Communication about distress and well-being: Epistemic and ethical considerations

Abstract

Communication about well-being and distress involves multiple stakeholders, including experts by experience (EBE), researchers, clinical practitioners, interpreters, and translators. Communication can involve a variety of discourses and languages and each of the stakeholders may employ diverging epistemologies to understand and explain experiences. These epistemologies may link to different sources of authority and be articulated using particular linguistic resources. Epistemic injustice can occur when stakeholders, intentionally or unintentionally, fail to recognise the validity of other stakeholders’ ways of conceptualising and verbalising their experience of well-being and distress. Language lies at the heart of the risk of epistemic injustice involved in the process of expressing well-being and distress as seen in: 1) the interface between divergent discourses on well-being and distress (e.g., biomedical vs. spiritual); and 2) communications involving multiple linguistic resources, which can be subdivided into multi-language communications involving a) translation of assessment measures, and b) interpreted interactions. Some of the challenges of multi-language communication can be addressed by translators or interpreters who strive for conceptual equivalence. We argue, however, that all stakeholders have an important role as “epistemic brokers” in the languaging of possible epistemological differences. Effective epistemic brokering requires that all stakeholders are reflexively and critically aware of the risks of epistemic injustice inherent in multi-language communication. The article concludes with a set of prompts to help raise stakeholder awareness and reflexivity when engaging in communication about well-being and distress.

Maximising impactful and locally relevant mental health research: ethical considerations

“…Our case studies have drawn attention to the key driver for achieving both meaningful and impactful mental health research is the mediating role of locally embedded researchers who bring knowledge of the research setting and context, and whose insight should be central to shaping how research is approached, including integrating novel and locally feasible research methodologies. This is particularly important when researching established interventions in LMIC contexts, taking steps to balance ecological validity of intervention implementation with the demands of scientific research standards; and in ensuring the relevance and cross-cultural / cross-language validity of research instruments or tools 51 . Achieving this requires continued investment and support for the development of mental health researchers and practitioners in LMIC settings.…”

Conceptual and methodological challenges in idioms of distress research: Common questions and a step-by-step guide

“…Some may, through prior examination of the literature or through long-term experience in the research context, begin with a target IOD already in mind (e.g., Cassaniti, 2019, whose study focused on the concept of “mindlessness” in Thailand, or our prior work on “tension” in India, Weaver, 2017). Others may begin with an interest in local manifestations of a particular psychiatric syndrome, such as depression or anxiety (Patel et al, 2001), addictive behaviors (Snodgrass et al, 2019), Alzheimer's disease (Yahalom, 2019), or posttraumatic stress disorder (PTSD) (Hinton & Lewis-Fernández, 2010; Hinton et al, 2010; Kohrt & Hruschka, 2010). In yet other cases, researchers may do exploratory work to identify idioms without a particular syndrome in mind.…”

“…Inherent to this approach are ethnographically grounded research methods, which avoid relying on etic categories of distress and facilitate research embedded in cultural context. Such holism is a guiding principle for IOD work: this research almost always involves a study of distress expressions themselves and the social functions that they perform—that is, their role as both reflections and constituents of culture (Kohrt & Hruschka, 2010; Yahalom, 2019).…”

Culture-bound syndromes, idioms of distress, and cultural concepts of distress: New directions for an old concept in psychological anthropology

“…In multilingual settings, how might quantitative tools be employed consistently across languages without becoming significantly more time-consuming to adapt or validate? Highlighting the challenges inherent in translation and interpretation across languages, White et al (2022) provide a set of prompts to facilitate reflexivity, communication, and planning for research studies.…”

“…If an idiom of distress is indeed a linguistic expression, is it limited to a specific language-or can the equivalent concept be expressed across multiple languages in the same multilingual setting? White et al (2022) explore how such issues are handled in research. For example, in assessing idioms of distress within a quantitative tool, to what extent is one language considered paramount, potentially displacing other, equivalent idioms of distress that might be more salient to some individuals?…”