Psychiatria clin. I l : 8 7 -8 9 (1978)
Affective Disorder in Asian Immigrants1 M.F. Hussain and J.D. Gomersall Whitely Wood Clinic, Sheffield, and Department of Psychiatry, University of Sheffield, Sheffield
Abstract. Socio-cultural factors play a contributory role in presentation and symptom atology of affective illness. Cultural shock, communication barriers, fear of loss of racial identity, different child rearing attitudes and dietary restrictions may all contribute towards the manifestation of reactive depression. An understanding of the immigrant’s background will greatly help the therapist in management of his patient.
1 Paper presented at the International Congress on Transcultural Psychiatry, Bradford, England July 27-31, 1976.
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/4/2018 10:18:00 AM
The pattern of affective disorder varies considerably from one culture to another. Although all societies have a cultural heritage which is transmitted from one generation to the next the particular style varies from one group to another. Where contrast is marked it is possible to speak of different cultures. Thus cultures have been grouped as ‘Western’ and ‘Eastern’, ‘agricultural’ and ‘indus trial’. Some conditions such as demented, manic and stuprose states manifest themselves in a universally typical pattern and can be easily recognised in Asians or native population. However, in the individual reaction to past and present stress, whether this is expressed by classical neurotic response, psychosomatic symptoms or anti-social behaviour, the cultural influence will obviously be of major significance. Socio-cultural factors play a contributory role in the entire character, in presentation and symptomatology of the affective illness. Clinical experience of cross-cultural variations has confirmed this view. Feelings of guilt, paranoid ideas and obsessional symptoms are more marked in English studies. The city of Bradford proves the saying ‘The Asian is fortunate in that he takes Iris culture with him wherever he goes’. Asians settled in U.K. still differ in presenting symptoms of depression. The incidence of depression is as common amongst Asians in this country as it is in local population although the added stress of cultural shock, communication barriers, fears of loss of racial
88
identity, different child rearing attitudes and dietary restrictions may contribute towards reactive depressions manifestation. Asians’ varied religious practices, lack of proper educational, working and housing facilities and fear of being discriminated against do play a major role in aetiology. The sick role of the depressed person is acknowledged in Western and East ern literature although unlike the situation in the West, hypochondriasis is more common in the East though there are rarely nihilistic attitudes, feelings of guilt, paranoid symptoms or suicide. The symptoms with greater frequency in Asians are a preponderance of somatized symptoms and complaints such as generalised weakness, bowel con sciousness, pre-occupation with the fear of having a heart attack, concern about sexual potency and the health of genital organs, loss of semen in urine or nocturnal emission. All these may mislead the Western trained doctor to advise the patient to have extensive physical check-ups or repeated laboratory investi gations thus exaggerating a neurotic depression. Sometimes the severity of symptoms is evident in the presenting picture. This may be due to delayed consultation as a result of ignorance, superstitions, beliefs, prejudice against modern medicine, or the ill person’s persisting in the use of herbal medicine or amulets from the local priest. The stigma of being admit ted to a psychiatric hospital affects part of the extended family or community. The fear of being deported often gives rise to this late consultation and pres entation with unnecessary severe symptoms. The immigrant tends to respond to stress according to the cultures of his childhood environment. The early development influences to which an Asian child is exposed emphasize a sense of belongingness to the family and a sense of responsibility towards the family members, leading in turn to formation of a superego which has more a social than a personal character. My personal experience with Asian patients from this country is that the second generation, having been educated here and brought up in a Western culture, find it difficult to conform to the family set-up and acquire a sense of independence. At an early age they find it difficult to adjust smoothly to their parents’ attitudes and authority and their own preference for the native culture. Anxiety and depression in the adolescents of second generation has to be treated, taking this difficulty into consideration. The attitude of passivity, am bivalence, non-violence and morbid introspection causes the mental breakdown to be directed inwardly rather than to be projected upon the environment. Practical problems like co-education, arranged marriages, sexual liberty and the manner of dressing of the adolescents born here can lead to feelings of depression in parents when they see the lack of conformation to their own ideals by their own children. The social breakdown syndrome concept assumes a very direct relationship
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/4/2018 10:18:00 AM
Hussain/Gomersall
Affective Disorders in Asian Immigrants
89
Dr. M.F. Hussain, M.R.C. Psych., D.P.M., Consultant Psychiatrist, St. Augustines Hospital, Chartham, Canterbury, Kent CT4 7LL (England)
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/4/2018 10:18:00 AM
between the surroundings of a mentally ill person and the cause of his illness. Therefore, psychiatrists must have information available to them about the total environment of the individual patient, that person’s family, Iris home com munity, the background of his culture and sub-culture — and that information must be as precise and as personal as can possibly be achieved. What general conclusion can be drawn? Some of the questions posed are unanswerable as much more work remains to be done on the psychiatric problems of Asian immigrants, especially as they now form a substantial and permanent part of the population of Great Britain. Transcultural psychiatry has its practical applications. In actual management of patients, due regard should be given to cultural considerations. An understanding of the immigrants’ background will greatly help the therapist in the management of his patient.
