|INTERVIEWING TIP OF THE MONTH
# 7 September 2000
Asking Asian Americans about a Family History of Mental Illness: Some Cross Cultural Tips
TISA Description of the Problem: Individuals from Asian cultures may experience relatively extreme stigmatization concerning mental illness. To admit to mental illness in oneself or one's family members may, essentially, be a taboo topic. Consequently when interviewing Asians or Asian Americans, it pays to be particularly aware of cross-cultural issues. In this regard clinicians may need to be sensitive to the usefulness of subtlety in the phrasing of potentially disengaging questions about the presence of mental illness in family members.
Tip: When asking about past family psychiatric history, it can be of use to avoid asking direct questions such as, "Does anyone in your family have a mental illness?" or "Anyone in your family with psychiatric problems?" Sometimes it is best to proceed with questions that cue directly off of the symptoms of the patient himself or herself, focusing more upon phenomenology or stress, such as:
1. "Does anyone in your family have similar difficulties as yourself?"
2. "Anyone in the family with mood problems?
3. "Has anyone been feeling anxious like you have been feeling?"
4. "Anyone in your family been feeling particularly stressed?"
Even the term "nervous breakdown" may sound less stigmatizing to an Asian American than "psychiatric illness". Thus one could ask, if there appears to be confusion over the less direct questions above, "Has anyone in your family, perhaps related to stress, had a nervous breakdown?"
Result: Such approaches often help Asian Americans to feel less threatened by the interviewer. Actually, these questions are often of use, with almost any patient, who is particularly afraid of stigmatization, no matter what their cultural backgrounds.
Tip provided by:
Michael K.S. Cheng, 2nd Generation Chinese Canadian, Psychiatric Resident, University of Ottawa, Canada