How do Desis Respond to Bipolar Disorder in their Spouses and Friends?

A South Asian psychiatrist who has treated hundreds of patients explains

by Ranu Boppana, MD

Bipolar disorder or Manic-Depressive Illness is a brain disorder characterized by unusual shifts in a person’s mood, energy and ability to function. A person with bipolar disorder vacillates between “highs” and “lows” referred to as mania and depression. The mania can lead to dangerous lapses in judgment and impulse while the depression can lead to an inability to function and suicidal thinking.

Even with the best of care, bipolar disorder can be a confusing diagnosis. The mood swings, temper outbursts, and impulsive actions can appear to be a problem other than mental illness such as substance abuse, laziness or poor character. Not infrequently, bipolar disorder leads people to become suicidal. [Anyone who talks about suicide, by the way, needs to be taken seriously and needs immediate medical attention.] Recently there has been growing awareness that bipolar disorder can present itself in children and adolescents, although there is still much debate regarding its presentation and diagnosis.

Bipolar disorder is thought to occur within Desi families at much the same rate at which it occurs in the general population, about 1 percent of the adult population. It results from an imbalance in brain neurotransmitter chemicals and also runs in families. While there is no cure, medication and psychotherapy in combination, can effectively control bipolar disorder and prevent future cyclical mood problems and the resultant havoc in people’s lives. When bipolar disorder presents itself in a Desi however, cultural factors can also interfere with getting optimal treatment and fully understanding the disorder.

Firstly, there is less awareness of mental illness within the South Asian community. Sometimes, when the symptoms of bipolar illness are first presenting, there is a tendency to blame the ill person and their Western values, especially if they are second generation Americans, as the cause of the illness. Perhaps because the illness presented in America and there was no awareness of it back home in the South Asian countries, there is a tendency to see it as a result of living here. Conversely, sometimes the symptoms are seen as signs of Western values themselves rather than illness! While acculturation can lead to increased stress, and cultural conflict within families, Western values are not and do not lead to bipolar disorder! In my practice as a psychiatrist, I have seen some families return to India or send their children back only to return the following year with the realization that this did not help.

Secondly, there is increased shame and stigma associated with mental health treatment within the community that can result in delays in seeking help. Chronic or more severe mental illness, like compounded medical illness, is harder to treat so it is best to seek help as soon as you realize something may be wrong.

Thirdly, culturally different minority groups are more likely to be offered incorrect diagnoses and ineffective treatments. There is a lack of understanding by mental health practitioners of what is culturally normal versus what is abnormal or pathology. By my observation, there is as a tendency to attribute cultural differences to pathology, just as there is to attribute pathology to cultural difference. For example, a culturally normal family may be seen as “enmeshed” and harmful to the patient; or conversely, the withdrawn, depressed individual may be viewed as “another quiet Asian”. Therefore, be sure to speak up if you feel you are being misunderstood or seek out another practioner with whom you feel comfortable. This may or may not be someone from a South Asian background. An interest in and willingness to understand is often all it takes.

Fourthly, I have noticed that there is an easier acceptance within the community for biological therapies, i.e. medication, than there is for the psychotherapies. Psychotherapy or talking about your feelings is sometimes seen as “blaming your problems on your family.” This is diametrically opposed to the Desi values of suppressing your emotions and maintaining harmony at all costs. Managed care and cost cutting trends also lead to favoring biological therapies instead of psychotherapies. Sometimes psychotherapies are not offered by clinicians because there is an assumption that Asians are resistant to psychotherapy or because services are not available in an Asian language. Psychotherapy actually helps people to know themselves better and learn better coping skills however and both psychotherapy and biological therapy are needed for a good, long-lasting outcome.

In the end, strong family support and good Desi values also help individuals to better cope with the illness. It’s important to strengthen what works but also seek out help for what doesn’t. Ask questions, and get the best treatment available because a diagnosis of bipolar disorder need not hold one back from living a full and productive life.