Prof. Chung explained how one culture
depression may not be another's, and
how in New York City some even consider
it hip to be depressed.
Within the field of
psychology, immigrants are often overlooked when it
comes to assessing mental health. The Asian immigrant
population in particular is a group that has gone
through a lot of losses, including having to leave their
home country, friends and family. Even though there are
good reasons for traveling so far, there’s still a
period of loss, and if left unresolved, could lead to
depression and anxiety.
Assessment
Depression comes in
varying degrees. Mild depression is consistent and goes
on for a long period of time. There is also depression
with psychotic features, which include having delusions,
imagining and hearing things.
Recent research
studies indicate that immigrants, especially Asians,
tend to suffer from depression and anxiety. Yet some
immigrants only display certain symptoms of depression,
and under the DSM IV (diagnostic manual with list of
criteria for determining depression and anxiety), to be
clinically diagnosed as depressed is difficult to say.
Assessment really depends upon who is doing it, and how
it’s being done.
Each culture has a
different set of values as to how one is to behave,
think and feel. One country’s depression may not be
another’s. Within the Asian culture, working hard is a
prominent value, while having fun is less important.
Thus, a person’s self worth is tied to work, and family
approval becomes very crucial. Depression within the
Asian culture isn’t even recognized, which leads to the
need for culturally relevant ways of looking at mental
illness, and more thorough assessments, in order to
classify Asians as depressed.
Causes for
depression include having a lot of negative thoughts and
not liking yourself, sometimes even to the point of
hurting or killing yourself. There is a general sense of
hopelessness, a lack of control over life. Immigrants
have to deal with racism, discrimination and poverty,
which could all very easily lead to a sense of having no
control, and put them at risk for depression and
anxiety.
Psychodynamics
Factor - According to Sigmund Freud, aggression is
turned inward during depression onto oneself, taking the
blame for things you have no control over.
Asian Culture
Factor – Responsibility is put onto oneself, and if
things don’t happen the way they should, you take the
blame for it.
Thus, the culture
itself sanctions this internalization of aggression.
There is something positive about that though, because
we own our own responsibilities, but if we let it go too
far, you stand the risk of taking on the blame for
everything that doesn’t work out in your life. What one
does with disappointment is a key issue. Some people
will externalize the problem, blaming everyone else, or
internalize the problem and blame themselves. The Asian
culture pushes people to work harder, leading to more of
a tendency to internalize their problems. There are
already two strikes against immigrants, their cultural
tendency to internalize their problems, and reality,
having to overcome obstacles and the loss of control
over their lives.
Coping with the losses they've
suffered since leaving their home country and
facing obstacles in the United States, Prof. Chung
explained how
many Asian immigrants are in great need of mental health
aid.
Clearly there are
differences between the Western and Asian take on
depression. In the Western model, people with depression
don’t work, want to be left alone, and don’t want to go
out or be productive. Asians on the other hand, though
depressed, still manage to go out and work, becoming an
important aspect of one’s identity. Since childhood,
Asians have been taught to work, providing a structure
and purpose in life, as well becoming a defense
mechanism, distracting them their problems. The American
culture values emotions, while the Asian culture tends
to shy away it. The idea that as long as you do your
work and not think about it, everything will be all
right, works only to a certain extent.
There also lies
another extreme, in which they actually want to talk
about their problems. A person’s feelings are learned,
traceable back to their childhood, whether it was good
or bad. Feelings can also be induced by one’s cultural
background, growing up thinking certain things were very
important, and if they don’t have those things, might
lead to anxiety. Easily more agitated from keeping their
feelings in for too long; Asians often take it out on
their children or spouse.
Treatment
There are several
options for treatment including medication, talk
therapy/counseling and group therapy. Within the Asian
culture counseling isn’t favored because it costs money,
and the results aren’t immediately seen, leading them to
think that perhaps their problems can be self managed.
Changes have to be
made to the perception that Asians are not interested in
talk therapy. Even though the issue of mental health is
embarrassing to Asians, it is up to the mental health
profession to reframe and engage them. There needs to be
more creative way in how services are offered and how to
reach out to those who are embarrassed. Today, the Asian
culture itself is going through changes with the influx
of immigrants since 1970, creating a New York City
culture of working women, a fading patriarch structure,
domestic violence and generation clashes. As long people
don’t have to pay, they’re willing to talk. When the
issue of money comes up, the traditional side of that
person appears.
Before starting her lecture, Prof.
Chung went around the room asking the
attendees to introduce themselves in order to get a feel
of their
knowledge of psychology, to which most were familiar
with.
Talk therapy works,
but has to be modified in culturally relevant ways. The
Narrative Approach lets a person just tell their
stories, and helps point out their strengths. By
utilizing the strength perspective, it helps to rebuild
a person’s self-esteem of who they were before coming to
this country. Some people suffer from panic attacks, an
extreme form of anxiety disorder, usually accompanied by
hyperventilation and feeling sick. Most go on
medication, but end up feeling immobilized, which is why
talk therapy is choice option.
By talking to an
individual and uncovering the real person underneath
their current exterior, more progress can be made by
encouraging a person to do more with their lives.
Showing an interest in a person’s history will make them
feel like a person again, and create meaning in their
lives, rekindling their hopes. Thus, an easy way for
people to get into therapy is by asking for their
information and stories.
Yet, therein lays
the difference between the Western approaches of
engaging an individual versus the Asian approach,
whereby the West dictates that an objective stance be
undertaken between the professional and the client.
Within the Asian model, such an approach cannot be
taken, because the client will want to know who the
individual they are talking to is, in order to build
trust. A good clinical practice would be to answer any
personal questions the patient may have about them, so
long as it doesn’t interfere with their relationship.
Asian patients like getting advice, which makes them
unsuitable candidates for psychotherapy. A possible
option would be to offer clients some advice, but not
set up any expectations, allowing them different courses
of actions, and still maintain a culturally appropriate
treatment.
If the belief that
Asians don’t believe in counseling continues to persist,
then there won’t be any progress made. The need for more
culturally sensitive approaches to mental health
assessment and treatment among Asian immigrants becomes
a real important issue.
Synopsis by Antony Wong
With her own private practice, Prof.
Chung expressed from experience how
talk therapy was the best choice of treatment for Asian
immigrants, since
most were eager to tell their stories and get things off
their chests,
so long as it didn't cost them any money for the
service.
