You say mental health and language are very united.

Language is important in all areas of health. In any therapeutic relationship, it has been observed that the better the understanding between the component and the patient, the better the therapeutic results. When it comes to the first language of both, in addition to improving the therapeutic relationship between the component and the patient, adherence to treatment is improved.

The importance of language is more evident in mental health, we do not have complementary diagnostic tools. That is, our diagnostic tool is language, we are based on language when performing the psychiatric examination. In psychiatry and also in psychology. The analysis of the results of diagnosis and treatment is based on the psychiatric symptoms and signs shown by the patient.

So is it not the same to care for the patient in their mother tongue as in the second?

Literature review in the Summer Courses [Health and Language Days of the UPV/EHU in Bilbao]. Most published studies have been conducted with bilingual schizophrenic patients. For example, we do not know what happens in depressions or manic manifestations, because it is not published, it is not investigated. In most studies that have studied schizophrenia, it is observed that symptoms are expressed differently in the mother tongue and in the second language. In most cases, symptoms are expressed as more severe and are considered more severe by the therapist.

In the course, you said that researchers say that the mother tongue is related to emotions and that the use of the second language unites us to reality.

To explain the difference that has been detected, the following hypothesis is made: the mother is more related to emotions and the psychotic symptoms are very related to emotions, and appear as more severe in the mother tongue. For the transmission of the second language, executive functions have to be used, other brain functions have to be used. The second language doesn't come out that automatically. In the use of executive functions, the patient pays more attention to the form and transmission of language. Some researchers assert that greater care keeps the patient more connected to reality.

Among the publications he published, he mentioned one from Bizkaia. It was a sign of rejection of the rest of the investigations.

Most studies indicated that psychotic symptoms are expressed more severely in the mother tongue. Some also said that sound hallucinations are only heard in the mother tongue and others that are expressed more severely in the mother tongue. In 1991, three Biscayan psychiatrists (Pablo Malo, Juan Medrano and José Uriarte) investigated four elderly Basque schizophrenic patients who were diagnosed with breast cancer. They only heard sound hallucinations in Spanish. The opposite of what most researchers described.

How can you understand it?

It is true that there are only four patients, and it should be noted that in most cases there are evident methodological limitations. Most studies have been carried out with a small number of patients, in most cases the dexterity of the patients in each language has not been analyzed, nor the age at which they have learned the second language. It gives the impression that it's very important when you learn the language. Languages studied before the age of 5 are retained and used as primary languages, and languages acquired after the age of 5 are considered as secondary languages. The type of memory used for the transmission of each language is different, those older than 5 years are emitted automatically and those older than 5 years require a greater participation of executive functions, which has not been included in most studies.

I believe that despite the methodological limits the consequence is quite clear.

You said that language is very important in psychology and in psychiatry, but you also recognised that there is little research work.

There are studies about the health consequences of misunderstandings, but what surprised me is that there are no people who link mental health with language. There's very little about psychiatry.

I thought I'd done a lot of work on this. I don't know how many publications I mentioned in the course, but I think they wouldn't get to a dozen, and there's not much more work done. There are more publications on psychotherapy, but in specific psychiatric illnesses, being bilingual patients, there is very little work on the differences in the use of each language.

Where do those you mention come from?

Especially from the United States of America, from Latinos, and also from South Africa. In the United States, the importance of bilingualism in health has been worked on. There are meeting programs for Latino physicians and Latino patients.

Why did you choose that line of research?

In addition to psychiatrist [at the Mental Health Center of Barakaldo] and researcher [at the Cruces University Hospital], I am also a professor [at the Faculty of Medicine and Nursing at the UPV] and I have worked with Naiara Ozamiz. We started with a group of psychiatrists working in the Basurto hospital by translating psychometric tools (patient questionnaires). We had more children than adults, because more and more boys and girls have the first language in Basque, as they work in school from a young age. We thought it would be important for children to have questionnaires aimed at themselves. Hence, the review of the publications I made during the course also emerged.

How does the review of publications combine with the Basque translation of tools?

The review work has given much meaning to the work of translating the tools, in the end it is a kind of justification. Why is it important to translate psychometric tools or questionnaires into Basque? Because there is enough evidence that psychiatric examination in one language or another in bilingual patients will give different results. It seems important to have psychometric tools in your own language.

Will we see these questionnaires in health centers?

We, for the time being, are translating into Basque. The students of the Psychology faculty of San Sebastian have a lot of translations and validated. Most of the tools are published in the editorial TEA. It's an editorial that collects psychological tests.