Cultural Barriers: A Critical Look at Psychology

By Christopher Chen

 

Psychology involves the understanding of the human mind and its relation to behavior, environment, and the patient’s cultural background. Psychology uses this understanding about developmental factors in their analysis to aid in problem diagnosis. Often relying primarily on “predefined identity labels and Westernized definition systems that make up the psychology field,” psychology seems presently inadequate for real-world applications in the treatment of minority patients, especially the Asian population. Evident through academic studies and personal field studies, the accepted rules of psychology as assumed in academia appear too limiting to efficiently and effectively respond to minority mental health needs. Ethnicity and ethnic identity as developmental factors influencing psychological treatment and assessment of Asian populations particularly demand better analysis methods. These factors have traditionally created perceived barriers against psychological treatment. Through the integration of improved analysis and cultural awareness, the field of psychology will be able to better aid those patients from the minority spectrum.

Psychology scholars assert that the analysis needed for effective treatment “should include a full awareness of human development and behavior, including sociocultural factors, biological factors, and psychological factors” (Ho, 1992, p.7). In minority patients, especially, these developmental factors should consider the significance of ethnic identity and ethnicity, where “the latter refers to group patterns and the former refers to the individual’s acquisition of group patterns” (Ho, 1992, p. 8). Ethnicity refers to an individual’s identification with a group whose members “share a unique social and cultural heritage that is passed on from generation to generation;” this relationship plays a role in affecting the individual’s perception, cognition, emotions, and behavior (Ho, 1992, p. 8). Ethnic identity refers to the individual’s perceived role as relating to the ethnic group rather than his personal identity. Through shaping belief systems and values, these two factors particularly influence several areas of the assessment and treatment of minority patients, including symptom manifestation, defensive styles, coping mechanisms, conceptualization of a mental health problem, responses to treatment, and help-seeking patterns (Ho, 1992, p. 8).

For example, one particular patient admitted to the psychology ward of Tri-Services Military Hospital in Taiwan portrays the need for psychologists to not overlook the importance of cultural developmental factors in a patient’s background analysis. Patient E281 was a native Taiwanese put into our psychology ward because of his inability to stop hurting himself. He described himself poking his own eyes to the point of almost blinded himself for two years now. Later he moved onto hurting himself by almost breaking his fingers, ripping off his own finger nails, and shaving till bleeding. Although afraid of the act of hurting himself, he is overwhelmed with feelings of courage and exuberance after he inflicts pain upon himself. Without the pain, he felt extremely depressed. Probing into his childhood, we found that he was a bully in school. His grades were not up to par and soon left school at the age of 13. He started experimenting with alcohol and drugs, abusing the substances to an extreme. He then joined a gang where he robbed and stabbed a man for drug money at age 15 and was released at age 21. However, he had a very strong ability to make friends. He also took care of his family when he was working by setting aside a large percentage of his earnings for his parents. IQ tests indicated that his intelligence is slightly below average, with problem solving as his main difficulty. My diagnosis for this patient was borderline mental retardation combined with obsessive compulsive disorder. Conduct disorder resulted from his low self confidence and his need for support. The psychologists added that some of the symptoms could stem from his use of drugs and alcohol, or could signal the beginning stages of a schizophrenic disease. These diagnoses seemed adequate enough; however, further analysis to include his cultural background revealed something very interesting. The patient was native Taiwanese, where values of masculinity tied to responsibility and honor is very important. We discovered that Patient E28 started poking at his eyes after an incident where he was doing pushups and fell on his face, breaking his nose. His inability to support himself after a few pushups made him feel as if he wasn’t a man. However, being able to take pain validates his masculinity and his sense of worth. After this revelation, we started the patient on a program for self confidence support and to recondition his thoughts, along with antipsychotic medication. As his self confidence improved, his need to hurt himself subsided.

Because there is traditionally not enough emphasis on cultural factors during background analysis, certain barriers still exist between the Asian population and the field of psychology. The resistant behavior of Asian peoples to therapy, specifically, is founded on belief systems – values from religion, culture and family structures as support systems. Confucianism and Buddhism, heavy influences on Asian lifestyles, teach shame, honor, productivity, discipline, and self-control and its relationship to family support systems. Secondly, there exists a cultural barrier between therapists and patients. Additionally, the current psychological categorizations are too limiting and don’t dig deep enough into cultural background.

The influence of ethnicity on symptomatic behavior is evident through “studies showing that different ethnic patients manifested different symptoms, even though they suffered from the same disorder” (Ho, 1992, p. 13). Denial, resistance, frustration, and other negative behavior are often associated with minority help-seeking behavior and manifestation of mental ailment symptoms. For example, the resistant behavior and attitude of the Asian population towards psychology may stem from native values of Asian culture, including the doctrines of self control, self discipline, shame, fatalism, pride, honor, and productivity. Self discipline also encompasses the perseverance of an “uncomplaining attitude in the face of adversity and to display tolerance for life’s painful moments” (Ho, 1992, p. 37). According to a proverb of Confucius, a man should spend his time productively and responsibly (Confucius 2). Buddhism, another source of Asian values, reinforces the honorable partiality toward productivity over inactivity through its fundamental doctrines of discipline, concentration, and wisdom (Chu-Hung, 1994, p. 33). The values of productivity and self discipline especially teach Asians to refrain from complaining, especially about problems relating to emotions, which relates to uncivilized cultures such as how Western society is perceived from the Asian standpoint. Self-disclosure and the emotional expression related with psychology and mental disturbance is strongly discouraged by Asian culture (Ho, 1992, p. 40). Asian values also discourage seeking psychological help because of its additional affiliation with White elite socialites who lack discipline and waste their time on leisure and self-expression. Instead of wasting time philosophizing about life events, Asians take pride in meeting life pragmatically; their stance is often misconstrued by our Westernized culture as apathy, laziness, or resistance (Ho, 1992, p. 38).

