Idioms of Distress Research Papers (original) (raw)

In low-and middle-income countries (LMIC) it is vital to understand acceptable, comprehensive, and culturally appropriate ways of communicating about mental distress. Diagnostic terminology is rarely used, may be stigmatizing, and is subject to misinterpretation. Local terms, such as idioms of distress, can improve mental health literacy and service delivery. Our objective was to examine lived experience and coping connected to distress and depression in an underresearched population: young men from LMIC urban slums. We conducted 60 qualitative interviews with men (ages 18-29) in Bhashantek slum, Bangladesh. Themes were generated using thematic analysis and grounded theory techniques. The heart-mind (mon), mentality (manoshikota), mood (mejaj), head (matha or ''brain''), and body (shorir) comprised the self-concept, and were related to sadness, hopelessness, anger, worry, and mental illness. The English word ''tension'' was the central idiom of distress. ''Tension'' existed on a continuum, from mild distress or motivational anxiety, to moderate distress including rumination and somatic complaints, to severe psychopathology including anhedonia and suicidality. Respondents connected “tension” to burnout experiences and mental illness which was summarized in an ethnopsychological model. These findings can inform culturally sensitive measurement tools and interventions that are acceptable to the community, potentially increasing engagement and enhancing therapeutic outcomes.

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- Depression, Idioms of Distress, Urban Slums

Women in North India are socialized to care for others, so what do they do when they get a disease like diabetes that requires intensive self-care? In Sugar and Tension, Lesley Jo Weaver uses women’s experiences with diabetes in New Delhi as a lens to explore how gendered roles and expectations are taking shape in contemporary India. Weaver argues that although women’s domestic care of others may be at odds with the self-care mandates of biomedically-managed diabetes, these roles nevertheless do important cultural work that may buffer women’s mental and physical health by fostering social belonging. Weaver describes how women negotiate the many responsibilities in their lives when chronic disease is at stake. As women weigh their options, the choices they make raise questions about whose priorities should count in domestic, health, and family worlds. The varied experiences of women illustrate that there are many routes to living well or poorly with diabetes, and these are not always the ones canonized in biomedical models of diabetes management.

- by Lesley Jo Weaver
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- Psychological Anthropology, Medical Anthropology, Depression, Diabetes

"Researchers have tried to determine and verify the effects of violent conflicts on the men- tal health of those affected by focusing on war trauma, posttraumatic stress disorder (PTSD), and other trauma-related disorders. This, in turn, led to the development of differ- ent kinds of theories and aid programs that aim at preventing and treating the conse- quences of violence and mental health. Until now, there is no agreement on the public health value of the concept of PTSD and no agreement on the appropriate type of men- tal-health care. Instead, psychiatrists have engaged in sometimes fierce discussions over the universality of war trauma, PTSD, and other trauma-related disorders. The two most polar positions are those who try to validate PTSD as a universal and cross-culturally valid psychopathological response to traumatic distress which may be cured or ameliorated with (Western) clinical and psychosocial therapeutic measures, and those who argue that the Western discourse on trauma only makes sense in the context of a particular cultural and moral framework and, therefore, becomes problematic in the context of other cultural and social settings. Although these positions seem mutually exclusive, their debates have led to the development of less radical approaches toward war-trauma and PTSD.
The purpose of this literature review is to analyse the discourses on and debates over war- trauma and PTSD in the psychiatric literature in order to establish a better understanding for the diverse conceptualizations, interpretations and proposed healing strategies. More- over, I discuss the cultural construction and conceptualization of war-trauma and PTSD from an anthropological perspective and show how anthropologists contribute to psychi- atric debates so as to ensure more sophisticated diagnoses and healing strategies in cultur- ally diverse contexts."

- by Hanna Kienzler
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- Psychiatry, Medical Anthropology, Mental Health, War Studies
- by Richard Noll
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- Sociology of Religion, Psychiatry, Anthropology, Humanities
- by Richard Noll
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- New Religious Movements, History, History of Science and Technology, Sociology

Violence has been shown to be a global challenge resulting in long-lasting social, medical, and mental health sequelae. In this article, we focus on massive social violence, such as war and civil war. Social suffering and mental health problems related to violence as a global public health problem can be tackled only with a holistic approach that addresses the specific region, culture and group and the limited resources available in most countries. Research that can give a reliable assessment of complex long-term outcomes is still largely missing, and can be seen as a major and complex challenge for future study.

