Article Cultural explanations of psychotic illness and care-seeking of family caregivers in Java, Indonesia M. A. Subandi 1 , Ardian Praptomojati 1 , Carla R. Marchira 1 , Mary-Jo DelVecchio Good 2 and Byron J. Good 2 Abstract The cultural understanding of illness among caregivers of first-episode psychotic persons is a crucial issue. Not only does it influence caregivers’ care-seeking behavior and length of time until receiving medical treatment (known as the ‘duration of untreated psychosis’ or DUP), but it also predicts the outcome of the illness. This article aims to explore cultural understanding and care-seeking behavior among caregivers of psychotic patients in Java, Indonesia. Data for this article have been taken from two studies conducted by our research group in Yogyakarta, Indonesia. Methods of data collection include surveys, case studies, ethnographic fieldwork, and in-depth interviews. Results of analyses, within and across studies, indicate that caregivers have employed diverse cultural explanatory models in order to understand psychotic illness. Local cultural beliefs, including possession and forms of black magic, were among the most common initial concepts held by family members in relation to psychosis. This echoes broader cultural beliefs in Java. However, it was not uncommon for caregivers to also understand illness in psychological terms (such as frustration, disappointment, and stress) and attached medical explanations. Caregivers’ understanding of illness also changed over time following the changing course of the illness. Both models of illness and the rapidity of care-seeking are also related to the acuteness of onset. This article concludes that it is important for mental health providers, as well as those designing systems of care, to understand the diversity and changing nature of caregivers’ cultural understanding of psychotic illness. Keywords care seeking, explanatory model, Java-Indonesia, mental illness Introduction Serious mental illness is an enormous challenge to family members, and often leads to intensive care- seeking. Although we now know that the relationship between efforts to understand the cause of illness and care-seeking is very complex, these processes are inter- related and are deeply embedded in local cultures and access to services. Attributions and explanatory models have been studied in parallel by psychologists and medical anthropologists, with interesting similar- ities and differences, both with the goal of under- standing the links between efforts to understand causation of illness and care-seeking behaviors. This article examines illness attributions and explana- tory models and their relation to care-seeking for psychotic illness in the context of Javanese culture in Yogyakarta, Indonesia. Fritz Heider launched the field of Attribution Theory within social psychology in 1958 with his seminal book The Psychology of Interpersonal Relations. His work has had long influence, and was elaborated by Harold Kelley and Bernard Weiner in particular. Attribution Theory attempts to explain how individuals’ causal attributions contribute to behavior (Weiner, 1996). It has been extensively used in social psychology, and extended to areas such as 1 Gadjah Mada University 2 Harvard Medical School Corresponding author: M. A. Subandi, Faculty of Psychology, Gadjah Mada University, Bulaksmur, 55281 Yogyakarta, Indonesia. Email: subandi@ugm.ac.id Transcultural Psychiatry 0(0) 1–11 ! The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1363461520916290 journals.sagepub.com/home/tps