What Are Some Factors That a Person Receives From Their Family When They Are Born?

West J Med. 2002 Sep; 176(4): 227–231.

Cultural factors influencing the mental health of Asian Americans

Elizabeth J Kramer

^oneCharles B Wang Customs Wellness Center 125 Walker St New York, NY 10013

Kenny Kwong

²Charles B Wang Customs Health Eye 125 Walker St New York, NY 10013

Evelyn Lee

³RAMS 3626 Balboa St San Francisco, CA 94121

Henry Chung

^fourPfizer, Inc 235 E 42nd St New York, NY 10017

Summary points

• Cultural factors, such as language, age, gender, and others, can influencethe mental health of Asians, especially immigrants

• Traditional (adhering to native values) Asians place bully value on thefamily every bit a unit. Each individual has a conspicuously divers office and position inthe family hierarchy and is expected to function inside that function, submittingto the larger needs of the family unit

• Social stigma, shame, and saving face often prevent Asians from seekingbehavioral wellness care

• Asian patients are likely to express psychological distress equally physicalcomplaints

Asian Americans are the fastest growing racial grouping in the Us.They are likewise one of the virtually diverse, including at least 43 different ethnicgroups who speak more 100 languages and dialects(box 1). The Asian Americanpopulation in the U.s.a. has grown from fewer than 1 meg (0.5% ofthe total U.s. population) in 1960 to 7.2 million (2.9%) in 1990, to ten,242,998(iii.7%) in 2000. This number is expected to double by 2025. Approximately 7.2million (70.seven%) Asian Americans are foreign born, and Asian immigrants accountfor 2.6% of the total USpopulation.³

Box ane

Distribution of the Asian American/Pacific Islander population bysubgroup reporting only ane race in2000^*

Co-ordinate to the 2000 census, the distribution of the Asian American andPacific Islander population in the United States is equally follows (Demography Bureau2001a):

Chinese (25.4%) Filipino (19.3%) Asian Indian (17.6%) Vietnamese (11.seven%) Japanese (8.3%) Korean (8.3%) Other Asian (13.4%) Pacific Islander (iv.ii%)

KEY CULTURAL FACTORS THAT INFLUENCE MENTAL Health

Culture influences the Asian health conventionalities system and has an upshot on thediagnosis and handling of mental disorders. Several key cultural factors thatare relevant to this process are described below. However, at that place is tremendouscultural variability amongst groups and heterogeneity within groups. Thesefactors will have differing effects, depending on the individual's degree ofacculturation, socioeconomic status, and immigration status. Our emphasis hereis on new immigrants, who comprise i% of the USpopulation,¹ andthose who are more traditionally oriented. Nosotros accept chosen this focus becauseit is these patients who feel the greatest barriers to receiving mentalhealth care. Key cultural factors are:

• Language Noesis of English is 1 of the nearly important factorsinfluencing access to care. Asian languages and dialects usually are notwidely spoken outside the individual's indigenous group and, depending on degreeof acculturation, even within it. According to the President's AdvisoryCommission on Asian Americans and Pacific Islanders, 42% of VietnameseAmerican, 41% of Korean American, and 40% of Chinese American households are"linguistically isolated." This designation means that no one inthe household historic period 14 years or older speaks English "verywell."^iv

• Level of acculturation Typically, it takes three generations forimmigrants to fully adopt the lifestyle of the dominant culture. This intervalis nigh the amount of fourth dimension information technology takes to take Western medical care morereadily than traditionalcare.⁵

• Age In general, the younger people are when they migrate, the morereadily they adapt to living in a country in the West.

• Gender Historically, men have acculturated more apace than women.This standard may exist changing, however, every bit women enter the work force.

