Connecting minds across cultures and languages

Topic: Connecting minds

Ever more often, the patient sitting across us has grown up in a different cultural environment, and we lack a common language. However, the human need to be seen and heard is universal. In all medicine, and especially in psychiatry, medical history plays a crucial role in arriving at a diagnosis. When we lack a shared language to communicate with, an interpreter is required.

Coming from a different culture, the patient's perception of illness and health can differ significantly from ours. In Western cultures, the etiology of illness is thought to be biological, genetic and psychical. Other cultures may have different views, and depending on a person and their education, attitudes and beliefs about mental illnesses may vary.

Educational background often has a larger impact than culture on our perception of health and illness. When the patient is not aware of the biological and physiological principles, it’s hard for them to understand the biological basis for the symptoms, and thus easy to assign the symptoms to a higher power.

Some languages also lack the correct terminology for a certain symptom or illness and in some countries, the diagnostics for certain diseases f.ex. psychiatric, can be almost non-existent. The fear of social stigma can drive the covering up of symptoms, as well as mistrust of officials.

When we lack a shared language to communicate with, an interpreter is required. Working through one can feel laborious and time-consuming. However, proper assessment as well as correct treatment is impossible, if the patient cannot understand most of the questions and instructions.

Working through an interpreter, one must be ready to forgo some of the nuances of words. On the other hand, the understanding between doctor and patient can be promoted with the enhanced use of facial expressions, gestures and emotional mirroring.

When communication through an interpreter fails, the doctor can easily feel like the interpreter is not interpreting correctly. In the code of ethics for interpreters, they are told to transmit the linguistic and culturally specific, non-linguistic messages as comprehensively and in as original a form as possible. The interpreter is not supposed to, by their own initiative, explain the subject matter on behalf of either of the other parties. Relying on these instructions makes it hard for the interpreter to intervene when the communication between doctor and patient is working poorly. The interpreters often wish for the doctor to inquire more specifically when some issue fails to be understood.

In the case that the communication seems to be failing, the most efficient solution is to ask the patient, if there is something else that is hindering the communication. It may turn out that the patient does not understand the concepts the doctor is using, in which case they have to be explained in more detail. It is also possible that the patient does not understand the interpreter clearly because of difference in dialects, or that there is some other reason preventing the patient from openly discussing their situation in the presence of the interpreter. A professional interpreter does not mind if the patient requests a different interpreter. Remote interpreting is an option when the patient feels uneasy about the presence of a third party.

Psychiatric assessment tools are usually not validated with multicultural populations. There are also tools developed to help health professionals gather and organize culturally relevant clinical information such as Cultural Formulation Interview with it ́s 12 supplementary modules which is included in DSM-5- assessment tools. It is developed to enhance clinical understanding and decision-making, but not as the sole basis for making a clinical diagnosis.

In short, while difficulties remain, we are every day further on the road to understanding each other despite cultural boundaries. With patience, an open mind and relying on good communication skills, it is possible to connect minds across cultures and languages. □