Idioms of Distress, Resilience and Well-Being

Idioms of Distress, Resilience and Well-Being: Enhancing understanding about mental health in multilingual contexts

Richard Fay was one of the Co-Investigators on this UKRI/GCRF funded project.

Illustrative Research Writing arising from this project

Communication about well-being and distress involves multiple stakeholders – including experts by experience (EBE), researchers, clinical practitioners, interpreters, and translators. It often also involves multiple discourses and languages. Each of the stakeholders may understand and/or explain experiences using potentially diverging epistemologies. These may link to differing sources of authority, and be articulated using particular linguistic resources. We term this communication the ‘languaging of well-being and distress’. If the stakeholders, intentionally or unintentionally, fail to recognise the validity of other stakeholders’ ways of conceptualising and verbalising their experience of well-being and distress, epistemic injustice (Fricker 2007; 2013) can arise. Although diagnostic categories including idioms or cultural concepts of distress do recognise diverse ways of understanding well-being and distress, in seeking to value particular ethno-psychologies, they may reinforce the apparent universality of other, non-localised, diagnostic terms. Thus, the power of the general terms may be underscored by the identification of exoticised local terms, and the risk of epistemic injustice remains. Langage lies at the heart of the epistemic injustice risks involved in the languaging of well-being and distress. Its problematic presence can be seen in: 1) the interface between divergent discourses on well-being and distress (e.g. biomedical versus spiritual); and 2) communications involving multiple linguistic resources. The latter type can be subdivided into multi-language communications involving a) translation of assessment measures and b) interpreted interactions. Some of the multilingual challenges of communication can be addressed by translators and/or interpreters as, for example, they strive for conceptual equivalence. We argue, however, that all stakeholders have an important epistemic broker (Raymond, 2014) role in the languaging of possible epistemological differences – thus, fully equitable communication requires fully effective epistemic brokering. In turn, effective epistemic brokering requires stakeholders to be reflexively and critically aware of the epistemic injustice risks inherent in the communication. The article concludes with a set of prompts which we have developed to help raise such stakeholder awareness.

{draft Abstract for an article under revision as follows:

White, R., Fay, R., Chiumento, A. & Phipps, A. (revisions in process). Communication about well-being and distress: Epistemic and ethical considerations. For Transcultural Psychiatry.

Project Abstract

This project aims to extend research presently in Ghana, Gaza, Uganda and Zimbabwe by focusing on the way local languages are used to express distress and well-being. Specifically the proposed research aims to enhance understanding about how capabilities can be developed by drawing on local idioms – of well-being, resilience and distress. Arts and humanities perspectives will be brought together with the existing Global Mental Health literature to develop innovative ways of translating these idioms with greater sensitivity to the context in which they have emerged. IN particular the place of the local environment and its importance for expression of pain and of resilience and well-being will be analysed.

Proposed Activities: In order to achieve this aim this proposal will:
a) engage in desk research to conduct a comparative literature review of expressions of distress, resilience and well-being in both the medical literature on mental health and in language studies and anthropology.
b) Conduct fieldwork in-situ and digitally, using story-generating methodologies which encourage participants to tell stories about their languages and their use of words in translingual contexts and research sites with researchers and story-tellers.
c) Embed the data collected into programmes which raise awareness of the importance of multilingual sensitivity for working cross-culturally and which aim to mainstream approaches to well-being in populations under pain and pressure.
d) Translate linguistic data into artistic expressions through an intercultural, multilingual, production and conference, which create wider impacts through training programmes in each context.

Fieldwork will take place in the ODA compliant contexts represented in the large grant either in the existing case studies or through the researchers’ languages i.e. Ghana, Uganda, Gaza Strip, Zimbabwe and with new arrival refugees in Glasgow. By using the language story-generating methodologies we will strengthen cultural practices and intangible cultural heritage which is at risk, and mitigate the damage which can occur through a lack of methodological flexibility and sensitivity to the experience of researching multilingually in contexts of conflict or duress. By representing the data generated artistically, we will produce performance and digital materials for use in training and human development activities for both intercultural and local contexts.

Planned Impact

Key umbrella organisations identified for dissemination activities involving intercultural and multilingual collaboration focused on new arrival refugee populations in UK are Creative Scotland where the PI will develop a workshop in language-sensitive refugee arts and integration; Scottish Refugee Council’s Refugee Festival Co-ordinator where the film based activities will be planned into the annual Festival research stream supported by a workshop focused on the ‘languaging of distress’; Contacts have been established with Freedom from Torture (https://www.freedomfromtorture.org) and International Committee of the Red Cross (https://www.icrc.org). Through work with Mark Maughan (National Theatre Director) a series of workshops will be held as ‘wrap-around’ activity for his major production, now in pre-production phase, The Claim. The national campaign organisation Right to Remain (http://righttoremain.org.uk) and Detention Action (http://detentionaction.org.uk) are exploring a contribution to revise their detention tool-kit including a section on the languaging of distress, well-being and resilience. The Right to Remain toolkit is the main resource of support for asylum seekers and refugees in the UK and also in Calais. For dissemination through care-givers in the context of Global Mental Health Co-I White has existing relationships with CBM International (http://www.cbm.org), BasicNeeds (http://www.basicneeds.org), Marc van Ommeren at the Department of Mental Health and Substance Abuse at the World Health Organization; Peter Ventevogel at the Public Health Section at the United Nations High Commissioner for Refugees; and ‘Pan African Network of People with Psychosocial Disabilities’: https://www.facebook.com/PANPPD/ In Ghana: The School of Performing Arts and African Humanities Institute; Media organisations have been identified working to mitigate the effects of fractured education. Noyam (http://www.westartfrica.com/item/noyam-african-dance-institute-accra-2/) and Pan African Arts Musicians (http://gameli.co.uk). In Uganda: Caritas Uganda; TPO Uganda (http://www.healthnettpo.org/en/), BasicNeeds Foundation Uganda, Strong Minds (https://strongminds.org/staff/strongminds-uganda-team/). In Zimbabwe: Festivals for the Arts enabling dissemination of language-based arts and story-telling: Hifa; Shoka; Chibuku. In Gaza: Graduates of the Islamic University Gaza (http://www.iugaza.edu.ps/en/; The Ministry of Culture; PNGO; UNWRA, Medical Aid to Palestine, Women’s Union.

This proposal focuses on idioms of distress, resilience and well-being across four ODA contexts and on their value in promoting well-being in multilingual contexts of duress and distress. The proposed research will enhance both vertical articulation capacities (i.e. the interface between stakeholders involved in the research and (inter)national policy makers) and horizontal articulation capacities (i.e. the interface between the research stakeholders and change-makers working in other sectors) (Lederach, 1995).Beneficiaries for this research have been identified as follows:
1. care-giving organisations needing to work multilingually with survivors of violence, refugees and displaced peoples; mental health practitioners.
2. policy-makers responsible for refugee arrivals; internally displaced; third-country arrivals.
3. organizations working in post-conflict contexts and organizations multilateral understandings of refugee integration, especially in Europe and North America, where host populations are involved in the mitigation of distress.
4. global actors and NGOs campaigning to improve reception facilities in post-conflict and refugee arrival contexts; for humanitarian corridors; and for improved administration of asylum claims.
5. the general public, especially in resettlement contexts where capacity building of volunteers has been identified as an urgent need by partner organisations.