• Occupational issues Particularly among undocumented immigrants,professionals and highly skilled technicians often cannot access pathways totheir previous careers considering of language or license verification issues.Some are forced to accept low level jobs as is the example with white-collarworkers who get piece-appurtenances workers in garment factories and dishwashers orline cooks in restaurants where they earn minimum wage or less. Sometimes,women earn more than men, thereby disrupting family expectations andtraditionalvalues.^vi

• Family structure and intergenerational issues (see beneath).

• Religious behavior and spirituality The predominant religions ofAsians who do non practice some grade of Christianity or Muslim religion are:Buddhism, which promotes spiritual understanding of affliction causation;Confucianism, an ethical belief arrangement that stresses respect for authority,filial piety, justice, benevolence, fidelity, scholarship, andself-development; Taoism, which is the ground for yin andyang theory; and animism, which is the belief that human beings,animals, and inanimate objects possess souls andspirits.​

  Tabular array 2

  Traditional beliefs and behaviors relating to mental health

  Civilisation	Behavior	Coping behaviors and treatments
  Chinese	Mental illness caused past lack of harmony of emotions or by evil spirits	Often attempt traditional herbs and acupuncture first; healers may exist usedconcurrently to get rid of evil spirits
  Japanese	Mental illness caused by evil spirits; often thought not to be real illness	Delay or avert seeking professional help; many volition use traditional sources ofcare
  Korean	Mental affliction caused by disruption of harmony within private or byancestral spirit coming back to haunt patient considering of by bad beliefs;consequence of bad luck or misfortune; payback for something washed wrong in thepast; is considered shameful	May deny bug, resulting in helplessness and low; non probable toreveal the problem unless asked; may prove signs through nonverbalcommunication and posture; may use shamanism
  Vietnamese	Depression is sadness	Non readily acknowledged considering of stigma; ordinarily try home remedies,spiritual consultations, or Chinese herbs before seeking Western medical care;some apply of exorcists; seek assist only when bug become acute or obvious;family members try to cheer up or distract the patient

• Traditional beliefs nigh mental health In the traditional beliefsystem, mental illnesses are caused by a lack of harmony of emotions or,sometimes, past evil spirits. Mental wellness occurs when psychological andphysiologic functions are integrated. Some elderly Asian Americans share theBuddhist conventionalities that problems in this life are almost likely related totransgressions committed in a past life. In addition, our previous life andour future life are equally much a office of the life cycle as our present life.

Health beliefs and behaviors of Chinese, Japanese, Korean, and Vietnamesecultures are briefly summarized in the Table.

Culture shapes the expression and recognition of psychiatric problems. Theinfluence of the teachings and philosophies of a Confucian, collectivisttradition discourages open up displays of emotions in society to maintain socialand familial harmony or to avoid exposure of personal weakness. Savingface—the ability to preserve the public appearance of the patient andfamily for the sake of customs propriety—is extremely of import tomost Asian groups. Patients may non be willing to discuss their moods orpsychological states because of fears of social stigma and shame. In manyAsian cultures, mental disease is stigmatizing; it reflects poorly on familylineage and can influence others' behavior about the suitability of anindividual for marriage. It is more acceptable for psychological distress tobe expressed through the body than through themind.^{i , 7 , viii , 9 , 10 , 11}

The Asian American family unit

Traditional (adhering to native values) Asians place great value on thefamily every bit a unit. Each private has a clearly defined function and position inthe family hierarchy, which is determined by age, gender, and social course.Each person is expected to function within that role, submitting to the largerneeds of the family. Rituals and customs such equally ancestor worship, familycelebrations, funeral rites, and the maintenance of genealogy recordsreinforce this concept. To achieve peaceful coexistence with the family unit andothers, harmonious interpersonal relationships and interdependence areemphasized. Mutual obligations and shame are the mechanisms that help toreinforce societal expectations and proper behavior.

Extended families are common among Asian Americans, and two or threegenerations ofttimes live in the same household. In traditional Asian Americanfamilies, major decision-making is the purview of the father, followed by theoldest son who receives preferential treatment on the supposition that he willaccept greater responsibleness in the intendance of the family. The mother's job isto nurture and intendance for her husband and children. Female children have a lowerstatus than male person children within the family. In some cultures, such every bit theChinese, the married woman is expected to become function of her hubby'southward family unit.

