Idioms Of Distress Research Articles

“Kull wahad la haalu”

Recently arrived Yemeni immigrant women in San Francisco's Tenderloin neighborhood face a series of challenges as they go about living their everyday lives in a poor and crime‐ridden neighborhood. They experience feelings of isolation and distress because of their limited English skills, their conservative Islamic dress that draws comments and unfriendly looks, and their household chores as mothers of often large families, which keep them busy at home. Despite living in close proximity to other Yemeni immigrants, these women feel profoundly lonely. In this study, based on interviews with 15 recently arrived Yemeni women, I show different “idioms of distress” that connect the women's emotional states to experiences of physical space and the body. I also raise methodological and epistemological questions about conducting anthropological work in communities whose members experience profound isolation.

Opportunity for Development or Necessary Nuisance? The Case for Viewing Working with Interpreters as a Bonus in Therapeutic Work

This paper explores the central role a language interpreter can play in the process of the therapeutic relationship. Although others have described the changes to the therapeutic dyad that the presence of a third party (an interpreter) brings, little attention has been paid to the advantages and additional opportunities of this altered therapeutic situation. This paper details these gains and further argues that clinicians who are willing to gain experience of working with interpreters will find that benefits accrue at the micro and macro levels: at the micro level, through enhancement of their work with individual non English speaking clients, and at the macro level through learning about different cultural perspectives, idioms of distress and the role of language in the therapeutic endeavour. This is in addition to developing skills to fulfil legal and professional requirements relating to equity of service provision. Some ideas are offered to explain the negative slant than runs throughout the literature in this area and tends to colour the overall discussion of therapeutic work with interpreters and, before the final section, makes some specific suggestions which may help maximise the gains possible in such work while reducing difficulties.

Transnational Lives, Travelling Emotions and Idioms of Distress Among Bolivian Migrants in Spain

This article examines the emotional and health impacts that immigration to Spain has on Bolivian families. We explore transnational preventive and healing activities deployed in Spain and Bolivia to allay emergent anxieties, frustrations and illnesses. Although undocumented migrants have access to a universal public health system, they adopt pluralistic approaches to healing, combining traditional and biomedical treatments. An understanding of these healing strategies requires attention to how emotions and their embodiment are experienced in the context of immigration. We propose a theoretical framework which draws upon a constructivist approach to emotions and expand its potential by linking it to influences of transnational lifestyles and bifocality. Preoccupation and sorrow are considered key etiological agents for many illnesses in the Andes and therefore migrants are particularly mindful about how their own suffering abroad affects vulnerable relatives in Bolivia. Communication between migrants and relatives is permeated by white lies, non-disclosure or blatant suppression of information about illnesses or personal difficulties. Migrants rely on particular relatives to access transnational healing methods, while simultaneously concealing information about their health from others. A migrant's health experiences are thus constrained not only by difficulties with the public health system but also by emotional considerations that span informal transnational networks.

A Model of the Generation of Ataque de Nervios: The Role of Fear of Negative Affect and Fear of Arousal Symptoms

This article examines a model of the generation of ataque de nervios, according to which both fear of negative affectivity and fear of arousal symptoms are associated with the emergence of ataques. We examine the relationship of fear of negative affectivity and fear of arousal to the severity of ataque de nervios during the last month and the last 6 months among Caribbean Latinos residing in the United States. The measures include a Fear of Anger Scale and the Anxiety Sensitivity Index (ASI), the ASI augmented with two items that assess fear of arousal symptoms common in ataques: chest tightness and a sense of inner heat. In keeping with the model of ataque generation, one-way analysis of variances (ANOVAs) and discriminant function analyses illustrated that items assessing "fear of negative affect" and "fear of somatic and psychological symptoms of arousal" both differentiated well among the levels of ataque severity. In addition, key ataque symptoms-mental incapacitation fears, shakiness, chest tightness, palpitations, and a sense of inner heat-were the best discriminators among levels of ataque severity. In patients with severe ataques, the scores of "fear of negative affect" and "fear of ataque-de-nervios-type somatic and psychological symptoms" were extremely elevated. This further suggests that both these types of fears are associated with this idiom of distress and that the specific content of the fears is linked to the symptom picture of the idiom. This suggests specific therapeutic targets for the treatment of ataque, namely, the reduction of anxiety sensitivity (and more generally negative-emotion and arousal sensitivity) using cognitive behavioral therapy (CBT), relaxation, and mindfulness techniques.

