What does 'tension' really mean?
It is a sentence I have heard many times in my consulting room in suburban Sydney. A Bangladeshi patient tells me that they have tension. When I ask what they mean by tension, they sometimes point to their head or neck and shoulders. They describe a heavy head, tight muscles, headaches, dizziness, poor sleep, palpitations or an uncomfortable sensation that something is wrong with their body. After several consultations, it becomes clear that the body is telling a story that the patient has not yet learned, or perhaps has not yet felt able, to tell in psychological language.
The word is deceptively simple
Tension is English, but it has been thoroughly absorbed into Bangladeshi Bengali. It is not quite the same as the English word “stress”. It is certainly not synonymous with any particular psychiatric diagnosis. In context, it can describe ordinary worry, physical discomfort, emotional suffering, social pressure and, at its extreme, something very close to what a psychiatrist would call major depression or an anxiety disorder.
Research in Bangladesh has begun to demonstrate just how much is contained within this apparently ordinary word, tension. A qualitative study of young men in Dhaka found tension to be the central idiom of distress. The researchers described it as existing on a continuum, from shadharon tension (ordinary tension), through excessive rumination and physical symptoms, to kharap or otirikto tension (bad or excessive tension), which could include hopelessness, anhedonia and even suicidality.
Another recent ethnographic study of women in rural Bangladesh found that tension could encompass both bodily and emotional suffering, with participants describing headaches, chest discomfort, sleeplessness, restlessness and worry about money, children, houses and the future. One woman captured its expansiveness with a question that almost seems to define the word: “Does tension have a limit?”
This is why I am interested in what Bangladeshis mean when they say they have tension. It can offer a small but revealing window into how distress is understood, communicated and experienced.
Tension is not quite stress
There is an obvious temptation to translate tension into the English word ‘stress’, but something important is lost in the translation. A person might say that they have tension because they cannot find a job. Tension gives them headaches and sleeplessness. Since they cannot sleep, they become irritated with their wife. Their marriage deteriorates, which gives them more tension. Eventually, they may become depressed. The word can contain the whole chain.
It can also preserve an important distinction between suffering and illness. Bangladeshi men interviewed in one study did not necessarily regard ordinary tension as a psychiatric problem. Some considered a degree of worry necessary for getting ahead in life. It was excessive, persistent tension that became concerning. This is not entirely unfamiliar to Western psychiatry: a certain amount of anxiety can be adaptive. But the language makes the continuum particularly visible.
“Tell me how you feel” is not always an adequate question. For some patients, the more important question is: What has happened between you and the people who matter to you? The difference is subtle but important.
There is something else about the word that interests me clinically. When someone points to their head or shoulders and says, ‘I have tension,’ they are not necessarily making a distinction between the psychological and physical self. The distinction may be much less important to them than it is to the doctor. This is where the concept of an ‘idiom of distress’ becomes useful. People everywhere experience distress through the cultural vocabulary available to them. Some patients say they are depressed; others say they are exhausted, overwhelmed, unable to cope, or that their heart is broken. In Bangladesh, tension can provide a socially acceptable language for experiences that might otherwise be difficult to identify as psychological.
Sometimes, therefore, the physical symptom is not an inaccurate description of psychological distress.
The social life of distress
There is another reason why tension seems particularly revealing among Bangladeshis: distress is often profoundly relational.
I do not mean that Bangladeshis are all the same, or that every Bangladeshi possesses some special collectivist personality. Recent work on South Asian mental health is right to warn against precisely this kind of cultural shorthand. The category ‘South Asian’ is itself too broad, and within Bangladesh there are enormous differences of class, education, geography, generation, religiosity and migration history. Nevertheless, the social world matters.
In many of the Bangladeshi patients I see, suffering is inseparable from relationships and social roles: being a good son, daughter, husband, wife, parent, sibling or provider. Distress often arises not simply because someone has an unpleasant thought, but because something has gone wrong in the web of relationships through which that person understands themselves.