Gender

Traditional roles for men and women prevail among the Vietnamese. Womenusually maintain that their husbands accept a legitimate correct to brand finaldecisions, and they usually will withdraw from spousal conflict to maintainharmony inside the family unit.

Women are at specially loftier take chances for the evolution of psychiatricdisorders during their lifetimes. Well-nigh major mood and anxiety disorders, withthe exception of obsessive compulsive disorder, occur more frequently in womenthan in men.¹²Various biologic, social, and cultural hypotheses accept been avant-garde toexplain this phenomenon.

Unfortunately, the value placed on males manifests in sex-specificinfanticide and a disproportionate number of females in orphanages andavailable for adoption in China.

In the United States, traditional Asian expectations of women tin severelyconflict with ethics that emphasize independent thinking, achievement, andself-sufficiency, even at the expense of others' feelings and needs. Theseconflicting values can play out in several ways:

• Stress and conflict in teenagers pb to isolation and withdrawal or actingout behaviors that in turn tin lead to low

• Spousal conflict can occur as women piece of work in and collaborate with a culture inwhich their status is compared to that of their husband

• Resistance to or refusal of psychiatric treatment resulting from chroniclow self-esteem can lead to a sense of fatalism

Among persons anile xv to 24 and older than 65, Asian females are at thegreatest risk of suicide compared with women of all other racialgroups.^xiii

Health practitioners must be sensitive and attuned to these bug so theycan heighten the therapeutic brotherhood and do not miss opportunities fordiagnosis and treatment.

The life bicycle

Asian gild has specific expectations of each age group that differgreatly from those in American society. Considering of this difference, all agegroups are exposed to conflicts or clashes that may increase the risk fordevelopment of mental disease.

Children and adolescents

Children are highly valued in Asian American families. They are taught tobe polite, tranquillity, shy, humble, and deferential. Conformity to expectations isemphasized, and emotional outbursts are discouraged. Failure to run into thefamily'southward expectations brings shame and loss of face to both the children andtheir parents. Parents are seldom forthcoming with amore and praisebecause of fear that such demonstrations volition encourage laziness. Education isimportant and children who do non exercise well in school bring shame to theirfamilies. Positive reinforcement and give-and-take of personal achievements areuncommon.

Adolescence has limited meaning in most Asian cultures becauseindividuation carries little value and seeking a definition of self outsidethe family is not encouraged.

Children usually civilize more than readily than their parents and otherelders. Members of older generations benefit from this rapid acculturation bythe children serving every bit interpreters and negotiators for them in the newculture. Although parents await their children to acquire the linguistic communication andskills that will enable them to be successful in their new country, they oftenare reluctant to take them fully embrace most aspects of American civilization forfear that they volition abandon their native civilization. For instance, parents mayencourage their children to learn English in order to succeed in Americansociety but may refuse to let them to speak English at home. Such confusingmessages to the child pb to transgenerational conflict.

Young adults

For many Asians, young adulthood means achieving for the family. However,with increased exposure to or immersion in Western cultures and values, andconflict between peer pressure and family unit expectations, many immature AsianAmerican adults brainstorm to question their family values. Interpersonalrelationships get more of a claiming. Interracial relationships may causeserious conflicts because of parental fears that biracial children willdiffuse the family unit lineage and civilization. Asian men may feel pressured to dateonly women from their specific indigenous grouping.

Many Asian adults may misunderstand the meaning of the often brief andtransient personal relationships that are common in urban settings in theWest. Young adults too confront such dilemmas as deciding the group with whichthey want to be identified and having one identity at home and another whenout in public, a phenomenon known as dual identity.

