The following examples of several different idioms of distress in Syria and Afghanistan as well as their interpretation can neither be understood as exclusively valid nor as true for every individual from these countries. Furthermore, the following idioms of distress mainly refer to mental health issues. However, the overview can serve you as guidance while acknowledging a certain leeway in terms of the individual character of expression of distress and suffering a patient from these countries might show.
Hassan et al. (2015) write the following about Syrian people and mental health issues:
- Concepts such as ‘psychological state’, ‘psychological wellbeing’, or ‘mental health’ are not commonly understood and often carry negative connotations in the Syrian context, while suffering is commonly understood as a normal part of life, and therefore, not requiring medical or psychiatric intervention, except in really severe cases.
- Patients with psychological or mental problems often first present at medical services with a physical complaint, before addressing the psychological, relational or spiritual dimensions of their condition. (However, this can very likely be said as generally normal in the context of people seeking treatment for mental health issue.)
- Most Arabic and Syrian idioms of distress do not distinguish between physical experience and mental symptoms, because in the local explanatory models of illness, body and soul are interlinked. People may resort to images, metaphors and proverbs that assume the connection of the psychological and the physical.
- Attention should be given to Syrians’ use of everyday expressions and proverbs or metaphors of expressing distress. Some may be misunderstood as ‘resistance’ to direct communication, or even misinterpreted as psychotic symptoms, when observed through the prism of Western culture. For instance, some Syrians may attribute obsessive rumination to satanic temptations, using the Arabic word “wisswas” ( س ْ س ْ), meaning both the devil and unpleasant recurrent thoughts.
Some examples of such culturally specific expressions of mental health issues in the Syrian context (Hassan et al. 2015, 23)
|General distress||Often expressed through physical symptoms, like cramps in the guts, pain in the stomach, head or heart, tightness in chest, numbness of body parts or having the feeling of ants crawling over the skin.|
|Fear and anticipated anxiety||
|Sadness||Hozon ( حزن†, ‘sadness’ ) and difficulty in face of an acute or sudden stressor may be referred to as
Below is some information on Afghan people, currently the largest group of refugees in Austria, that might prove to be useful to your practice:
- Afghans usually fear social stigma and ridicule when consulting mental health services (Maroney, Potter, and Thacore 2014).
- Afghan women tend to speak loudly, tend to be very affectionate and, in public settings, speak loudly to express their affection. A mother’s voice symbolizes power and control of the children at home. A Westerner would likely consider this form of communication as high-volume speech. Contrarious, Afghan men tend to use a soft voice both in private or public settings thereby demonstrating that they are in control of the given situation, are relaxed and comfortable. For Afghan men, speaking loudly and showing aggression publicly is considered a loss of control and as disrespectful (Lipson, Iqbal, and Omidian 2007).
- Emotional suffering is perceived as a sign of weakness among Afghan men, and certain expressions of distress (e.g. crying) are not shown in order to save face in the eyes of others (Miller et al. 2006).
- Women’s elevated distress might be related to the multiple stressors associated with the reality of systematic discrimination that women continue to experience in Afghanistan. Afghan women have a greater freedom since the fall of the Taliban, however, they continue to experience oppression and discrimination in many spheres of life (Miller et al. 2006).
Common Afghan idioms of distress (de Jong 2002, Miller et al. 2006):
|Commonly recognized symptom of distress found throughout Asia||“Thinking too much”|
|Sadness incl. grief following interpersonal loss or a reaction to any deeply disappointing or painful experience. The term describes the emotional reaction of people who had lost family members during the war.||jigar khun|
|Sadness in general||gham-geen|
|Feeling nervous or highly stressed (referring to people who are overwhelmed by major life stressors (poverty, domestic violence, single parenting) thus more likely to quarrel with family members and to turn violent towards their children)||asabi|
|Involves hitting oneself on the head or elsewhere on the body; an expression of intense distress only among women.||“Beating oneself”|
|Internal state of emotional pressure and agitation (fishar-e-bala) or low energy and motivation (fisha-e- payin).
Terms are commonly misinterpreted by Afghans as high and low blood pressure.
Afghans often only refer to both as fishar; fishar is a common reason for seeking medical treatment or self-medicating, typically with ben- zodiazepines or herbal remedies