At Friday’s training, Peter recommended Anne Fadiman’s book The Spirit Catches You and You Fall Down. It examines the culture of medicine in the US- its assumptions, institutional practices, and particular language- and explores what happens when it comes into contact with another culture with different conceptions of the body, medicine, and the materialness of the soul. How do these cultures communicate? How does cultural awareness grow, and where are its limitations? Who is involved in the process of translating experience- whether it be physical, cognitive, or emotional?
My own personal experiences, as well as the situations I have witnessed as an AmeriCorps member this year working with a diverse group of families, compels me to examine these questions now. More specifically, I would like to explore the culture of therapy within America, and how its assumptions and methods can prevent effective behavioral health treatment for youth from different cultures and their families.
[Disclaimer: I have never taken a psychology course, and know very little about how this topic has been treated in academia or the world of behavioral psychology. The little research I have done has yielded a scant selection of articles, and I am using this blog post as a jumping-off point for more ideas (from y’all!) on how to learn more. This is simply a personal, anecdotal perspective].
I recall in particular one family therapy session in which my parents, first-generation immigrants from India, sat on the couch with me facing my American psychologist. As we begin talking, it became clear that we were speaking different languages, and that serious gaps in our vocabulary were hindering communication between the four of us. My parents speak English fluently, and so our problem lied beyond the literal level; it was the cultural concepts that were causing confusion.
At one point, the psychologist asked me (as someone who could ‘translate’ between cultures, being a second-generation immigrant) for Bengali culture’s analogy for “leaving the nest” and the process of individuation of young adults from their parents. I fumbled for a bit and realized- there wasn’t any. Girls do not typically leave their paternal home until they are married, and there really isn’t any word for “individual” that doesn’t have selfish connotations. Similar un-translatable moments occurred around the concepts of boundaries and privacy, depression, and the use of pharmaceuticals in treatment.
I share this experience because I believe it is quite common. Within the Western traditions of therapy, counseling, and particularly- psychoanalysis, there exist some cultural assumptions that can come into conflict with the values, traditions, and beliefs. Within the very personal and sensitive arena of mental and behavioral health, this may lead to a family’s decision to disengage with the parties responsible for providing counseling or treatment. If members of a family don’t feel that the person who is supposed to be helping them understands them, or feels that they should not be involved in their family’s private affairs, then problems within the youth or family can go ignored, compound and intensify.
So here are some very general culturally-variable concepts/issues that I think that we may need to think about when it comes to therapy:
· Boundaries and privacy, both within a family and in regards to the family’s relationships with social workers, therapists, case workers, etc.
· Individualism/individuation
· Shame, guilt, and taboo- even the idea of “needing” therapy or receiving a “diagnosis” can be seen as shameful to some families
· Gender dynamics- who has the power to influence and make decisions? How will people navigate these realities in a safe and healthy manner?
· Different communication styles (or lack thereof) within families or cultures
I’m sure that there has been conversations about this topic and work has been done, I just wanted to share my vague initial thoughts....perhaps more for another blog post or research for a paper!
Very insightful initial exploration!
ReplyDeleteIt's almost as if we, as a culture, should conjure or develop, as it were, a new profession. Perhaps a position that required the the therapist to be trained in Western medicine and treatment strategies, but also must choose a culture of focus, requiring a great deal of immersion and case studies within that culture, and, preferrably, the practioner would be from the target culture, ideally of course. This may be a aspect of treatment just peripherally dealt with with non-profits, but a formalization of identifying, understanding, relating, and prioritizing a patient's familial/cultural identity should be paramount in training programs for the hypothetical therapist mentioned above.
Surely cultural sensitiviites are taught in formal education, but nothing on the scale that the populations you describe require.
I think a joint program in anthropology and psychology with a specific focus on the population you plan to serve would be ideal. Especially if the education process incorporates in-the-field learning experiences; real world, intimate opportunities to help or volunteer could be fantastic for nurturing and developing the appropriate sensitivities.
Wow, I think I may be bordering on babbling here, sorry. But great observations, you surely got my wheels turning!