- by Thomas Wenzel and +2
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- Psychiatry, Violence, Humanitarianism, Mental Health

This article explores a variety of spirit possession within Vodou in the Dominican Republic that is unbidden and characterized by uncontrolled movement. Local explanatory models for states of distressing possession are being overwhelmed or punished by the spirits. While in most cases possession behavior becomes more organized and rich in symbolic meaning as an individual progresses on her spiritual path there also exist (rare) cases of chronic unbidden possession with violent features. The article draws on such case, in which dissociative states reflecting the dynamics of trauma are locally interpreted as possession by an unruly Indian spirit. In this case possession functions as an idiom of distress, allowing a young woman to communicate her past traumatic experience in a culturally acceptable way, which opens the possibility to receive attention and comfort. Since both Vodou and psychodrama are based on experiencing and making visible the soul in action, communalities and differences between the two therapeutic systems are elaborated and juxtaposed.

This article examines some of the long-term health outcomes of extreme adversities and the ways in which social inequalities and idioms of distress are historically and socially produced in the Peruvian context. We describe how the highland Quechua of northern Ayacucho construct and experience expressions of distress and suffering such as pinsamientuwan (worrying thoughts, worries), ñakary (suffering) and llaki (sorrow, sadness), in a context of persistent social inequalities, social exclusion and a recent history of political violence. It is concluded that the multiple expressions of distress and suffering are closely related to past and current events, shaped by beliefs, core values and cultural norms and, in this process, transformed, recreated and invested with new meanings and attributions.

- by Hanna Kienzler and +1
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- Latin American Studies, Psychiatry, Violence, Mental Health

Background and Objectives: Nepal has witnessed several periods of organized violence since its beginnings as a sovereign nation. Most recently, during the decade-long Maoist Conflict (1996-2006), armed forces used excessive violence, including torture, resulting in deaths and disappearances. Moreover, there is widespread gender-, ethnic-and caste-based discrimination, and grossly unequal distribution of wealth in the country. While the immediate mental health effects of the conflict are well studied, less is known about the long-term effects of the conflict. This article sets out to explain how Nepalese survivors of violence perceive their wellbeing and mental health, search for help and construct their health care pathways and therapeutic itineraries. The aim is to provide a better understanding of local explanatory models and healthcare behaviors.

- by Hanna Kienzler
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- Violence, Human Rights, Mental Health, Coping Strategies

Extending classic anthropological “idioms of distress” research, we argue that intensive online videogame involvement is better conceptualized as a new global idiom, not only of distress but also of wellness, especially for emerging adults (late teens through the twenties). Drawing on cognitive anthropological cultural domain interviews conducted with a small sample of U.S. gamers (N=26 free-list and 34 pile-sort respondents) (Study 1) and a large sample of survey data on gaming experience (N=3629) (Study 2), we discuss the cultural meaning and social context of this new cultural idiom of wellness and distress. Our analysis suggests that the “addiction” frame provides a means for gamers to communicate their passion and commitment to online play, even furthering their enthusiasm for the hobby and community in the process, but also a way for players to express and even resolve life distress such as depression and loneliness. The American Psychiatric Association (APA) has recently included “Internet gaming disorder” (IGD) as a possible behavioral addiction, akin to gambling, warranting further consideration for eventual formal inclusion in the next iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Our study leads us to suggest that clinicians only sparingly use IGD as a clinical category, given the manner that medical and gamer understandings of “addictive” play differ so markedly. This includes better distinguishing positive online gaming involvement—also sometimes framed by gamers as “addictive”—from other play patterns more clearly entailing distress and dysfunction.

Abstract: We present a perspective to analyze mental health without either a) imposing Western illness categories or b) adopting local or “native” categories of mental distress. Our approach takes as axiomatic only that locals within any culture share a cognitive and verbal lexicon of salient positive and negative emotional experiences, which an appropriate and repeatable set of ethnographic procedures can elicit. Our approach is provisionally agnostic with respect to either Western or native nosological categories, and instead focuses on persons’ relative frequency of experiencing emotions. Putting this perspective into practice in India, our ethnographic fieldwork (2006-2014) and survey analysis (N=219) resulted in a 40-item Positive and Negative Affect Scale (PANAS), which we used to assess the mental well-being of Indigenous persons (the tribal Sahariya) in the Indian states of Rajasthan and Madhya Pradesh. Generated via standard cognitive anthropological procedures that can be replicated elsewhere, measures such as this possess features of psychiatric scales favored by leaders in global mental health initiatives. Though not capturing locally named distress syndromes, our scale is nonetheless sensitive to local emotional experiences, frames of meaning, and “idioms of distress.” By sharing traits of both global and also locally-derived diagnoses, approaches like ours can help identify synergies between them. For example, employing data reduction techniques such as factor analysis—where diagnostic and screening categories emerge inductively ex post facto from emotional symptom clusters, rather than being deduced or assigned a priori by either global mental health experts or locals themselves—reveals hidden overlaps between local wellness idioms and global ones. Practically speaking, our perspective, which assesses both emotional frailty and also potential sources of emotional resilience and balance, while eschewing all named illness categories, can be deployed in mental health initiatives in ways that minimize stigma and increase both the acceptability and validity of assessment instruments.

