title: Cultural attribution of mental health suffering in Chinese societies: the views of Chinese patients with mental illness and their caregivers.
abstract: OBJECTIVE
  This study examined the cultural attribution of distress in the Chinese, the special role of the family in distress and the specific emotional reactions within distress dictated by culture.
  
  
  METHODS
  This phenomenological study illustrated the narrative representation of the experiences of suffering by the Chinese patients with mental illness. Twenty-eight Chinese-Australian patients and their caregivers were interviewed together in their homes. They were invited to talk about the stories of the patients' experiences of suffering from mental illness. The interviews were recorded and transcribed to be further analysed according to the principles of narrative analysis.
  
  
  RESULTS
  The results of case narration indicated that (1) because of the influence of Confucian ideals, interpersonal harmony was the key element of maintaining the Chinese patients' mental health, (2) Chinese patients' failure to fulfil cultural expectations of appropriate behaviours as family members contributed to disturbance of interpersonal relationships and (3) Chinese patients' failure to fulfil their familial obligations contributes to their diminished self-worth and increased sense of guilt and shame.
  
  
  CONCLUSIONS
  The findings of the present study suggest that Chinese people's well-being is significantly determined by a harmonious relationship with others in the social and cultural context. Psychotherapy emphasizing an individual's growth and autonomy may ignore the importance of maintaining interpersonal harmony in Chinese culture. The results of this study contribute to the essential knowledge about culturally sensitive nursing practices. An understanding of patient suffering that is shaped by traditional cultural values helps nurses communicate empathy in a culturally sensitive manner to facilitate the therapeutic relationship and clinical outcomes.
authors.affiliation: College of Nursing, Wan Fang Hospital, Taipei Medical University, Taiwan. hsiaofei@tmu.edu.tw
authors.forename: Fei-Hsiu
authors.initials: FH
authors.lastname: Hsiao
authors.forename: Steven
authors.initials: S
authors.lastname: Klimidis
authors.forename: Harry
authors.initials: H
authors.lastname: Minas
authors.forename: Eng-Seong
authors.initials: ES
authors.lastname: Tan
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health / Q000208:ethnology*; D017028:Caregivers / Q000523:psychology*; D002681:China / Q000208:ethnology; D032903:Confucianism / Q000523:psychology; D003299:Cooperative Behavior; D003466:Cultural Characteristics; D005190:Family / Q000208:ethnology*; D005260:Female; D006167:Guilt; D006801:Humans; D016901:Intergenerational Relations / Q000208:ethnology; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000208:ethnology* / Q000517:prevention & control; D008875:Middle Aged; D033262:Narration; D015404:Nursing Methodology Research; D012380:Role; D012649:Self Concept; D012938:Social Perception; D012941:Social Responsibility; D012945:Social Values / Q000208:ethnology; D011795:Surveys and Questionnaires; D014739:Victoria