Indians Lag Behind in Mental Health Talk, Why Language Barrier May Be the Reason
What happens when we restrict the conversation around mental health to just one language?
(Trigger warning: Mention of suicide, grief, and trauma. If you feel suicidal or know someone in distress, please reach out to them with kindness and call these numbers of local emergency services, helplines, and mental health NGOs.)
When Shalini Tuscano, an Indo-Canadian mental health activist, found out on 5 October 2018 that her husband, Anand Almeida, was dead, her worst fears were confirmed. She had reported him missing just a few days earlier, but his life-long struggle with depression and anxiety had led to his death by suicide.
A year later, on Anand’s death anniversary, Shalini first wrote about the incident and everything that led to it on her blog, and in English. However, along with “cultural stigma, grief, and societal norms as a widow,” she was met with a new block that excluded her family from having access to this particular piece – the language barrier.
“Our extended families are back home in Vasai, Maharashtra. Wanting to reach to a wider audience among our community, for whom Marathi is the primary language and in particular, the Kadodi dialect, I felt that having my work translated to Marathi would be a good idea,” Shalini told FIT.
“That’s when I decided to seek the help of a professional translator and had my blog produced in Marathi for the sake of our families,” she added.
When FIT came across Shalini’s story recently, it gave rise to a lot of questions like why does a country like India, with hundreds of different languages, not have accessible, affordable, and non-academic reading material on mental health.
We reached out to doctors, mental healthcare workers, publishers, and other stakeholders in the field to gain a better perspective of this situation.
Translations Scant, But Demand Extremely High
Shalini Tuscano’s article was translated into Marathi by Anant Ghotghalkar. A translator for five years, he told FIT that this was the only article on mental health awareness that he had ever translated.
“I found this work to be more helpful to readers. It was very dear to me, very important to translate this piece particularly,” he said.
“The article was received well by many, especially on Facebook. With so many suffering from depression and many others surviving suicide loss, those who are left behind need to live as well right? I felt Shalini’s article would help in achieving that perspective,” he added.
But what happens when we restrict the conversation around mental health to just one language?
Dr Sadhana Natu, associate professor and the head of the department of Psychology at Modern College, Pune, shed some light on this scenario.
“When we use English as the messaging language, it automatically excludes the non-English speaking Indian population, which, not surprisingly, are the marginalised sections of the society across religions and regions. They actually face more mental health challenges and are more vulnerable than the mostly elite English-speaking class.”Dr Sadhana Natu
Dr Neha Bhave Salankar, a psychiatrist at the Bhave Institute of Mental Health in Maharashtra’s Nagpur, explained that they treat a substantial number of patients from rural areas in Maharashtra, and from other neighbouring states as well.
“Language barrier is a real issue when it comes to patients from rural areas with certain dialects. Often, they come with a relative who acts as a translator on their behalf. This leads to things getting lost in translation, and also, a breach of privacy,” Dr Bhave Salankar explained.
As part of patient service, she explained that they are developing their own reading material in Hindi and Marathi for lay persons to avail, which is still unheard of in most parts.
“So far, we have been circulating the information booklets or pamphlets in Marathi that pharmaceutical companies give us along with their drug samples. While they are informative, we realised that they are not exactly what we require to equip patients. Hence, we are developing our own material in regional languages so that anyone can read them and understand mental illnesses,” Dr Bhave Salankar added.
Gendered Symptoms and Faith Healers: Why Vernacular Reading Material Is a Necessity
Another important reason that Dr Bhave Salankar highlighted the need of reading material in regional languages is that 90 percent of the rural population relies heavily on “faith healers.”
She explained, “Most don’t know what they are suffering from, so they turn to what they understand. There is also a dearth of skilled professionals in these parts of the country to correctly guide them. Many primary healthcare centres will only give sleeping pills as a solution to these citizens.”
Many rural patients reach out for proper help at their institute only when the symptoms are visible, she said.
“Their identifiers of change in attitude are very different and gender specific. If a woman is neglecting household work or childcare, then they bring her to us. Likewise, when a man starts muttering, smiling absentmindedly, becomes unproductive, or hostile, that rings a warning bell for their relatives.”Dr Neha Bhave Salankar
“We take stronger efforts to effectively communicate in simple terms the patient’s condition and to guide their caregivers that this is a diagnosable and treatable illness,” she added.