A son cannot find adequate work amid limited opportunities. It might be a daughter who has married someone her parents disapprove of. A husband feels that his wife no longer respects him, or a mother is worried about a child’s behaviour. Someone has failed to live up to expectations. A family member has become estranged. Or perhaps a relative has made a humiliating comment.
The psychiatric formulation cannot therefore stop at the individual.
This is particularly obvious in migrant communities. The geographical distance between Australia and Bangladesh does not necessarily produce psychological distance. In some families, it does almost the opposite. I have seen how a comment made by a relative in a Bangladeshi village can reverberate through a household in Sydney or Melbourne. A criticism from an uncle, an observation from a sister-in-law, a comparison with another family, a perceived insult, or a question about someone’s children or marriage can enter the kitchen, the bedroom and eventually the consulting room. The person sitting in front of me may be thousands of kilometres from the person who has upset them. Psychologically, however, that person can still be in the room. Migration changes the physical environment without necessarily changing the social field.
Learning the language of emotion
Something is changing, however.
Bangladeshis in Australia are increasingly learning the language of psychological distress. Younger people, particularly those educated in Australia, are much more likely to talk about anxiety, depression, boundaries, trauma, self-esteem and emotional regulation. They may arrive in my consulting room already familiar with the vocabulary of contemporary psychology.
Religion adds another dimension, particularly among Bangladeshi Muslims. When some of my patients become anxious or distressed, they do not necessarily turn first to psychotherapy. They may begin praying more regularly.
Something similar is happening in Bangladesh itself. Mental health has become a more visible subject, particularly among younger, urban and educated people. Social media has accelerated this process, bringing a new vocabulary of diagnoses and psychological concepts into everyday conversation. Bangladeshi psychiatrist Dr Helal Uddin Ahmed has observed that younger people are increasingly encountering mental-health information online, although he has also warned about the rise of self-diagnosis through social media.
This is an important development. Psychological language can give people new ways of understanding themselves, reduce shame and make treatment possible. It is much easier to ask for help with depression when depression has become an intelligible thing to have. But the therapeutic vocabulary we import from the West may not be sufficiently spacious to contain the experience.
“Tell me how you feel” is not always an adequate question. For some patients, the more important question is: What has happened between you and the people who matter to you? The difference is subtle but important. Much contemporary Western psychotherapy begins with the individual mind: my thoughts, my feelings, my boundaries, my needs. A more relational formulation begins elsewhere. What has happened to my place in the family and my responsibilities? Who have I disappointed? Who is talking about me? In this context, tension can be understood as the felt pressure generated at the intersection of the person, the body and the social world.
Religion as a response
Religion adds another dimension, particularly among Bangladeshi Muslims. When some of my patients become anxious or distressed, they do not necessarily turn first to psychotherapy. They may begin praying more regularly. They may read the Quran or listen to religious lectures on YouTube. They may seek advice from an imam or a respected religious figure.
This can be an entirely healthy response. Religious practice can provide meaning, routine, community, moral orientation and a sense of being held within something larger than the individual self. In its communal forms, it may counter precisely the isolation that can make psychological distress worse.
But there is a difference between religiosity that reconnects someone to a community and religiosity that becomes increasingly solitary. Watching hours of religious lectures alone in a bedroom can look superficially similar to spiritual engagement while functioning psychologically as withdrawal.
This distinction seems increasingly important as Bangladeshi life changes. The question is not whether religion is good or bad for mental health; it is what impact religious practice has on a particular person’s life. Is it connecting them to others, giving them meaning and allowing them to tolerate uncertainty, or is it turning into another way of retreating from an increasingly difficult social world?
The paradox of Dhaka
Bangladesh is one of the world’s most densely populated countries. Dhaka can feel almost impossibly crowded. Yet physical proximity does not necessarily produce social connection.
Traffic, pollution, long working hours, cramped living arrangements and the scarcity of accessible natural spaces can make spontaneous communal life increasingly difficult. The city is crowded, but people may become psychologically isolated.
There is an intriguing paradox here: crowding can coexist with loneliness.
This matters because the old image of Bangladesh as an intensely communal society can obscure the ways in which modern urban life is changing the experience of community. It is possible to live surrounded by millions of people and have very little unstructured, meaningful contact with them. Mental wellbeing requires both individual and collective effort. Mental health cannot be reduced to teaching individuals to manage their thoughts while leaving the social environment untouched.
