Angry characters and frightened souls: Patients and family explanatory models of bipolar disorder in Taiwan.

摘要

Bipolar disorder (BD) affects a significant proportion of Taiwanese individuals. Psychotropic medications are typically considered the mainstay of treatment for BD, and there is an abundance of international research on biological etiology and medication options. However, comparatively little exists on psychosocial aspects of the management of BD, including how it is conceptualized and managed within the family system, especially among the Taiwanese. As culture provides the context in which psychiatric disease is managed, there is a need to study distinct Chinese psychosocial perspectives that might shed light on unique family intervention options. The purpose of this study was to learn about how patients and family members in Taiwan comprehend and cope with BD. Forty-two participants, including 20 Taiwanese patients diagnosed with BD for at least 4 years, and 22 family caregivers, participated in separate, semi-structured interviews based on Arthur Kleinman's illness explanatory model questions. Qualitative thematic analysis focused on features that were unique from those in current Western research literature. Five themes were identified that represented Taiwanese conceptualizations of BD, notions of etiology, views regarding treatment, and the difficulties in managing the disorder. Participants used Chinese linguistic terms for BD and its symptoms that implied greater anger and greater characterological components of the condition. Their responses reflected their acceptance of lifelong family responsibility for caretaking; clashing beliefs between patient, caregiver, and physicians regarding biomedical versus traditional Chinese spiritual models of etiology and cure; profound concerns about the effects of psychotropic medication on the liver and kidneys, difficulties with compliance; and desire for communication with medical staff regarding the daily lived experience of the illness.