Idioms of Distress Revisited

This paper focuses attention on alternative modes of expressing distress and the need to analyze particular manifestations of distress in relation to personal and cultural meaning complexes as well as the availability and social implications of coexisting idioms of expression. To illustrate this point the case of South Kanarese Havik Brahmin women is presented. These women are described as having a weak social support network and limited opportunities to ventilate feelings and seek counsel outside the household. Alternative means of expressing psychosocial distress resorted to by Havik women are discussed in relation to associated Brahminic values, norms and stereotypes. Somatization is focused upon as an important idiom through which distress is communicated. Idioms of distress more peripheral to the personal or cultural behavioral repertoire of Havik women are considered as adaptive responses in circumstances where other modes of expression fail to communicate distress adequately or provide appropriate coping strategies. The importance of an 'idioms of distress' approach to psychiatric evaluation is noted.

Our understanding of the psychosocial and cultural dimensions of disease and illness is limited not merely by a lack of empirical knowledge but also by an inadequate medical semantics. The empiricist theories of medical language commonly employed both by comparative ethnosemantic studies and by medical theory are unable to account for the integration of illness and the language of high medical traditions into distinctive social and symbolic contexts. A semantic network analysis conceives the meaning of illness categories to be constituted not primarily as an ostensive relationship between signs and natural disease entities but as a 'syndrome' of symbols and experiences which typically 'run together' for the members of a society. Such analysis dirests our attention to the patterns of associations which provide meaning to elements of a medical lexicon and to the constitution of that meaning through the use of medical discourse to articulate distinctive configurations of social stress and to negotiate relief for the sufferer. This paper provides a critical discussion of medical semantics and develops a semantic network analysis of 'heart distress', a folk illness in Iran.