Culture's Influence on the Treatment of ill Patients - Term Paper Example

«Culture's Influence on the Treatment of ill Patients» Abstract For Korean children and Asian-American immigrants, cultural traditions hinder the recognition and proactive prevention of mental health issues. The systemic failure is linear in that there is no provision made for addressing mental heath issues in early childhood development, there are very few counselors available at the pre-school and elementary levels, there is no formal family education as a result of cultural denial, and even those who study early childhood curriculum are not provided with adequate tools and training. This paper analyzes these conditions and makes recommendations for addressing these issues through recognition, training, and proactive social programs in the community. Societal Image: The Refusal to Recognize Mental Illness in Korean and Asian Children For Korean and many other Asian children, the specter of mental illness is not properly treated because it is not recognized as a condition that needs treatment. Although these subjects have the same incidence of depression, ADD, and other mental illness as any other national population, it is not recognized as a clinical illness. The societal impression, particularly from parents, is that the presenting of symptoms of these conditions is considered as a generalized craziness that will be outgrown. This cultural perception has fostered conditions in these cultures that are contributing to the absence of diagnosis, clinical and social training for professionals, and an unnecessary incidence of suicide and other negative social behaviors. This is the direct result of no early childhood programs. In Nelson’s study (as cited in Wong, 2007, p. 145), the author states that early child programs “can have lasting positive effects by increasing children’s chances of continuing education through high school and beyond and being employed as adults and reducing the likelihood of later substance misuse, mental illness and suicide, domestic violence and crime” (Nelson, 2003, p. 3). There will not be any social programs, however, if cultural and social mores prevent the acknowledgement of the problem. In many Asian cultures, then, the negative results of untreated mental conditions are clear—what isn’t immediately visible is the suffering of the individual. In addition to dealing with a mental condition like depression, which can be painful both psychologically and physically, an individual is not prevented from accessing the healthcare needed or access to social programs designed to mitigate the condition, but also has to attempt to hide the symptoms of the condition from family and friends to prevent further stigmatization. It is axiomatic that the denial of a mental health illness, coupled with limited or no treatment, simply causes the individual additional harm. As Marsh (1992) points out, "denial is terribly unhealthful, and all the feelings of anger, guilt, resentment remain buried" (p. 137). In children, who are generally not even aware of the indicators of the illness, there is absolutely no support structure except the exhortation to act “right.” These behaviors are not limited to the nations of the Pacific Rim; the families and individuals who immigrate to the United States bring the cultural influences with them and, although they are in a new country, they remain in the old mindset. Part of the distinction between western thought and medical approach and that of the Asian culture is the perspective difference related to the individual. Marsella, (as cited in Bowers, 2000, p. 49) “drew a clear distinction between the perspectives of Western and Asian/Pacific cultures. In the West, he argues, the self is considered to be distinct, individual, different from others…whereas in some other cultures the self is not clearly demarcated from others, boundaries are more permeable, and actions are a function of social relationships” (Marsella, 1982, n.p.). If the Asian culture perceives the actions of the individual as a reflection upon their social relationships, then it is no wonder why parents and relatives of children with mental illness are resistant to treatment and social programs; it is a negative reflection on themselves. The purpose of this paper is to set forth the consequential impact of this attitude on policy and curriculum development, as well as services delivery, for children and their families. It will conclude with the recommendation of changes that can be made to improve outcomes and opportunities for children. Analysis The consequential impact of this attitude on policy development, services delivery, and curriculum development are severe. The systemic failure extends to four primary areas, which follow a linear path; there is no provision made for addressing mental health issues in early childhood development, there are almost no counselors or early childhood therapists available in the pre-school and elementary school systems, there is no level of family education in support as a result of the cultural denial, and even those who study early childhood curriculum are never provided with the tools and training to positively address the problems. These four elements of systemic failure will guide the analysis that follows. In South Korea and within Asian-American communities located in the United States, there is a conflict regarding the social service provisions made. In South Korea, there are very few resources allocated for this as a result of the social perception. As Henry notes, the “history of attitudes toward the mentally ill is a history of ways in which our values and beliefs are influenced by the culture in which we live…it is only relatively recently that the world has come to see them as patients who should be treated and aided; it is even more recently that we have sought means of preventing mental illness (1955, p. 7). Given that the culture in South Korea, while becoming more modernized (some would way more westernized), still has elements of the traditional Korean family life which are positive—including extended