Bethlem's Irish: migration and distress in nineteenth-century London

Association between migration and mental illness is widely reported. This study aimed to gain insight into the mental health of Irish migrants into Britain in the years 1843-53. Casebooks from the period were examined for Irish ethnicity, and clinical profiles were compared with those of age-matched control samples. Irish-born patients were found to have a greater proportion of diagnoses of mania than controls (p < or = 0.01). They were more likely to be admitted for 12 months or longer (p < or = 0.001) and more likely to receive religious attributions for illnesses by the treating physician. The more common diagnosis of mania in the Irish group can be explained in terms of the effects of migration, differences in idioms of distress, or in terms of prejudice.

Is it Possible to Eradicate Poverty without Attending to Mental Health? Listening to Migrant Workers in Chile through their Idioms of Distress

Departing from the existing critique of the Millennium Development Goals (MDGs), regarding the absence of mental health dimensions in the formulation of its poverty related goal, this article explores the interrelation between poverty and mental health by examining experiences of emotional distress of Peruvian migrant workers in Chile. Through an analysis of the idioms that Peruvian migrants use to communicate their distress, this article proposes an understanding of Peruvian migrant's emotional suffering that attends to the broader unequal relations that migrant workers are subjected to in the host society. The analysis enables an understanding of their experiences of social exclusion and personal uprootedness, making visible the agency that the migrants display in giving meanings and coping with their emotional distress, most often outside the medical system. This article argues for the need to develop alternative and culturally sensitive approaches to mental health, in order to support the everyday struggles of the poor.

Somatization as cultural idiom of distress: rethinking mind and body in a multicultural society

This paper is a critique of the cross-cultural utility and validity of somatization in the diagnosis and treatment of psychological disorders. Somatization is defined as the process by which psychological distress is expressed as physical symptoms that have no known organic basis. Rather than a phenomenon limited to non-western cultures as commonly thought of in the past, somatization should be recognized as a universal experience found across cultures. It underscores the significant interrelationships between the mind/psyche and the body, an area embraced by some disciplines such as Jungian psychology and psychotherapy, but historically neglected by bioscience. This paper argues that the reputedly low prevalence of somatization observed in western cultures is an artifact, due to the overly restrictive diagnostic criteria used in clinical practice. This paper argues in favor of the retention of somatization as a valid concept in diagnosis, treatment, and in psychotherapy, especially at a time of increasing cultural diversity.

The Experience of Low Back Pain in Iranian Women: A Focus Group Study

Chronic low back pain (CLBP) often proves resistant to treatment because there are different biological, psychological, and social factors that can affect its treatment. In this study, we explored Iranian women's beliefs regarding the cause of their LBP. Findings are based on four focus groups (N = 24 participants) with LBP patients. Participants articulated their causation beliefs (Explanatory Models) about low back pain through three themes: idioms of distress: stress in women's lives; lack of knowledge resulted in high-risk behaviors; and organic/biomedical. Given the difficultly regarding diagnosis and treatment of CLBP, understanding patients’ health beliefs, causation beliefs, and experiences are warranted.

“Spiritual Starvation” in a Holy Space—a Form of “Jerusalem Syndrome”

The purpose of this article is to study the narratives of two religious tourists who have chosen self-starvation on the streets of Jerusalem as their idiom of distress. Both were hospitalized involuntarily due to self-endangering behavior. It appears that in specific groups, restrictions of food intake are regarded as particularly holy, pure, and blessed. Extreme cases of self-starvation using religious explanatory models could be regarded as forms of “spiritual starvation”. Patients involved in these acts of fasting differ in both religious and cultural backgrounds, as well as the extent to which their families regard the importance of religiosity. Representing extreme forms of religious practice, both spiritual starvation and Jerusalem Syndrome are rare phenomena. The so-called “Jerusalem syndrome” is a rather dramatic, cultural–religious phenomenon, rarely displayed by pilgrims and tourists visiting the Holy City. Jerusalem, the “axis mundi” of faith, is perceived as the arena where great events are about to occur. This eschatological core element is at times exploited in a broader sense in the service of a public or an individual, to the extent where boundaries between reality and imagination are blurred. For some vulnerable individuals (mostly with previous recorded psychiatric history), the extraordinary and overwhelming mental experience of facing the holy space of Jerusalem might yield an emotional response that exceeds an adequate reaction. The narratives described display a unique form of the so-called syndrome. The current study examines spiritual and cultural aspects of delusion and shared beliefs and the complex relationship between normal religious belief and “pathological” religious delusions. I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear.—Matthew 6:19. Who shall separate us from the love of Christ? Shall trouble or hardship or persecution or famine or nakedness or danger or sword?—Romans 8:30.

