Rune Pedersen is looking for the tools to speak more openly about mental health.
Often, we talk about journeys – next steps, finding our way, sticking to the path.
For men, we might use metaphors about cars and football. The warning light is on, or you're struggling to get back in the game. Maybe instead we should be talking about gardening. Growing a seed, not fixing a blown gasket.
In this episode, Rune chats with Dr Grant Blashki, Lead Clinical Advisor at Beyond Blue about how we talk about mental health.
You may be using idioms thinking that you're creating trust... a sense that we're part of the same group. But it's very easy to confuse people.
If you'd like to speak to someone, you can reach a counsellor at Beyond Blue at any time, day or night, by calling 1300 22 4636 or visiting www.beyondblue.org.au. Also, Lifeline offers 24/7 crisis support on 13 11 14, and Embrace Multicultural Mental Health supports people from culturally and linguistically diverse backgrounds.
In an emergency call 000.
The Idiom is a podcast about how language shapes the way we see the world and relate to each other. Find it in your podcast app such as the SBS Audio app, Apple Podcasts, Spotify, or LiSTNR.
The Idiom is an SBS Audio podcast produced by Think HQ CultureVerse.
- Host: Rune Pedersen
- Producers: Jake Im, Jacob Aguis, Beaurey Chan, Stefan Delatovic
- Writers: Rune Pedersen and Stefan Delatovic
- Art and design: Wendy Tang
- SBS team: Max Gosford, Joel Supple, Caroline Gates
- Guest: Dr Grant Blashki
- Other voices: Jess Glass, Laura Kennewell
- Special thanks to Jen Sharpe
Transcript
Rune
We acknowledge the Traditional Owners of the land on which we work - the Yaluk-ut Weelam Clan of the Boon Wurrung, Naarm. We pay our respects to their Elders past, present and emerging as we try to live up to their example as storytellers.
RUNE
I know first hand that you can’t just directly translate words. I mean, you can, but chances are they won’t translate well if your language is slightly colorful, and your audience won’t get the message. Idioms don’t translate easily, for example.
In English when we want to focus and do the work, we buckle down and roll up our sleeves, but in Danish I might say (speaking in Danish “Now, guys, we really need to squeeze our buttscheeks together and finish this task”.
This one always gets me in trouble with HR
HR MANAGER
“Rune, I’ve already told you, there will be no squeezing of buttcheeks in the workplace
Rune
Okay, cute misunderstanding - or potentially terrible lawsuit aside - what about the more difficult topics in society, like mental health? It's easy to get our wires crossed when speaking idiomatically, so to speak.
I’ve been thinking about the way we talk about mental health in a society. Why is it so hard to talk about, and do we talk about it differently across cultures? What roles do language and idioms play?
I needed some expert advice, so I talked to Dr Grant Blashki from Beyond Blue, an Australian organisation providing support on wellbeing and mental health.
Why do you think it's so hard to talk about?
Grant
I think that the mental health conditions, they really do impact on our sense of identity, our social roles, who we are, how we feel about ourselves. And so as much as we have, you know, great campaigns to get people talking about mental health and famous people talking about it, it is more complicated than just saying, Hey, I broke my leg, or I've got the flu, it's much more loaded. Because there is this idea that it's impacting on your capacity in your social roles in your family, or in your work or in relationships, and certainly also in your cultural background. And so, whereas a lot of medical conditions, are pretty much the same concept throughout the world, you know, a, asthma is pretty much asthma wherever else you go. Whereas take a concept like depression, and compare around the world, it's going to be very loaded with cultural ideas about what depression is and how it affects people and how best to help them.
Rune Pedersen
Very interesting, Could you expand on some of those different perceptions of mental health or for example, depression that you have experienced with?
Grant
So to give you an example, and it's very relevant in Australia, where we really have a multicultural community from so many different backgrounds, the very explanatory models about what let's say depression is differ vastly across cultures. So you can have that very western what we call medical model idea of, you know, something in your brain not working right. And that's, you know, quite a common conception in Western cultures about what a mental health issue is. But it's not the only way of looking at it. A lot of different cultural backgrounds will look at it as something that occurs more in your relationships.
