Commentary on Hsiao FH, Klimidis S, Minas H & Tan ES (2006) Cultural attribution of mental health suffering in Chinese societies: the views of Chinese patients with mental illness and their caregivers. Journal of Clinical Nursing 15, 998–1006

Abstract

This paper (Hsiao et al. 2006) describes a qualitative study which aimed to investigate the cultural attribution of mental health suffering in Chinese societies. Both patients and their caregivers were interviewed. The family is an important source of social support to individuals in Chinese societies; Chinese lives are so intertwined in the family system. To understand Chinese lived experience, it is important to examine them not only at an ‘individual’ level, but at a ‘family’ level as well (Lin et al. 1995). The authors of this paper have to be commended for their attempt to understand mental health and mental illness from the perspective of the patients and their family caregivers. To provide culturally sensitive care, health-care providers need to appreciate patients’ and their families’ cultural values and understand how these values shape their reaction to mental illness and help-seeking behaviour. Although the family is an important source of social support in Chinese society, it can also be a burden and source of unhappiness (Chan et al. 2002). Lin et al. (1995) analysed more than 20 studies relating to the cultural aspect of mental health in Chinese population, and found that the family has diphasic effects – providing a source of support and at the same time, creating stress. Hsiao et al.’s study confirmed that family members could be a source of stress for the mentally ill persons. Family caregivers may not be able to take care of the mentally ill family members, thus leading to relapse or readmission to hospital. Chinese families may need particular help to deal with their family dynamics. This paper confirmed that many traditional Chinese values, such as filial piety, saving ‘face’, and maintaining harmonious relationships with others (Chan et al. 2002, Kuo & Kavanagh 1994), prevailed in a group of Chinese-Australian participants. Culture is characterized by tradition by definition. However, culture is not static. It is dynamic and subject to change in association with the development of history and environment (Lin et al. 1995). In Mainland China, the rapid industrialization, westernization, modernization and improvement in economic conditions over the past 30 yearshave an impact on Chinese traditional culture. In studying Chinese culture, there is a need to pay attention to issues of tradition vs. cultural change. Hsiao et al.’s study involved Chinese-Australian participants. Immigration to other countries resulted in dramatic changes in the languages, social system, education system, lifestyle and work, thus a change in cultural practice. When studying Chinese families who immigrated to other country, both the traditional culture and what is changed need careful evaluation. Examples of cultural issues that could be further investigated in Hsiao et al.’s study included: an examination of how family relations are changing along with changes in family structure after immigration to Australia; what kind of stress and conflict are faced by the contemporary family in Chinese-Australian and how the Chinese family in Australia utilizes resources to cope with problems. Chinese have immigrated to countries all over the world. Due to large world population of Chinese and the great variations in sub-areas, sometimes regarded as ‘traditional’ in Chinese life is not necessarily the same for all Chinese. For example, Chinese immigrants in Australia may have different cultural values from that of the United Kingdom. Lin et al. (1995) recommended that homogeneity vs. heterogeneity should be considered when studying Chinese culture. It would be of interest to know whether Hsiao et al.’s study generated findings that are not regarded as ‘traditional’ Chinese culture. Also, as Hsiao et al. maintained that the length of immigration needs to be considered. The second or subsequent generation of the immigrants would have different cultural outlook when compared with their parents or grandparents. Chinese culture and mental health is a complex subject, which is not easily presented. The authors have to be congratulated for their effort in tackling this difficult subject. This paper contains interesting findings. To help the readers making sense of data in the context, more demo-sociographic data of the participants could be provided. For example, the authors commented that age could have an impact on the cultural value of the individual. The age range of the participants could be presented. The paper mentioned that no caregiver but one patient was employed in jobs requiring higher education. Other participants’ job nature and their source of income could be provided. Of the 28 interviews, there was only one case-story supporting Plot II. The author could have discussed whether this was an outstanding case.