Item analysis enabled a closer look at the influence of translation, language and inter
related cultural conceptions on the samples responses. Indeed, as predicted by hypothesis II, differential endorsement patterns counter to the general trend of P>B>BP were
observed on several items.
B respondents were found to have higher symptom levels than Ps and BPs on six out of
thirteen psychological items (1, 2 ,4 , 6, 7, 11). Whilst this may in part be a reflection of certain psychological items being more relevant to British cultural groups, a closer
semantic inspection of these items revealed that in certain cases the differential
English. In contrast to the preceding GHQ study and predominantly Western centicultural
bias, this analysis identified items that were inappropriate to and / or difficult to translate
into a British cultural context. It thereby also exposed linguistic and conceptual
assumptions integral to Pakistani cultural beliefs.
A particular example of such translational problems, and one also previously identified by the devisors of the AKUADS was item 4 - "Have you felt anxious" (refer to section
5.2.2). The original Urdu term used in this item 'gabrahat' posed an interesting
translational dilemma. However whilst 'anxiety' evoked an interpretation with more
psychological connotations, 'palpitations' evoked an interpretation with more somatic connotations. Neither term evoked the true essence of the psyche / soma overlap inherent
in the linguistic term 'gabrahat'. This type of translational problem, it is suggested, is
fundamentally due to the metonomic nature of the Urdu statement, which in turn reflects
the metonymy correspondence and correlation stressed by the Ayuverdic (Zimmerman,
1987) and Unani treatises (refer to Part III for a fuller understanding of this argument). Such a conceptual leap is difficult to bridge and translate into a language such as English
which, on the other hand, constructs a separation in psyche and soma in line with its own
cultural conceptions of modern medicine. This subtle un-equivalence in meaning in item 4 may be responsible for the observed differential endorsements of the P / BP and B samples.
In contrast to the differential pattern evident in the direction o f the B sample, on five psychological and somatic items (8, 9, 15, 21, 25) both P and BP samples (counter to the
general trend) were found to have higher symptom levels than the B sample. This
suggested that these items, in turn, may be more relevant or appropriate to Pakistani
cultural groups.
Interestingly, item 9 - "Have you felt hopeless" counter to previous studies (Currer, 1986; Krause et al., 1990), as well as the GHQ study (refer to Chapter 4), was marked by
relatively high endorsements in the P and BP samples. Currer (1986) and Krause et al.
their samples was attributable to the difference between Western and South Asian world
views (Obeyesekere, 1982; Shweder & Bourne, 1982). They argued, in more devotional South Asian cultures, hope and worthiness are not considered the domain of the individual
but rather the domain of the divine and fate. The concept o f 'hopelessness', thus, as
juxtaposed to 'hopefulness' embues or assumes the individual to have some control.
Gaines (1992) points out that this very notion is reflective of western cultural thinking and a belief in an internal locus of control. The reason for this some-what counter
intuitive findings in the AKUADS, however, can again be traced to the translation procedure and the subtleties in alteration of meaning. The original Urdu term that was
translated into 'hopelessness' was 'mauosee', which more literally translated as
'despondency'. In can be argued, that this concept of 'despondency' / 'mauosee' in Urdu
does not evoke or carry the same religious connotations as the notion of'hopelessness'.
The religious connotations of hopelessness are more evident in the Urdu terms 'nakabiV
or 'naomeed' (as was used in the GHQ). This bypassing of the religious connotations, it
is suggested, leads to the greater endorsement of item 9 by more P and BPs than Bs in this study, and in comparison to previous studies.
The other psychological item that was endorsed more by the Ps and BPs was item 8 - "Have you felt lonely". What was interesting about this item was that the Urdu term
'thanhayi', meaning 'lonely' is often given as a conceptual translation of the English term
'depression'. It can be speculated that the inherent social, or 'lack of social', nature o f this
term and the relatively greater endorsement of it may relate to a more socially as opposed
to individually defined concept of sadness in Pakistanis.
This greater emphasis on the social also appears to correspond with the conceptual mis
interpretation of item 7 - "Have you wanted to be by y o u rself. Item 7 was questioned by many of the P and BP respondents, even though this may seem some-what counter
intuitive considering that the AKUADS was developed in Pakistan. Many respondents interpreted item 7 as expressing a preference for living alone in a nuclear family as
opposed to a joint family. Subsequently responses were heavily prone to a social
living with others in an extended network was repeatedly re-affirmed by the respondents. This may then have accounted for the particularly low endorsement and differential factor
loading of this item in Ps and BPs.
In the case of the somatic sub-scale, higher P and BP symptom ratings were found on
items 15 - "Have you had heartburn", 21 - "Have your hands or feet gone numb" and 25 -
"Have you had to urinate again and again". These items refer to somatic symptoms that
are not frequently found in Western inventories of depression and anxiety and thus appear to represent somatic symptoms or associations that are specific to Pakistani cultures.
They are also covered in Mumford et al.’s. (1991b) somatic inventory.