Is There an Asian Idiom of Distress?: Somatic Symptoms in Female Japanese and Korean Students

The term 'idiom of distress' is used to describe culturally specific experiences of suffering. Most of these studies have been conducted with small groups, making comparison of symptom profiles difficult. Female undergraduate and graduate students in Japan (n = 50) and Korea (n = 61) completed the Beck Depression Inventory (BDI) and 7-day daily reports of their experiences of 46 somatic symptoms. Between-culture comparisons revealed that BDI scores did not differ; however, the Korean women had significantly higher somatic distress means than the Japanese women. Despite the higher Korean distress mean, regression analysis showed that somatic distress explained 30% of the variance of BDI score for the Japanese but only 22% of the variance for the Koreans. Within-culture comparisons showed that both high-BDI Japanese and Koreans had 19 somatic distress symptoms with significantly higher means than their low-BDI counterparts; 11 somatic symptoms were shared by the two groups. Multidimensional scaling matrices were used to compare symptom proximities and revealed cultural differences. The problems with using broad racial categories in clinical research, the clinical significance of these findings, and the implications for psychiatric nursing assessment and practice are discussed.

Languages of Labor: Negotiating the “Real” and the Relational in Indo‐Fijian Women's Expressions of Physical Pain

Medical personnel in public clinics in Fiji routinely contend that state-funded medical resources are misallocated on patients who complain of, but do not actually experience, physical pain. Frequently, these patients are identified as being Indo-Fijian women (i.e., women of South Asian origin in Fiji). In this article, I examine clinical interactions between medical staff and female Indo-Fijian patients to demonstrate how "real" and 'unreal' pain are distinguished in the clinical setting and to indicate some of the roles clinical encounters play in community processes that ascribe alternative meanings to physical pain. Focusing on how both physicians and women patients foster certain interpretations of physical pain over others, I argue that the category of 'unreal' pain, as employed by Fiji's physicians, consists of pain that medical professionals consider to be induced by psychological or physical, work-related stresses. I then show how Indo-Fijian women engage in a complementary but distinct discourse that emphasizes links between physical labor and pain and suggests that, in some cases, expressions of physical pain are as much an idiom of pride as an idiom of distress.

Social Support and Distress among Q'eqchi' Refugee Women in Maya Tecún, Mexico

This article addresses issues of vulnerability and distress through an analysis of the relationship between social support networks and traumatic stress in a Q'eqchi' refugee community in southern Mexico. The sociopolitical violence, forced displacement, and encampment of Guatemalan Mayan populations resulted in the breakdown and dispersal of kin and community groups, leaving many Q'eqchi' women with weakened social support networks. Research involving testimonial interviews and traumatic stress and social support questionnaires revealed that Q'eqchi' refugee women with weak natal kin social support networks reported greater feelings of distress and symptoms of traumatic stress than did women with strong networks. In particular, a condition identified as muchkej emerged as one of the most significant symptoms reported by women with weak natal kin support networks. I critically consider muchkej as an idiom of distress and argue that aid organizations should consider the relationship between social support and traumatic stress, as expressed through such idioms, when attempting to identify vulnerable members of a refugee population.

Cultural identity, cultural congruity and distress

Migration, cultural identity and mental distress are linked. In addition, social support can provide a buffer against mental illness. Other vulnerability factors in migrants include the type of society they originate from and the type of society they settle in. Societies and cultures have been described as being individualistic or collectivist (also called ego-centric or socio-centric). Similarly, individuals are idiocentric or allocentric. When individuals migrate from one type of culture to another it is likely that, depending upon their own personality traits (along with their biopsycho social vulnerabilities), they may develop psychiatric disorders. It is possible that response to stress as a result of migration will depend upon the type of culture people migrate to. However, the cultural identity of the individuals will also determine their coping strategies. Under these circumstances, it is crucial that clinician are aware of the impact cultural identity has on the expression of distress and coping among individuals The cognitions and idioms of distress will be influenced by cultural factors. The clinicians must take into account cultural background when planning any interventions to enable a stronger therapeutic alliance.

Research Issues for Improving Treatment of U.S. Hispanics With Persistent Mental Disorders

Research Issues for Improving Treatment of U.S. Hispanics With Persistent Mental Disorders

Articulating Distress on Multiple Levels: Illness, History, and Culture Among the Kumiai of Baja California, Mexico

Illness among disenfranchised indigenous communities in Mexico reflects not only disease but also structural relations of power based on ethnicity, gender, and economic status. As such, physiological explanations of illness alone are not sufficient to understand and address suffering caused by common illnesses. Among the Kumiai Indians of one rural community in Baja California, one of the most commonly reported health problems is presión baja (low blood pressure), and the overlapping condition of alternating high and low blood pressure. Low/variable blood pressure is most likely to affect women from one of two clans and who are relatively poorer than other community members. For these women, low/variable blood pressure embodies the lived experience of and response to high rates of diabetes, local gender relations, and a changing kinship structure. As a local idiom of distress that carries national cultural currency as a reflection of the experiences of indigenous Mexican women living in rural poverty, low/variable blood pressure requires interventions that directly target diabetes but also gender-sensitive economic development programs to promote community health.

