It would make healthcare practitioners’ jobs simpler if all Americans described their depression using the exact same words and phrases. It would be even easier if they used the therapeutic terminology learned in medical school.

But, in the real world, that isn’t the way it works.

Due to America’s diverse cultural mix, not everybody uses the same language to name the signs and symptoms of depression. As a result, there exists a probability of miscommunication, misunderstanding, and misdiagnosis.

The Latinx/Hispanic American Community

In a paper published in Social Psychiatry and Psychiatric Epidemiology, many Hispanic Americans may use different words to categorize their experience of mental illness.

“There are kind ofthird-rail wordsto not use, often the words that white, Anglo medical professionals want to use like ‘depression,’ like ‘anxiety;’ or big ticket ones like, ‘Bipolar,’ ‘PTSD.’ Those are not terms [Hispanic Americans] want to apply,” Michael Kelly, professor of social work at Loyola University in Chicago, told WBEZ, Chicago’s NPR station.

The idioms of distress that may be used in the Hispanic community could include:

• Susto implies an experience of fright. According to an article published in the Journal of the American Medical Association, patients who refer to suffering from susto can experience a myriad of symptoms, including “restless during sleep, listless, debilitated, depressed, and indifferent to food, dress, and personal hygiene.”
• Nervios refers to “chronic dysphoric mood states accompanied with somatic complaints; common symptoms include nervousness, sleep disturbances, easy tearfulness, concentration difficulties, irritability, and somatic symptoms such as headaches, stomach disturbances, tingling sensations, and dizziness,” reports the article from Social Psychiatry and Psychiatric Epidemiology. “Nervios may be triggered or maintained by stressful events, such as anger, grief, other illnesses and the birth of a child.”
• Ataque de nervios are described as attacks that are usually brief and triggered by traumatic stressful events. Symptoms may include such things as brief episodes of “shouting uncontrollably, attacks of crying, trembling, difficulty breathing, dizziness, a feeling of the mind going ‘blank’ and numbness or tingling sensations, and becoming verbally and physically abusive,” according to the Social Psychiatry and Psychiatric Epidemiology.

The African American Community

African Americans may be reluctant to discuss, let alone get treatment for, depression and other emotional conditions, according to Monnica T. Williams, Ph.D., in Psychology Today.

“Talking about problems with an outsider (i.e., a therapist) may be viewed as airing one’s ‘dirty laundry,’ and even more telling is [African Americans who already used mental health services] felt that discussions about mental illness would not be appropriate even among family,” Williams writes.

In a study published in the Journal of Advanced Nursing, African American male participants referred to “the funk” to describe their responses to both personal and external life stressors. “The funk” was later identified as depression.

“During the funk, [study participants] experienced several noticeable changes including: isolation; interpersonal relationship strain; wearing the mask to hide emotional stress or turmoil; feelings and emotional fluctuations that men identified as the mind; and physical changes/neglect of self-care,” the authors explained. “During the first episode of the funk, participants typically did not recognize what was happening to them, although they could sense that something was ‘off’, ‘not right’, or that they felt unlike themselves.”

Despite experiencing “the funk,” many hid their pain from friends, family, healthcare providers and clients, “thinking that they would eventually run their course or that they could control the situation.” Even after several bouts, many stated that instead of seeking help from professionals, they “just wanted to shake it off” and devised their own methods of dealing with it.

How the Asian-American Community Talks About Depression

According to an Online Readings in Psychology and Culture article, Asian Americans, in general, tend to refrain from speaking about their mental health problems unless directly asked. They are unlikely, for example, to express suicidal ideation on a pre-intake questionnaire, unless directly asked by an intake therapist.

They often express feelings of mental distress in physical rather than psychological words and phrases.

“Emotion terms in particular often lack equivalents between English and Asian languages, resulting in Asian American clients having problems discerning subtle yet importance differences between words like ‘sadness,’ ‘despair,’ and ‘depression,’” according to an article by Joyce P. Chu and Stanley Sue. “As a result, Asian American clients may have a difficult time understanding Western-based scales and provide responses that are not conceptually equivalent to the measures’ intended meanings.”

The Native/Indigenous Community

The culture of the Native/Indigenous community is rooted in connectedness. According to Mental Health America, many Native/Indigenous tribes “embrace a worldview that encompasses the notions of connectedness (with the past and with others), strong family bonds, adaptability, oneness with nature, wisdom of elders, meaningful traditions and strong spirit that may serve as protective factors when it comes to mental health.” Further:

Timothy C. Thomason, Ed.D., professor in the Educational Psychology Department for Northern Arizona University, writes about a research study where Hopi Indians were asked about mental illness. “No exact conceptual equivalent to ‘depression’ was found among the Hopi, but the condition ‘heartbreak’ was strongly associated with symptoms of depression and was the most frequent condition among those Hopi people diagnosed with major depressive disorder,” writes Dr. Thomason.

Additionally, one of the ways that Indigenous people may talk about their mental health is called “Ghost Sickness.” This condition can present with symptoms very similar to major depressive disorder, including loss of appetite, nausea, and physical symptoms, according to a Psychology Today article. Further, the patient may report symptoms of dizziness and fainting spells.

“… the Navajo people believe that ghost sickness is caused by the spirit of the dead attaching to a living person, usually a family member. The attachment causes harm to the person by draining his or her energy,” writes Marilyn Mendoza, Ph.D., in the Psychology Today article.

Another condition noted by an article in the American Journal of Psychiatry is called the wacinko syndrome. Found in the Oglala Sioux, wacinko syndrome is thought to be similar to reactive depressive illness. Symptoms may include pathological degrees of anger, pouting, withdrawal, depression, psychomotor retardation, mutism, immobility, and suicide.

Idioms of Distress in Minorities

By recognizing idioms of distress and becoming more familiar with how minority cultures talk about depression, practitioners can demonstrate to patients with mental health issues that they understand the context of their cultural experience. This can help to establish rapport and build empathic connections.

For more information about the connection between language and depression, read our blog post “Signs of Depression Could Actually Be…Sounds.”