Man-made and natural disasters continue to increase worldwide. A day does not go by without headline stories documenting human tragedy resulting from acts of violence or natural disasters. Emotionally charged photos on the internet, TV or newspapers showing bloody bodies or grieving families grab the viewing public's attention acutely, but quickly become " yesterday's news ". Rarely do they portray the devastating and complex emotional and social impact which is likely to follow in the days, weeks, months and years to follow: emotional wounds are not bandaged, and do not create an impactful visual image that will sell news journalism, but are often the most devastating injuries suffered by victims of all ages exposed to trauma and violence. In this chapter, the authors explore the psychiatric impact resulting from man-made disasters, specifically from violence, focusing on an integrated approach. The critical role of culture in assessing and treating victims is highlighted. A critique of current PTSD criteria is offered and neglected issues such as brain trauma are discussed. The need for more comprehensive research into the biopsychosocial aspects of psychopathology related to exposure to disasters is discussed. The contribution of events, framework and culture are also presented as Neglected Factors in Addressing Violence as a Man-Made Disaster 204 important variables in understanding and treating victims of man-made and natural disasters.

- by David Baron and +1
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- Violence, Posttraumatic Stress Disorder (PTSD), War Studies, Trauma Studies

In Nepal, spirit possession is a common phenomenon occurring both in individuals and in groups. To identify the cultural contexts and psychosocial correlates of spirit possession, we conducted a mixed-method study in a village in central Nepal experiencing a cluster of spirit possession events. The study was carried out in three stages: (1) a pilot study consisting of informal interviews with possessed individuals, observations of the possession spells, and video recording of possession events; (2) a case-control study comparing the prevalence of symptoms of common mental disorders in women who had and had not experienced possession; and (3) a follow-up study with focus group discussions and in-depth interviews with possessed and non-possessed men and women, and key informants. Quantitative results indicated that possessed women had higher rates of traumatic events and higher levels of symptoms of mental disorder (Anxiety 68% vs. 18%, Depression 41% vs. 19%, and PTSD 27%). However, qualitative interviews with possessed individuals, family members, and traditional healers indicated that they did not associate possession states with mental illness. Spirit possession was viewed as an affliction that provided a unique mode of communication between humans and spirits. As such, it functioned as an idiom of distress that allowed individuals to express suffering related to mental illness, sociopolitical violence, traumatic events, and the oppression of women. The study results clearly indicate that spirit possession is a multi-dimensional phenomenon that cannot be mapped onto any single psychiatric or psychological diagnostic category or construct. Clinical and public health efforts to address spirit possession must take the socio-cultural context and systemic dynamics into account to avoid creating iatrogenic illness, undermining coping strategies, and exacerbating underlying social problems.

- by Laurence J Kirmayer and +3
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- Mental Health, War Studies, Nepal, Transcultural Psychiatry

- by Thomas Wenzel
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- Psychiatry, Violence, Humanitarianism, Mental Health

'Resilience' is trending in development theory and practice, where it is often measured using countable socioeconomic outcomes. This paper draws on ethnographic research with South Sudanese Zande refugees in Kiryandongo Refugee Settlement, Uganda, to show a different and often overlooked perspective; that of elderly refugee women. Having lived through decades of war and displacement, these women have developed a rich body of knowledge about suffering, coping, and resilience. Mixing idioms, folktales, and anecdotes, they teach youth not to focus on outcomes or 'big dreams', but on a stoic acceptance of loss and perpetual precarity. They advise actions like farming, childcare, and faith. Even so, suffering and coping are socially conditioned and policed, and the intimate circle harbours both protection and dangers, like witchcraft. The women's accounts contrast bleakly with up-beat neoliberal developmentalism which sees cash-infused 'resilience' as the key to refugees' self-reliant futures.