So it's much less sort of defined as just within inside your head and much more relational idea. And if we go further, if we look at our First Nations people and their idea of wellbeing and mental wellness, it's deeply connected to ideas of land, and land being healthy and having access to your land and all sorts of deeper concepts. So I think mental health, mental wellbeing deeply connected to cultural ideas, and they form our explanatory models of what mental wellness actually is.
Rune Pedersen
And as a doctor working in this field, what are some of the things that from a Western perspective, you know, from your own own perspective that made you raise an eyebrow, err, made you made made you made you raise an eyebrow? Were thinking, Oh, that's something to be to be learned here.
Grant
I really appreciate your question. And at the same time, demonstrating the use of an idiom, raising an eyebrow. Actually, it makes me want to make a point here, about the risk of idioms and metaphors and understanding mental health using these sorts of devices, is there's a lot of potential for confusion. So I understood what you meant when you said raise an eyebrow. But I can imagine people from different cultures would perhaps be wondering, why is he talking about my eyebrows? See, does he not like my eyebrows? You know, so they make the point there about potential for miscommunication. But to take your question. As soon as I worked as a GP, I was quickly aware that about a third of the consultations are pretty psychologically based.
One thing I always emphasize to people from other cultural backgrounds is that the GP is quite central in Australia to our mental health workforce. Because very often, in many other countries, the GP is not someone you would consider talking to about a mental health issue. I find this with a lot of the international students that I help at the university. And they would never consider the family doctor as someone that they would begin with. So certainly, when I started in general practice in Australia, it became clear to me that this was a really important part of my work. It was a little bit in my blood. To use another idiom, my father did one of the first studies of GP management of depression in the world using some antidepressants.
And I actually took him with me on a teaching trip that I did in China. And I was spending quite a lot of time going back and forward to China, speaking to Chinese GP’s about how are they managing patients with mental health issues. And the patients were not very comfortable for the doctor to say, Well, I think you've got depression, or I think you've got anxiety, that might actually take offence even. And so we got in some good conversations about how to approach people in a way that they don't feel stigmatises them or embarrasses them. And I think for people listening from many different cultures, they'll relate to that. That the very upfront sort of headline approach to mental health that we've developed in Australia is a bit too in your face. For a lot of people coming from other cultures where it might be a more subtle and nuanced conversation.
Rune Pedersen
What could that subtle conversation sound like?
Grant
People from different cultural backgrounds have different ways of expressing mental health issues. And it doesn't really correlate very well with our main psychiatric textbook called the DSM five. There's lots of ways people present. So the first thing is to say is that many people from different cultural backgrounds are more comfortable coming in with physical symptoms. So they'll come to the GP and they'll say, I'm tired, I can't sleep, or I've got aches, headaches, menstrual problems, backaches, and we call this in medicine; somatization. And actually, some of the psychiatric textbooks call it an “idiom of distress”. So when I was thinking about your podcast show, I thought, Oh, that's interesting. But it is expressing distress rather than through the overt, classic mental health sort of language, you know, through bodily expression of your distress. And that's very common, not just in people from different cultural backgrounds, but very much in the Australian culture as well.
Rune Pedersen
Well, since we are on the idiom, I am very curious to hear your thoughts on idioms relating to mental health or, yeah, health in general.
Grant
Thinking about the way that we use idioms, metaphors in mental health, really had me reflect on why do we have so many. And I think that health topics that are sensitive or confronting or embarrassing we like to have sort of euphemisms and metaphors because they feel safer, and they feel more distant and as I reflect on many of the metaphors that we use in mental health. They do relate to those everyday activities that we participate in.
So I'll give you an example. There's lots of metaphors around the journey. So when you think about how we talk about mental health with people, often when we say, Oh, you're stuck in a rut, we're getting back on the road. You know, we were a bit off the tracks at the moment, we're getting back on the journey. So we use a lot of that. Sometimes bike metaphors, particularly, you know, riding against the wind riding up a hill. So that's one sort of area that I'm quite interested in, that we talk very much about journeys, but it's not the only one. I think the weather is another theme that comes up. And we use a lot of weather-metaphorical language, or under the weather, stormy times, you know, not much sunshine at the moment. So we use it a lot to actually describe mental illnesses. But we also use those metaphors very much when talking about recovery. And I find that they can be very helpful.
