Guest Blog: You Would Have to Be Crazy to Use the Term ‘Shen Disturbed’
August 24th, 2010
Guest Blog: You Would Have to Be Crazy to Use the Term ‘Shen Disturbed’
Written by:Eric Brand
Published on August 24th, 2010 @ 10:29:00 am , using 726 words, 2680 views
Published on August 24th, 2010 @ 10:29:00 am , using 726 words, 2680 views
Posted in Guest Blogs
Eric's note: The other day one of our readers spontaneously sent me the following essay that relates to Chinese medical translation. I have a lot of thoughts on translation myself and I will probably follow up with another blog on language and terminology issues. The blog below was written by our reader David Price, and I am posting it here because David offers an interesting perspective on the term "shen disturbance."
By David H. Price
Mistranslations of Chinese medical terms are more than just semantic issues; in some cases, careless expression of Chinese terms in English may lead to substantive clinical problems. One of the most unfortunate terms appearing in Western clinical practice is the term ‘shen disturbed’. This term is neither an accurate rendering of the Chinese nor is it of clinical utility. On the contrary, several decades of using this inaccurate term in the West has compromised some of the methodology in Chinese medical psychiatry and has manifested in callous and unprofessional behavior.
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‘Shen disturbed’ is most often a translation of the Chinese 神不安 shen bu an. Although it is an awkward pairing of the Chinese pinyin term shen and the English word ‘disturbed’, a rendering of the remaining two characters in the compound, this translation is not fundamentally incorrect. The ideograph 不bu is a standard negative in Chinese, while the character 安 an implies peace, quiet, and tranquility. The English word ‘disturbed’ might therefore be considered a viable equivalent for the Chinese characters 不安bu an. If we were to assume that 神shen, not unlike the term 气 qi, is so culturally distinct as to have no meaningful English correlate, then one might indeed end up with the mixed compound ‘shen disturbed’ or something similar.
The problem arises when handling the translation of related expressions from the Chinese. In particular, one faces a challenge with finding a reasonable and logical translation for安神 an shen, which I translate, following Nigel Wiseman’s lead, as ‘quiet the spirit’. When a patient suffers from神不安shen bu an, ‘shen disturbance’ or, more correctly, ‘disquietude of spirit’, the practitioner is charged with choosing a treatment method to restore normalcy. When thinking in Chinese, shen bu an or disquietude of spirit is logically addressed by the treatment method of an shen or quieting the spirit. Conversely, it is difficult to find an English equivalent for the method that logically rectifies ‘shen disturbance’ unless we coin a new, clumsy expression such as ‘undisturb’—not very catchy. For the Chinese speaker, determining suitable treatment for a person who suffers from神不安 shen bu an is simple: nothing more than rearranging two of the ideographs which comprise the name of the pathocondition to reveal the treatment of choice, 安神an shen or ‘quieting the spirit’. Moreover, the term ‘quieting the spirit’ carries over to formulas, medicinals, and acupoints ascribed this treatment method, allowing the practitioner rapid movement from disease state to concrete treatment options. This linguistic flow is part of the secret behind the efficiency of Chinese masters who treat 100 or more patients each day.
This example demonstrates the logic inherent throughout the Chinese medical language, serving as a good argument for incorporating more faithful renderings of the source language. Maintaining parity with the Chinese precedent in our English translation affords the Western practitioner the clarity and precision enjoyed by Chinese doctors in China, making analysis and treatment easier and more effective. In this case, the fact that the disease state itself directly implies a solution puts practitioners into a positive, problem-solving frame of mind is an additional benefit.
Unaware of the relationship between the pathocondition and its logical treatment in English, many in the West use the term ‘shen disturbed’ in a pejorative and unproductive manner. Functionally, it often seems to be an equivalent of the lay term ‘crazy’. I have frequently heard TCM students and practitioners make remarks such as, ‘There is nothing I can do with this patient; she is too ‘shen disturbed’. This sort of comment is both disrespectful and ineffectual. In my experience, ‘shen disturbed’ is an expression that readily becomes a vehicle for marginalizing patients and avoiding the task of crafting a reasonable treatment strategy to assist in restoring harmony and mitigating suffering. Instead of reinventing the wheel, we Western practitioners should follow the examples of our Chinese colleagues and stick to using the gifts that centuries of brilliant Chinese doctors have bestowed upon us.