- by Bruno Braak and +1
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- Social Psychology, Refugee Studies, Resilience, Uganda

The existing literature on Indian ethnopsychology has long asserted that somatization is a key aspect of experiences of distress. The study of idioms of distress arose out of work done in India (Nichter in Cult Med Psychiatry 5(4):379–408, 1981), but ironically, little subsequent work has systematically explored idioms of distress in this part of the world. This ethnographic study focused on the term tension (tenśan) and its relation to a cultural syndrome among women in urban North India. This syndrome appears to involve rapid-onset anger, irritation, rumination, and sleeplessness as key symptoms. It is often linked to specific circumstances such as domestic conflict and is associated with the stresses of modern urban life. People who report more symptoms of tension had consistently higher scores on the Hopkins Symptoms Checklist-25 for depression and anxiety. In this cultural context where psychiatric care is highly stigmatized, the language of tension can aid providers of mental healthcare (many of whom, in India, are not psychiatrists or psychologists) to identify and communicate effectively with potential patients whose mental healthcare needs might otherwise go unaddressed.

- by Jo Weaver
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- Psychological Anthropology, Cross-Cultural Psychology, India, Idioms of Distress

- by Laurence J Kirmayer
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- Psychopathology, Qualitative Research, Nepal, Transcultural Psychiatry
- by Ram Sapkota and +1
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- Psychopathology, Qualitative Research, Nepal, Transcultural Psychiatry

n this article, we analyse the response of UK academics to the UK government decision to cut international development research funding as part of the overseas aid budget reduction, undertaken in March 2021. This decision affects and will have long-lasting effects on any research project involving the UK and international partners, particularly in Global South contexts. We use Critical Metaphor Analysis (CMA) to analyse news, blogs, interviews that UK-based academics wrote in response to the cuts announcement, from 11 March 2021 to 30 April 2021. We identified the following metaphors: CUTS ARE AN ENTITY; CUTS ARE A THREAT, CUTS ARE ILLNESS, CUTS ARE VIOLENCE; plus, on the other hand, RESEARCH IS HEALTH, RESEARCH IS A JOURNEY, RESEARCH IS CONNECTION. UK academics have used ‘idioms of distress’, which are cultural expressions, often metaphorical, through which people articulate distress. Therefore, our contribution is threefold. First, we suggest that the metaphors used have a persuasive and evaluative aim and function. Second, we open up a space for an interdisciplinarity between CMA and ‘idioms of distress’. Third, we warn about the need for the UK government and responsible institutional bodies to restore communication and trust with the global academic research community in International Development.

- by arifur rahman Apu
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- Depression, Multidisciplinary, Idioms of Distress, Urban Slums

With the aim of advancing the cross-cultural investigation of the folk illness nervios, I conducted a dual-sited comparative study of symptom descriptions among two diverse research settings in Honduras. Baer et al. (Cult Med Psychiatry 27(3):315–337, 2003) used cultural consensus modeling (CCM) to confirm a core description of nervios among four Latino groups in the US, Mexico, and Guatemala, but observed that overall agreement and average competence in a shared illness model decreased along a gradient from presumably more-to-less economically developed sites. This has left unresolved whether such variation extends to other Latin American regions. This paper is an exploratory analysis of inter- and intracultural variation in nervios symptom descriptions by 50 Hondurans from the market town of Copán Ruinas (n = 25) and city of San Pedro Sula (n = 25). I performed CCM using a combination of free-listing, pile-sorting, and rating activities to establish if respondents across sites share a single model of nervios. I found consensus for the San Pedro Sula subsample, but not for Copán Ruinas or for the overall sample. Results suggest nervios is constitutive of differing forms of distress ranging from chronic illness to acute suffering, as well as anger- and panic-based manifestations that overlap with biomedical ideas about depression, anxiety, and panic disorder. This variation derives in part from demographic factors such as age, gender, and residence, but may also result from ethnic and regional diversity among subsamples. However, consensus only being present among San Pedro Sula respondents suggests their greater awareness of cultural distinctions between biomedical and folk medical knowledge, which is likely due to their exposure to manifold health frameworks in those settings. https://rdcu.be/bhkIt

- by Max J Stein
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- Medical Anthropology, Honduras, Culture-Bound Syndromes, Idioms of Distress

