The term “culture-broker” often comes up in discussing the role of the medical interpreter. This term refers to the extent to which the interpreter’s role goes beyond the strictly linguistic, to assist in a successful interaction by helping participants to understand where their interlocutors are coming from culturally. This usually involves helping a provider to understand that in the patient’s culture there is a belief about a health issue that he or she may be unfamiliar with, and that the client’s own analysis of his or her own situation may be based on this belief. The role of culture-broker is particularly salient in the world of multicultural adolescent mental health. We can generally assume that most mental health professionals differ from most adolescents in their understanding of the world, but we must also be aware that the mental health client’s beliefs may be distorted as a result of their condition or emotional state. In the case of clients from linguistic and cultural minorities, we must also remember that the minority culture may present alternate views of the world that should not be confused with psychiatric symptoms or symptoms of emotional distress. After all, the briefest glance at the history of intercultural interaction tells us that human difference has often been pathologized. This is particularly true where there is an inherent imbalance of power such as that between a minority and majority culture or between a patient and a provider. While some psychiatric pathologies are universal, their symptomology may be culturally determined, as will other emotional conflicts and emotional reactions to life events. An understanding of the client’s family structure, beliefs about self and others, and beliefs about his or her present situation is necessary before the provider can helpfully address the reason for the interaction. Cultural interpretation may help provide that understanding with regard to aspects of culture of which the provider may be entirely unaware. At the same time, we must recognize that whatever his or her cultural insight, and any such insight is necessarily limited by his or her position outside the cohort-specific culture of the client, the role of the interpreter remains primarily that of facilitator for the parties most directly involved in the interaction: the client and the provider. As in any interpreting situation, the interpreter must be cautious not to distort the most important dyadic interaction taking place, that between the provider and the client.

A few pointers then on the importance of linguistic interpretation in the adolescent mental health setting, where many clients speak a language other than English at home and a significant number speak no English at all:

1) Mental health clients report less difficulty in seeking help when interpretation is available. Surveys show that clients express increased satisfaction as a result of interpretation, saying that they feel more helped and more comfortable.

2) The use of the language in which a client best expresses him or herself has a positive effect on his or her ability to effectively communicate with the provider

3) Professional interpreting must be available in the medical setting because untrained interpreters or helpful family members may be unable or unwilling to accurately represent what is said by a client, and a client may be unwilling to speak freely in the presence of family or community members. Adolescents commonly have ambiguous feelings about revealing aspects of their lives to others, particularly family members and authority figures. Untrained or “naïve” interpreters are not often able to manipulate both the registers, or the levels of grammatical and terminological sophistication, that are produced by most immigrant populations and most highly-educated providers. These problems are magnified in the mental health setting and their resolution may be decisive in the success or failure of the interaction, particularly where adolescents are concerned.

4) A skilled mental health interpreter should be able to provide insight into the meaning of certain gestures or manners of speaking that would otherwise go uninterpreted. In addition, he or she may provide information about culturally-conditioned expressions of affect, if a client is speaking more or less articulately than at other times, if he or she appears confused, etc. This type of information is almost always available to the provider in an English-language interaction, but may be partially or completely obscured by linguistic and cultural difference. The interpretation of these behaviors may be provided in the form of asides to the provider or may simply be integrated into the “performance” of interpreting.

Finally, the interpreter’s role is amplified and perhaps critical in a family or other group meeting where participants’ differ in their linguistic knowledge or preference. For example, meetings involving immigrant families often involve bilingual adolescents, non-English monolingual parents, and English monolingual providers. Only the presence of an interpreter, preferably one who can interpret simultaneously, makes it possible for such a meeting to proceed and for all voices to be heard. If you are ever involved in such a meeting, please keep in mind that the task of interpreting continually, perhaps simultaneously, and alternating from language A to language B and then from language B to language A is mentally taxing. In this kind of situation, there will necessarily be a limit to the interpreter’s ability to work accurately and interpreter fatigue should be taken into consideration.