A couple that I like, particularly gardening sort of metaphors. And I spent a bit of time talking with my patients about the difference between mechanical and organic time. What I mean by that is, we live in a very digital world where everything happens ridiculously quickly, you hit a button, and the Uber turns up, you hit another button and the local supermarket delivers everything. But we've got quite out of touch with the heal(...), the slow rhythms of healing, you know, particularly those of us who have nothing to do with farming or food production or gardening. So often I'm saying to people, when we talk about getting them better, listen, we're halfway through the year. Now, this is something we're going to work on till the end of the year, it's going to take time, and we're going, you know, think more a new plant growing, rather than getting your broken screen fixed on your iPhone, it's gonna take a bit of time. So that I think is a another useful metaphor that I really like.
One more, that I think is very good are: steps. And I think what we see with recovery with a lot of mental health conditions, is two steps forward one step back, very useful for people, this idea that you sort of going up steps, but it's gonna take a while. Also talking about setbacks. So you know, you're not right at the bottom of the stairwell, but you've gone down a couple of steps. And also really important one, when people are in a complete crisis, one step at a time, just just get on to the next step. That's all you got to do for today. So I think that words are very powerful. And those metaphors can be very helpful to describe diagnoses, but they can also help people have an imagery in their mind when they're getting better, and manage their expectations about getting better. So I'm very thoughtful and cautious about what language I use. Just a caveat, for people from different cultural backgrounds, there's a risk that all of us and particularly as a clinician, is that you may be using idioms thinking that you're creating trust, that you know, sort of a sense that we're part of the same group. But it's very easy to confuse people. And they may not know what you're talking about with those idioms, or they might not relate to them, or they might have some unintended negative connotations that you hadn't thought of.
Rune Pedersen
I have this understanding that that men have a different and maybe a more difficult time expression their the mental wealth or mental well being. Is that the case? And why do you think that is?
Grant
When we look across the way in which men experience mental health issues, we've seen quite a lot of change over time. I mean, I want to say up front, even though it's sort of a heavy topic, for your podcast, that we've got a really sad statistic in Australia with some 3000 people a year taking their lives. So that ends up being about nine a day, of which seven are men. So this really drives us at Beyond Blue and a lot of the other mental health organisations around Australia. And around the world, you know that that's just so sad. And it's the most common cause of a young man dying between, you know, 15 and 44, I think it's the highest, most common cause.
So we've got to do better on that. And we have to keep opening up the conversation with men in particular, and women, of course, as well. But since your questions about men, a couple of things, we know men are less likely to go and get professional help. And I think, you know, one of the messages for people from different cultural backgrounds is, they might feel uncomfortable, might be unusual in their culture to put up your hand. But they should know in Australia, there's lots of help. Great help out there. For men who are having a hard time. The classic I see in my practice, would be men who've gone through relationship breakups. And for a lot of men out there, their social world sort of happens, they're a little bit of a passenger, and their partner is the one who does a lot of the social organising. And if that blows up, that can be really quite isolating. And if you throw in the mix a bit of drinking as well, that can really be quite a risky time. So we're really encouraging those guys in particular to put up their hands and, and get help, but you can always ring Beyond Blue anytime. And I'm sure you'll have your number at the end of the podcast, we'd love to hear from you. There's excellent mental health counsellors there.
But don't feel like you've got to manage it all yourself, you know, if you've got some red flags in your life, you're not sleeping, you're getting into arguments, you're withdrawing, stopped answering your phone, drinking too much alcohol, maybe getting violent. You know, maybe you've lost your licence, because you've been driving, drinking, always sort of red flags, you know, or particularly your friends saying you don't seem right. Like listen to that get the help early.
Happily, I think ideas of masculinity are changing. I noticed even, you know, having couple of sons, who, you know, quarter of a century younger than me. And you can see quite a difference in the way that the young men are talking about mental health issues in Australia. And that's a really good thing. So there's great help out there. We really encourage the men who are listening to reach out get support early, and make sure that they're looking after themselves.
Rune Pedersen
Well, I can say from my own life, that it's very, very hard making the phone call. It's very easy to ignore.
