Chinese Culture and Mental Health

PART I

CULTURE, SOCIETY, AND PERSONALITY

INTRODUCTION TO CULTURE, SOCIETY, AND PERSONALITY

In order to understand fully the cultural aspect of mental health, it is essential to have adequate knowledge about the society, culture, and people we are concerned with. It is the aim of this introduction to address the Chinese background.

In the first chapter, Wu and Tseng begin by pointing out that there are different courses of sociocultural change undertaken in different Chinese communities. Then they describe common characteristics of Chinese culture shared by all ethnic Chinese, whether in the homeland or other settings.

Chu (Chapter 2) analyzes the emergence of a new culture in mainland China, which was brought about by the process of social reform and indoctrination and was influenced by cultural revolution. As a result of the emergence of this new culture, varying elements of Chinese culture are discerned in different generations: Both tradition and change shape the future of culture in China.

In Chapter 3, the concept of Chinese personality is elaborated by King and Bond, both sociologists. Most scholars view Confucianism as a social theory that tends to mold the Chinese into group-oriented, socially interdependent beings. However, King and Bond point out that the Confucian paradigm of man has the theoretical thrust, as well as a built-in structural imperative, to develop humans into relation-oriented individuals who are not only socially responsive and interdependent, but also capable of assuming self-directed roles in constructing their social world.

In Chapter 4, Song describes her psychometric study of the character traits of the Chinese people. Using the Chinese version of the Minnesota Multiphasic Personality Inventory (MMPI), she found that the Chinese character profile contrasts with its American counterpart in several aspects. The Chinese are emotionally more reserved, introverted, fond of tranquility, overly considerate, socially overly cautious, and habituated to self-restraint. These traits are not only manifested in the test results, but also are corroborated in the daily lives of the Chinese people.

Following this discussion of personality, is Y. Y. Li’s (Chapter 5) review of social change and religious movements and their relation to personality adjustment. From the anthropological point of view, he describes and categorizes the religious cults prevailing in the rapidly changing society of Taiwan. Li then correlates the various types of cults with the personal adjustments to social change of their members and with shifting patterns of the society itself.

Part I concludes with T’ien’s study of traditional views on mental illness in Chapter 6. From ancient records and medical books, he draws the basis for formulating the ancient Chinese concept of mental disorder. He also uses descriptions of emotional disturbance in the popular literature of pre-modern times to present insights into the psychic unity of the Chinese people.

CHAPTER 1

Introduction: The Characteristics of Chinese Culture

David Y.H. Wu and Wen-Shing Tseng

Publisher Summary

The chapter discusses the contemporary situations in Chinese culture that relate to social structure, sociocultural change, and the relationship of these factors to the current state of mental health of the Chinese people. The chapter focuses on the issues of mind, body, and behavior. The cultural framework is of central concern to Chinese participants, whether they are social scientists, humanists, or clinical psychiatrists. Chinese culture appears to affect the state of body and health, parent–child interaction, social relationships, individual and group aspirations, models of health care services, and the patterns of disorders and methods of coping under the impact of migration, industrialization, and urbanization. The chapter focuses on the importance of the impact of cultural tradition upon perception, behavioral orientation, pathology, coping, and help-seeking. The mental health concerns that are relevant to the population of mainland China are related to the recent dramatic socialist revolution and particularly to the 10-year period of the Cultural Revolution.

BACKGROUND

Whether it is published in Chinese or English, the literature relevant to Chinese culture and mental health is scarce. Thus, the essays in this volume, which focus upon contemporary situations in Chinese culture and which relate to social structure, sociocultural change, and the relationship of these factors to the current state of mental health of the Chinese people, afford valuable scholarly insights unlikely to be otherwise encountered. This volume records a unique meeting of Chinese minds, a congress of scholars who dealt with the issues of mind, body, and behavior.

Mental health issues most often deal with the normal and abnormal states of the mind (see Kleinman and Lin, 1981), with culture being seen as the arbiter of rules of conduct in the minds of individuals in a particular culture (Geertz, 1973; Keesing, 1974). In this overview of Chinese culture and mental health, we present case after case showing that the cultural framework is of central concern to this group of Chinese participants, whether they be social scientists, humanists, or clinical psychiatrists. Chinese culture as a way of thinking appears to affect the state of body and health, parent–child interaction, social relationships, individual and group aspirations, models of health care services, and above all, as emphasized in several parts of this volume, the patterns of disorders as well as methods of coping under the impact of migration, industrialization, and urbanization. It is striking to see here the convergence of scholarly views from experts in Chinese communities that are physically distant from each other as well as disparate in social systems. It also appears that the sociobehavioral scientists and psychiatrists represented in this volume more often than not agree on the importance of the impact of cultural tradition upon perception, behavioral orientation, pathology, coping, and help-seeking. Throughout this volume, common concerns addressed by our authors can be summarized in the following questions:

1. What are the characteristics of the Chinese culture? What are some of the recent changes in different Chinese communities? How are these changes related to mental health issues?

