Berliners’ Models of Heart Disease Causation

Abstract

Following the collapse of socialism and subsequent German reunification, cardiac mortality rose unexpectedly in the former East Germany; although rates improved by mid-decade, a West/East health gradient persisted. Psychosocial stress from regime change, postsocialism, was one hypothesis proposed to explain the health transition. Absent from the scholarly conversation were individuals’ own assessments of their illness experiences in this time of social upheaval. I hypothesized that such data might illuminate processes linking illness and social change. I analyzed illness narratives of East and West Berliners with heart disease, attending to subjective notions of causation. Both groups cited nonmodifiable and modifiable risk factors; half of the East Berliners incorporated additional material that referenced processes associated with postsocialism. I propose that ethnographic investigations of illness experiences can contribute to the development of more culturally relevant, comprehensive hypotheses of nonbiologic risk factors for cardiovascular disease.