The same transformation is occurring in subtler ways within diaspora communities. Traditional forms of collective life can weaken as families become smaller, people become busier, and younger generations negotiate identities between Bangladesh and Australia. The result can be a new kind of tension.
The first generation may experience distress through separation, obligation and concern about relatives in Bangladesh. The second generation may experience something different: the strain of moving between cultural worlds. They may be Australian at school or work and Bangladeshi at home; highly individualistic in one setting and deeply embedded in family expectations in another.
The question is no longer simply, “Which culture are you from?”
It is: How many cultural worlds are you required to inhabit at once?
A country under pressure
It would also be a mistake to turn tension into a purely cultural curiosity.
Bangladeshis have plenty to be tense about.
Bangladesh faces economic insecurity, difficulties finding meaningful employment, intense educational and occupational competition, rapid urbanisation, environmental pressures and political uncertainty. For young people in particular, aspirations can rise faster than opportunities.
This is an important point because the physical expression of distress should not become an excuse for explaining away suffering as “just culture”. If someone is unemployed, socially isolated and uncertain about the future, their distress is not merely a culturally distinctive way of talking about anxiety. There are real structural reasons for it. The body may be expressing a social reality.
Bangladesh’s mental-health system itself remains severely under-resourced. A Cambridge review of mental healthcare in Bangladesh describes a substantial burden of mental disorder alongside inadequate services, a shortage of professionals and significant stigma. There is an enormous treatment gap between the number of people experiencing mental-health problems and the professionals available to treat them. The growing visibility of mental health therefore reflects something more than the spread of Western therapeutic language. It also reflects genuine social change and genuine suffering.
Young Bangladeshis are being asked to aspire to lives that may be increasingly difficult to attain. They are exposed to images of prosperity and individual fulfilment while confronting unemployment, educational competition and political instability. The old forms of social containment may be weakening at precisely the moment when the pressures on the individual are increasing.
Perhaps that is another reason why tension remains such a useful word.
What tension teaches psychiatry
Perhaps the greatest lesson of tension is that psychiatry needs to become better at translation.
While we should not romanticise the word as some uniquely authentic Bangladeshi psychology, the task is not to replace tension with “generalised anxiety disorder” or “somatic symptoms”.
Instead, we should ask what becomes visible when we take the patient’s own language seriously.
When a Bangladeshi patient points to their head and says, “Doctor, amar tension ache,” I may need to ask about headaches and sleep. But I also need to ask what they are thinking about, from their fears to changes in their family to the expectations they have for themselves and those around them. The clinical questions more specific to anxiety or depression may come afterwards, to assess whether ordinary suffering has crossed the threshold into what we might define as illness.
Bangladesh is one of the world’s most densely populated countries. Dhaka can feel almost impossibly crowded. Yet physical proximity does not necessarily produce social connection.
The concept of tension reminds us that distress does not arrive in neatly separated psychiatric compartments. It arrives through bodies, relationships, families, religions, workplaces and communities. This is why the call for greater “granularity” in understanding South Asian mental health matters. The Bangladeshi Muslim living in suburban Sydney cannot simply be understood as “South Asian”, nor as “Bangladeshi”, nor even as “Bangladeshi Muslim”. Their experience is shaped by generation, class, family structure, personality, gender, education and the particular relationships that matter to them.
Yet sometimes one word opens the door.
Tension.
It may begin as a complaint about a tight neck, a heavy head or a headache. If we listen carefully enough, it may lead us somewhere else entirely: to a family in Bangladesh, a marriage in Sydney, a son without work, a daughter caught between two identities, a mother worrying about her children, a young person praying alone in their bedroom, or a community trying to work out how to remain connected while living thousands of kilometres from home.
The word is English, but the experience has become distinctly Bangladeshi. But the suffering is human.
And that is precisely why it deserves to be taken seriously.
Tanveer Ahmed is an Australian-based psychiatrist and author of The Exotic Rissole.
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