29 Mar 2018
In recent decades, globalization has influenced economic development, political action, and means of social interaction. With increased interconnectedness, many cultures have begun to acquire Western ideology due to various channels of communication and access to Western advancements. Although some may view interconnectedness as a progressive movement, Ethan Watters’ 2010 book, Crazy Like Us: The Globalization of the American Psyche, explores the effects of globalization on the perception of mental health and the preservation of cultural authenticity. This essay will explore the controversy surrounding the globalization of psychological practices and the social construction of global standards that influence clinical diagnosis and treatment techniques. In addition, I will examine Edward Sampson’s 1993 book, Celebrating the Other: A Dialogue Account of Human Nature and the importance of establishing dialogic interactions in order to ameliorate the power dynamic that frequently exists between therapists and culturally diverse clients. Lastly, I will discuss the need for a fundamental shift in the value of cultural differences in order to understand the complexities of human behavior and foster intellectual growth worldwide.
Keywords: globalization, culture, mental health
The Morality of Globalization
Throughout history, civilizations have influenced and conquered other cultures with the hope of becoming a dominant and enduring world power. The social, political, and economic progression of these dominant societies continues to influence and determine the expectations and aspirations of many cultures around the world (Sampson, 1993; Watters, 2010). For instance, the Ancient Greeks first developed the ideals of democracy or a government ruled by the people. Throughout the course of history, the democratic ideals continue to be a constitution that many countries fight for in order to gain or protect their independence from dictating authority (Robbins, 2007).
In recent decades, the advancements in technology, social media, transportation, and globalization of consumer goods have assisted in making our world increasingly interconnected. Many cultures have begun to acquire Western ideology due to various means of communication and access to Western advancements in medical discoveries, political action, and economic development. Although some may view interconnectedness as a progressive movement, it is important to acknowledge the psychological and cultural cost of globalization (Watters, 2010). This essay will explore the controversy surrounding the globalization of psychological practices and the social construction of global standards that influence clinical diagnosis, treatment techniques, and the importance of considering ethical implications regarding the preservation of cultural authenticity.
The Conflict of Globalization
The influence of Westernized systems and beliefs continues to spread around the world at a rapid pace. It is difficult to travel abroad without seeing a Starbucks, McDonalds, or an internet café on every street corner. With continued technological advancements, society has become dependent on electronic forms of communication and we tend to feel isolated without access to Facebook, Google, or BBC News. Some argue that globalization provides an opportunity to strengthen the recognition of human rights, produce openness to new cultural experiences, eliminate cultural barriers, and create dialogue about cultural differences (Chiu & Cheng, 2007). Furthermore, research indicates that increased access to information about other cultural traditions generates stronger cultural identities and fosters more effective problem solving skills by incorporating other cultural strategies like meditation and mindfulness into personal development (Chiu & Cheng, 2007).
In addition, some view culture as a dynamic system rather than an established set of cultural guidelines of a community and is therefore, thought to be continuously evolving in response to environmental changes and cultural “hybridization” due to the effects of globalization (Kirmayer, 2006). Lastly, the concept of universal biological processes, physiological responses, and psychological well-being that connects humanity may foster the effects of globalization by justifying the continuous spread of Western ideology for the “global good” (Bhugra & Mastrogianni, 2004). This assumption of biological and psychological unity among humans validates Westerners who feel obligated to provide care to other cultures based on the belief that they have more advanced and accurate understandings of medical and psychological processes than other developing countries.
On the other hand, many are wary of the cultural impact associated with globalization and the irreversible damage of diluting cultural beliefs and practices that help form cultural identity and communal responsibility (Watters, 2010). The formation of ethnic identity may be instrumental in the development of self-esteem, coping mechanisms, and culturally appropriate responses. Globalization may also alter previously determined social contracts within a community resulting in a divide rather than unity between members, which may hinder psychological well-being and social functioning (Bhugra & Mastrogianni, 2004; Watters, 2010). To illustrate this point, Edward Sampson (1993) discusses the cultural impact Western education has on young Samoan children and their communal traditions of supporting others. He states, “they learn to dispense with their Samoan world-view and its notion of a supporter…and to take on the attributes of a Western, self-contained individual” (Sampson, 1993, p. 69). The gradual change of cultural dynamics within a society due to the globalization of Western ideology and the emphasis on independence rather than interdependence may have adverse effects on the prevalence of psychopathology by creating weaker community ties between its members (Timimi, 2005; Watters, 2010). Lastly, the idea of cultural homogeny due to the effects of globalization may lead to conflicts and destabilization between communities who value their cultural background and resist the influence of Westernization (Chiu & Cheng, 2007; Watters, 2010).
