Cultural differences in bipolar I

Have you had any patients for whom you believe their cultural and/or social background has had a significant impact on their prognosis?

Yes. Socio-economic factors have a lot to do with it, because a lot of the time access to healthcare is tied to financial resources, which can adversely, or positively, affect patient outcomes.

From a cultural perspective, there are a lot of cultures or sub-cultures where they don’t believe it is mental illness. Stigmatisation can also be a barrier to people even seeking care. Sometimes their families even sabotage their care - they are embarrassed, they don’t believe it is real, that the person can just snap out of it, don’t need the medication, that kind of thing.

What’s your opinion on combining psychiatric and psychotherapeutic approaches to care?

I would almost always recommend it. I always tell people it would be better if they did both. Because living with bipolar takes some to get used to, especially if it is a new diagnosis. It takes a lot to accept that you have this illness, and you have to do things to take care of yourself that other people don’t have to do.

Almost invariably with people suffering from bipolar, when they get better they stop taking their medication. And so they need a lot of support, for you to say “you have to stay on it, you have to stay with it”.