What's the Role Of Public Organisations?
While there are non-profit organisations that are working at the grassroots level to bridge the gap between mental healthcare and its accessibility for all, the process remains non-uniform.
Pallavi Rohatgi, executive director at The Banyan, said, “We run two projects in Maharashtra’s Ratnagiri and Aghai to aid the homeless and those suffering from mental illnesses. In my experience, mother tongue is very important for mental health. These are very deep-rooted stories that people want to share, and heal from, but cannot otherwise.”
“The staff here is trained to communicate with the people in Marathi. I firmly believe that not just the written word, but the spoken word on mental health is necessary as well. Material with pictorial depictions which is contextualised to the local languages and practices will bring about a massive change in how we tackle this situation, the way it is done in some of the war-torn African countries.”
She emphasised the need for creative advertisement campaigns and a standardised document created by the government that everyone else can refer to whenever needed.
“Keeping the lack of funds in mind, I would like to see a national resource hub for mental health literature, awareness campaigns in all medium, grassroots level capacity building and sensitisation/awareness sessions being implemented,” she said.
Dr Natu mentioned how her students from Pune's Modern College have written a booklet called Mental Health for All in very simple English with illustrations, visuals, and graphics. “It has been well-received and is being widely circulated,” she said.
The Centre For Mental Health Law And Policy (CMHLP) in Pune is also one such organisation that translates its resources into Marathi.
The Problematic Messaging
A Marathi playwright, requesting anonymity, shared his experience of not being able to reach out for help due to the shame he felt in not being able to speak in English.
“I didn’t know that what I felt in the initial days of my career was called anxiety. I would go around saying ‘kasatari hotay’ (I am feeling uneasy). My peers noticed it and started recommending some positive pages to follow on Instagram and I also read popularly translated self-help books,” he said.
Most small book shop owners based out of Maharashtra that FIT reached out to said that they usually only stock up the course books for psychology. “I will only keep what sells right? Annually, students purchase these books, and in case they need extra reference books prescribed to them, I order it for them, but even that sale is taken up by e-commerce companies now,” said the owner of a family-run book shop in Maharashtra’s Nashik, where the Maharashtra University of Health Sciences (MUHS) is located.
While there is abundant information available on mental illnesses in English, there is no onus on anyone for responsibly delivering it.
Echoing this, Dr Natu added, “Even in English, there are problems with the mental health messaging that is by and large from a biomedical perspective, filled with jargon, and makes no attempts to demystify mental illnesses for lay persons.”
“What matters is who is actually using these English language platforms to lay out the conversations on mental health. Are they honest mental health professionals with skills, training, and truly bio-psycho-social perspective, or quacks and Instagram influencers? This is a grave and serious problem too.”
One would then be forced to think about why such material in regional languages is not popular in India even now, to which Dr Natu added, “It is not a question of popularity. It has more to do with the elite backgrounds of the majority of practitioners. How many multilingual, diversity-friendly experts do we have? Very few.”
Highlighting that translations cannot be literal with regional language jargon replacing the English jargon, Dr Natu said, “Regional language material has to consider cultural contexts, dialects, and their lived realities. Sometimes the regional language material ends up being guilty of some of the same faults as the English language; it is elitist too. For instance, Chinnamanskata is as alien as Schizophrenia is to a regional Marathi language speaker. The term 'stress' is more familiar to a lay person.”
How Can the Narrative Be Changed?
Dr Natu trains her students by helping them actively become multilingual and engage in well-designed, structured internships with organisations so that they learn cross-sectionally friendly mental health and wellness communication in a hands-on manner.
“The students are also trained to take self-care sessions for our tertiary staff – peons, security personnel, canteen, library, and clerical staff. This is done in either Marathi or Hindi. This creates a bottom-up approach towards mental health instead of the usual top-down,” she added.
Shalini Tuscano said, “The individual struggling with mental illness, as well as their caregiver, both require a support system. Mental health advocacy is the journey of a wounded healer. As a suicide loss survivor, opening up has helped in my on going healing process, as I honour my husband by sharing our truth and shedding light on a very stigmatised issue in the South Asian culture. This has created a safe space for others to come forward with their own stories and with the Marathi translation, it has expanded my reach.”
With concentrated efforts on negating complacency, increased affordability and accessibility seem the only way forward when it comes to tackling the problems of untreated mental illnesses in India.
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