On a humid morning inside a small clinic just outside DC, a middle-aged woman sat across from a physician and tried to describe a feeling she had carried for months.

“Es como… un peso aquí,” she said softly, pressing her hand to the center of her chest.

The doctor, scribbling notes, translated mechanically from the limited Spanish education she had received in college. “Chest pressure. Possible anxiety. Maybe acid reflux.”

But the woman shook her head.

“No es dolor,” she said. “Es… tristeza. Que no se va.” It’s not pain, but rather sadness. The kind that doesn’t leave.

The literal English phrasing, which was chronic sadness, significantly flattened what she meant. In Spanish, her words held emotional heaviness and the quiet loneliness which builds in the spaces between language. The doctor had caught the vocabulary, but missed the essence of what she had truly meant. What unfolded in that exam room is not unusual. It’s the everyday reality of multilingual care where illness becomes something vastly different than what the patient had intended. For many Spanish-speaking patients, the boundary between health and language is blurred.

The boundary impacts more than the isolated encounters. The U.S. Census Bureau reports amongst people who spoke another language than English in the United States, “approximately 61% spoke Spanish” and “more than 1 in 5 people age 5 and older in the United States spoke a language other than English at home.” Furthermore, according to a 2024 Medicaid and CHIP Payment and Access Commission (MACPAC) report, 25.7 million individuals in the United States had limited English proficiency in 2021.

The Real Story Behind Two Languages Covering One Illness

This journalistic piece investigates how English and Spanish language media reports on the same health conditions in different emotional registers and how ultimately these differences shape immigrant communities. In fact, according to a study conducted on identifying key medical errors in patients with limited English proficiency, approximately 98,000 individuals die per year due to medical errors in hospitals and “Communication problems are among the root causes of 59% of serious adverse events.”

Over the last few weeks, I analyzed academic studies on language barriers in medicine, articles on mental health disorders such as depression and anxiety, and conducted interviews with bilingual healthcare workers to review linguistic patterns across Spanish and English language outlets. I attempted to reach out to two journalists as well: Sarah Kliff of the New York Times (specializing in health policy) and Chad Terhune of Reuters (specializing in healthcare business and policy) but did not hear back from either.

Mental health reporting seems to be a high-stakes domain for the slippage because its prevalence is considerably high. Its symptoms are also communicated through everyday language. An estimated 19.1% of U.S. adults experienced some anxiety disorder in the past year according to the National Institute of Mental Health. This number is further exacerbated for immigrant communities, especially given the recent anti-immigrant rhetoric in the United States. According to a study conducted by the UCLA Center for Health Policy Research, “For immigrants living in the United States fewer than five years, rates of serious psychological distress increased 140%, from 5% of those surveyed between 2015–2017 to 12% for those surveyed between 2019–2021.”

This reporting suggests that language drastically reshapes illness, vastly determines what pain becomes legible, and what emotional states count as treatable conditions. When patient metaphors collide with clinician vocabulary, meanings readily slip.

How Health Narratives Shift Across Languages

When I was analyzing how health stories are told across different languages, I noticed one of the first differences which emerged was tone. English-language health reporting relied on clinical sustenance - in terms of diagnostic criteria and expert commentary. Outlets such as the New York Times or The Washington Post often write about illnesses through established medical frameworks already. For instance, a 2021 National Library of Medicine re-publication of an article from The Washington Post is titled: “The Big Number: About 76 million people suffered anxiety because of the pandemic.” It is standardized and dryly explanatory. Even when discussing personal conditions, English reporting often treats emotion to be something analyzed or supported with research citations.

Spanish-language reporting on the other hand, tends to frame illness through lived experience and metaphor, especially in outlets such as Telemundo, Univision Salud, or El Tiempo Latino. A concrete example appears in the Spanish-language piece by Univision titled “Vivir con ansiedad, no es vivir” (to live with anxiety is not living). This article further quotes psychiatrist Gonzalo Pérez-García who states, “Agrega que no es algo de lo que se habla fácilmente en la comunidad hispana y puede dejar a muchos sufriendo en silencio” (anxiety is not something which is easily talked about in the Hispanic community and can leave many suffering in silence). In other words, the language to educate and spread awareness to this population should be and is more intimate and diagnostic only in a literary sense. Across articles, patterns such as the imagery of shadows, knots, internal coldness and direct address to the reader with references to family, faith, and emotional vocabulary that replaces clinical jargon. In English, symptoms are listed. In Spanish, suffering is narrated.