family groups, respect for parents and elders, respect for teachers and others in position of authority—the public policy is still largely influenced by tradition: Confucian decorum-structured around the enhancement of ethical-moral virtues, patriarch, social hierarchy and obedience—[has] dominated life and thinking…the notion of individual rights [is] relatively weak compared [to] the emphasis placed on group responsibility and duty. Although rapid monderisation [sic] has weakened some of the traditional form of behaviour [sic]…a deep sense of these traditions is embedded in the culture and foundation s of Korean child and family policy. (OECD, 2004, p. 9) The primary contributor, then, to the insufficient provision for mental heath issues in early childhood development in Korea is the culture. This is a top-down effect that is exacerbated by the fact that the professors and curriculum committees in the South Korean carry the cultural bias against mental health issues into the classrooms. The cumulative effect of mental health stigma and the actions of an individual reflecting on the family and community results in the Korean system of education and health services provision lacking the proper foundation for building social service infrastructure to address the problems, proactively addressing the early childhood development programs that could contribute to mitigating the problems, and few facilities for children services. In the United States, there is ample educational and social programs addressing the issues of mental health in general, and early childhood development specifically. The problem is that many first- and second-generation Asian-American immigrants will not make use of these services as a result of their cultural perceptions. Ethnic groups in America tend to fall into two basic groups; those who encourage individuals to utilize the professional help available, and those who deny the problems and tolerate problem behaviors. Research as shown that “Asian groups use services less, when compared with Caucasians” (Cave, 2002, p. 123). Sue, et al. (1991) as noted in Cave, determined that “Orientals are more likely to seek medical help than psychological help (Sue et al., 1991, n.p.), while Kendall and Hammen (1995) attribute these differences to variations in cultural attitudes about such problems and where to seek help (n.p.). Thus, even when a substantial range of social service programs are available, the cultural barrier of mental illness stigmatization prevents many Koreans and other members of Asian cultures from accessing the help that is available. A secondary contributing factor to the Asian-American community’s reluctance to seek help with these conditions is revealed in research conducted by Krimayer, et al. (as cited in Cave, 2002, p. 123), which found that the “most important factor was found to be ‘ethnic mismatch.’ By this the immigrants meant their expectations that they would be unable to see professionals from their own ethnic groups, that they would not be understood by those they did see, and that they would encounter prejudice” (Krimayer, et al., 1996, n.p.). It is difficult to deal with early childhood development mental health issues when there is no systemic support, trained professionals, or physical facilities (South Korea). It is even more frustrating when the social support infrastructure and professional services depth are available, but the individuals will not, or cannot, take advantage of those services as a result of attitudes developed and strengthened by cultural perceptions and ethnic community attitudes. Even when individuals get treatment, they are frequently subjected to alienation. Take the case of “Adam,” whose story is told in his own words: I’m Asian American and was diagnosed Bipolar and ADHD during college. I dealt with severe alienation from my family - they specifically told me to hide the mental illnesses from anyone as best I could. I didn’t hide it, and told my friends about it, but still felt I paid a price in terms of the reactions within my Asian American community. Too often I was laughed at to my face. Too often I heard the typical Asian male response of ‘you gotta [sic] get accountable, like a man, forget those pills.’ (Adam, 2007, July 6) This compelling account is illustrative of the experience of many Asian-American individuals and it is completely caused by the cultural attitudes of the community. Another individual, Ernie, asserted that “I can tell you that the idea of mental illness is something difficult for my family to accept, even to this day; the “public face” is a big deal in Chinese culture, and the concept of psychologists and psychiatrists are relatively unfamiliar at best, and “weird” and “foreign” at worst” (Ernie, 2007, April 19). Recently, in reporting about the Virginia Tech shootings (April 16, 2007 where 32 people where killed by Seung-Tui Cho before he took his own life), CNN had a report on the Korean shooter’s relatives in South Korea, about which one writer said: His great aunt revealed that Cho had been quiet since he was a child and that they always suspected he may have had some sort of mental illness. She would call Cho’s mother, who constantly worried about him since he was so non-communicative and distant. We won’t know why no action was taken by his parents regarding these ‘problems,’ but one reason could be the stigma attached to mental illness by certain Asian cultures. Mental illnesses are not thought of as clinical illnesses, but rather a certain ‘craziness’ that should not be revealed and can be treated by simply ‘growing up’ or whatnot. (James, April 19, 2007) Thus, the cultural perceptions prevent the early childhood assessment and treatment of mental illness with sometimes-disastrous results. The second causative contributor to this condition is the fact that there are almost no counselors or early childhood professionals provided in pre-school, kindergarten, or elementary schools for dealing with these problems within the Republic of South Korea. The “elementary school counselor is in a unique position to help students, school