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Problems of expression in psychiatry


According to the Old Testament, the entire human kind spoke one and the same language. There was much arrogance, however, and a decision was made to build a tower that would reach up into the sky: God punished them for their arrogance and mixed their language rendering them unable to understand one another and would abandon their plans.

Ever since this time mankind has spoken many languages, hindering all interaction between people. A few attempts have been made to create a universal language that could unite mankind. The most famous of these is Esperanto created by the Polish Jew and ophthalmologist, Ludvik Zamenhoff at the turn of the 19th century. He was a sincere pacifist and felt that a universal language for all mankind could prevent warfare. However, this language never spread to the extent its creator had hoped. World War One with all its suffering and hardship was a major disappointment to Zamenhoff.

The English language came closest to being a universal. It suits well in many respects because speaking bad English is easy. Generally, a native English person can and uses some 10,000-30,000 words. One can easily exist at busy tourist venues just by using only 500 words. The grammar is easy compared to several other languages; this means that many people think they speak good English despite their limited know-how and lack of vocabulary. More often than not this causes endless misunderstanding as many think that the person they are talking to has a better understanding and is more capable whereas the fact is that this causes extensive misunderstanding. Both parties misunderstand each other. This is quite common in psychiatry where competence in expressing one’s emotions is of utmost importance.

The finer aspects and diversity of emotions put’s one’s language skills to the test. Frequently, expression becomes superficial as the patient does not possess the language know-how to express his or her real psychological situation.

When the English language does not suffice, an interpreter needs to be recruited. Usually, this goes well although this also involves various problems. What should be the gender of the interpreter? Does the interpreter speak a correct dialect? Does the interpreter convey everything correctly and honestly? Is the interpreter unbiased?

I have worked with many interpreters and have learned that the smaller the community is the more difficult it becomes for the patient to trust the interpreter. The interpreter may know the patient’s immediate family or may be involved in some kind of internal conflict within the relevant ethnic group. The interpreter’s gender frequently causes problems. Men often find it difficult to accept a female interpreter and women often lack trust in male interpreters. These are all issues the psychiatrist must bear in mind.

Interpretation by telephone has worked well for me. Such interpretation method is more impersonal and the patient does not see the interpreter, which in turn creates more relaxation and trust.

There is several interpretation software (interpretation machines) on the Internet. Such software can be quite useful; however, have a tendency to misinterpret and thereby rendering the translation as strange, even weird. This can easily be seen in emails I receive every day from distant countries where the sender has obviously used translation software. The content and intent of such mail are frequently confusing even though including informing me of being the owner of a fortune abroad and that the only thing I need to do is to dispatch my personal information and bank number in order to open the flow of gold.

Attempt is made in psychiatry to comprehend people’s emotions; hence expression is paramount when reading into non-verbal expression, facial expression, the tone of the voice, etc.

The increasing number of immigrants and growing tourism increase the need for interpretation service. I am a great believer in technology and think that interpretation by telephone will become increasingly more common in years to come. Translation software will become better and perhaps it can be relied more upon in years to come. □


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