2. Are these mental health or psychological problems peculiar to the Chinese? What are common factors of mental illness that are evident in Chinese society?

3. What kinds of coping methods in response to environmental and cultural change are distinctively culturally related?

4. What are some of the popular ways of delivering mental health services in the Chinese society?

DIFFERENT COURSES OF SOCIOCULTURAL CHANGE

Before we attempt to answer these questions, it is appropriate for us to know whether the various Chinese societies represented in the present volume are comparable units for comparison. In other words, do they all reflect the same Chinese culture on the basis of which an investigation of the behavioral and mental health issues can be conducted? We cannot deny the fact that all the societies under discussion share certain common features in their cultural backgrounds, but we cannot ignore the separation in time and space of these societies, in addition to the effects of recent socioeconomic changes. If indeed we could document a variety of patterns of changes occurring in these societies and if we could note the persistence of common cultural characteristics, we could then discuss those mental health issues pertinent to a contemporary Chinese culture.

A quick review of the recent history of the Chinese societies represented here leads us to see three kinds of sociocultural change: One can be observed in mainland China; one is characteristic of Hong Kong and Taiwan; and another is found in immigrant Chinese communities overseas, such as those in Australia, Singapore, and the United States. These three categories of change have given rise to dissimilar social as well as individual problems that warrant the attention of mental health professionals and researchers.

In mainland China, dramatic change has taken place in both the socio-political system as well as in social ideology. However, it is uncertain to what degree these changes have affected the cultural behavior, or rules of conduct, of the population. Until recently, little research information in this area has been available. Given the fact that 75% of the population remains involved in agricultural production, with little change noticeable in the agrarian way of life, we might not anticipate the kind of change occurring elsewhere due to forces of industrialization, Westernization, and urbanization. This is why the term Chinese model of development has been used in the literature. The mental health concerns that are relevant to the population of mainland China, as indicated in several chapters by resident specialists contributing to this volume, are related to the recent dramatic socialist revolution and particularly to the 10-year period of the Cultural Revolution. While the legacy of the Cultural Revolution has not been specifically dealt with by the mental health professionals from China, cer-tain legacies of such a drastic sociopolitical movement—explicit societal concern for the general moral order and education for the young—have been quite revealing in our discussions. In short, a concern for constructing (or reconstructing) society for the future generation of Chinese has become the central issue with regard to maintaining good mental health.

In the decades after World War II, Hong Kong and Taiwan shared a similar course of socioeconomic development. Both underwent rapid growth in light industry and expanded export-oriented international trade. The two societies also share the demographical feature of a large, dislocated migrant population. While mental health problems are often associated with migration in Western literature, they did not surface as serious issues for the Chinese society in Hong Kong or in Taiwan. The more salient issue is the impact of economic development and population growth on the urban centers, where the change of life-styles due to economic affluence may have caused many of the mental disorders and social ills that are new to the society. One important issue that requires further research is the macropolitical situation in the society. How does individual concern with continuing political instability and uncertainty affect the mental health of the entire society? Investigation relevant to this question may well yield clues to the more profound problems of group and individual well-being. (If the concepts health, adjusted, and well can be linked to the improving economic situation and rising standard of living, the people in Hong Kong and Taiwan could be said to be coping quite well.)

Among the immigrant Chinese in Australia, Singapore, and the United States, cultural adjustment and cultural identity have deep meaning even after the passing of several generations. The successful, socioculturally adjusted, elite Chinese in Hawaii (see Lum and Char, Chapter 15, this volume), take pride in a Chinese culture they claim to possess but find difficult to pinpoint. As generations pass, the roots of Chinese culture begin to disappear, yet individuals continue to express their interest in maintaining a Chinese identity.

