Research：Stigmatisation of bipolar disorder in Chinese culture

Topic: How to promote better understanding of bipolar disorder in China?

Through my research, I found that the biggest problem with bipolar disorder in China is stigma and stereotypes. So I did more research on the stigma of bipolar disorder in Chinese culture.

I would like have more discussions revolving around the relationship between bipolar disorder and Chinese 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.

1/Stigma associated with the Chinese translation of the term ‘bipolar disorder’

When I talked to my friends about my project, I realised that there were many people who had heard of but were unaware of the symptoms of the illness and that many of them did not understand what bipolar disorder meant, literally, due to translation issues. Secondly, the Chinese vocabulary used in the translation severely vilifies bipolar disorder.

The Chinese term for manic depression was directly translated from the West from the very outset. Mania was translated as zao kuang (躁狂), depression as yi yu (抑郁), manic depressive as zao kuang yi yu (躁狂抑郁) (Chen, 2002), and its abbreviation as zao yu zheng (躁郁症).

The full term zao kuang yi yu（躁狂抑郁） refers to the most severe state of the illness and carries a rather negative connotation, not less than that carried by its English or German counterpart. 

 kuang（狂） signifies violence and insanity and is not uncommonly used in conjunction with feng (瘋) (madness) in literary Chinese as in feng kuang (瘋狂) or fa kuang (發狂). It is such a harsh word, and not surprisingly, it is frequently unacceptable and stigmatizing to both patients and the general public who often react with skepticism and denial.This applies to all patients with BD but especially those with bipolar II, who can hardly be identified as being mad or violent during their occasional mood swing. 

The term bipolar disorder has been officially translated as shuang xiang zhang ai (雙相障礙) in mainland China (Chen, 2002)

The translation of polar as xiang (相) is grossly inaccurate, as the Chinese term means appearance, look, form, or state, all of which stray far from the meaning of pole which denotes an end or extreme. It also encompasses the meaning of distinct differences when used in plural (as different as poles). 

The translation shuang xiang (double forms) could thus only restrict our understanding on the diversity of symptoms or manifestations of BD.

translation of the term “disorder” , Literally, the original English word signifies out of or loss of order. Disorder is defined by the Merriam-Webster dictionary as “a confused or messy state: a lack of order or organization.” Disorder was first translated in Chinese psychiatry as yi chang (異常) and later zhang ai (障礙) in mainland China (Xia, 1982)

The term zhang ai (障礙), meaning handicap or obstruction, translate mental disorder as jing shen zhang ai (精神障礙)—the obstruction of mental function—is inaccurate and deviates from the original meaning of disorder. 

2/Stigma associated with traditional beliefs in Chinese culture

Mental Illness Considered as Ghost Haunting or Higher Punishment

Chinese people have different beliefs and different treatments for mental health problems. The Chinese like to restrain their emotions, and once someone is unable to self-restrain their emotions and behaviour, it automatically means that a person is crazy or “possessed”

As we know, our attempts of treatment often stem from our understanding and core belief of the issue at hand. Someone that holds a firm belief that mental health issues are caused by evil spirits or personal wrong-doings may find it difficult to see the benefit of seeking mental health services such as therapy. This is further discussed in the book “Chinese Religious Life, pp 93-96”, which outlines different Chinese beliefs about mental health issues and the differing methods of treatment. 

During childhood, discussions and expressions of emotions were not encouraged. Emotions were often viewed as weaknesses and explained in terms of shame. For example, feelings of sadness have been explained to be self-inflicted because the person “must have done something bad to be punished with this feeling”. Mental health concerns, when discussed, were often explained in that manner.

3/The traditional viewpoint that cultivation of restraint is integral to moral character further shapes how mental illness stigma is felt

In Confucian thought, one must learn to control oneself before exerting social influence (Lau, 1984). Partly due to public beliefs in China that people with mental illness act dangerously and unpredictably (Phillips & Gao, 1999), we propose that such persons are viewed as not fully cultivated and thus incompetent to participate in social life. 

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.

4/Loss of face and social capital – i.e. loss of social opportunities to achieve desired social status

The interpersonal level of stigma includes all individual-to-individual forms of discrimination, including social distancing and rejection. Our analysis highlights physician and family member stigma as particularly salient in China. In addition, loss of guanxi or social capital – i.e., loss of social opportunities to achieve desired social statuses such as marriage, and diminished access to material resources (via social-exchange networks) – also constitutes a crucial aspect of interpersonal stigma. Because loss of face compromises one’s moral standing in a local community and access to social resources, stigma is further seen to directly threaten the interpersonal engagements that define what is most at stake for ordinary Chinese in everyday life 

INTERVIEW （planning to do

Interview ( people with BD

1. If possible, would you prefer to people from knowing about this problem?

2. On the other hand, is there anyone in particular whom you would like to about it?

3. Do you think less of yourself because of this problem?

4. Have you ever been made to feel ashamed or embarrassed (loss of face) because of your problem?

5. If they knew about it, would your neighbors, colleagues, or others in your community think less of you because of this problem?

6. Do you feel others have avoided you because of your problem?

7. Would some people refuse to visit your home because of this condition?

8. If they knew about it, would your neighbors, colleagues, or others in your community think less of the family because of this problem?

9. If others were to find out about your problem, might it cause problems for your family?

10. Would your family prefer to keep others from finding out about your condition?

11. (If you are unmarried) If people know about it, might this problem make it more difficult to marry? (If you are married) Might this condition cause problems in your marriage?

12. Could this problem make it more difficult for someone in your family to marry?

Interview ( others

1. Do you know anything about bipolar disorder
2. If so, how did you learn about it
3. Are you close to someone who have bipolar disorder？ and if so, have you helped them
4. If someone with symptoms similar to those of bipolar disorder, your first reaction would be- Bad karma / I’m going to help him / Stay away
5. If you were to experience symptoms of bipolar disorder one day, would you choose to tell your parents?
6. Are you willing to let people around you