Permalink13 comments
Comment from: James Flowers [Visitor]
Interesting point. How would you translate 神 志 昏 乱？How would you translate 神 经 病？
08/24/10 @ 18:51
Hi James,It is possible that the colloquial use of the phrase "shen disturbance" is an American thing- is it common down there in Australia? The only time I hear the phrase "shen disturbed" used is primarily related to two contexts- 1) as a joke (the person is "crazy" in the slang sense of the word, maybe a bit crazy for real) or 2) by students that are generally saying that someone is wrong with the patient's psyche. The only time I ever use the phrase "shen disturbance" is as a joke or a casual observation of general madness, the same way that Chinese people use the phrase jing shen bing (mental illness 精神病 or 神经病) or feng (疯） as a joke. I don't think of shen disturbance in the colloquial sense as a specific term related to a clear Chinese medical concept, it is just used as a casual catch-all term to say that someone isn't quite right in the head.
In a more proper medical context, of course the shen can be disturbed from many causes and it is more clear to describe the situation based on specific Chinese medicine concepts rather than the catch-all phrase "crazy." To say someone is just broadly crazy ("shen disturbed" in the colloquial sense) is like calling them a feng zi (疯子）, it is a lay concept that doesn't have any medical specificity. In a medical text, of course people can be crazy but there are many different degrees and types that can be clinically separated. For example, TCM differentiates many different things that are all essentially disturbances of the shen, such as fan (烦), kuang 狂， dian 癫, 神志昏乱 (confused), etc. All this is not to say that our patients aren't crazy, obviously many of them are a little bit weird. But just saying someone is generally messed up doesn't provide a very specific road map to therapy. Any of their friends could tell the patient they are crazy for free, the point of seeing a doctor is that the doctor can provide insight into their specific type of crazy and hopefully can help to improve the presentation. I think David's point centers around the idea that yes, people are crazy, but as professionals we have the tools to describe the scenario with greater accuracy and we can use that accuracy as a guide to better treatments. -Eric
08/25/10 @ 10:34
Comment from: David Price [Visitor]
HELLO EVERYONE--I very much appreciate the opportunity to post this blog and am glad that James found it worthy of comment. Thank you, Eric, for your reading of my intention. You very accurately expressed my impetus in writing the blog.
Not being a professional translator, I hope readers will excuse any errors that I make and assist me with corrections. It is my understanding that 神经 shen jing or nerves and 神经病 shen jing bing, which can be rendered as mental illness, are both modern terms. Owing to the fact that the nervous system, as we understand it today, was not identified by the ancient Chinese, I am less interested in the specific choices in translation of terms which incorporate compounds such as 神经 shen jing. Although these compounds will appear in modern Chinese medical literature, I feel that the exact translation is less relevant to clinical work than my previous example.
The other term you mention, 神 志 昏 乱 shen zhi hun luan, would appear to be a more traditional expression. The combination of 神 shen 'spirit' and 志 zhi 'mind' or 'will' is intriguing. With the association of 神 shen 'spirit' to the heart and 志 zhi 'mind' or 'will' to the kidney, this compound is similar to the familiar 'jing shen' in the sense that 'jing' or 'essence' is stored by the kidney, while 'shen' or 'spirit' is stored by the heart. Having said that, I am not sure how frequently 神志昏乱 shen zhi hun luan appears in mainstream medical literature. A few potential functional translations might be 'befuddlement', 'confusion', or 'derangement'.
I should mention a couple of things not discussed in the blog. First, I am not suggesting that 'quieting the spirit' is the only treatment method that would be applied in a case of 'disquietude of heart spirit'. One would have to also discern the root cause of the condition and employ the appropriate methods, such as nourishing the heart, coursing the liver, or clearing heat and draining fire. Secondly, the specific choice of character 安 an 'quiet' is significant. Disquietude of heart spirit is a species of stirring, where yang becomes pathologically hyperactive. An argument could be made that 安 an 'quiet' implies a settling of heart spirit that is failing to keep its abode. Medicinally, this may additionally suggest agents that are heavy, perhaps even stone and shell substances. A review of spirit-quieting agents does reveal that many of them are physically heavy and would therefore have the ability to pull the stirred spirit back to its place of level tranquility.
DAVID.
08/25/10 @ 14:30
Comment from: James Flowers [Visitor]
David and Eric, thanks for your comments. Of course the point made appropriately is that we need to understand the source language before we go around bandying half-cocked and poorly understood concepts. Sure, shen disturbance is the commonly accepted term in Australia. I have been guilty of using it when talking to students for the sake of convenience. It is not a term I use when talking with patients or people in the community. I agree that it tends to dichotomise people- either we are disturbed or we are not and it carries negative connotations with different ways of understandings across the language barrier. The term is slightly ugly and lacks the elegance of the source language. There is nothing for it but to insist that students learn the characters. Can we do that? I hope we can. I have asked all my students to learn the characters and then to be able to speak- Chinese, Korean, Japanese are all good. A few have trod that path but alas these are the brave few. The message may hit home one day.
