Past research has suggested that there are significant differences in the prevalence and progress of anxiety and depression in different ethnic groups in England and that patterns of help seeking also differ. In parallel, research has also reported distinctive differences in the language and representations of mental distress across different ethnic groups. Differences both in the expression of depression and underlying conceptual models of mental health and illness may be part of the explanation for different patterns of help seeking, as the accounts people give of their experience of health and illness, including the meaning they attach to symptoms and signs for example, have been shown to be an important mediator of the action they take to protect their health or to respond to ill health. In this paper we will use evidence from recent mixed-method research with people of Pakistani origin and white people living in a locality in northwest England to explore the constructions and representations of mental distress, and in particular the physical imagery and ‘somatic metaphors’ of narratives used by our respondents, and consider how these data might illuminate debates about the experience of mental ill health and help-seeking practices.