Friday, July 20, 2007
Saving face, seeking treatment
From the RoundTable blog
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Suchitra Samanta
Samanta is a visiting assistant professor and an anthropologist who teaches in the Department of Interdisciplinary Studies at Virginia Tech.
A significant issue has been left unaddressed after the Virginia Tech shootings of April 16: understanding how cultural norms impact both the recognition of, and intervention in, cases of mental illness.
Where Korean Seung-Hui Cho has been diagnosed, post-fact, as an uncommunicative, angry, suicidal individual with possible schizophrenia, the question arises why all this did not, effectively, see the light of day much earlier. This is especially surprising since, in 2001, the surgeon general recognized that in treating mental illness, one size does not fit all.
Noting that "culture counts" in a nation whose strength lies in its diversity, then-Surgeon General David Satcher specifically noted that culture affects "all aspects of mental health and illness": the stresses minorities confront, whether they seek help, the symptoms they describe, as well as mental health providers' own unawareness about culture's powerful role ("Mental Health: Culture, Race and Ethnicity," 2001, Supplement to "Mental Health: A Report of the Surgeon General, 1999").
Asian-Americans, for example, are 25 percent as likely as whites to seek outpatient care, less likely than whites to receive in-patient care, and more likely to be misdiagnosed as problem-free. Mental illness is stigmatizing for Asian-Americans, reflecting on family "face" and marriage suitability. Confucian values of self-control discourage displaying emotion, which may disrupt social harmony.
Also, mental illness often manifests itself through bodily symptoms rather than psychological ones, such as headaches, chest constriction and palpitations, not officially identifiable by standard American diagnostic parameters. One such condition is hwa-byung ("suppressed anger" syndrome). A 1992 survey in Los Angeles found that 12 percent of recently immigrated Koreans suffered from this condition, at higher rates than found in Korea.
The supplement also states that 21 percent of Asian-Americans lack health insurance, that Medicaid coverage is "well below" that of whites, and less than 6 percent of those who do seek help for drugs or alcohol problems see a mental health professional.
The document advocates recognizing the cultural diversity within Asian-Americans; moving beyond "model minority" stereotypes, which conceal real problems, and justifies lack of research; understanding the complex and stressful process for immigrants -- by age, generation and gender -- in adjusting to a foreign culture; identifying cultural variations in expression of mental disorders (so, how is "abnormal" defined?); providing ethnic matches in mental health providers (this has been proven to be effective in Los Angeles); educating communities, and addressing issues central to Asian traditions of "shame" and "face."
As a first-generation immigrant myself, I can personally comment on my own struggles to find a balance between the cultural norms I grew up with in India and acculturating to different values in a new country. Twenty-five years later, as a naturalized citizen, I cannot say that I have achieved an entirely comfortable balance, despite a doctorate in the social sciences and being fluent in English. Raising a daughter here has often meant conflict, for her and for myself.
Most Indians, including myself, would, I think, only reluctantly approach a mental health professional, preferring to talk of very painful matters to friends or family, as I did after the Virginia Tech shootings. Issues of isolation and keeping "face" result, as many studies show, in high rates of domestic violence, even in a "model minority," where abused women prefer not to seek help publicly.
What changes need to be made to prevent such a tragedy in the future? Virginia Tech and Gov. Tim Kaine have set the ball rolling. On April 25-27, Virginia Tech convened a group of faculty, administrators, staff and representatives from the Asian-American community to understand as well as sustain diversity on campus.
Two Korean student organizations worked effectively, it was mentioned, as first-responders for Tech's Korean community, saying that they would "not lose face over this." I was also told that Korean students distributed cooked rice to all the students in their dorm in a gesture of peace. Future plans at Tech include diversity education for faculty and staff, Big Brother/Sister programs for incoming freshmen and diversity-specific courses.
Kaine has met with Korean-American community leaders to re-evaluate mental health outreach in the state. In the wake of April 16, such re-evaluation needs to take into account the nexus between mental illness and culture.
Where this has already been recognized in 2001 at the federal level, there is need now to educate providers, and implement an effective, culturally sensitive mental health infrastructure across the nation.