In contrast to these nostalgic sentiments concerning cultural identity expressed by Chinese Americans, the cultural adjustment process among the Chinese in Singapore takes the form of official state-level planning and intervention. In Chapter 13, Kuo deals with language policy and shows that the selection of an official language can be considered one index of cultural or behavioral norms. Therefore, speakers of Mandarin in Singapore could be seen as subscribing to a traditional Chinese cultural norm. Yet it is clear that the effects on individual identity and on behavioral norms in the society are far more complicated than was anticipated by those leaders who saw a simplistic relationship between language and culture.

Tsoi, in Chapter 16, offers an intriguing revelation about the superficial Westernization of a society in which traditional religious behavior is closely related to mental illness as well as to processes of healing. The Singaporean Chinese case thus provides us with one of the most interesting cases for examining further the study of culture identity and mental health.

COMMON CHARACTERISTICS OF CHINESE CULTURE

From the point of view of population adjustment and adaptation to culture and sociopolitical changes, we recognize the three previously mentioned types of process. We must ask what characteristics of Chinese cultural behavior, as manifested in individual behavior, group organization, social relationships, and emotional and psychological concerns, have persisted in the face of such changes and what is prototypically Chinese. We find it interesting that, indeed, we are able to extract some common characteristics of Chinese culture as we go through each chapter in this volume. We abstract some of these common features.

Family and Collective Responsibility

Perhaps most central to Chinese culture is the value of the family as the fundamental unit of the society. This concern permeates all sociopolitical activities. J. Hsu (Chapter 8) recognizes the Chinese family system, not the individual, as the focal point of psychotherapy. King and Bond (Chapter 3) discuss Confucian ethics and emphasize the collective quality in the nature of the individual’s life and behavior. The meaning of face, for example, should be viewed in relation to the gain or loss of the status of the family, not just of the individual. Though King and Bond argue for the existence of individuality and initiative under the Confucian paradigm, the existing literature often associates individual achievement and proper conduct with that of the family.

Family relationships are, to this day, perceived as essential in mainland China, despite the extreme changes that have taken place in the sociopolitical structures beyond family. X. T. Li (Chapter 7) reports recent occurrences of individuals coming together to construct a family by uniting members who have no actual kin relationship. The significance of these remarkable examples lies in the fact that caring for family structure and relationship is dear to the hearts of the Chinese people. Therefore, we are not surprised to learn from the overseas ethnic Chinese, as shown in the Hawaiian case in Chapter 15, that a strong sense of obligation and responsibility to one’s family is still cherished as Chinese virtue, whereas values in other areas may have given way to Western influence.

However, psychological problems may be generated in a seemingly closely knit family. On the one hand, J. Hsu (Chapter 8) lists the following as common problems in the family: inadequate parent-child communication, the generation gap, split loyalties, and sibling rivalries. Hsu holds that these problems may be considered inherent in Chinese family relations, especially as they concern relationships between parents and children. Wu (Chapter 9), on the other hand, emphasizes the parent-child bond in early childhood. The paradox in the Chinese family of bonds and interdependence versus lack of communication and the generation gap perhaps will be better understood if future studies concentrate on the Chinese style of nonverbal emotional expression. The fact that Chinese patients are in-clinded to exhibit somatic compliance rather than to express problems in emotional or psychological terms, as indicated in earlier literature and in Cheung’s Chapter 19, serves to suggest the existence of interpersonal com-munication patterns that are peculiarly Chinese.

Emphasis on the Parent–Child Bond

The process of child socialization may provide clues to the reasons for the persistence of a closely knit family as the center of Chinese culture. Wu (Chapter 9) describes in detail the ways in which children are encouraged to be both physically and emotionally close to their parents through sharing common as well as social activities. During the conference discussion, C. C. Hsu confirmed that child-rearing patterns in Taiwan are quite similar to Wu’s ethnographical report on an overseas community.

Since we presently have no research information about the child’s so-cialization process in mainland China, we hope that very soon research will be undertaken and that the kind of rudimentary data presented by Wu will be made available. Such research would help to establish some analysis as to whether the prevailing cultural values in China have indeed shaped the current child-rearing and training practices. It also would be hlepful if C. C. Hsu’s (Chapter 10) research methods in assessing infant temperament could be used among various mainland Chinese communities in a way that would test some of the mental health hypotheses associating early childhood emotion and temperament.

As the size of the Chinese family changes, because the official policy limits a married couple to one child, the mainland Chinese are now preoccupied with the task of properly rearing a healthy and disciplined only child. This fact increases the significance of Tao and Chiu’s (Chapter 11) discussion of the one-child family. Consistency and variation in child rearing, differences in training practices between rural and urban areas, and variations in rearing between the one-child families and multiple-child families remain to be studied. Certainly, there are other interesting potential consequences if the one-child family should become the norm in mainland China. The role of kinship and the relationships of the parent to the child and the grandparent to the grandchild need to be researched. Some of the resulting societal changes may well be unprecedented in human social and cultural history.