08/25/10 @ 19:33
Comment from: Patrick [Visitor]
Ｈｏｗ ｉｓ 望神 (wang Shen) translated in the west? What exactly are you observing when you wang Shen? I think many of the modern misunderstandings of Shen in the clinical setting can be cleared up this way.What's it mean when someone has 无神, wu shen, literally lacking or without Shen? Does it mean they have no spirit?
Also, Shenjingbing 神经病 almost always refers to neurological disorders. Psychological disorders are 精神病, Jingshenbing. Both are modern terms used in western medicine here. Really they demonstrate how deeply Chinese medicine is woven into Chinese culture. Even in western medical terms can't escape classical influence. Nerves, Shenjing, are literally channels of spirit/mind/consciousness. Jingshen, which is also widely used colloquially, is of course just Jing, as in Kidney Jing, and Shen, as in Heart Shen, mashed together.
08/26/10 @ 20:45
Comment from: David Price [Visitor]
HI PATRICK—It is a bit awkward to write on topics that others would be much better suited to answer: for example, Eric Brand is certainly an authority on the translation of Chinese medical language, while Bob Flaws is an expert on Chinese medical psychiatry. At any rate, here are my thoughts on your questions.
望神 wang shen can be rendered as inspecting the spirit, while 无神 wu shen may be expressed as spiritlessness. For both of these terms, it is important to recall that there are two different relevant concepts for spirit within Chinese medical psychiatry. The first, a narrow meaning of shen, refers to consciousness and thought-feeling. When inspecting this phenomenon of spirit, the doctor may observe devitalized essence-spirit or clouded spirit. These are both pathologies of the heart spirit that can be treated, to some extent, with Chinese medicine and are neither necessarily fatal nor incurable conditions. The second definition pertains less to behavior and more to general vitality. Bob Flaws in Chinese Medical Psychiatry uses the inspired example of the spiritedness of a spirited horse. In cases when spirit in the broad sense of the word is lacking, the prognosis of the patient is in question and life hangs in the balance. This meaning of spirit is typically inferred by the word spiritlessness which is, moreover, contrasted with spiritedness and the critical phenomenon of false spiritedness.
As for the term 神经病 shen jing bing, although it may imply neurological disorders in a medical context, it definitely suggests ‘craziness’ in everyday conversation. Whenever I use this compound jokingly with Chinese friends, their response is exactly what one would expect in English when you tell someone in jest that he is ‘out of his mind’. Your experience, Patrick, demonstrates that our Chinese colleagues are scrupulous in sticking to professional medical language in a clinical context, a practice I was trying to encourage in my blog.
Finally, I think that if you ask Chinese scientists and allopathic psychiatrists about the terms 神经 shen jing ‘nerves’ and 精神 jing shen ‘psycho-’, they will disavow any connection to traditional Chinese medical or cultural concepts. Chinese speakers frequently use compounds without being consciously aware of the etymological significance of the characters which comprise them. This is similar to the use of English words without stopping to consider the Greek and Latin origins, for example. Unlike the Japanese, who use katakana to reproduce foreign loan words phonetically, the Chinese neither have access to a system to copy imported words nor do they typically create new characters to add into their vocabulary. All translations from imported lingo into Chinese, therefore, must rely on a supply of ideographs predating the modern era and may give the misleading impression of being vehicles for more traditional concepts and culture. In actuality, the modern Chinese speaker would more than likely perceive the compound as a single, undifferentiated unit, understanding it exclusively as an expression of its modern idea.
David.
08/27/10 @ 18:05
Comment from: Peter Borten [Visitor]
Thanks for the great discussion.In talking and writing about Chinese medicine to those unfamiliar with it, one of the primary strengths I always mention is that there is a seamless integration of the diagnostic (pattern discrimination) terminology with the therapeutic terminology. On this, I agree with you wholeheartedly. It's something that doesn't exist in biomedicine. If a patient's diagnosis is Multiple Sclerosis, there is no clear therapeutic direction that immediately follows from this. Even if we were to take a component part of this syndrome - e.g., immune dysfunction causing inflammation and demyelination of neurons - there is still no clear therapeutic direction. Suppress the immune system? Modulate the immune system? Suppress inflammation? Stimulate neuronal regeneration?
We don't have this problem in Chinese medicine.
