Words about mental health need to align with people’s understanding of well-being

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In South Africa, English is only the sixth most spoken language in households. But it is dominant outside the home, including in health and medical settings.

Communicating health information in South Africa requires careful consideration of the cultural context in which this information is to be received. Clinicians need to think about it to improve their relationship with patients and the patient experience.

The COVID-19 pandemic has shown the need to communicate health concepts in a way that the public understands.

It’s also important when it comes to mental health – an area often tied to people’s cultures and histories, and where outward symptoms may not show up. South Africa has come a long way in understanding the struggle of language in psychiatric or mental health care. But some concepts are still only vaguely understood by the general public. This isn’t just true for poor mental health — like anxiety and depression — it’s also true for good mental health.

Thriving is one way of thinking about good mental health. To flourish as a concept implies what it means to live a good life or a life worth living. Fulfillment is an old concept. But in recent years, interest has grown in the relationship between fulfillment and health. Much of the published research, however, is overshadowed by Western ideals and concepts, mostly pointing to internal mechanisms such as personal traits for flourishing.

We sought to understand what it means to thrive by diving deep into the study of real people and cultures in South Africa. Fulfillment is linked to people’s lived experiences, which differ from place to place.

Recognizing how people conceive of flourishing in relation to, or despite, a diagnosed medical condition can help clinicians understand why and how patients’ perceptions of health do not always match medical terms. Such local understanding can transform how clinicians frame clinical decisions and assess the impact that community resources and relationships can have on how patients are cared for or feel cared for in clinical spaces.

Ukuphumelela in Soweto

Early in our second year of studying stress and chronic disease, we realized that people wanted to talk about how they conceptualized good health as much as they wanted to explain what had made them sick.

We interviewed 30 people in Soweto who had expressed an interest in discussing what it means to live a good, fulfilling life. They were a balance between men and women. Most were middle-class, middle-aged (around 45-50) and relatively healthy.

Soweto is an urban area of ​​over five million people. It is heterogeneous in terms of housing, language, professions and standard of living. Speaking IsiZulu, the language most commonly spoken in South African households, we found that fulfillment was largely a social concept and had personal attributes. People we spoke to used the word IsiZulu ukuphumela (roughly translated as “to become victorious”) in speaking of doing well despite obstacles.

Many people have used their personal journey to describe how they flourished (or didn’t) and how they defined ukuphumela. We have found ukuphumela involved three elements: material or structural factors (such as money or financial security); internal or personal character (such as discipline); and social dynamics (such as reciprocity and concern for others).

A young man explained:

I can tell he is a person who is not from a good background… Managed to finish school after all those worst case scenarios so now he has made it… He just started a family, got married and we have all witnessed it. He now drives luxury cars. He takes care of his brothers and sisters and he has renovated his house to show that he has succeeded in life.

A woman in her thirties explained ukuphumela in terms of term ubuntu, generally understood to mean “a person is a person because of other people”. She said it was important to her to help others, despite her own limited means. This emphasizes the idea that the self extends beyond an individual to include their community.

These results show that the ideas people use to describe good mental health are not universal.

Our results showed that Soweto residents defined fulfillment by both individual and collective elements. Individual elements include things like determination, faith in God, and overcoming challenges. Often, these individual characteristics were reinforced by structural elements such as the possibility of having a good education and having enough money to cover basic needs.

Collective elements were also linked, such as having good mentors and taking care of others. Fulfillment is not only about what an individual becomes in their pursuit of a good life, but also about the impact they have on the people around them. In this way, many people described fulfillment not as an end point or a goal, but as a journey.

Good life and health

Recognizing how people view themselves in relation to others and what it means to live a good, meaningful, and fulfilled life is crucial to understanding health.

Speaking the language of good health is also an important element in understanding, designing programs and improving the health of individuals and populations.

This research emphasizes the social and relational aspects of health that could make the clinic a poor solution for promoting good public health. Investing in churches as places of gathering or in mentoring programs in schools and community centers can facilitate improvements in health and well-being in significant ways.

Without understanding ukuphumela – what fuels or prevents someone from thriving – health promotion will struggle to serve the people who need it most.

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