S’appuyant sur une recherche de terrain conduite dans trois ressources alternatives en santé mentale au Québec en 2000, ce chapitre met en lumière les enjeux que soulève le parti pris des services membres du Regroupement de soutenir leurs participants dans l’expression de leurs "vérités propres". La prise de parole des personnes aux prises avec la folie implique un ensemble de processus de nature à la fois politique et sémantique: politique de par la négociation qui engage dès lors les autres acteurs du domaine relationnel, dans un champ de discours et de contre-discours dominé par des savoirs experts; et sémantique à travers le recours à des langages qui impliquent des manières différentiées de donner sens aux troubles mentaux et d’y réagir. Dans ce chapitre, j'analyse les espaces de parole aménagés par les ressources que j’ai visitées en m’interrogeant sur la manière dont on y accueille et dont on y soutient les voix des usagers. Plus largement, mon étude de ces espaces met en exergue les questions que soulèvent l’élaboration de langages et l’aménagement de milieux d’expression qui prétendent accueillir la souffrance dans toutes ses dimensions (soit la souffrance dite "sociale").

- by Jo Weaver
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- Sociology, Anthropology, Psychological Anthropology, Medical Anthropology

- by Ram Sapkota
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- Psychology, Violence, Human Rights, Mental Health

Efforts to provide culturally appropriate global mental health interventions have included attention to local idioms of distress. This article critically examines the potential gap between lay ethnopsychological understandings of the Cambodian idiom of baksbat (broken courage) on the one hand and clinical con-ceptualizations of the idiom as a potential indicator of posttraumatic stress disorder. Ethnographic semi-structured interviews with trauma survivors reveal resistance to current clinical translations and hybrid Euro-Western and Khmer treatment interventions. While the notion of idioms of distress is intended to draw attention to everyday non-pathologizing forms of discourse, the creation of hybrid assessment and treatment constructs linking idioms to trauma-related pathology may obscure the pragmatic communicative functions of the idiom, making them subordinate to an existing model of psychiatric disorder and pathologizing everyday modes of coping. Participants' narratives highlight self-perceived connections between stressors that determine the trajectory and outcome of distress and shared cultural worldviews that together uniquely shape their meaning. These observations point to the dilemmas of linking idioms of distress with co-morbid illness constructs in ways that may pathologize normal emotional responses. Results have implications for efforts to develop effective models of post-conflict trauma care in global mental health.

- by Laurence J Kirmayer
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- Psychopathology, Qualitative Research, Nepal, Transcultural Psychiatry

Objectives: Biocultural research remains a challenge in the field of global mental health. We sought to test associations between blood pressure and idioms of distress in a population survey. Methods: We drew on a randomly selected sample of 991 adults (498 men, 493 women) in Afghanistan, for whom physiological and psychosocial data were systematically collected. Assessment of mental health (Self-Reported Questionnaire, Afghan Symptom Checklist) included conceptualizations of distress related to pressure (fishar), anxiety, and dysphoria, as well as dimensions of negative affect and aggression. We used principal component analysis to map survey responses to fishar, and multiple regressions to examine associations with systolic/diastolic blood pressure, controlling for age, body mass index, and wealth, and differentiating by gender, mental health, and medication.

- by Catherine Panter-brick
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- Mental Health, Afghanistan, Biomarkers, Blood Pressure

- by Isaac Hillary
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- Social Psychology, Refugee Studies, Resilience, Political Science

The existing literature on Indian ethnopsychology has long asserted that somatization is a key aspect of experiences of distress. The study of idioms of distress arose out of work done in India (Nichter in Cult Med Psychiatry 5(4):379-408, 1981), but ironically, little subsequent work has systematically explored idioms of distress in this part of the world. This ethnographic study focused on the term tension (tenśan) and its relation to a cultural syndrome among women in urban North India. This syndrome appears to involve rapid-onset anger, irritation, rumination, and sleeplessness as key symptoms. It is often linked to specific circumstances such as domestic conflict and is associated with the stresses of modern urban life. People who report more symptoms of tension had consistently higher scores on the Hopkins Symptoms Checklist-25 for depression and anxiety. In this cultural context where psychiatric care is highly stigmatized, the language of tension can aid providers of mental healthcare (many of whom, in India, are not psychiatrists or psychologists) to identify and communicate effectively with potential patients whose mental healthcare needs might otherwise go unaddressed.

- by Lesley Jo Weaver
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- Psychological Anthropology, Multidisciplinary, India, Cross Cultural Psychology