Mental Health’s Zubaan: English Is Lacking As Therapy’s Language

English may be the universal language of mental health therapeutic practice but its inadequacies hinder healing.

“Think of me as a room with its windows nailed shut. I exist in an Outside that can’t see me, nor I it but my existence is a constant reminder of its presence as well as its unavailability. So, I try to find a way to describe this room to you but I realise that the language I am borrowing to construct this trestle is fractured in itself. I can’t describe my interiority. In therapy, I clean this room as per instructions so now it is not so empty; I have an old desk in this room; a delicately gilded mirror; some new linen curtains with a paisley design but I am still alone with these objects. I can’t find a way to explore them in a relationship with me or others outside this room.”

This is from one of the many unsent drafts of letters I intended to mail to my father before his eventual suicide.

He was a Roma Spanish man of archaic masculinity, so speaking about mental illness was a taboo. I was his “foreign” daughter–born and raised far away from him after his separation from my Indian mother.

The thread that ran through both of us was depression.

Language of Pathology and Diagnosis

I am a clinical psychologist and I have lived with a Major Depressive Disorder for over a decade. I have seen the patterned shifts in our conversational weather where I am a lot more comfortable engaging with others about my own condition now than I was even 5 years ago. However, when I do want to talk about it, I wish to explore my depression not as a universally perceived pathology. For this, the language available to me is English and often it seems insufficient.

Sometime back, I was reading Niyati Evers’ interview with Colin Campbell, a South African sangoma (shaman), as part of a paper on how mental illness is perceived and received in tribal cultures. He defined pathologies as a symptom of the parts of us that are missing and that we have peripherized.

This description finally felt like I had turned up to a new and welcoming door rather than suffocating under the same old debris of stifling diagnostic language time and again.

My education is grounded in a Western psychiatric discipline that still largely fastens its locus to the weight of functionality. There is an almost utilitarian mandate for mental wellness or illness—an obsessive tendency to individualize everything through consistent demands of labour and the pull-yourself-up-by-your-bootstraps mindset. If you can “do” it, you can “be” it.

Inadequacy of Clinical Language

Mental health often centers this ideal of a fully realized personhood without disclaiming the Sisyphean nature of its pursuit. In talk therapy, you have to “describe” what you experience right at the onset. A lot depends on anecdotal evidence especially in clinical diagnoses. Its taxonomies can invest heavily in verbal potencies; easily classifiable descriptors, sometimes even an impossible linearity that hinges on how getting better is directly proportional to constantly talking about it mantra without pausing to ask—what indeed is this “It”, who designated it such?

Do we have access to an intimate/inherited vocabulary that encompasses this “It” in its several complexities?

As a clinician, I understand that scientific research values a certain skinflint approach to establishing boundaries with validity, reliability et al. These methods aren’t entirely unsound. But, are they enough when I am still struggling to define for myself what my personhood must mean outside these boundaries? A lot of us exist in the margins not at the centre: margins of caste, class, queerness, gender, social and geographical locations. Yet, the clinical language doesn’t always rise up to embrace the waves we make in these margins. How do we then aim to speak of this singular personhood when so many variables play at the cusp of our being & becoming?

Multiple Selves Confined Within a Single ‘I’

English is the preferred language for communication in my therapeutic practice. English is also a consistent reminder of my peoples’ colonization. When memory is stormed, this language serves as a bridge as well as a whip. Language becomes means for detonation during my depressive phases. I am a writer and, therefore, I have a ready quiver of words when I transform into my own bull’s eye. All through my college years, I viewed Lacanian analysis under a lens of suspicion but I could never entirely deny that the unconscious is indeed constructed in language.

In English there is a singular “I”, in Hindi/Urdu I can be a “Main”(I) or a “Hum”(We). A client with paranoid schizophrenia pointed out how they could be comfortable with their multiplicities in Urdu but had to unify into a single, solid creature to be accepted in English.

I am successful at being a “Person” when I am on anti-depressants —functional, organized, less prone to apathy. However, I am also acutely aware that this congruent “Person” doesn’t always authentically calibrate with the innate “Selves” that want to be accepted not despite but with the apathy, with the prolonged shadows of grief, with the invisible schisms in the psyche.

In her essay “In defense of De-persons”, Johanna Hedva writes— “In neoliberalism, “wellness” is a prevarication: it usually stands in for “life,” but life in terms of wealth, race, power, and, primarily, ability.” I wish to possess this space of Selves v/s Person and do so without owning it. The challenge is that more often than not, I have to do so in the language of those that once owned me or at least parts of my ancestry.

Audacity and Sadness can Co-Exist

I don’t wish for a lack of sadness, I wish for this sadness to not be a synonym for weakness. In Urdu, the term is “naala-e-bebak”; an audacious sorrow. The first time I encountered this phrase, I felt a key turn in the very dark attic between my ears. There was dust but there was also light.

This audacity co-existing with grief was absent so far, at least within the contours of language used to define depression.

In New Zealand, Poutu Puketapu, a 25 years old mental health worker or a matora (a change-maker) at Gisborne service Te Kūwatawata elucidates— “That's where the healing starts, with an exchange of words.” This is the cornerstone of Mahi a Atua – a form of narrative therapy guided by Māori language and culture; implemented to work through the pain of inter-generational trauma on account of oppression and colonization. In this format, unlike the Western standards, there are no clients or patients, just “whanau” —a Māori expression for extended family. This language of interaction between a mental health practitioner and folks in their care releases all implicit power differentials. The result is taking turns being vines and walls holding space for each other without a rush to “fix” what seems broken in each other.

(Scherezade Sanchita Siobhan is a clinical psychologist and author. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)