personnel, families, and the community to work toward overcoming” the difficulties faced by children as they develop in their own culture, or adjust to life in the U.S. (Frenza, 1984, p. 1). In the United States, there is sufficient social infrastructure to support the counselors needed, if only the Asian-American community would make use of such support. In South Korea, however, the system is not providing the necessary resources. Scientific literature on the subject has established that early childhood education and care has the “potential to contribute to social justice,” but it must “first be available to all children and families” (Wong, 2007, p. 144). Research has shown that the particular details of any early childhood development program is less important than the fact that a country has identified and targeted such programs to its citizens (Boocock, 1995, p. 102). The failure of the South Korean government in this area is not acceptable, and the government’s attitude toward isolation of those with mental health issues is not helpful. “The definition of mental health policy in Korea can be broadly interpreted as including a concern for treatment and rehabilitation and having the characteristic of isolation in mental health facilities" (Kimp, 1993, p. 181). The reason that there are almost no counselors or early childhood counselors provided in the childhood development social programs is because the government is taking a policy approach that isolates such individuals rather than helping them. Families are also contributing to the problem by the lack of education regarding mental health, combined with fact that parents do not even want to hear that their children may have a problem. As mentioned, the attitude that a child will simply grow out of such a condition is a major problem. Individuals do not grow out of mental illness-in fact, early childhood identification of the condition leads to therapies and behavior modifications that mitigate the symptoms. The fact that many Koreans tend to seek medical solutions for the problems to which they will admit could allow for pharmacological treatment; but denial by the family does not even permit this assistance. As any healthcare professional will advise for particular conditions, e.g., depression, it is impossible for individuals to “bootstrap” themselves beyond the illness. The individual can no more think or act their way out of clinical depression than they can cancer. It is a medical condition which needs to be diagnosed and treated as soon as symptoms set in; all waiting does is prolong the suffering of the individual and increase the severity of the symptoms. In the typical Korean family, the pressure from adults can make things even worse by causing the individual to have feelings of guilt, pressure, isolation, and violation of their parents’ expectations. This cohesion is derived from a variety of historical influences, not the least of which is Confucianism and Shamanism. The central pillar of Confucianism is the family. Indeed, family cohesion and continuity are taken as the foundation for sustaining the human community and the state (Park & Cho, 1995, p. 117). As a result of the family taking on the stigma associated with mental illness, the subject is repressed and ignored. With the cultural setup, enforced by the lack of government intervention and social programs, issues of mental health go unaddressed. Were government policy to change, and the system provided the necessary philosophy and social programs, families would begin to feel free to discuss and address the issues. Finally, people studying early childhood curriculum are almost never exposed to this kind of training. This is largely due to the structure of the Korean educational system, which allows individual institutions or instructors to set the curriculum. “In spite of the wider social significance of what is taught to students in colleges and/or universities, college curriculum in contemporary Korea has been left largely to the discretion of individual institutions or professors under the cloak of academic freedom” (Kim, 2000, p. 55). If the cultural bias of professors and institutions of higher education means that there are no professionals emerging that are trained in early childhood development and the ways of specifically addressing mental health issues, the cycle of denial will only continue. This will be to the obvious detriment of society and the preventable harm to the countries citizens. Changes Needed Given the analysis of the impact of the social stigma of mental illness and its reflection upon the family within Koreans and Asian-American cultures, the changes needed to improve the quality of life of children and the early-onset treatment of mental health conditions are intuitive. These changes should include an official recognition of the issue, training of educators, professionals and families (through the provision of social programs as well as literature and public information initiatives), as well as a proactive social program of support and education in the community. It is only by acknowledging the problem that it can be solved. This has to occur on the governmental level as well as the family level. Cultural influences are an important part of any community’s life, but when that culture prevents the treatment of mentally ill patients with effective methods—and contributes a detrimental element to both individual and society—the culture needs to be adjusted. This is particularly true for early childhood conditions. The only way to effectively address this is through governmental policy and the training of professionals. Ironically, the Korean family is very proud when their children do well in school and grow up to be professionals; yet, the cultural bias against mental illness treatment prevents this very thing from happening. Through education and governmental social programs, these cultural deterrents to effective treatment can be mitigated and the entire Korean and Asian-American communities benefitted . References Adam (2007, July 6). 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