Exporting psychological treatments, importing wisdom

A recent 60 country World Health Organisation study found that depression is the most serious chronic illness, worse than angina, arthritis, asthma, and diabetes. Unfortunately, the majority of people who experience depression live in low income countries where help is least likely to be available.

The New York Times has a fascinating article on an ongoing project in Goa, India, that screens every attendee at a local health centre and then uses psychological therapy to help with low mood or anxiety.

It’s not a simple case of just using Western techniques in a new environment.

As the NYT article mentions, mental illness carries a significant stigma in many cultures. For example, a diagnosis may not only be stigmatising for the affected person, but it may also mean the person’s children are less likely to be thought of as suitable marriage partners, potentially affecting the whole family’s future.

Futhermore, depression is known to present quite differently in some non-Western cultures. Studies have found that people are more likely to report ‘somatic symptoms’ such as diffuse pains or tiredness, rather than low mood or emotional problems.

This is partly due to stigma, but sometimes because certain languages don’t have the same, or even such a varied vocabulary for emotions and mental states.

I’m currently working with a Pakistani psychiatrist who often surprises me by pointing out that even what I assume are relatively straightforward words, such as depression or anxiety, might not have a direct translation in some Asian languages.

All of these issues mean that the treatment centre in Goa tackles the issue in a slightly different way:

Most are also apparently wary of visiting a mental hospital. In India, the stigma of mental illness remains strong. To minimize the problem, health workers avoid using the words “mental illness,” “depression” or “anxiety” with patients, relying on more commonly used words like “strain” and “tension.”

The patients “are happy to talk,” Dr. Sudipto Chatterjee, a psychiatrist at Sangath, said, “as long as you stay away from the idea of mental illness.”

I find the issue of having different vocabularies for our mental states fascinating.

The philosopher Wittgenstein noted how difficult it is to agree on common words for internal states because errors are so hard to correct.

If a mother and child see a rabbit and the child says “elephant!”, the mother can point to the rabbit and correct the misnomer. But what can a mother, or anyone do, if someone ‘misnames’ an emotion?

Or to put it another way, as we don’t have external things to refer to for internal states, how do we ever agree on a vocabulary that is at all meaningful?

I’m always curious when I come across differences concerning emotion words in other languages. For example, Spanish has the same word (verg√ºenza) for shame and embarrassment.

From my native language perspective it strikes me as amazing that another language doesn’t individually label these two states which seem to have such different personal and social implications.

I’m sure there are many reverse examples and many other emotional vocabulary mismatches across the world’s languages.

Link to NYT article ‘Psychotherapy for All: An Experiment’.

2 Comments

  1. Posted March 12, 2008 at 12:47 pm | Permalink

    The language of emotional health is both fascinating and revealing. For example, when i look at the postings on bigwhitewall.com i see that someone creates a ‘brick’ that is full on anger and yet the tags read hurt, pain, loss. Out of the range of emotions we feel in difficult life situations the one we choose to present with speaks volumes whilst those that underlie are still struggling to find their voice. So, perhaps, the Spanish are able to deal with the complexity of emotional response – recognising that shame often underlies embarassment and vice versa?

  2. Posted March 13, 2008 at 3:10 am | Permalink

    When I was in Portugal a few years ago, I was told that they have an emotion “saudade” that cannot be translated into any other language. I was given the impression that to even experience the emotion you had to be Portuguese.
    My Portuguese friends would describe what situations evoked the feeling and I would throw out words like “nostalgia”, “yearning”, “wistfulness”, but to all of them, they said, no, no, that’s not it.


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