Between Structural Violence and Idioms of Distress: The Case of Social Suffering in the French Caribbean

Between Structural Violence and Idioms of Distress: The Case of Social Suffering in the French Caribbean

Culture and eating disorders classification

This paper discusses cultural considerations for classification of eating disorders. The literature on epidemiology and phenomenology of eating disorders in culturally diverse populations was selectively reviewed to identify methodologic challenges in classification and characterization of prevalence and phenomenology. Prevalence of eating disorders among culturally diverse populations is incompletely characterized. Few studies address the epidemiology of eating disorders or provide qualitative data on variation in presentation in these populations. Unrecognized cultural diversity may result in misclassification of cases. Development of culturally valid assessments, ethnographic data on indigenous nosologic correlates and idioms of distress, and attention to phenomenologic diversity may have critical impact on understanding clinical presentations and risk factors that may be culturally particular. A flexible classificatory system for the eating disorders may help to encompass their culturally based phenomenologic diversity, facilitate culturally sensitive and strategic prevention strategies, and reduce ethnic disparities in access to care for them.

The explanatory models of depression in low income countries: Listening to women in India

Introduction Women, and persons facing social and economic disadvantage, are at greater risk for depressive disorders. Our objective was to describe the explanatory models of illness in depressed women, in particular, their idioms of distress, and their views of their social circumstances and how this related to their illness. Method We carried out a qualitative investigation nested in a population based cohort study of women's mental and reproductive health in Goa, India. We purposively sampled women who were ever-married and who had been found to be suffering from a depressive disorder on the basis of a structured diagnostic interview. In-depth interviews were carried out about six months apart exploring stressors in women's lives, a typical day in their recent lives, and their illness narratives (idioms of distress, causal models, impact of illness, help-seeking). Results 35 women consented to participate in the study, 28 completing both interviews. Women gave expression to their problems primarily through somatic complaints, typically a variety of body aches, autonomic symptoms, gynecological symptoms and sleep problems. There was frequent mention of overall “weakness” and tiredness. Economic difficulties and difficulties with interpersonal relationships (particularly related to marital relationships) were the most common causal models. However, women rarely considered biomedical concepts, for example, the notion that they may suffer from an illness or that their complaints were due to a biochemical disturbance in the brain. Despite the lack of a biomedical concept, most of the participants had sought medical help, typically for reproductive and somatic complaints. Conclusions We recommend the use of somatic idioms as the defining clinical features, and a broader, psychosocial model for understanding the aetiology and conceptualization of the clinical syndrome of depression for public health interventions and mental health promotion in the Indian context.

Somatoform disorders: Perspectives from Pakistan

Somatoform disorders represent widespread and largely unsolved problems at the border between psychiatry and medicine. Patients with somatoform disorders often present difficult diagnostic and management problems. A series of three community-based epidemiological surveys of rural and urban populations in Pakistan found high prevalence of common mental disorders where the core presentations were somatic complaints. All the three epidemiological surveys used the Bradford Somatic Inventory (BSI), which was developed from symptom reports by psychiatric patients in Pakistan; these enquired about somatic symptoms in the local language, taking into account local cultural idioms of distress. At a conservative estimate, 66% of women and 25% men suffered from anxiety and depressive disorders whereby the complaints predominantly were somatic in nature. People in rural non-Western cultures are not psychologically minded and do not have abstract language or concepts of emotional distress and therefore communicate their emotions somatically. In Pakistan somatoform disorders possess a prominent diagnostic dilemma. The cornerstone of the management is a comprehensive medical, psychiatric and psychosocial evaluation of the patient. Patients with multiple somatic complaints not only present formidable management problems but also often have severe functional impairments that may outweigh those of patients with other so-called severe mental illnesses. Since somatoform disorders are the most common psychiatric disorders to present in non-psychiatric settings, it is important that training about them begin at undergraduate level. It should also be incorporated in the training of a wide variety of non-psychiatric specialists, both medical and non-medical.

Idioms of Distress: Psychosomatic Disorders in Medical and Imaginative Literature

Idioms of Distress: Psychosomatic Disorders in Medical and Imaginative Literature