Leaving out the most complex clinical terms and diagnoses, the language of mental health is typically reasonably straight-forward. We may struggle to find the words to express how we’re feeling, but once we do, they don’t usually involve a lot of complicated terminology. So why is it that localising mental health content is still such a tricky task? We look at a few cultural implications and considerations.
All healthcare relies on good communication in order to be effective. From that first GP visit to the phone call to emergency services, your ability to explain what is happening to you – and the ability of the other person to understand what you are trying to say – is crucial. In order to obtain truly informed consent when discussing treatment options, or indeed hospitalisation, the healthcare practitioner needs to be able to explain in great detail the implications of different options, including to a patient who speaks a different language and is of a different culture and faith.
It goes without saying, then, that medical interpreters can be life-savers, sometimes literally. But other times, crucial details can get lost not just in the words and languages, but in how different cultures think about health and bodily experiences – especially when those experiences revolve around mental health.
Lost in translation – and lost for words
Take the example of a patient who calls the emergency services complaining of the sensation of insects crawling underneath their skin. A doctor of a Western background will likely assume that they’re having a psychotic episode, alternatively are high on Class A drugs. If the patient happens to be Nigerian, however, what they’re probably trying to communicate is a case of what they call ‘ode ori’, the experience of acute distress often described as a crawling sensation, heart palpitations and ringing in the ears – in other words, what we in Western cultures would describe as a panic attack.
In some other cultures, there simply aren’t enough words to label mental health struggles in any way equivalent to what Western medical professionals might expect. In Vietnamese, for instance, you might just have to go with either ‘bình thường’, for ‘normal’, or ‘điên’, for ‘crazy’, which doesn’t leave a lot of room for talking about mild anxiety or depression. On the other hand, there are cultures where mental conditions are commonly known about which may never be discussed in Western contexts, and so the descriptions of the symptoms will make little sense to a Western doctor.
Stigma and Western science
In addition to huge variations in the ways in which different cultures think and talk about mental health, stigma can be a significant barrier to care. Take addiction, for instance, which is often steeped in shame, but probably never more so than in Arabic countries, where the laws around alcoholic beverages and drugs are incredibly strict. Similarly, research has shown that British Muslims are much more likely than other faith groups to rely on religious coping mechanisms rather than seeking help from a medical professional when struggling mentally.
It’s also important to remember, when talking about mental health and minority groups in a Western context, that there’s always a risk of slipping into what has sometimes been described as a culturally imperialist approach. The division of the human being into different parts, with physiology and mental wellbeing mostly diagnosed and treated separately, is in itself a Western scientific stance. Some ancient medical traditions, such as Ayurvedic and Chinese medicine, take a holistic view, with mind, body and spirit being inseparable. As such, an integrated approach to health communication can be necessary to achieve a fully inclusive outcome.
An important task with the potential for positive change
All of the above should be considered crucial knowledge for any medical and mental health interpreter, and indeed for any healthcare practitioner working in areas where they come across patients from different ethnic and minority groups. Translators and other language service professionals are no different. The damaging effects of poorly adapted mental health content can be devastating, but the flipside is that the positive impact of culturally sensitive localisation can be huge. Research has shown that patients with limited English in English-speaking high-income countries tend to seek help for mental health problems much later than their majority-community peers, often presenting in acute stages of mental distress, so helping these groups to feel able to advocate for themselves and to trust that they will be understood is an important and urgent task.