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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Making Connections Between Mental Health and Physical Illness

The case of an elderly Chinese woman

Han Zao Li, PhD

Reprinted from the "Immigrants and Refugees" issue of Visions Journal, 2010, 6 (3), p. 9

One often hears an elderly Chinese woman talking about her physical illnesses, but never about her mental health issues—because she is not aware that she has any. Even if she was aware, she would never admit that she has a mental health problem. Reasons for this “non-admitting” behaviour could include: 1) belief or hope that over time the illness can be overcome or will simply go away, and 2) to hide it from family, friends, relatives and acquaintances. There is a cultural stigma around mental health, and once the stigma is there, it’s there forever.

In the Chinese cultural context, mental illness is often perceived as hereditary and not curable. A mentally ill person is called “shen jing bing” (神经病) or said to have disorders in the nervous system). Neighbours—and thus everyone—would shun the person with a mental illness, thinking it could be contagious and/or would bring bad luck.

Over my 20 years in Canada, I have observed that a mental health issue, if unnoticed and unaddressed, will eventually manifest as a physical illness. If our general practitioners (GPs) don’t see or don’t have time to diagnose the connection and address the root mental health issue, the treatment for the physical ailment may not be effective.
I have collected numerous anecdotes to illustrate this point. The following is a made-up scenario, but is typical of many immigrant women in Canada.

The Case of Mrs. Zhu*

Mrs. Zhu was in her mid 20s when she came to Canada with her husband and their baby girl. It was her husband’s idea to immigrate to Canada, study for a master’s degree and then develop a career in this country.

Mrs. Zhu hardly spoke any English. While Mr. Zhu studied for his degree, she had to make ends meet by taking various jobs, such as waitressing in a Chinese restaurant and doing home care and house cleaning. And she had to leave their young daughter in daycare.

After Mr. Zhu had completed his studies and found a professional job in Canada, Mrs. Zhu complained that her husband had changed into a “piece of silent wood.” He faced new difficulties in the workplace and didn’t share his frustrations with anyone, not even his wife, for fear of losing face. Mrs. Zhu became increasingly lonely as her husband, consumed by the challenges in his job, spent his evenings watching TV.

To cope with her disappointment, Mrs. Zhu started to spend her evenings talking on the phone with her female Chinese friends who were in similar situations. She also started to lose her temper easily with her husband. He didn’t even bother to argue with her; he simply ignored her. At one Chinese New Year gathering, Mrs. Zhu yelled at her husband for showing up late. He glanced at her with contempt and, without uttering a word, walked to the food table at the far end of the hall.

Forty years have passed since they arrived in Canada, and the couple are now in their mid 60s, with grey hair and wrinkled faces. They have one house paid for, a second house for rental income and a grown daughter who excelled at university and found a high-paying job here in Canada.

Mrs. Zhu still feels shut out by her husband. For instance, he frequently sends money to his relatives in China without informing Mrs. Zhu. When confronted, Mr. Zhu simply says: “I made the money; therefore, I can do whatever I like with it.” Mrs. Zhu is speechless. “It’s true, you make more money,” she says, “but what about my sacrifices while you studied for your degree in Canada?”

To make things worse, Mrs. Zhu doesn’t feel close to her daughter either. Her daughter speaks fluent English, identifies herself more as Canadian than Chinese, and considers her mother ignorant of the issues in Canada.

About 20 years ago, when she was 45, Mrs. Zhu was diagnosed with “three highs”: high blood sugar levels, high blood pressure and high cholesterol. Her skin is dry, her hair sparse, she suffers from insomnia and from time to time gets migraine headaches. She has been taking medication prescribed by a Western medical doctor for these ailments for many years, but the symptoms have not gone away.

Traditional Chinese medicine—a holistic approach

Let’s analyze Mrs. Zhu’s symptoms from the point of view of traditional Chinese medicine (TCM). In TCM, diseases are considered a reaction to the environment and other people, and diagnosis looks at lifestyle adjustment as well as strengthening health using herbs and physical therapies such as acupuncture. A patient is examined on three levels:

  • biological—i.e., whether there is a personal and family history of the illness; the patient’s diet, lifestyle choices (e.g., whether they smoke, drink, etc.), physical activity, and so on

  • psychological—i.e., whether there are recent and historical stresses, including chronic and acute worries

  • Social/relational—i.e., whether there are resolvable and unresolvable disagreements with significant others (i.e., the important people in a person’s life)

Mrs. Zhu does not have a family and personal history of her physical illnesses. In her case, it’s easy to see a clear connection between Mrs. Zhu’s mental and emotional (psychosocial) state and her physical illness.

Further observation of, and informal conversations with, Mrs. Zhu found the following behaviours: cleaning her house constantly, cooking more food than necessary, frequent shopping trips for items “on sale” or “for clearance,” being on the phone for at least one hour almost every evening, and actively passing gossip in the local Chinese community.

Although the connection between mental health and physical health is well known,1-3 we often fail to notice it in our daily lives. Mrs. Zhu’s behaviours clearly signal that she may have an underlying depression4-5—not surprising given the strained relationship with her husband and the long-time stress associated with having immigrated to a foreign culture. Unresolved stress is also a known factor in high blood pressure, cholesterol and blood sugar levels.6

From the mind–body interaction point of view more common in TCM, we could help Mrs. Zhu look for factors contributing to her physical ailments. Her insomnia, for instance, might be related to her disagreements with her husband. If so, these interpersonal issues should be addressed. If harmony was revived in the marriage—or if Mrs. Zhu just had a friend, TCM doctor or community leader to talk to—she may be able to reduce her stress. This could, in turn, lessen her migraine headaches as well as other physical symptoms.

The TCM model requires us to shift our Western perception of physical illness from a biological perspective to a biopsychosocial viewpoint, which embraces mental health.

To do so would require family, friends and medical doctors to be more watchful in order to gain a better understanding of the causes of Mrs. Zhu’s problems and help her find remedies. GPs are the first medical professionals patients seek help from. In cases such as Mrs. Zhu’s, a GP’s attention to factors other than biological may play a central role in searching for—and finding—a more effective treatment.

In conclusion, I propose that patients, GPs, as well as family and friends, adopt a biopsychosocial approach in viewing stress and illness. This would undoubtedly benefit not only Chinese immigrants, but also people of all cultural backgrounds.

* Zhu is a pseudonym.

About the author

Han is a Professor of psychology at the University of Northern British Columbia. She has researched extensively in the areas of intercultural communication and physician–patient communication. Han’s historical novel The Water Lily Pond, based on her experiences growing up in Maoist China, is now translated into German

  1. Desroches, N. & Li, H.Z. (2010). Physician communication style and patient satisfaction: Micro-analyses of physician–patient consultations. Saarbrücken, Germany: Lambert Academic Publishing.

  2. Li, H.Z. & Browne, A. (2000). Defining mental health illness and accessing mental health services: Perspectives of Asian immigrants. Canadian Journal of Community Mental Health, 19(1), 143-159.

  3. Taylor, S.E. (1990). Health psychology: The science and the field. American Psychologist, 45(1), 40-50.

  4. Nydegger, R.V. (2008). Understanding and treating depression: Ways to find hope and help. Westport, CT: Praeger Publishers.

  5. Keyes, C. & Goodman, S. (2006). Women and depression: A handbook for the social, behavioral, and biomedical sciences. New York: Cambridge University Press.

  6. Steed, L. Cook, D. & Newman, S. (2003). A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus. Patient Education and Counseling, 51(1), 5-15.


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