However, I think the linguistic particulars of CM's diagnostic-therapeutic integration are of primary importance in the process of learning the medicine. Whatever a practitioner goes on to call shen bu an in English, the important part is that they understand something is not right with the patient's Shen and they know what to do about it. While "disquietude" may be a more literal translation, it's hardly a more useful term than "disturbance." In the same way, Liver Depression Qi Stagnation may be a more accurate rendering of the Chinese, but in my humble opinion, it is cumbersome and confusing, if only because "depression" already has a medical meaning in English. The key is that a practitioner understands Liver Depression Qi Stagnation experientially, can perceive it in someone's pulse or tongue, and knows what to do about it.
I agree that it may be problematic to label patients as "disturbed," especially if we do so dismissively. But there are innumerable ways in which a patient's Shen may be disquieted - grief, hysteria, anger, pensiveness, fear, etc., and I know there are legions of sensitive practitioners out there who are adept at ascertaining the particular disquietude of a patient's Shen and leading them back to balance, even if they still call it "shen disturbance."
08/28/10 @ 00:08
Comment from: Peter Borten [Visitor]
One more thing...I will be eternally grateful to my multilingual colleagues who have made and continue to make enormous contributions to our field. It would not be what it is today without the painstaking attention to detail that its translators have exercised.
That said, I am not a Chinese speaker, and I don't know that I will ever be. I would love to be instantly fluent, ala The Matrix. I wish for this sometimes and hope I will just wake up one day knowing Chinese. I know there are many fantastic teachers and practitioners, like Bob Flaws, and the folks at SIOM, who feel that learning the Chinese language (at least to read it) is of tremendous importance if one wishes to really understand Chinese medicine. I have even heard it said that in order to be a great practitioner, one MUST know Chinese.
As for me, since I don't have time to learn Chinese, I am content to rely on my Chinese speaking colleagues, for whom I have the utmost respect. I may be deluded in thinking I have a decent grasp on Chinese medical theory without knowing Chinese, but I can certainly say I have encountered some masterful practitioners who were earnest, perceptive, compassionate, and powerful, and yet, they butchered Chinese medical terminology.
08/28/10 @ 00:25
Great comments, Peter. I particularly like this one; "I can certainly say I have encountered some masterful practitioners who were earnest, perceptive, compassionate, and powerful, and yet, they butchered Chinese medical terminology."Successful clinical results rely on a complex blend of many skills, and many of these skills or talents are far more profound than something like terminology. Terminology is primarily a concern if one is doing written work that is directly based on a Chinese original. The only reason the subject of terminology comes up is if someone is translating something and they want to figure out how to use English to convey the meaning of the original work in the most transparent way possible. Preserving the details of the Chinese language in spoken English is only something that one would do if one was thinking about a Chinese concept and translating it directly (for example, when I verbally translate for a Chinese lecturer, I try to preserve the terminology they use).
The main time terminology comes up is in books, particularly English books based on Chinese originals. In most other situations we use English in a more relaxed, colloquial manner. I do try to translate with consistent terminology because I like to keep my work close to the Chinese original. But I don't think that the way that one writes when translating needs to be the same way that one speaks colloquially in clinic.
And I personally do not believe that it is practical or necessary for practitioners to universally study Chinese. The main way to learn Chinese well is to stop your life and immerse yourself in difficult classes in a foreign country, which is just not practical for 95% of practitioners (and may not be the most useful way of utilizing several years of brain power, depending on what you like to do). For people that enjoy such things, it is tremendously rewarding, but being a good practitioner is much deeper and more complex than simply studying or not studying a language.
I am not in any way an authority on terminology, in fact, I think there are only a few true authorities on Chinese medical English in the world. Such a thing requires advanced knowledge in multiple disciplines. I am just a student, but I was fortunate to study with people that were real experts. And we have also all had teachers with an incredibly profound grasp of Chinese medicine that completely butcher English terminology, and it obviously does not make their clinical ability any less profound. However, I was grateful that I read a lot of Wiseman's books in school because the English terminology mirrored the Chinese terminology and it made it really easy to pick up Chinese medical Chinese when I moved to Taiwan.
08/28/10 @ 22:54
Comment from: David Price [Visitor]
I hesistated about writing another comment in response to Eric and Peter’s excellent contributions. It is not my intention to belabor the point, but the example of liver depression is too enticing to resist.There are three points I would like to make. First, I think it is reasonable to expect our schooling to provide at least some exposure to the Chinese language. Ours may be the only graduate level study of foreign culture that does not require students to have some level of exposure to, if not proficiency with, the language of the target culture. Eric is, of course, entirely correct in stating that few of us will become expert at Chinese medical language but knowing some of the basics is a modest enough requirement. In Asia, most MD’s have had some English, and those who participate in international forums cannot escape the necessity of learning both spoken and written English.