Often the obligation to parents takes precedence over the private'schoice of career. Choice of a career that is unlike from that chosen by hisor her parents can result in loss of emotional and financial back up.

Other stresses facing Asian young adults are shown inbox ii.

Box 2

Stresses facing Asian young adults

• Peer pressure to smoke, drink, and have sex

• Pressure to adjust to societal norms of individuation, which oftenconflict with traditional family unit expectations

• Common traditional Asian modes of communication (eg, being indirect,fugitive direct disharmonize, respect for authority through verbal and nonverbalbehavior, and deference toward authority figures) oftentimes are not understoodwithin the majority culture

• New immigrants face severe and sudden challenges to cope with the cultureand demands of a new state

• Anti-Asian sentiment

The elderly

Whereas elderly Americans emphasize independence as a means to maintaintheir self-esteem and to avert becoming burdens to their children, elderlyAsians look forward to having their grown children intendance for them. TraditionalAsian elders tend to have full control over family and fiscal decisionswhether or not they alive with their children. Most elderly Chinese immigrantsprefer to have their children movement in with them rather than moving in withtheir children. They are not inclined to value independence and, when theylive separately, it is to avoid conflict over family roles.

Elders are highly respected and honored by all Asian cultures. In extendedChinese families, grandparents often are responsible for the care ofgrandchildren. Families are expected to intendance for their children and elders.Japanese Americans frequently maintain carve up households from their childrenand grandchildren. Korean and Vietnamese elders are welcomed to live withtheir children for the balance of their lives. Those who reside with children andgrandchildren are viewed equally having been rewarded for everything they haveprovided to younger generations.

ELICITING PATIENTS' VIEWS Virtually THEIR ILLNESS

Culturally competent cess and handling of mental health problems inAsian Americans requires that wellness professionals ask patients and theirfamily members to share their cultural views on the cause of the problem, pastcoping patterns, health intendance-seeking behaviors, and treatmentexpectations.^xiv Inthe context of health care, the doc-patient human relationship is not seen asa partnership; rather, the dr. is considered the authority. Asianpatients will answer questions merely are not likely to raise issues, and theywill tell the physician what they think he or she wants to hear. The healthcare provider must reassure patients that they may talk about their problemsand no judgments virtually them or their family will be made.

Kleinman's seminal work in the evolution of a health explanatory beliefmodel has led to a series of questions that can be used to arm-twist informationfrom patients and their families (box3).¹⁵Specifically, these questions draw out patients' agreement of the causesof illness. The explanatory model is critical to successful patient engagementbecause it provides a context for diagnosis and treatment negotiation.

Box 3

Questions from the Patient's Cultural Health BeliefsQuestionnaire

1. What brought y'all to the doctor today?

2. What practise you think caused your problem?

3. Why do you recollect information technology started when it did?

4. What exercise you lot think your sickness does to your body?

   1. How does it work?

5. How bad is your sickness?

   1. Has this difficulty interfered with your normal daily routines?

   2. If yes, how?

6. How long practise you lot recollect it will last?

7. Do you know others who take had this problem?

   1. What did they practise to care for it?

8. Did you discuss the problem with any of your relatives or friends?

   1. What did they say?

9. What kinds of medicines, home remedies, or other treatments take yous triedfor this sickness? (Include quantity, dosage, frequency, how treatmentsprepared)

   1. Did they help?

   2. Are you still using them?

10. What blazon of treatment exercise y'all think y'all need from the dr. today?

    1. What do you hope the treatment will exercise for y'all?

11. Do you think there is any mode to preclude this problem in the future?

Another of import pace for the practitioner is to identify sources ofsupport and strength to the individual, family, and community network in pastadaptation, coping, and problemsolving.¹⁶ In Asianculture, forcefulness lies in the Confucian teaching of the "middleway," the Buddhist pedagogy of compassion, the stiff focus on theimportance of family harmony and interpersonal relationships, and the highvalue of teaching and hard work. Asian cultures emphasize family, friends,and indigenous community. During a crisis, Asian families can commonly count onsupport from extended family unit members, friends/villagers, and community networkand organizations. We observe it helpful to explore, recognize, and make use ofthese support systems in the treatment procedure.