Another question worth pondering with regard to the Chinese family and culture involves the antecedents of culture change. Chu (Chapter 2) sees the change taking place in mainland China as having its source in the younger generation. He attributes the changing perceptions and cultural values of rebellious youth in contemporary China to the lack of socialization provided by traditional culture. This suggestion leads us to a more profound theorizing in testing the relative influences of early child socialization as compared to the effect of a powerful sociopolitical movement.

The Art of Social Interaction and the Importance of the Personal Network

Another aspect of Chinese culture that surfaces in our discussions in various chapters is the Chinese art of handling social interaction and personal relationships. King and Bond (Chapter 3) illustrate an important aspect of Chinese culture as revealed in the seemingly oppressive Confucian cultural ideal. Because this ideal is not to be found in actual cultural behavior among Chinese individuals, Confucian conformity to cultural norms is nothing more than superficial conformity.

If one accepts this superficial conformity to sociocultural norms of conduct as a prevailing force in shaping Chinese perception and behavior in social interaction, it is not surprising that many social and political movements aimed at making fundamental changes in mainland Chinese society have not worked. Indeed, many traditional patterns of social interaction that are diametrically opposed to the new sociocultural ideals—such as using the back door (i.e., unorthodox approaches) or personal ties for one’s gains—have once again surfaced in the aftermath of drastic political reform.

Pragmatism is perhaps a better term to characterize this discrepancy between cultural ideal and actual behavior. One finds a similar attitude expressed in the Chinese concept of a greater personal network outside of the family structure. In Chapter 14, Lee makes a convincing presentation on this point in analyzing Hong Kong’s Chinese society. The distinguishing of insider from outsider (non-family member) was a traditional, ideal practice, which seems now to have given way to a more personalized network that serves pragmatic purposes. However, the situation may not be due to sociocultural change but may simply reflect the perception of the researchers.

In Y. Y. Li’s Chapter 5, we again find evidence of the use of a nonkinship group as a means of adjusting to urban life among the increasing number of religious cult groups. These groups consist predominantly of migrants from rural areas and form the lower socioeconomic stratum of the industrialized society. Some of these new religious cults are more successful than others in attracting followers, and this fact further illustrates that the continuity of certain personality types are associated with traditional values and conform to collective group norms.Control of Emotion and Cultivation of Morality

From childhood, Chinese are trained to control emotions that are considered adverse and disruptive to harmonious social interaction. Punishment of aggressive behavior among children is a characteristic Chinese child-training technique that may account for the learning of self-control and emotional restraint at an early age (see Wu, Chapter 9). Emotional control among the Chinese may also be seen in the report that in Hong Kong, despite the extreme population density of the dislocated migrants from the mainland, the rate of occurrence of emotional problems is lower than that for Thais, Malays, and Indians in their homelands (Lee, Chapter 14).

Song’s findings in this regard (Chapter 4) were based upon data provided by the Minnesota Multiphasic Personality Inventory (MMPI) tests, the first MMPI tests ever done on the mainland of China. In contrast to the personality profile reported for Westerners, the mainland Chinese are still found to be emotionally more reserved, introverted, fond of tranquility, overly considerate, socially overcautious, habituated to self-restraint. This finding adds additional evidence to our confident assertion that there is continuity of certain culture values and cultural behavior on the Chinese mainland despite some four decades of dramatic political and social reform.

Song attributes this continuity in personality traits to Confucian thought, which for two thousand years has dominated the Chinese code of conduct and which never ceased in its influence on Chinese society.

The data from the MMPI tests conducted in mainland China reveal one kind of change that must have been the result of conscious official social intervention. This is shown in the higher masculinity score of Chinese women as compared to women in Hong Kong, Japan, and Europe and America. Women who are liberated from the passive domestive role are now actively participating in sociopolitical life and in productivity. It would be interesting for our cross-cultural study of mental health to evaluate the next generation of Chinese women and compare our findings with those of studies of other societies.