These differences matter because the language surrounding illness shapes expectations for what healing looks like. When anxiety is framed in English as a biochemical imbalance, therapy protocols and treatment points are prevalent. When anxiety in Spanish is described as un susto que se te quedó adentro (a fright that stayed inside you) according to a bilingual healthcare worker I interviewed in Trenton, NJ who chose to remain anonymous, the pathway to relief usually involves faith or spiritual guidance. None of these frameworks are inherently incorrect, but rather a symbiotic relationship that cannot live independently from one another.

Over Thanksgiving break, I chose to visit El Centro (a local healthcare clinic dedicated to providing treatment to the Latino population of Trenton) and the Capital Health Hospital Trauma Center in Trenton, NJ, both where I had previously volunteered in high school. Though I did not have any contacts I could have reached out to in advance, upon identifying myself as a former volunteer and student in college interested in exploring healthcare disparities, I was afforded the opportunity to speak to two bilingual healthcare workers from the Capital Health Trauma Center. No one from El Centro opted to speak with me.

Both individuals, one male (Nurse A) and one female (Nurse B), from Capital Health decided to remain anonymous for the purposes of this piece. In my conversations with both, I compared the past anecdotal narratives they have previously seen - especially with immigration-linked anxiety to analyze how such dynamics play out in practice. Nurse A spoke about how he previously witnessed patients describing their anxiety as “El miedo te acompaña” - where anxiety he stated became a companion instead of a policy failure like the American counterpart. Chronic illness also shifts dramatically depending on the language. English reporting seems to zero in on management of disease such as glucose levels or carbohydrate intake. However, Spanish reporting emphasizes responsibility and relationships according to Nurse B. She shared a former story of a mother of four who had come in with chronic bronchitis. This mother had expressed her concern to Nurse B as “Tengo que cuidarme por mis hijos” - I have to take care of myself for my children. Spanish stories therefore seemed to be shaped by several family dynamics and intergenerational expectations. Nurse B continued with the fact that teenagers struggling in school would tell her things like “Me duele el pensamiento”—my thinking hurts—or “Siento frío por dentro”—I feel cold on the inside.

The phrases both nurses told me they hear from patients do not seem to fit neatly into medical categories. Nurse A said that he has heard from his colleagues anxiety being described as “un animal chiquito corriendo en mi pecho”—a little animal running inside my chest. Such expressions are vividly descriptive, but are unable to be charted onto a diagnostic chart. As Nurse A’s colleague could not effectively chart the patient’s illness, the patient was mistakenly evaluated for cardiac issues because the English interpretation sounded like chest palpitations. What patients express emotionally in Spanish is sometimes charted incorrectly in English - and these results are often miscommunication and incomplete care. Nurse A summarized the issue clearly: English captures the clinical truths of illness and Spanish captures the emotional truth.

To conclude, combating language barriers in healthcare requires more than simple ad hoc interpretation or cultural sensitivity training. Translation seems to be pushing towards the infrastructural aspect instead of interpersonal. For journalists this further presents a structural challenge in terms of how they must report on multilingual societies without defaulting to English-centric frames. Health policy is becoming increasingly crucial to determine whether language services exist and whether patients are forced to compress their complex health narratives to fit English forms.

Note, please see the source list on the following page.

Source List (Websites Cited APA):

Source 1: Bureau, U. C. (2025, June 3). New Data on Detailed Languages Spoken at Home and the Ability to Speak English. Census.gov.https://www.census.gov/newsroom/press-releases/2025/2017-2021-acs-language-use-tables.html

Source 2: ‌Enrollment and Access Barriers for People with Limited English Proficiency. (2024, July 23). MACPAC. https://www.macpac.gov/publication/enrollment-and-access-barriers-for-people-with-limited-english- proficiency/‌

Source 3: National Institute of Mental Health. (2024). Any Anxiety Disorder. Www.nimh.nih.gov; National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder

‌Source 4: News: The Big Number: About 76 million... (The Washington Post) - Behind the headlines - NLM. (2021). NCBI. https://www.ncbi.nlm.nih.gov/search/research-news/14828/

Source 5: Wasserman, M., Renfrew, M. R., Green, A. R., Lopez, L., Tan-McGrory, A., Brach, C., & Betancourt, J. R. (2014). Identifying and Preventing Medical Errors in Patients With Limited English Proficiency: Key Findings and Tools for the Field. Journal for Healthcare Quality, 36(3), 5–16. https://doi.org/10.1111/jhq.12065

Personal Interview Conducted - Nurse A; Capital Health Trauma Center, Trenton, NJ (Nov. 2025)

Personal Interview Conducted - Nurse B; Capital Health Trauma Center, Trenton, NJ (Nov. 2025)