Shooting the messenger: the problem is widespread

Professor Singh has raised very important issues in his editorial. ¹ I would like to point out that the problems he has highlighted lie at the very heart of discourse in transcultural psychiatry as a whole, not just in relation to the ethnicity research. The discourse in transcultural psychiatry has mostly been driven by ideological points of view and there are not many examples of converting the ideological and philosophical assertions into testable scientific hypothesis. Worse still, the field has rarely addressed issues of practical clinical significance.

A good example is the language barrier. Language is the key investigative and therapeutic tool in mental health, and the unmet language need is considered as one the one of key drivers of social exclusion and inequity in access to services. ² The language barrier presents at two levels: translation and interpretation. There are scores of articles on translation of written material and questionnaires in the literature. Undoubtedly, this research has great value, but this is mostly limited to detecting and quantifying the disorders in research and field studies, and has limited applicability outside the research setting. Even as screening tools these have found limited applicability in practice. This may well be due to fact that the quality of these translation varies widely and these may not be acceptable to the indigenous population. Transcultural psychiatry has failed to develop consensus guidelines or a gold standard which could guide the translation and reporting of the scales/questionnaires when used in non-English-speaking communities.

Even worse is the case of interpreters in psychiatry. The use of interpreters requires skills which are neither taught in psychiatric training nor addressed in research. The literature in this vital area is limited to a few descriptive studies which is lamentable considering the practical significance of the subject. ³ This is perhaps just one of the reflections of the field being bogged down by an agenda which has helped neither scientific study nor services. Jablensky claimed that transcultural psychiatry is an applied science. ⁴ However, to sustain this position, transcultural psychiatry will need a fresh research agenda which could guide the development of research-derived concepts into reliable health strategies.