Paper short abstract:

This paper explores how a local mental health agenda advances communication and measurement in mental health practice. Drawing on examples from Haiti, the paper describes development of culturally appropriate instruments and the identification of particularly local means of communicating distress.

Paper long abstract:

Of central concern to mental health practice is an understanding of how mental distress is experienced and communicated. Idioms of distress provide a powerful means of communicating distress in local worlds. This paper describes research in Haiti's Central Plateau to identify idioms of distress that represent cultural syndromes, with a focus on the idiom of distress reflechi twòp (thinking too much). This syndrome is characterized by troubled rumination at the intersection of sadness, severe mental disorder, suicide, and social and structural hardship. Recognizing and understanding "thinking too much" may facilitate culturally appropriate recognition, communication, and intervention to reduce long-term psychosocial suffering. Beyond improving clinical communication, idioms of distress reflect broader social ills. Reflechi twòp is explicitly linked to socioeconomic realities that shape life possibilities, suggesting that considerations of structural violence are central to understanding this idiom.

Complementary to questions of communication are questions of measurement. The development of culturally appropriate mental health assessment instruments is a central concern for much anthropology of mental health work. Simple translation of questionnaires can produce misleading and inaccurate conclusions. Multiple alternate approaches have been proposed, and this paper describes two approaches in rural Haiti. First, ethnographic data collection was employed to develop new instruments: the Kreyòl Distress Idioms and Kreyòl Function Assessment scales. In tandem, an established transcultural translation process was used to develop Haitian Kreyòl versions of the Beck Depression Inventory and Beck Anxiety Inventory. Without these efforts, screening would have captured a combination of atypical suffering, everyday phenomena, and potential psychotic symptoms.