Affective Disorder in Asian Immigrants1 M.F. Hussain and J.D. Gomersall Whitely Wood Clinic, Sheffield, and Department of Psychiatry, University of Sheffield, Sheffield
Abstract. Socio-cultural factors play a contributory role in presentation and symptom atology of affective illness. Cultural shock, communication barriers, fear of loss of racial identity, different child rearing attitudes and dietary restrictions may all contribute towards the manifestation of reactive depression. An understanding of the immigrant’s background will greatly help the therapist in management of his patient.
1 Paper presented at the International Congress on Transcultural Psychiatry, Bradford, England July 27-31, 1976.
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/4/2018 10:18:00 AM
The pattern of affective disorder varies considerably from one culture to another. Although all societies have a cultural heritage which is transmitted from one generation to the next the particular style varies from one group to another. Where contrast is marked it is possible to speak of different cultures. Thus cultures have been grouped as ‘Western’ and ‘Eastern’, ‘agricultural’ and ‘indus trial’. Some conditions such as demented, manic and stuprose states manifest themselves in a universally typical pattern and can be easily recognised in Asians or native population. However, in the individual reaction to past and present stress, whether this is expressed by classical neurotic response, psychosomatic symptoms or anti-social behaviour, the cultural influence will obviously be of major significance. Socio-cultural factors play a contributory role in the entire character, in presentation and symptomatology of the affective illness. Clinical experience of cross-cultural variations has confirmed this view. Feelings of guilt, paranoid ideas and obsessional symptoms are more marked in English studies. The city of Bradford proves the saying ‘The Asian is fortunate in that he takes Iris culture with him wherever he goes’. Asians settled in U.K. still differ in presenting symptoms of depression. The incidence of depression is as common amongst Asians in this country as it is in local population although the added stress of cultural shock, communication barriers, fears of loss of racial
88
identity, different child rearing attitudes and dietary restrictions may contribute towards reactive depressions manifestation. Asians’ varied religious practices, lack of proper educational, working and housing facilities and fear of being discriminated against do play a major role in aetiology. The sick role of the depressed person is acknowledged in Western and East ern literature although unlike the situation in the West, hypochondriasis is more common in the East though there are rarely nihilistic attitudes, feelings of guilt, paranoid symptoms or suicide. The symptoms with greater frequency in Asians are a preponderance of somatized symptoms and complaints such as generalised weakness, bowel con sciousness, pre-occupation with the fear of having a heart attack, concern about sexual potency and the health of genital organs, loss of semen in urine or nocturnal emission. All these may mislead the Western trained doctor to advise the patient to have extensive physical check-ups or repeated laboratory investi gations thus exaggerating a neurotic depression. Sometimes the severity of symptoms is evident in the presenting picture. This may be due to delayed consultation as a result of ignorance, superstitions, beliefs, prejudice against modern medicine, or the ill person’s persisting in the use of herbal medicine or amulets from the local priest. The stigma of being admit ted to a psychiatric hospital affects part of the extended family or community. The fear of being deported often gives rise to this late consultation and pres entation with unnecessary severe symptoms. The immigrant tends to respond to stress according to the cultures of his childhood environment. The early development influences to which an Asian child is exposed emphasize a sense of belongingness to the family and a sense of responsibility towards the family members, leading in turn to formation of a superego which has more a social than a personal character. My personal experience with Asian patients from this country is that the second generation, having been educated here and brought up in a Western culture, find it difficult to conform to the family set-up and acquire a sense of independence. At an early age they find it difficult to adjust smoothly to their parents’ attitudes and authority and their own preference for the native culture. Anxiety and depression in the adolescents of second generation has to be treated, taking this difficulty into consideration. The attitude of passivity, am bivalence, non-violence and morbid introspection causes the mental breakdown to be directed inwardly rather than to be projected upon the environment. Practical problems like co-education, arranged marriages, sexual liberty and the manner of dressing of the adolescents born here can lead to feelings of depression in parents when they see the lack of conformation to their own ideals by their own children. The social breakdown syndrome concept assumes a very direct relationship
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/4/2018 10:18:00 AM
Hussain/Gomersall
Affective Disorders in Asian Immigrants
89
Dr. M.F. Hussain, M.R.C. Psych., D.P.M., Consultant Psychiatrist, St. Augustines Hospital, Chartham, Canterbury, Kent CT4 7LL (England)
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/4/2018 10:18:00 AM
between the surroundings of a mentally ill person and the cause of his illness. Therefore, psychiatrists must have information available to them about the total environment of the individual patient, that person’s family, Iris home com munity, the background of his culture and sub-culture — and that information must be as precise and as personal as can possibly be achieved. What general conclusion can be drawn? Some of the questions posed are unanswerable as much more work remains to be done on the psychiatric problems of Asian immigrants, especially as they now form a substantial and permanent part of the population of Great Britain. Transcultural psychiatry has its practical applications. In actual management of patients, due regard should be given to cultural considerations. An understanding of the immigrants’ background will greatly help the therapist in the management of his patient.