Implications for Westernizing Psychology
Although some may argue that interconnectedness creates more cultural competence, Ethan Watters’ 2010 book, Crazy Like Us: The Globalization of the American Psyche, discusses the problematic influences of globalization in regards to cross-cultural psychological practices. According to Watters (2010), “we are engaged in the grand project of Americanizing the world’s understanding of the human mind” (p. 1). The way in which we understand the human mind is a social construct that gradually develops and is what society adheres to in order to comprehend internal emotional states, cognitive processes, and behavioral responses of ourselves and of others.
In regards to psychology, the Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines and discusses the standards that Western societies have determined to be atypical for human behavior and mental health. The influence of the DSM around the world may lead to overdiagnosis of mental disorders based on inadequate training or familiarization of Westernized constructs regarding psychological processes. That said, the ideology of human nature is not universal and it is important not to assume similarities of mental states between cultural groups. When we do, we are enforcing Westernized standards and constructs of mental health onto other cultures and thereby diluting the authenticity of cultural perceptions, symptomology, and treatment of mental illness.
Watters (2010), discusses this matter through an example of the development and prevalence of anorexia in Hong Kong. Prior to 1994, anorexia was a rare occurrence described as the somatic inability to consume nutrients due to throat blockages and abdominal pain, and had nothing to do with weight loss or body image. However, after the publicity stemming from a young girls death from starvation, the prevalence of anorexia increased dramatically which led to an influx of Westernized understanding of the disorder, associated symptomology, and interventions for anorexia. According to Edward Shorter, as discussed in Watters (2010), when symptoms become more socially acceptable as a manifestation of mental illness, the prevalence of such symptoms increase as a way to express internal distress. These ‘symptom pools’ are culturally determined and driven in a manner that reinforces the social constructs of how we identify and perceive mental illness (Watters, 2010).
From a cultural perspective, introducing descriptions of mental illness and criteria for diagnoses into communities who are unaccustomed to Westernized ideology may have damaging effects including increased stigmatization and maltreatment of the mentally ill. To prevent cultural stigmas, many individuals with mental illness avoid seeking treatment in fear of the consequences including social ostracism and involuntary detainment and possible abuse in mental institutions (Saxena, Thornicroft, Knapp, & Whiteford, 2007). On the other hand, the novelty of Westernized mental standards and expectations may amplify symptomology in those experiencing emotional distress by causing increased attention and concentration on behavior considered culturally abnormal (Aceves-Avila, Ferrari, & Ramos-Remus, 2004). When communities label certain behaviors as atypical in accordance to Western criteria, non-Western cultures may fear the unfamiliarity of mental diagnoses, lack sufficiently trained clinical professionals, and may be uninformed of appropriate treatment interventions.
Based on these social constructs, Western societies have created and implemented a monological perception of mental health. As discussed in Edward Sampson’s 1993 book, Celebrating the Other: A Dialogue Account of Human Nature, dominant groups create and maintain the constructs of society in order to serve and sustain their own “ needs, values, interests, and points of view” (p. 4). To demonstrate the concept of a monologic perception in relation to psychological practice, Watters (2010) discusses the attempt of clinical professionals to alleviate psychological distress of Sri Lankan tsunami survivors. Based on this account, several clinical professionals who came to help survivors arrived with preconceived assumptions about the nature of distress and effective treatment methods to address post-traumatic stress disorder (PTSD). The inability to look beyond Westernized social constructs of mental health including the notion that disastrous circumstances are the driving force behind PTSD symptomology, inevitably inhibited clinical professionals from providing effective treatment for those affected by the tsunami.
