Post date: Sep 1, 2018 3:11:56 AM
When Freud established psychoanalysis with its emphasis on the identification and function of unconscious in the 1890s, there was a backdrop of European culture going through changes in literary, philosophical and scientific movements. Freud’s finding, in a way, is considered by some as a culmination of collective social and intellectual progression.
As the development of psychoanalysis originated in Western culture, Asians, specifically Chinese, have been slow to adapt to this modality as a treatment option for emotional disturbances. The concept of psychoanalysis and psychotherapy has often felt to be a foreign notion to many Asians. So it seems the lack of familiarity about the subject matter has been a significant barrier for the acceptance and utilization of psychoanalysis amongst Asians, and specifically, the Chinese.
Another commonly recognized barrier in Chinese culture for the practice of psychoanalysis seems to be the shame and stigma associated with emotional disturbances and mental illness. These Chinese phrases illustrate this effect: loss of face (沒面子，丟臉), keep scandals within family (家醜不外揚).
However, in the past twenty to thirty years, some significant changes have taken place. There has been increased awareness of mental illness through public education and dissemination of inform, which led to more sensitivity and recognition of emotional disturbances and symptoms, and the resulting willingness to explore psychological treatments. The economic development in China in recent decades most undeniably plays a role as a catalyst to bring about such a change.
One aspect of Chinese culture emphasizes efficiency; the speed in which a task can be completed. This tendency is mockingly portrayed by foreigners as a kind of motto amongst Chinese: “快, 快, 快.” The pronunciation of the word is kuai, meaning fast. So it is “fast, fast, fast,” or “hurry, hurry, hurry.” This cultural inclination often manifests itself, in psychotherapy or psychoanalysis, through questions at the onset of treatment such as: “how many sessions will it take?” and “Is there a kind of method you can teach me to handle this condition?” Additionally, this inclination can be seen through actions by simply dropping out of therapy.
Another area of difference between Eastern and Western culture, stereotypically, is that the latter emphasizes individualism, verbal ability and expressiveness of one’s emotions. On the other hand, Chinese culture, through the influence of the teachings of Confucius and other educators and philosophers, provide moralistic guidelines for one’s conduct in various relationships. These teachings emphasize a person’s role in relationships such as husband and wife, parent and child, between siblings, amongst neighbors, superiors and inferiors, and the emperor with commoners. It is quite likely that these moral standards and guidelines could be emotionally inhibiting. This reservedness compounded with unfamiliarity with the nature of psychotherapy and psychoanalysis might be part of the difficulty for Chinese patients committing to longer term treatments.
Another phenomenon worth mentioning entails my own experiences working with Chinese and Chinese-American patients and observations of other clinicians’ work and their experiences. When certain non-Asian patients are interested in pursuing treatment, they open up and discuss their budget in attempt to working out a treatment plan. It seems this kind of conversation rarely happens with Chinese patients based on my experience. The possible causes of such occurrence or the lack of it could be many. The speculations perhaps will be addressed in a different paper.
To understand early drop-out behaviors from psychological perspectives, I’m reminded what Bion, one of the most revered and profoundly studied psychoanalysts after Freud, once said that when two people meet, there stirs turbulent emotions in both (Bion, 1963). In order to accomplish anything or to get any work done, both are required to tolerate such turbulence. Freud said that people hates psychoanalysis because it reveals who they really are, not what they like to believe they are. Most people are dreary of the cost of a long psychoanalysis, however, what they are not aware of, nor ready to shoulder are the emotional costs in such an endeavor, above and beyond monetary expense (James Gooch in a personal conversation). In psychoanalytical pursuit, one is confronted with who he really is, not what he imagines himself to be, along with the memories of painful emotions of anxiety, despair, anger, hatred, envy and jealousy, to name a few.
The unwillingness or inability to deal with painful emotions results in specific symptoms or difficulties in a person’s life. But this very reason might also lead to avoidance of treatment. Another possible mechanism could be manic defense. The senses of all knowing and all capable implied in statements such as, “I don’t need anyone,” “I know what my problem is,” or more specifically, “I don’t need therapy.” These statements seem to have their early roots in omnipotence and omniscience.
Psychoanalysis or psychotherapy, in my opinion, can be seen as a second chance for childhood by revisiting the incidents and experiences that were traumatic, painful and difficult to come to terms with. Parents, as much as they love their children, are humans with their own flaws and limitations. Furthermore, depending on their own early childhood experiences, parents are most likely raise their children the way they had been raised. The parents could not give something to their children they themselves had never had. In fact, a baby’s multiplicity of needs could be overwhelming to a young mother. Depending on the mother’s, or the primary care giver’s attunement with the baby’s physical and emotional needs, which is referred to by Winnicott (1960) as primary maternal preoccupation, and maternal reverie by Bion (1962), the baby develops what Freud calls the apparatus of conscious awareness. This apparatus eventually develops thinking and feeling capabilities (Bion, 1956). The psychical functions, like the functions of our eyes and nose, provide the awareness of internal and external reality (Bion, 1953) . If the development of the apparatus of perception is being attacked or has gone awry, one can be like a blindman psychically, or a person without olfactory capability.
Life is an ongoing quest to learn about ourselves and the world surrounding us. With the rapid growth of technologies, the qualities of our lives might have been improved somewhat, and communications with others made more accessible on the one hand. On the other, our lives have become much more isolated and connection with others more tenuous through the very same technologies. The often seen and talked about restaurant scenes in which family members each staring at one’s cell phone without talking to each other. This compulsive, even addictive, use of cell phone and other electronic devises for internet access by children, adolescent and young adults alike is a pandemic condition. Perhaps that is another serious issue to be addressed independently of this short essay.
Bion, W. R. (1953). Notes on the Theory of Schizophrenia, paper presented in the Symposium “The Psychology of Schizophrenia” at the 18th International Psychoanalytical Congress in London.
Bion, W.R. (1956). Development of Schizophrenic Thought, in International Journal of Psycyoanalysis, Vol. 37, Parts 4-5,
Bion, W. R. (1962). A Theory of Thinking in International Journal of Psychoanalysis, Vol.43, Parts 4-5.
Bion, W. R. (1963). Elements of Psychoanalysis. London: Maresfield Library.
Winnicott, D. W. (1960). The Theory of the Parent-Infant Relationship. International Journal of Psychoanalysis, 41:585-595.