Song’s chapter parallels several other chapters in which the authors from China pay marked attention to the question of the moral standards of the current younger generation (see Tao, Chapter 11; Xu, Chapter 12). Viewing this concern with social order and moral standards in social conduct in the context of a long Confucian moral tradition in China, current societal concern for the moral development of citizens can be understood from the point of view of the continuation of a Chinese cultural value, rather than the novelty of the development of a socialist state. Related to the overall development of social order and moral standards is another Chinese value—that of educating the young generation. This value of learning and achievement prevails in every Chinese society covered by the discussions in this volume.

Value of Education and Achievement

Many authors in this book touch on the issue of educating the young, particularly Tao (Chapter 11), Xu (Chapter 12), Yu (Chapter 20), Kuo (Chapter 13), and, in part, Lum and Char (Chapter 15). Such attention was not the result of prior selection of arrangement for the conference meeting; it was a coincidence. But the fact that so many authors chose to discuss the education issue is not accidental, for it ties in to the traditional cultural value of enhancing the welfare of the next generation by focusing on its education.

In the family, Chinese parents pay special attention to training children to adhere to socially desirable and culturally approved behavior. One way to measure the success of parental intervention is the ability of children to perform well in school. Children who fail to live up to adults′ standards of performance in school are often viewed as expressing abnormal, deviant, or antisocial behavior. Once we understand this point, it is not difficult to understand why both social scientists and psychiatrists in Chinese society, as represented by our authors in this volume, treat the education and learning issues as if they are mental illness issues. Some of the chapters give us the impression that when children fail to achieve a certain standard in school in both grades and proper conduct by, for example, showing disobedience and stubbornness, and being over-demanding, these failures may sometimes be considered abnormal in almost mental pathological terms. The chapters concerning the issue of school behavior in mainland China demonstrate, though implictly, certain efforts of socially engineering the state in expectation of producing desireable child behavior and values. This issue is also noticeable in Singapore, as is already common knowl-edge.

Even without state intervention in a direct way as seen in mainland China, Lum and Char (Chapter 15) provide some indication of the Chinese perception in the United States of the special value of education. The authors see a correlation between the Chinese value of education for the young and their achievement in adulthood in the areas of business success and upward social mobility. This view reflects a common belief shared by many Chinese overseas.

CONCLUDING REMARKS

Although many scholars have attempted to study and describe the char-acteristics of Chinese culture, most of them focus on and elaborate on these characteristics from different angles. Some approach the subject of concep-tualizing culture as civilization (Qian, 1969), while others focus on the dimensions of thought and philosophy and have reviewed such matter mainly from historical aspects (de Riencourt, 1965; Greel, 1953; Wei, 1979). In contrast to this, by comparing the different lifestyles of Chinese and Americans, Hsu (1981) make an attempt to describe the Chinese culture as reflected in behavior and ways of life. Furthermore, in concentrating on the personality, a group of behavioral and social scientists has tried to describe the characteristics of the Chinese personality (Li and Yang 1972), and the subject of normal and abnormal behavior in Chinese culture has been dealt with by Kleinman and Lin (1981).

From a mental health point of view, it is more useful and pertinent to understand how a culture affects the mind, behavior, and mental health of an individual, a group of people, and a society as a whole. More specifically, personal development, personality formation, family, and social behavior are some of the subjects needing investigation. It is also necessary to elaborate on how cultural factors influence the nature of stress in society, how the manifestation of psychopathology is created, and how cultural factors determine patterns of coping mechanisms and styles of adjustment. Particularly pertinent to the contemporary time is our understanding of how the processes of cultural change and modernization affect our emotional life and mental health and what ways of coping are available in such processes of change. Throughout this volume, authors explore all these themes from the point of view of their own disciplines, based on their work in different settings of Chinese communities, both on the mainland and overseas. It is hoped that this volume will help us to understand the common characteristics of Chinese culture and its impact on mental health.

REFERENCES

de Riencourt, A. The soul of China: An interpretation of Chinese history (Rev. Ed.). New York: Harper and Row., 1965.

Geertz, C. Thick description: Toward an interpretive theory of culture. In: Geertz C., ed. The interpretation of cultures. New York: Basic Books., 1973.

Greel, H.G. Chinese thought: From Confucius to Mao Tse-Tung. New York: The New American Library., 1953.

Hsu, F.L.K. Americans and Chinese: Passage to differences, 3rd Ed. Honolulu: University Press of Hawaii., 1981.

Keesing, R.M. Theories of culture. Annual Review of Anthropology. 1974; 3:73–97.

Kleinman, A., Lin, T.Y. Normal and abnormal behavior in Chinese culture. Dordrecht, Holland: Reidel.,