"It's frustrating not being able to describe how you feel"
One in four psychiatrists at Akademiska Hospital in Uppsala is foreign-born, but among up and coming trainee doctors, immigrants now heavily outnumber ethnic Swedes. Does this shift mean trouble ahead as doctors and mental health patients face language and cultural barriers?
The psychiatric unit nestles in a turn-of-the-last-century building perched on a hill. It's near the duck pound here on the sprawling Akademiska Hospital campus.
On a cold but clear spring day, the birds are causing a racket, but when Lewis Hamilton came here a few months ago, the dark winter months still stretched out ahead of him.
"I probably ‘hit the wall’ as you say in Swedish, it was in November last year, and it got to a stage where I didn’t want to live anymore," he says. His GP recommended he call up or go straight to the acute psychiatric intake facility at Akademiska. Which he did.
Lewis Hamilton does speak good Swedish, but he says he understood only two thirds of the form that he was asked to fill in. His wife, with whom he's raising five children, was there to help.
Lewis Hamilton's case of asking for help in a second language is not unique in Sweden, where migrants for decades now have added to the cultural mix of this once homogenous nation.
Janet Cunningham is in training to become a psychiatrist at Akademiska Hospital.
“You’ll hear quite often they just don’t have the energy to express themselves in their second language and that’s a symptom of the depression,” she says.
“If the patient doesn’t have Swedish at a level high enough to express their symptoms we have a serious problem, and then we use translators,” she says. “It can work but it takes longer and requires both a very patient doctor and a professional translator.”
Janet Cunningham is herself an immigrant, having moved here from Canada. Outside her office window, a gleaming behemoth of steel and glass is being gingerly put together by shoals of construction workers. It's the new psychiatric centre, which will gather all the departments in one place.
Around 80 per cent of trainee psychiatrists at the hospital are now foreign-born, with Greeks fleeing the financial crisis at home making up much of the crew. Other names on the doors along the dusky corridor tell of Hispanic and Slavic roots among the doctors.
Janet Cunningham says her own background can be helpful when speaking with patients.
"I think they feel that I am empathetic with their situation, that I am not judging them the way they feel they’ve judged in other situations,” she says, adding that doctors who have themselves made the transition to Sweden understand what it's like to "feel different", a huge help in understanding culture shock and integration difficulties.
By law, anyone who requires a translator is provided with one. But that in itself can provide problems. The doctors at Akademiska all testify to it - regional and ethnic conflicts in people's countries of birth means there can be trust issues.
Their colleague in the Stockholm satellite town Södertälje, psychiatrist Maria Sundvall, is an expert on the challenges of taking care of migrants
“Many patients are hesitant to use translators,” she says, “Because they don’t trust the proffesional secrecy.”
She works at the mental health initiative Transcultural Centre in the migrant-rich town, and is part of the team trying to teach psychiatric workers across Stockholm to recognise that mental problems can manifest themselves in different ways depending on the patients' backgrounds.
“We tend, in our diagnostic manuals, to underline the kind of symptoms of brooding and being very self-critical, having negative thoughts,” Sundvall says. “But internationally, the most common core of the depression is tiredness, lack of energy, and other somatic symptoms.”
“There is an obvious risk if you express only those symptoms, you depression might be missed,” she adds.
Talking, despite the barriers, was key to Lewis Hamilton's recovery. He says staff from Akademiska in Uppsala called him every day for the first period after showing up there, until they assessed he was out of the risk zone.
In Sweden, where most people do speak good, often fluent English, Lewis Hamilton was able to quickly converse in his native tongue, his wife at the ready to translate anything. We ask how he thinks he would have felt if that hadn't been an option?
"I would have struggled and it would have taken time," he says. "It’s a frustration when you can’t describe what you feel... in any language."