Saturday, November 7, 2009

remarkably different meanings

One of my funniest lost in translations moments to date began with a simple question: how long?

It was a typical training day, one like any other. For me, this meant a fine balance between didactic lessons and experiential trust building activities that facilitate self-disclosure and the feelings of the therapeutic experience rather than simply an intellectual understanding of the therapeutic experience. With time and experience I have found that my students all over the globe are much like I was when I was a green inexperienced therapist: suckers for a good case study and a deeper understanding of all the fascinating diagnosis that touch our captivating species. So the idea was to first teach a wide variety of diagnosis from depression to anxiety with PTSD and Bi-Polar mood disorder at the spectrum ends (for those of you who are curious these are all diagnosis I have seen in the numerous developed and undeveloped countries I have worked in).

As I explained each symptom constellation I stressed that the point was not to diagnosis just to diagnosis but rather to enlighten the patient, the counselor and his or her family about their experienced emotional or psychological struggles and to create a plan towards less suffering, less confusion and an experience of feeling less alone in the world. After I explained the 9 most common disorders, disorders that occur on average in 1 in 20 individuals at least once in their lifetime in a stable environment (now for a minute consider what the rates must be in environments that have been impacted by war, human rights violations, discrimination and mass violence has on psychological well being), I told them we would be would be playing a diagnosis game. I shared 8 case studies and they were to diagnosis each case base on the symptoms presented and described. The two most important features to differentiating between spectrum diagnosis (like dysthymia and major depression or acute stress disorder and post traumatic stress disorder) are frequency and duration; or, “How long and how often?”

This is where it all began. In my dramatic presentation of each diagnosis full of tears, hand wringing, lethargy, flashback and obsessive checking behavior I always ended with, “always remember we should ask for how long and how often the symptoms have been present.” Each time I said this I sensed something. It wasn’t anything that was said or even any non-verbal signs just something in the air I suppose. As I got more dramatic in my acting out of various symptom consolations came a more relaxed audience who were getting a kick out of me making a fool of myself. As they became more relaxed, the more noticeable reactions I started to get to my “now remember always ask for how long and how often the symptoms have been present.”

The module went on and they got completely enthralled by the case studies and the diagnosis game that I forgot about all the subtle confusion I was feeling and went on with my day. The next day I was enjoying a cup of 3-in-1 Nescafe while groups of trainees prepared for a pending presentation when one of the participants approached me quietly and asked if we could chat. He shared part of her personal story and then, as others started moving towards us, quickly changed the subject and said, “Gwan I have to tell you something funny about something you have been saying a lot lately.” At first I was worried that maybe I was saying or doing something that was culturally inappropriate and he was trying to be nice about breaking the news to me, but instead he said, “it’s when you say how long.”

“How long?” I replied. “Tell me more” (tell me more is my classic therapy reaction to just about anything to keep people talking in a non-directive manner).

“Well in Burmese…” he replies, “How long means without longyi.”

“Like someone who wears pants instead of the classic Burmese skirt” (that is commonly worn by both men and women albeit in a gender specific wrap style), I reply.

“No not exactly,” he says, “like when someone’s longyi has fallen off accidently.”

I start laughing which causes him to give out a sigh of relief as he must have been worried I might feel ashamed when I heard such news. I yell out “How long!” and look down at and pat my skirt to make sure it is there and we both crack up. His laugh was so fantastic that I fall into one of my silent laughing fits that lead to tears and breathless gasps (I know those of you who know me best are shaking your heads right now with deep understanding). This loss of control on my part causes everyone in the room to be briefed on the fact I had been briefed by the “how long issue” and after a collective sigh, everyone bursts out in laughter.

From there on out “How Long” was our group’s inside joke and it did wonders for the togetherness and connectivity and I didn’t mind in the least that it was at my expense. When on the final day I wrote “Mr. How Long” on this gentleman’s compliment card it was a sealed deal: we would all always remember an ever so slightly strange and potentially awkward lost in translation moment that turned into an unforgettable shared moment. Given unadulterated shared laughter is such a rare event in environments between foreigners, where language and culture and power and respect and a ton of other potentially disconnecting elements prevent such simple yet important playful events to occur, this lost in translation moment will forever remain a cherished memory for me and I will never again be able to say “how long” without a small smirk and giggle.

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