Grant
And I might just mention at this point, in your theme of idioms, that there are a lot of metaphors and concepts that I think work really well with my male patients. So, particularly your more blokey patients the car metaphor, so you know, are the emergency lights on? We need to do a 10,000 service. We need a bit of a pitstop. We can use all that sort of car language. And also, I think for a lot of men, given the primacy of football is occupying a huge proportion of their mental real estate at any time that, you know, football metaphors are good too, you know, getting back on the field or on the bench for a couple of months or, you know, I think those ideas are useful both for understanding mental health, and actually also for recovery. In football, there's this idea called the one percenter, so often, football coaches will say, I want you to chase those extra little, you know, free balls just a little bit harder, just 1% better. And I know at Beyond Blue, we used that idea in one of our communication campaigns, the one percenters to say just try and get up and just go to work today, or just do a little bit more exercise or just drink a little bit less, or, you know, making a little bit of effort every day. So I think that the metaphors can be really useful.
Rune Pedersen
If I am sitting at home, and I don't feel good, and I do want to contact someone, could you help provide the words for how I can communicate maybe through metaphors, maybe for idioms? When I actually do get the courage to call? Who do I call?
Grant
An easy start is to ring Beyond Blue. One 300 double 2 4636 all around Australia, speak to a counselor. And they're non judgmental. They're lovely people, their mental health trained, and you shouldn't feel like you're being judged in any way for calling so that's a really good way to start. For some people who feel a bit nervous about ringing, Be aware that Beyond Blue has got this amazing online forum. That's anonymous.. The next sort of level is don't forget, in Australia, general practitioners can undertake what's called a GP mental health treatment plan. So basically, you book this with your GP, any GP in Australia can do it. Usually, it's about half an hour or so. So book a double appointment. And they'll go through and just do an assessment of your mental health,. And if need be, they can refer you to psychologists, which is subsidised by Medicare, once you've done one of these mental health plans. So it's another option.
Rune Pedersen 44:28
What role does language play in mental health?
Grant 44:37
Mental Health, unlike physical health conditions, is intimately bound up with language. The things we tell ourselves, the conversation we have with our clinicians about diagnosis or treatments. And so immediately cultural understandings become not up background issue, but really front and centre with the whole discussion around mental health. So words matter. Words can help, words can heal. Words can cause misunderstandings. But in the midst of all this, the rich metaphors, and the idioms that we use can be beautiful, and part of the healing process. And I think find some that you really relate to, and they can become a way of thinking about things as you recover.
WOMAN
Good morning, How can I assist you?
RUNE
Hey, I need to schedule an appointment. I'm feeling like my engine's about to blow!
WOMAN
Of course, I understand. We can help with that.
RUNE
I see a therapist - sometimes - it’s kind expensive so I deprioritize it though I know I shouldn’t. Making the phone call to get the appointment drags on for weeks. It kind of gives me anxiety, so it feels counterintuitive.
What got me over the finish line was watching the TV series ‘The Sopranos’.
For some reason watching Tony Soprano, a New Jersey mobster, struggling with anxiety because of family dynamics - and maybe a little bit of murdering? - just hit home.
Someone spoke to me in a language and context that resonated with me, and it didn’t feel like a chore. And I think that’s the key for meaningful conversations on something as important as your mental health. Providing content and different spaces that capture people where they are.
Sometimes direct speech is the best approach, and other times we gotta read between the lines and tread a little bit more carefully.
If this episode has raised issues for you and you’d like to seek mental health support, you can contact Beyond Blue on 1300 22 4636 or visit beyondblue.org.au. Also, Embrace Multicultural Mental Health supports people from culturally and linguistically diverse backgrounds. For 24/7 crisis support, call Lifeline on 13 11 14 or in an emergency call 000 in an emergency.
RUNE
The Idiom is a production of Think HQ CultureVerse and SBS.
It is hosted by me, Rune Pedersen. Produced by Jacob Agius, Beauty Chan, Jake Im and Stefan Delatovic and written by me and Stefan Delatovic. The SBS team is Caroline Gates, Joel Supple & Max Gosford. Our artwork is by Wendy Tang. Follow and review us wherever you found this podcast, and tell us your favourite idiom at theidiom@sbs.com.au
