Guest Post with Hideyuki Motohashi

Category or Narrative? 
Perspectives in Mental Health Translation 
By Hideyuki Motohashi 

Expressions from Social Media 

He is so bipolar today. 
She is delusional if she thinks we’ll meet again. 
I’m OCD about keeping my room neat. 

How do you translate these expressions? They may simply mean “moody,” “unrealistic,” or “overly particular.” Translators may hesitate between staying close to the original nuance and replacing it with everyday Japanese that reflects the speaker’s intended meaning. 

When I encounter such expressions in my work, I still pause over the right Japanese wording. Translators may balance the speaker’s voice with ethical considerations, as metaphorical uses of mental health diagnoses can contribute to stigma. Sometimes I hit a wall, and my desk soon fills with reference books. 

	Clinical translation	Everyday translation
He is so bipolar today.	彼は今日、双極症の症状を呈している。	彼は今日、気分の浮き沈みが激しい。
She is delusional if she thinks we’ll meet again.	彼女には、私たちの再会に関して妄想的確信が認められる。	彼女は「私たちが再会する」と思い込んでいる。
I’m OCD about keeping my room neat.	私は強迫症で、部屋をきれいに保つことに強いこだわりがある。	自分の部屋をきれいに保つことに、私は細かく気を使う。

These examples show how context affects word choice in Japanese. Clinical meanings tend to use more kanji and formal noun phrases, while everyday meanings often use more familiar words, hiragana, and verb or adjective phrases. In Japanese, kanji can feel formal or technical, while hiragana often feels softer and more approachable.  

English often uses related words in both clinical and everyday contexts, while Japanese can make the distinction more explicit through word choice. Choosing the right level of formality is important. 

When Categories and Narratives Coexist 

In mental health translation, diagnostic language and personal narrative sometimes coexist, bringing together the clinical perspective of the treatment team and the patient’s own words. In psychotherapy transcripts, even small irregularities in speech can carry meaning. 

The doctor and psychologist agreed that the patient’s restlessness was more consistent with an anxiety disorder than attention-deficit/hyperactivity disorder (ADHD), as her childhood history revealed no clear evidence of ADHD symptoms. She said, “I just… I couldn’t stop pacing around the room. I kept thinking something bad was about to happen. My breathing just got faster and faster. That was really tough.”

生育歴において注意欠如・多動症（ADHD）の症状を示唆する所見が認められないため、患者の落ち着きのなさはADHDではなく不安症によるものと医師・心理士間で意見が一致した。彼女はこう話した。「ただ……部屋の中を歩き回るのをやめられなくて。何か良くないことが起きるんじゃないかって、ずっと思っていました。息がどんどん速くなって。本当にきつかったです。」

For that reason, I start by asking what function the term serves. 

• A diagnostic label 
• A clinical description
• An everyday or metaphorical expression 

The following examples show how much the Japanese translation can change: 

Diagnostic label	She was diagnosed with recurrent depressive disorder.	彼女は反復性うつ病と診断された。
Clinical description	Her depression appears to stem from trauma.	彼女の抑うつは心的外傷に起因するようだ。
Everyday language	I’ve been depressed since the breakup.	別れてから、落ち込んでいる。

EBM and NBM 

The distinction between category and narrative can also be viewed through two complementary perspectives in medicine: Evidence-Based Medicine (EBM) and Narrative-Based Medicine (NBM). For translators, the key is knowing which perspective is warranted for the context. 

The following table compares these perspectives:  

	EBM	NBM
Basic concepts	Integrates the best available research evidence with clinical expertise and the patient’s values and preferences.	Emphasizes understanding a patient’s experience and its meaning by listening to their stories about illness and recovery.
Situations	Treatment planning, multidisciplinary collaboration, and research	Providing humanistic care and building trust
Documents	Accuracy and consistency in terminology are vital.	Descriptive language conveys patient’s experience vividly.

Moving Between the Two Perspectives 

Sometimes it is worth checking with the client whether your understanding matches the intended meaning. Before translating a mental health term, ask yourself:

Is it a diagnostic label, a clinical description, or an everyday or metaphorical expression?  
Who is speaking, and who will read the translation? 
What is the purpose of the document?  
Where does the emphasis lie: category or narrative? 

When I translate mental health texts, I ask myself, “Category or Narrative?” 

Note: All examples are hypothetical and do not refer to any real persons or events. The diagnostic terms follow the Japanese terminology adopted for ICD-11. 

References 

Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ, 312(7023), 71–72.  

Greenhalgh, T., & Hurwitz, B. (1999). Why study narrative? BMJ, 318(7175), 48–50. 

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Author: Hideyuki Motohashi (本橋英之)

Editor: Nadine Edwards