I am pleased to see more discussions revolving around the relationship between mental health, in this case bipolar disorder and culture. This is because I share the view that different cultures have their unique takes on mental health problems, and it is important to incorporate cultural concepts into the conditions to reduce stigma and stereotypes, and to better support people affected by the condition.
Recently I came across an article in Asia-Pacific Psychiatry titled Conceptual issues behind the Chinese translations of the term “Bipolar Disorder”, which examines the problems of the existing nomenclature, or naming in Chinese psychiatry. While I appreciate the authors’ effort as well as their cultural sensitivity, I have some reservations about their suggestion of translating bipolar disorder into er yuan shi heng (二元失衡).
While the Chinese character yuan (元) may be an accurate and aesthetically elegant translation of pole, it doesn’t quite embody the emotional element that is a core feature in our understanding of bipolar disorder. In fact, to discuss the relationship between bipolar disorder and Chinese culture, one must look into the Chinese concept of emotions, which has three levels of meaning.
First, at a social level, holding back one’s emotions is often considered a virtue in Chinese society. Expressing strong emotions could disrupt harmony and may lead to confrontation. This kind of emotional dismissal, or denial, or strict emotional regulation may complicate the situation for people who are charting their way to managing their emotions.
Second, according to Confucian humanism, “people are born to be virtuous”, with ren (仁) and li (禮) being the twin pillars of society which is about people treating each other with courtesy, and respecting each other’s roles and statuses within a family/social system. Given the symptoms of mental disorders are often disruptive to social and behavioral norms, the subject of mental illness or bipolar disorder is seen as moral weaknesses and shame to an individual or the entire family. Thus, it might be fine to talk about mild emotional concern such as “feeling sad, worrying” but not the acting out the high mood (e.g., excessive spending, sexually active, acting on the grandiose plan) or hearing of voices. In other words, there may be a value system attached to various emotions in Chinese culture; for instance, “feeling sad, worrying” is acceptable but not in extreme forms of emotions.
Finally, emotions are related to our bodily functions according to the Traditional Chinese Medicine. Take the seven emotions: Namely Joy, Anger, Anxiety, Pensiveness, Grief, Fear and Fright. The excess, or the bottling up, of these emotions will affect organs such as heart, liver, lungs, large intestine, spleen and kidney. For example, if someone is suffering at work and is constantly experiencing violent mood swings, he or she is likely to experience breathing problems and irregular bowel movements. These organ imbalances cannot be fully cured unless the person’s emotional stress, as well as the context leading to the imbalance, are addressed.
The Chinese concept of emotions therefore leads to distinctive coping strategies. In our earlier work on mental illness (jointly with Dr. Erin Michalak and Dr. Melinda Suto from the University of British Columbia, Vancouver), we found that Chinese people with bipolar disorder would employ traditional means of practicing Tai Chi or drinking herbal soup to tackle mental health issues. It is believed – and demonstrated by some studies (Solloway et al., 2016) – that practicing Tai Chi, which seeks to balance the yin and yang, helps redress organ imbalances, which in turn improves psychological well-being.
Also, it is important to take into consideration social and moral factors. The notion of shame and moral weakness could undermine a person’s willingness to seek service. Unsurprisingly, most Chinese people will first reach out to family members rather than helping professionals for help due to the thinking of “not washing the dirty linens in public”. Also, stigma and stereotypes could further erode the morale of caregivers and adversely affect the way they interact with their loved one living with the condition.
Stigma is one of the largest barriers to treatment engagement, and revising existing nomenclature in Chinese psychiatry is crucial in mitigating the stigma associated with bipolar disorder. Yet to do so the understanding of emotions and their cultural implications are of paramount importance. I am delighted to be a co-applicant on CREST.BD’s application to the Vancouver Foundation to advance our knowledge of understandings of bipolar disorder in Chinese communities in British Columbia. It is only with this knowledge in hand that we will be able to develop culturally appropriate supports for Chinese people facing the condition.
Solloway, M. R., Taylor, S. L., Shekelle, P. G., Miake-Lye, I. M., Beroes, J. M., Shanman, R. M., & Hempel, S. (2016). An evidence map of the effect of Tai Chi on health outcomes. Systematic Reviews, 5(1), 126 (11 pages).
Tse, S., Yuen, Y. M. Y., & Suto, M. (2014). Expected possible selves and coping skills among young and middle-aged adults with bipolar disorder. East Asian Archives of Psychiatry, 24(3), 117-124.
Wang, G., Tse, S., & Michalak, E. E. (2009). Self-management techniques for bipolar disorder in a sample of New Zealand Chinese. International Journal of Therapy and Rehabilitation, 16(11), 602-608.