiatry. He has also applied these methods in the field of global health to address complementary social science and public health priorities for treatment and control of tuberculosis, malaria, leprosy and other neglected tropical diseases (NTDs). His approach to cultural epidemiology focuses on the practical implications of cultural patterns of experience and meaning of illness. It considers their impact on the community effectiveness of interventions and services with a regional specialization in India. Current work is being developed with colleagues at the Foundation for Medical Research in Mumbai and Imperial College in London, based on quantitative modelling enhanced by qualitative study, to account for sociocultural determinants of patient behavior. The aim is to address problems of delayed help seeking, incomplete treatment and health system operations that affect increasing multidrug-resistant tuberculosis.
Much of this research derives from Weiss’s training and experience at Harvard, and it endeavors to extend the GHSM Department’s efforts to strengthen global mental health and broader global health interests for disease control and culturally sensitive clinical care. He contributed to the gender and culture group developing the original Outline for Cultural Formulation (OCF) for the DSM-IV, and he has played a key role on the gender and culture committee of the task force in motivating and guiding international trials of the Cultural Formulation Interview (CFI) for DSM-5. This work has led to a methodology for assessing the validity of the CFI and implications from analysis of interview content for a revised OCF for improved assessment and documentation. Pilot study of this revised clinical assessment tool based on the revised OCF is ongoing in Pune.
In the field of suicide studies, a research partnership at KEM Hospital in Mumbai, informed by rural studies of suicidal behavior in the rural Sundarban region of West Bengal, has adapted methods of cultural epidemiology and psychological autopsy to better explain practical features of suicidal behavior in the framework of a sociocultural autopsy. Weiss was the principal author of the chapter on suicide for the department’s landmark book, World Mental Health: Priorities, Problems and Responses in Low-Income Countries (edited by Robert Desjarlais, Leon Eisenberg, Byron Good and Arthur Kleinman, 1995). His additional contributions to study of suicide include enhancement of Scambler’s hidden distress model of stigma for NTDs, mental illness and other health problems; his tools for assessment continue to be used by other NTD, TB, HIV and mental health stigma researchers. Current stigma research based on empirical study of survivors of deliberate self-harm is examining the implications of distinguishing the stigma of self-harm events, underlying prior problems motivating suicidal self-harm and ideas of these patients about the stigma of mental illness generally apart from their own problems.
Weiss’s research on vaccine acceptance began with a study of sociocultural determinants of oral cholera vaccine (OCV) uptake in the context of a campaign in endemic areas of Zanzibar. This work initially considered the respective roles of health-system factors and community acceptance as determinants of limited uptake, which in turn limits herd immunity. Additional studies of anticipated acceptance of OCVs followed in Western Kenya and DR Congo. Subsequently, in partnership with WHO, another set of studies have examined the relative roles of access and acceptance on use of influenza vaccine over the course of outbreaks during and after the pandemic of 2009 in Pune, India. Pune was among the most seriously affected cities in India. A subsequent study developed a protocol for improving the WHO-recommended vaccination coverage of pregnant women for their own protection and protection of their newborn children. The importance of cultural context and differences in the relative role of community hesitancy and clinician priorities that distinguish Europe and North America from India and other low-income countries was an important finding with demonstrate practical significance. Further research on vaccine coverage, currently in development with WHO partners, includes attention to the problem of poor uptake of HPV vaccine in many settings.
Additional research complementing field research activities includes Weiss’s scholarly studies of the classical Hindu medical system, Ayurveda, and its coverage of relevant concepts of mental illness in India based on primary textual sources. This work is a legacy of his doctoral training in Sanskrit and the cultural history of medicine in India, which he completed in the South Asia Studies Center of the University of Pennsylvania prior to enrolling in medical school. Another complementary activity, undertaken with a partner in India, psychiatrist and well-known actor Mohan Agashe, is currently developing both a new community-based project and academic curricula for use of feature films to promote audiovisual literacy. This work aims to integrate use of quality films and facilitated public engagement to promote awareness and recognition of mental health and public health problems, capitalizing on the synergy of emotional responses to films and cognitive processing that together minimize vulnerability and enhance resilience more effectively.
Mitchell G. Weiss is a cultural psychiatrist, medical anthropologist, and health social science researcher. He undertook residency training in psychiatry at Harvard Medical School from 1981 to 1985 and then joined the Department of Social Medicine. His training in cultural psychiatry and medical anthropology was mentored by Arthur Kleinman, MD and supported by an NIMH Research Scientist Development Award from 1987 to 1992. He was appointed instructor in psychiatry and instructor in social medicine from July 1985 to June 1988 and then assistant professor. He remained affiliated with the Department of Global Health and Social Medicine as lecturer after moving to the University of Toronto as associate professor in 1992 and then to Basel in 1995 as professor at the Swiss Tropical and Public Health Institute (Swiss TPH, formerly Swiss Tropical Institute) and the University of Basel. He served as chair of the Swiss TPH Department of Public Health and Epidemiology from 1997 for the next 12 years. He established the Health Social Science Unit in that department, and he also developed a cultural epidemiology research group. His research collaborations over more than 35 years, have benefited from a network of partnerships primarily in India and also in Ghana, Kenya, and other countries of South Asia and Sub-Saharan Africa. Topical interests in mental health include cultural studies of various mental health problems, stigma, suicide, and relevant features of culture and cultural formulation in clinical practice. He became professor emeritus in Basel in July 2015, and he remains associated with the Department of Global Health and Social Medicine as a corresponding member of the faculty.
Weiss developed an interdisciplinary approach to cultural epidemiology based on integrated quantitative and qualitative research methods. The approach involves both linking illness narratives to quantitative data and quantifying essential features of ethnographic qualitative data. His work has applied principles gleaned from cultural studies in psychiatry and mental health to other topics and challenges in global health, especially cultural determinants of help seeking, access to services and timely treatment of tuberculosis, leprosy, malaria, onchocerciasis, and other neglected tropical diseases. Additional interests include study of the nature of stigma and its impact on illness experience and its implications for disease control. His work also addresses a set of research questions concerning the particular respective roles of cultural, community and health system factors limiting vaccine coverage. Weiss has trained 14 masters, 18 doctoral and 7 postdoctoral postgraduates at the Swiss TPH.
He has taught modules on global mental health and developed courses in the program there, and in cultural epidemiology training workshops in Australia, India, Tanzania, Kenya, and South Africa. He has served on the boards of major U.S. and global professional organizations for cultural psychiatry (e.g., Society for the Study of Psychiatry and Culture, Transcultural Psychiatry Section of the World Psychiatric Association and the World Association for Cultural Psychiatry), and he currently serves on WHO’s Technical Advisory Group on Leprosy, which guides the Global Leprosy Program. He also serves on WHO’s Immunization and Vaccines-Related Implementation Research Advisory Committee (IVIR AC).
BMC public health, January 14, 2016
Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, October 8, 2015
PloS one, September 29, 2015
BMC international health and human rights, September 16, 2015
The Journal of nervous and mental disease, July 1, 2015
International journal of health policy and management, March 9, 2015
Indian journal of psychiatry, January 1, 2015
Human vaccines & immunotherapeutics, January 1, 2015
BMJ open, December 8, 2014
Infectious diseases of poverty, November 3, 2014