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

Abstract

Research premised on the construct of idioms of distress has proliferated in the last 40 years. The aim of this work is to foreground the experiential and socially adaptive functions of cultural expressions of distress around the world. Researchers who work in this field often begin from very different starting points in terms of their prior knowledge of the research context, their interest in theoretical or applied implications of their work, and the target areas of distress that they study. While this multiplicity of approaches ensures that the literature captures diverse manifestations of suffering, it also creates confusion for those who are new to the field and who may not know where to begin. This article seeks to resolve some of that confusion by identifying common conceptual challenges across the idioms of distress literature, and then providing a detailed step-by-step methodological example of an idioms of distress study in India that could be adapted for similar work in other contexts.

From idioms of distress, concern, and care to moral distress leading to moral injury in the time of Covid

“…The same is true of shifts in the meaning attributed to allopathic diagnosis. For example, calling attention to one's high "BP" (blood pressure) has increasingly become conflated with another common idiom of distress in India-tension-which encompasses stress and anxiety (Weaver et al, 2022a). 7 A second trend involves symptom reporting.…”

“…Each of these methods has its own utility and addresses different research questions starting with the identification of idiom of distress candidates and prototypes and proceeding onto documentation of trends in use. The step-by-step guide to identifying potential idioms of distress in this special issue (Weaver et al, 2022a) is a useful tool incorporating several of the methods listed above. The article also identifies efforts to develop scales measuring the intensity of distress.…”

“…7. Tension is a common idiom of distress in South Asia (Weaver, 2017;Weaver et al, 2022a) which encompasses far more than stress and anxiety. See, for example, Weaver's (2018) analysis of tension as related to conflicting roles and expectations among middle-and upper-class Indian females in New Delhi, India, and Atal and Foster (2021) and Simpson (2021) for a similar gender-focused analysis elsewhere in India.…”

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

“…Such studies help to bring idioms of distress into psychiatric epidemiology and provide an example of Kohrt et al's (2014) call for ensuring that our mental health assessments capture what matters most to people. The article by Weaver et al (2022) promotes research in this area by providing a step-by-step methodological approach to the study of idioms of distress that could be applied across contexts and by researchers with differing levels of cultural expertise. While they argue that an ideal approach to this research is collaborative and immersive, they also outline strategies researchers could use to develop familiarity with modes of expression, even in cases where they might be working across languages.…”

“…Cork et al, 2019). Yet, in many settings, individuals transition easily among multiple languages, for instance, maintaining functional proficiency in a national language yet communicating more regularly in a regional language (Weaver et al, 2022). 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?…”