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Words – they define us and help us to express how we feel. So what if there are no right words attached to a particular condition or experience? We can become lost and unable to clearly understand what we’re going through. This is something I have been exploring more recently whilst conducting my research with Millennium University on youth mental health literacy in Malawi. The project involves delivering workshops to university students so that they can better understand what mental health is, but it is also a way to promote mental health by encouraging young people and their peers to talk more about the issue and seek necessary support. The hope is that this approach will reduce stigma around mental health in the society.

 

So far, I have held ten focus groups with around 50 young people from various community youth groups and universities across the country. The discussions revealed people’s views and experiences of mental health, existing support services and ideas for more accessible youth friendly solutions. One key issue that has come up over and over again in our discussions; “People do not talk about mental health”. Well, they do somewhat but there are no words in Chichewa (the official local language) for conditions like depression or anxiety.

 

This can make it difficult for people to recognise when they are suffering mentally and describe what exactly they are suffering from. Others felt their parents did not recognise mental health and conditions like depression in a serious medical sense. Depression and anxiety are now the most common mental health conditions that afflict young people worldwide. So, if you are clinically depressed in Malawi but your language has no words to describe your condition easily, what do you do?

 

Another part of my project asks participants to complete a mental health literacy survey to assess mental health knowledge and attitudes of young people before and after they attend a mental health workshop. This will help evaluate whether attending these workshops helps improve mental health literacy. I’ve been working with local stakeholders such as the NGO Drug Fight Malawi and the National Youth Council of Malawi to help me engage young people across the country from various social economic backgrounds in completing the survey. In order to increase accessibility of the survey it was suggested that we should translate it into Chichewa.

 

The translation process has been a steep learning curve. As someone fluent in both English and Chichewa, I had underestimated the challenge of what I thought would be “a straightforward task”. Instead, I found myself struggling to translate words and concepts I commonly use as a psychologist and researcher from English into my native tongue. Suddenly unsure of my linguistic ability, I consulted with fellow researchers and even family and friends, asking them how to say words like ‘mental health’, ‘depression’ and ‘delusions’ in Chichewa. Interestingly, they all came back with slightly different interpretations.

 

Take for instance the word depression. Suggested translations ranged from sadness, low mood, feeling very low and feeling troubled, which are all interesting nuances of depressive symptomatology. A very common suggestion was ‘matenda a nkhawa’ which translated back to English means illness of anxiety and in broader terms links more to anxiety disorder. The issue that had been highlighted in the focus groups came to light so clearly during this translation process.

 

So let us go back and reflect on the importance and power of language, particularly in mental healthcare. Research shows that when patients and providers speak the same language, patients report less confusion and better health care quality. Could it be that the lack of words describing mental health limit people’s ability to recognise illness and express themselves when feeling mentally distressed? This may consequently hamper help seeking and ability for others to understand what that person is talking about. Could it be that not having apt words to describe mental conditions limit the integration of mental health conversations beyond psychiatric boundaries into everyday speech? If this is the case, then there is a risk that mental health is ‘lost in translation’ from decision making levels where mental health services are commissioned all the way down to the grassroots where individuals are left to suffer in silence. To me, one project mission is clear; talk more about mental health, to break down stereotypes, improve relationships and aid recovery. Talk so that we can create the words that we don’t even know we need yet and take stigma out of something that affects us all.

 

About the author

Dr Sandra Jumbe is a Health Services Researcher at Queen Mary, University of London – an LIDC member university. Sandra is a health psychologist with expertise in health research and behaviour change solutions. This essentially focuses on how biological, social, and psychological factors influence health and illness. She has experience in developing health interventions in both clinical and non-clinical settings. Her current research interests include developing complex interventions for non-communicable diseases and understanding mental health in sub-Saharan Africa. She previously worked in the National Health Service (NHS) as a primary care and mental health researcher, an assistant psychologist and in research governance. She has also independently delivered consultancy work around tailored stress management in organisations. Alongside her research work, Sandra is a general adviser for the NIHR Research Design Service London team based at Queen Mary University. This role involves supporting health professionals and researchers within the North East London area to develop their research ideas into full funding applications to the NIHR and other peer reviewed funders.