Second, there is a good argument to be made that the fact that most practitioners will not master Chinese medical language is the best reason to embrace a translation scheme that is standardized and as accurate as possible. If everyone knew the characters and could read the Chinese easily, we would not have to have a discussion about English nomenclature. Ultimately there is no substitute for learning Chinese medical language well enough to read Chinese texts, but that is not a realistic goal for all of our profession at this time. The next best thing is a very good English rendering of Chinese medical language.
Finally, I would like to explore Peter’s example of liver depression. He mentions that the term ‘depression’ already has a medical meaning in English and points out that this can be confusing. In fact, the character in Chinese for ‘depression’ in liver depression qi stagnation and the character used to describe emotional depression are actually identical! Moreover, the use of the same character is not coincidental but is, on the contrary, rich with meaning. Let me explain.
Bob Flaws has described the spirit as nothing other than an accumulation of qi and blood in the heart. The liver viscus, in turn, governs the free coursing of qi throughout the entire body, including the qi in the heart. One can thus state that emotional depression is fundamentally an expression of, or one could even say analagous to, liver depression. In the words of the Za Bing Yuan Liu Xi Zhu (as recorded in Bob’s Chinese Medical Psychiatry), “All depression can be classified as liver disease.” This realization greatly clarifies and simplifies the understanding and treatment of emotional depression. We should also remember that emotional depression is one of the key symptoms of a liver depression pattern. In Chinese medicine, almost everything functions bidirectionally.
We can take it one step further. If one remembers Zhu Dan-Xi’s six depressions, namely phlegm obstruction, damp accumulation, food stagnation, depressive heat, and blood stasis, the possible evolutions of the liver depression leading to emotional depression become apparent. Remembering that phlegm, dampness, and food stagnation are all related forms of yin evil and that enduring dampness congeals into phlegm, we can condense the six depressions into the three categories of phlegm, depressive heat, and blood stasis. These are exactly the three repletion evils mentioned in Chinese Medical Psychiatry under the category of repletion patterns of emotional depression. In premodern times, this sort of resonance aided in memorizing and understanding the medicine. It still comes in handy today.
The title of my blog was meant to be tongue-in-cheek. As Peter and Eric suggest, good clinical results are not solely dependent on semantics and nomenclature. There are many ingredients needed to be a good practitioner, with the elements of patience, postivity, and compassion topping the list. When dealing with a medical system built on the concept of resonance, however, preserving resonance in language allows for a better grasp of the essence of the medicine and assists in using the therapeutic tools as skillfully as possible. I am thankful everyday for the insight it provides me in clinical practice. If you choose to take advantage of it in your own practice, I can promise you that a scrupulous use of terminology will help you in opening doors of understanding the practice of Chinese medicine.
David.
08/29/10 @ 18:27
Saying someone's Shen is disturbed doesn't necessarily mean that the person is crazy. Couldn't anyone's shen become disturbed at any given time? And that our job as a practitioner would be to restore the balance to the patient?
10/02/10 @ 10:57
Comment from: Beth Griffing [Visitor] 
Thanks for this interesting discussion! As a student, this is very helpful. I think that as students, until more (and more accurate) translations are available, we should be STRONGLY encouraged to learn the language (at least the medical language plus basic grammatical concepts). I was actually discouraged from learning Chinese; this attitude seems ridiculous to me now, after 3 years in school and wishing I had committed to learning Chinese.Additionally, the "mystification" that occurs with metaphorical language can easily sidetrack students (i.e. the rich symbolism and associations of Chinese characters being put into one metaphorical idiom in English). Metaphors do act as excellent vectors for dense concepts; unpacking their meaning can be very rewarding, and they help to create a kind of shorthand in our medicine. However, I see many Western students going wild with the metaphors, interpreting them in ways that get further and further from the original meaning. We rely very heavily on teachers who have trained in China and can translate these important concepts for us in class, and I don't see that changing in the near future.
Consequently, thank you thank you for the progress that is happening in the field of translation and clarification of these medical definitions!
03/04/11 @ 16:14
Comment from: David H. Price [Visitor]
HI BETH--I just checked in on my blog entry and read your comment. Thank you for your astute observations on the subject. I could not agree with you more, and I am delighted to hear from a TCM learner like yourself who, while still in school, can demonstrate such a mature and insightful grasp of the essence of our medicine. My recommendation is to use the considerable resources we now have available and be patient and persistent in teaching yourself more about the native language of this ancient medicine.
Best of luck in your studies and practice,
David.
03/27/11 @ 20:37
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