In addition, the values of the family structure as the primary support system for an individual and the sense of honor and pride are fundamental to the Asian family-centered culture. Mental illness is affiliated with shame and dishonor to the family. Seeking psychological help often refers to a sense of the family failing to rear a successful and normal child. Seeking help carries the fear of losing family or community support (Ho, 1992, p. 37). In fact, an Asian individual’s reliance on natural support systems “produces fewer feelings of defeat, humiliation to self and to the family, and powerlessness” (Ho, 1992, p. 13).

The underutilization of health and mental services is attributed to several major reasons including fears of dishonor, shame, and humiliation to the family and self stemming from traditional values, as well as the common intercultural communication barrier between patients and therapists (Ho, 1992, p. 13). Historically, Asian acceptance and assimilation in America were difficult. Not only were Asians considered perpetual foreigners regardless of their citizenship, Asians did not necessarily want to attain acceptance and instead kept within their ethnicity. Regionalism maintains the status quo through segregation between the cultural identities. Regionalism also discourages psychology in two ways: first, the strong lack of support in the field of psychology disapproves of individuals entering the field as a profession within the community; second, psychologists who have traditionally been “monolinguistic, middle class, and ethnocentric in problem diagnosis and treatment” because of their lack of exposure to diversity, are considered outsiders in minority communities (Ho, 1992, p. 9). For example, in New York City Chinatown, there are only approximately 2 Chinese psychologists representing a Chinese population of over 150,000 (US Census 2000). There is a sense of distrust toward these perpetual outsiders who can not speak their language or understand their culture, as well as a lack of professionals who take on the task of entering the minority community that does not support the practice. Hence, availability and accessibility to the minority public is weak.

Lastly, a barrier exists created by the psychology field itself, through its definitions, rules, and categorizations that are infused with Western assumptions about the patient population. All patients, including minorities, are assumed to be on a level ground or the same reality where diagnosis and analysis can take place. Minorities are thus “called into a position that [they do] not normally occupy” when psychologists assume the same system of analysis and diagnosis for minority patients as they would utilize for patients who are not traditionally called “of color” (Nakayama 13). Thomas Nakayama claims that a location’s shared history among diverse cultures significantly affects the perception of an individual’s identity. In this case, America and its Western influence on sciences such as psychology affect the perception of patient identity and significance of developmental factors in background analysis. Often, this system overlooks the significance of ethnic factors within the analysis, alienating minority patients who may not behave, think, feel, or express themselves relative to Western norms. The rules of psychology are thus too limiting and assumes level field of assessment and analysis.

For example, the inability to diagnose Patient W37 clearly exemplifies psychology’s limiting scope. No medication had proved effective in relieving this patient’s symptoms. This 23-year-old claimed that since the age of 13, he had felt that another person was inside him, fighting to take over. Oftentimes, in order to control the internal building rage, he would punch walls. In the hospital ward with walls of concrete, the patient’s defense mechanism resulted in shattered knuckles. Other patients described him as reclusive and state that he often whimpers and cries a lot. Our diagnosis resulted in several possible theories. First, could this problem stem from a possible birthing problem? His mother confided in us that he was born early and that she had complications, requiring a Cesarean section. Research with mice has shown that oxygen deprivation causes the mice to become aggressive. Could it be from the complications that an early deprivation of oxygen caused an aggressive side to develop? However if this is the case, why did the aggression not reveal itself outside of the desire to hurt others and to punch walls? Another theory was split personality because of his description of another person within him. However, typical personality disorders like this (multiple personality or split personality) generally consist of a patient who is unaware of the other personality. The fact that he was aware and actively fighting off the other personality did not suit the diagnosis of split personality. Another theory was schizophrenia; however, the DSM-IV-TR’s2 other criteria for schizophrenia was not met, as he was quite eager to seek help and had very clear and concise speech patterns. Unfortunately for patients such as these, psychology’s limited definitions have yet to determine an adequate explanation.

Even though psychologists need to pay more attention to ethnicity and ethnic identity as developmental factors in background analysis, current approaches overemphasize the ethnic factors, and often lose sense of balance or even significance of other factors including gender, age, orientation, and other characteristics (Ho, 1992, pps. 14-16). Such exclusions show just how current theoretical perspectives are too limiting because they were either too generic or put too much emphasis on ethnicity’s effects. We need to find a balance or a way of putting ethnic factors into perspective during analysis, assessing its impact on the overall analysis on a patient-to-patient basis. According to Professor George Atwood at Rutgers University, “There are multiple realities. Not in the sense that there are multiple dimensions, even though that may be possible, but in the sense that each person translates a certain experience in their own specific way.” As a psychologist, we must delve into this reality and comprehend how this patient thinks and feels before we are to help them.

References

“Census 2000 Gateway.” US Census Bureau. 1 Apr. 2000. 22 Nov. 2005 .

Chu-Hung, and Cleary, J. C. Pure Land Pure Mind. New York: Sutra Translation Committee, 1994. 2.

Ho, Man K. Minority Children and Adolescents in Therapy. Newbury Park: Sage Publications, Inc., 1992. 7-40.

Christopher Chen is President ESP Tuning at https://www.esptuning.netPosted by permission, Copyright by C. Chen