Although the determination to help tsunami survivors was admirable and undoubtedly based on good intentions, I believe that it was also a method of sustaining one’s clinical expertise in a culture with limited access to Westernized beliefs about mental health. The influx of counseling assistance created an almost barbaric environment in which clinicians fought over client care, handed out anti-depressants like candy, and used survivors as Guinean pigs for clinical research (Watters, 2010). Furthermore, the clinicians behaved unethically when treating vulnerable survivors who had difficulty comprehending their treatment and whose traditional Sri Lankan beliefs were subordinate to Western standards of psychology. These behaviors may have caused more harm than good and consequently violated the general principles listed the American Psychological Association’s Ethical Code of Conduct including beneficence, integrity, and respect for human rights and dignity (APA, 2002).
This behavior highlights the importance of generating a dialogical relationship with others in order to ameliorate the power dynamic that frequently exists between therapists and clients. Sampson (1993) describes a genuine dialogue as requiring “two separable presences, each coming from its own standpoint, expressing and enacting its own particular specificity. To speak of celebrating the other, therefore, is to call for just a dialogue, not the self-celebratory monologues that have thus far dominated our understanding and our practice” (p. 15). Creating a dialogue with clients may help clinical professionals understand the subjective complexities involved in mental health including religion, cultural traditions, cultural understanding, ethnicity, and resiliency. The variability of symptoms and treatment methods that adhere to cultural beliefs regarding mental illness further stresses the importance of dialogical techniques in clinical settings.
In order to accomplish successful dialogue with culturally diverse clients, it is important to self-reflect on our biases, prejudices, and preconceptions of mental illness. Moreover, we need to recognize the limitations of creating universal standards of psychopathology based on Western beliefs. Although the fifth edition of the DSM (2013) includes sections involved in Cultural Formation and Culturally Bound Syndromes, it is not a comprehensive understanding of all differences between cultural communities around the world. As cultures continue to blend, remaining culturally sensitive and cognizant of personal biases is instrumental in therapeutic practices. In this regard, I believe it is important to self-reflect on how our biases may affect our ability to provide effective treatment to diverse populations (Moffett, 2009).
Self-reflection allows us to take a step back from the ingrained social constructs of Western society and provides an opportunity for clinical professionals to change the way we address mental health around the world without the preconceived notions and assumptions that tend to influence our judgment and ability to empathize with clients. Although cultural empathy is difficult to achieve based on the inability of most clinical professionals to relate to the effects of genocide, war, and deprivation, it is important to be mindful of important cultural differences including cultural dynamics, discrimination, historical contexts, and cultural views toward mental health. Furthermore, research suggests that culturally diverse clients consider their therapists more competent and empathetic when they acknowledged cultural differences and were cognizant of their client’s cultural beliefs (Chung & Bemak, 2002).
Developing a global psychology may be essential to break away from the Westernized mindset of how we perceive mental illness and allow us to appreciate perceptional differences (Marsella, 1998). Although globalization appears to be inevitable based on social, political, economic, and environmental events that continue to make our world increasingly interconnected, it does not necessarily have to be associated with the ethnocentric view of Western society. In order to continue advancing our knowledge of psychological processes and behavioral responses, it is essential to understand the perspectives of other cultures. There needs to be a fundamental shift in the value of cultural differences in order to understand the complexities of human behavior and foster intellectual growth. As discussed in Marsella (1998), “Western psychology will need to be repositioned as one of many psychologies worldwide rather than as the only or dominant psychology” (p.1286).
The idea of global psychology may sound impractical and idealistic; however, if psychologists on a global scale can preserve the cultural meaning, perception, and understanding of mental health in non-Western cultures, we may be able to avoid homogenizing mental illness in adherence to Western ideology. As Watters (2010) discussed, in order to reduce the influence of Western psychopathology around the world, we need to diminish the meaning that society has given mental health. From a historical perspective, the psychology community has regarded certain behaviors including hysteria and homosexuality as abnormal and subsequently altered their perspective as society’s perception of mental health changed. The definition of mental health continues to develop which has influenced multiple revisions to the DSM and the behavioral standards of Western society. The ability to diffuse the meaning and characteristics of mental disorders may consequently decrease the prevalence of symptomology and lessen societal value attached to mental illness.
Although this transition will not happen over-night, it is important for society to acknowledge the detriment that Western ideologies have caused to the survival of indigenous cultures and traditions. By implementing a more global standard of psychology, I believe we will restructure the perception of mental illness and provide an opportunity for local psychologies to re-establish their influence to the cultural understanding of human nature.
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