What other cultural factors might impact the treatment of bipolar disorder?

Cultural beliefs about mental illness can significantly impact how an individual, and his family, views bipolar disorder. In some Asian cultures, the stigma of mental illness is quite severe, and having a mental illness can be viewed as shameful (loss of face).

Certain religious groups will have strong beliefs against the taking of medications (Christian Scientists) or against having blood drawn routinely (Jehovah’s Witnesses). Still others, like the Church of Scientology, view the entire mental health field as a conspiracy.

Bottom line is that a person’s cultural identity (including religion and spirituality), level of acculturation/assimilation, and family beliefs and norms must be factored into the overall picture.

On a physiologic basis, specific ethnic groups are more likely to metabolize (break down) medications at different rates. This has to do with specific enzymes found in the liver.

Finally, much as we’d like to believe that racial prejudice and discrimination are things of the past, they are not. Additionally, where practitioners in various settings may have their own fears and prejudices (even on a subconscious level) toward different groups, it becomes important for friends and family to take an active role when their loved one is manic, hypomanic, or psychotic, essentially any state in which the behavior the person is exhibiting is scary, threatening, or out of control. This becomes especially true in situations where police, emergency personnel, and emergency rooms are involved.

One of the decisions made in the setting of out-of-control behavior is whether or not this is something medical/psychiatric or something criminal. A family member or friend who can clearly state to a police officer or paramedic that, “This is my son/daughter/ husband/friend; he has bipolar disorder and is off his medications and needs to go to an emergency room for evaluation,” may prevent an unwarranted, stigmatizing, and potentially harmful, trip to jail.

Once in the emergency room, it will be important to stay around and ensure that providers know you are there, you are concerned, and you are available. Make certain that the social worker or crisis worker assigned to your loved one’s case has a way to contact you, and if at all possible see if a release of information can be signed so that you can receive information about what decisions are being made.

If that’s not possible, you can still provide vital information (past psychiatric history, prior functioning, current medications, use of alcohol and drugs, etc.) to the professionals who will help ensure the appropriate care is provided.