CULTURAL FORMULATION OF PSYCHIATRIC DIAGNOSIS
Case No. 03 Psychosis Following Qi-Gong in a Chinese Immigrant CLINICAL HISTORY Patient identification. Mr. A. is a 57 year-old married Chinese-American man with no previous psychiatric history who presented at the psychiatrist's office in 1989 with a three-week history of auditory hallucinations and delusions.
History of present illness. The patient was in his normal state of good health until two years prior to presentation, when he stared developing intermittent acute backaches. He went to his physician and was told that he had kidney stones. Conventional medical treatment did not provide much alleviation of his symptoms, and Mr. A. gradually lost confidence in his Western-trained physician. Mr. A.'s back pain continued to flare up intermittently. After almost two years of treatment failures, Mr. A. was willing to try treatments from China. Three weeks prior to evaluation, he started practicing Qi-gong, a Chinese folk health-enhancing practice similar to Tai Chi, which consists of controlled, synchronized breathing and body movements, and is expected to have curative effects on physical illnesses. His practice of Qi-gong was intensive. Several days after starting these practices, he developed delusional and hallucinatory experiences, while he had never experienced before. These conditions persisted and intensified, interfering with his concentration, and prevented him from working as an engineer. His auditory hallucinations consisted of voices of supernatural beings communicating with him regarding how he should practice Qi-gong and delusions that he was contacting beings from another dimension. He returned to the Qi-gong masters for help, but they were unable to provide any relief. His wife, who was a registered nurse, became increasingly concerned over his inability to work. She consulted with a Caucasian psychiatrist co-worker from their health maintenance organization (HMO) who referred her husband to a Chinese-American psychiatrist in private practice. On presentation, the patient denied depressed mood,