Lost in translation
Authors: Pardeep Grewal
Journal: BMJ (2008)

I have never considered myself a fan of memoirs. The genre conjures up images of decaying politicians offering a final rant or celebrities lost in their narcissism. It was something of a surprise, then, to read Sathnam Sanghera’s debut novel, a memoir of his early life in a Sikh dominated area of Wolverhampton, growing up with a mentally unwell father and sister. At first glance the book promises to be a witty, well written series of anecdotes describing the author’s remarkable social mobility and his avoidance of an arranged marriage. On closer inspection it provides a powerful insight into the way ethnic minority families cope with a diagnosis of mental disorder.

Sanghera’s father and sister developed schizophrenia when he was a child. Somehow this diagnosis was kept from him until he stumbled across the truth in his mid-20s. This triggered both anxiety and curiosity: why and how did his traditional, uneducated Punjabi mother keep this diagnosis from the rest of the family? He also questions his mother’s understanding of the illness, the reaction of the extended family, and even the risk of developing the illness himself.

The story resonates with my own practice in an area of inner London with a large ethnic population and an abundance of social challenges. It is not unknown for families to misunderstand mental health diagnoses, perhaps because of language difficulties or a cultural gap. I see some families failing to grasp the basic concepts of mental illness. We are left with the impossible task of persuading patients to take unwanted medication, administered by families who struggle to understand treatment plans.

This experience contrasts well with Sanghera’s own account. A journalist by trade, most recently as a feature writer for the Times, he explores the way immigrant families were treated by the NHS. He finds the psychiatric system imprecise and jargonistic. He struggles to decipher or retrieve adequate information from the medical notes, complaining that a “psychiatrist uses 50 words when three words will do.” As is often the case, the Sanghera family’s general practitioner is left to act cautiously and pragmatically, and to intervene when symptoms drift towards violence or self harm.

The book also has positive themes. For example, Sanghera illustrates the positive prognostic influence of family support in patients with schizophrenia. The benefits of low “expressed emotions” are strikingly demonstrated: relatively low levels of family qualities, such as hostility and emotional overinvolvement, are well established in families with Indian-subcontinent origins. This may account for a better prognosis with schizophrenia in these regions. The book also follows the NHS theme of recovery, with the family accepting the presence of mental illness and Sanghera’s father reaching an accepted state of chronicity.

The thread is somewhat lost midway through the book, as the author drifts into a series of descriptive monologues about his mother’s efforts to arrange his marriage and conform to a cultural stereotype. Although this distracts from the underlying story of evolving mental illness, it does offer an entertaining and witty insight into the workings of an immigrant family enduring the challenges of poverty and cultural isolation.

I was impressed by the way Sanghera critiques popular writings about schizophrenia. He eventually finds support in a lesser known text, written by a doctor but expressed in remarkably simple terms. This signals the beginning of his own journey of recovery. He swiftly gains knowledge and understands how, within some cultures, the more subtle symptoms of mental illness might be considered to be within the normal range of human behaviour.

Common mental illnesses such as schizophrenia evoke a personal as well as professional response in healthcare professionals. We cannot help but be influenced by media representation of severely mentally unwell people, one that often headlines dangerousness or violence. For someone so closely associated with the media, Sanghera has produced a book of remarkable compassion and honesty. Rather than sensationalising events, he chooses to convey experiences of dealing with mental illness with great sensitivity.

What struck me most about this book is that it crosses genre so successfully. I felt it was neither a precis of mental illness nor a memoir of early life experiences. Rather it was more an observation of a family coping with, and ultimately surviving, the trauma of mental illness. I was left with the notion that memoirs can actually be relevant, educational, and enjoyable.

Sanghera struggles to retrieve adequate information from the medical notes, complaining that a “psychiatrist uses 50 words when three words will do.”