Cultural Formulation and Intervention in a Person with Bipolar Affective Disorder: A Case Study

Background: Culture is the overlapping of different views, values, knowledge, concepts, practices, rituals and customs which fashion an individual’s personality. These overlapping components of a particular culture go beyond races and ethnicities. The culture of an individual can affect his/her view and understanding regarding mental illness and the causal factors behind it. The way an individual describes the symptoms of mental illness is immensely affected by the culture they belong to. The overall meaning of the illness lies in deep settled attitudes and beliefs that a culture beholds within a population. Aim and objectives: This study aims to facilitate the narrative of mental illness by the patient’s caregiver in order to explore their understanding regarding the illness through cultural formulation and intervention. Methods: This study was a single case study design done in the in-patient department of LGBRIMH, Tezpur. A case diagnosed with bipolar affective disorder, current episode manic with psychotic symptoms (F31.2), according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems criteria (ICD 10), was selected. Clinical Interviewing and Cultural Formulation Interview (informant version) were administered. Based on the cultural formulation it was revealed that the caregiver was unaware of the illness and its symptoms. He referred to the cause of the illness as possessed by a supernatural power and a result of some kind of black magic. Believing the same as the cause of the illness, help was sought from faith healers before medical help was initiated. The cultural formulation also revealed financial issues as a major factor of stress and the coping mechanisms adapted for the same. After the cultural formulation, the psychosocial intervention was provided to the caregiver. Family psychoeducation was provided to enhance the knowledge and understanding of the caregiver regarding the mental illness of the patient and further interventions like supportive counselling and coping management were provided. Results: After the psychosocial intervention, there were changes observed in the understanding of the caregiver regarding mental illness. Significant changes were observed in his view and his way of coping with the illness. The patient was found to be motivated and was able to conduct his daily living activities without much supervision which further enhanced compliance with the medication. The overall meaning of the illness significantly changed after the intervention was provided to the caregiver as a result of which improvement was also seen in the patient. Conclusion: Cultural formulation helps to explore a narrative of the illness to place the patient better in the context of the community. This case study helped to bring the cultural views and concepts of the caregiver to the clinical encounter and further provided information regarding the help seeker’s perspective of seeking help. The psychosocial intervention provided a better outlook of mental illness which further enhanced their familiarity with the treatment.