Successful assessment of mental health problems in the Asian Americanpatient is based on:

• Practitioner sensation of individual patient demography

• The patient'southward beliefs most health and mental health

• Eliciting an explanatory model from the patient

• Negotiation around acceptable diagnosis and handling

• Employ of the family support system to increase adherence to treatmentregimens and to reduce barriers

​

UNICEF

Many Chinese girls who are abandoned by their parents grow upward inorphanages

UNICEF

Elders are honored and respected and often play a primal role in raising theirgrandchildren

Notes

Competing interests: None alleged

References

ane. Usa Agency of the Census (2001a). Profiles of general demographiccharacteristics: 2000 census of population and housing, United States.Available at:www2.census.gov/census_2000/datasets/demographic_profile.Accessed June 22, 2001.

3. Mental Health: Culture, Race and Ethnicity — ASupplement to Mental Health: A Study of the Surgeon General.Rockville, Medico: Us Dept of Health and Human Services, Office of the SurgeonGeneral; 2001.

4. President's Advisory Committee on Asian Americans andPacific Islanders, 2001. A people looking forward: action for admission andpartnerships in the 21st century. An interim report to thePresident. Washington, DC: US Government Printing Office;2001.

5. Ma GX. Between two worlds: the use of traditional and Westernhealth services past Chinese immigrants. J CommunityHealth 1999;24:421-437. [PubMed] [Google Scholar]

6. Ferran East, Tracy LC, Gany FM, Kramer EJ. Civilization and multiculturalcompetence. In: Kramer EJ, Ivey SL, eds. Immigrant Women's Health:Problems and Solutions. San Francisco: Jossey-Bass;1999: 19-34.

7. Tseng West. The nature of somatic complaints among psychiatricpatients: the Chinese case. Compr Psychiatry 1975;16:237-245. [PubMed] [Google Scholar]

8. Kleinman A. Depression, somatization and the "newcross-cultural psychiatry." Soc Sci Med 1977;i:229-231. [PubMed] [Google Scholar]

ix. Nguyen SD. Psychiatric and psychosomatic problems among SoutheastAsian refugees. Psychiatr J Univ Ott 1982;vii:163-172. [PubMed] [Google Scholar]

x. Gaw AC. Psychiatric care of Chinese Americans. In: Gaw Air-conditioning, ed.Culture, Ethnicity and Mental Disease. Washington, DC:American Psychiatric Printing; 1993:227-251.

11. Chun C, Enomoto Grand, Sue Southward. Wellness care problems among Asian Americans:implications of somatization. In: Kato PM, Mann T, eds. Handbook ofDiversity Issues in Wellness Psychology. New York, NY: Plenum;1996: 327-366.

12. Kessler RC, McGonagle, KA, Zhao S, et al. Lifetime and 12-monthprevalence of DSM-III-R psychiatric disorders in the Usa.Arch Gen Psychiatry 1994;52:3-nineteen. [PubMed] [Google Scholar]

xiii. National Center for Health Statistics. Health UnitedStates, 1995. Hyattsville, Doc: United states of america Public Health Service;1996.

14. Lee Eastward. Family unit therapy with Southeast Asian refugees. In: Mirkin MP,ed. The Social and Political Contexts of FamilyTherapy. Needham Heights, MA: Allyn & Bacon;1990: 331-354.

15. Kleinman A., Eisenberg 50, Skilful B. Civilisation, illness and intendance:clinical lessons from anthropologic and cross-cultural research.Ann Intern Med 1978;88:251-258. [PubMed] [Google Scholar]

sixteen. Lee E. Working with Asian Americans: A Guide forClinicians. New York, NY: The Guilford Press; 1997:19.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071736/

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