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

Abstract

In this invited commentary on the thematic issue of Transcultural Psychiatry on idioms of distress, concern, and care, I provide a brief overview of how my research agenda evolved over the years while conducting community and clinic-based research in South and Southeast Asia as well as North America. I then suggest areas where future research on idioms of distress, concern, care, and resilience will be needed among different demographics given social change and shifts in how we communicate face to face and in virtual reality, the impact of medicalization, pharmaceuticalization and bracket creep, changes in indigenous healing systems, and hybridization. I further call attention to the importance of conducting idioms guided research in occupational settings. Toward this end I highlight the moral distress health care workers in the U.S. have experienced during the Covid-19 pandemic and point out the importance of differentiating individual burnout from moral injury related to structural distress. I conclude by discussing the general utility of an idioms of distress perspective in the practice of cultural psychiatry and suggest that this perspective needs to be included in the training of all practitioners regardless of the system of medicine they practice. Doing so may enable the formation of mental health communities of practice in contexts where there are pluralistic health care arenas.

Cultural pragmatism: In search of alternative thinking about cultural competence in mental health.

“…6 Anthropologists make a similar point in attending to cultural "idioms of distress," defined as popular expressions of illness that express cultural viewpoints. Yet, anthropologists direct attention beyond what is different about a given idiom and instead encourage focus on why and how an idiom is expressive of social adaptive functions (Nichter, 1981(Nichter, , 2022Yahalom, 2019a). but rather as expression of what works in a given cultural setting.…”

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?…”

“…Finally, Nichter (2022), who originally introduced the construct of idioms of distress, reflects on the ways that this construct and his own work have evolved. The articles in this issue show the further strides made in refining our understanding of cultural concepts of distress.…”