Migration, cultural bereavement and cultural identity
DINESH BHUGRA1 and MATTHEW A BECKER2
World Psychiatry. 2005 Feb; 4(1): 18–24.
This article has been cited by other articles in PMC.
Migration has contributed to the richness in diversity of cultures, ethnicities and races in developed countries. Individuals who migrate experience multiple stresses that can impact their mental well being, including the loss of cultural norms, religious customs, and social support systems, adjustment to a new culture and changes in identity and concept of self. Indeed, the rates of mental illness are increased in some migrant groups. Mental health practitioners need to be attuned to the unique stresses and cultural aspects that affect immigrants and refugees in order to best address the needs of this increasing and vulnerable population. This paper will review the concepts of migration, cultural bereavement and cultural identity, and explore the interrelationship between these three aspects of the migrant's experience and cultural congruity. The complex interplay of the migration process, cultural bereavement, cultural identity, and cultural congruity, along with biological, psychological and social factors, is hypothesized as playing a major role in the increased rates of mental illness in affected migrant groups.
Keywords: Migration, cultural bereavement, cultural identity, cultural congruity, ethnic density
Mental health practitioners work in an increasingly multicultural world, shaped by the migrations of people of many different cultural, racial and ethnic backgrounds. People migrate for many reasons, including broadly political, socioeconomic and educational. The richness of this diversity of cultures, ethnicity, races and reasons for migration can make understanding experiences and diagnosis of illness challenging in people whose background and experience differ significantly from the clinician. Culture has an important role in the presentation of illness, and cultural differences impact upon the diagnosis and treatment of migrant populations in part due to linguistic, religious and social variation from the clinician providing care. Additionally, it appears that the incidence and prevalence of psychiatric disorders varies among people of different cultural backgrounds due to an interplay of biological, psychological and social factors.
The provision of healthcare is necessarily influenced by the demands of people of many different cultures, but relies on economic, social and political factors, and it is important that cultural differences be appreciated and understood to arrive at a correct diagnostic impression and treatment plan. The migration process itself can be stressful, depending upon the type and cause of migration, and can affect the mental health of migrating individuals and their families. Issues of cultural bereavement and identity occur with increased frequency among migrants and their families. This paper will review these concepts and how they impinge upon mental health and psychiatric care and, by so doing, help the clinician to identify and address these issues in a culturally sensitive way.
Migration can be defined as the process of going from one country, region or place of residence to settle in another. The duration of this new settlement varies, but for the purposes of this paper the focus is on individuals who relocate either semi-permanently or permanently to another country. Also, urban-rural migration within the same country is not being discussed here. Migrants may move en masse or singly. For example, people who migrate for economic or educational reasons may move singly and at a latter date be joined by their families, whereas people who move due to political reasons may move en masse but with or without their families (1). Although not all people who migrate are from ethnic minority groups, it is of note that a significant proportion is. The multicultural nature of British society is supported by the 1991 census. Ethnic categories were first used in the UK in the 1991 census, at which time over three million people, or approximately 5.5% of the general population, were from ethnic minority (non-white) groups (2). Of these, 30% described themselves as black, black African or other and 28% described themselves as Indian; however, by the 2001 census the categories of ethnic ascription had increased and the proportion of ethnic minorities had increased to 7.9%. The minority ethnic population in the UK grew by 53% between 1991 and 2001, from 3 million people to 4.6 million people respectively. Indians were the largest minority group, followed by Pakistanis, people of mixed ethnic backgrounds, black Caribbeans, black Africans and Bangladeshis (3).
The history of migration to Britain highlights some of the reasons why people migrate. Significant migration to Britain started in the nineteenth century. Irish immigration has been marked by periods of influx and efflux to and from Britain, as people have come to either settle permanently or work temporarily with ultimate return to Ireland as a goal. Eastern European Jews came at the latter part of the nineteenth century to escape both religious persecution and poverty, with additional numbers arriving in Britain both before and after World War II. In the 1960s, employers, especially in urban areas, recruited people from the West Indies to fill low paying jobs which were less attractive to the local population. People from the Indian subcontinent migrated to Britain for educational and economic reasons, the peak of which occurred about the same time as the West Indian migration. Asian people expelled by Idi Amin's government came from Uganda in the late 1970s. The 1980s saw a change in the immigration laws limiting the numbers of people allowed to relocate to Britain (4). Today, people from around the globe choose to migrate to the UK as well as other developed countries, both legally and illegally, for better educational and employment opportunities, to escape persecution, to relocate after catastrophic events, including terrorism, disasters and war, and/or to join relatives who migrated at an earlier time.
Migration can be classified in a number of ways; e.g., by the reasons for the migration, the social class and education of the migrating people, the duration of relocation and the geographic distribution of the resettlement. Further, a distinction can be made in the classification of migrants according to whether their contact with the 'majority' or 'dominant' culture is deemed voluntary. Migrants can be classified as immigrants and sojourners when the change in their location results in contact voluntarily, whereas refugees are deemed to change their location involuntarily (5). For example, immigrants choose to migrate, and thus be in increased and regular contact with the 'majority' culture in preparation for migration, for potential economic and/or educational advancement, whereas refugees are forced to migrate, and thus be in contact with the 'majority' population involuntarily, to escape persecution. Additionally, rural-urban migration has been associated with economic and educational reasons for relocation, whereas migration across nations has been associated with economic, educational, social and political reasons (6).
The process of migration has been described as occurring in broadly three stages. The first stage is pre-migration, involving the decision and preparation to move. The second stage, migration, is the physical relocation of individuals from one place to another. The third stage, postmigration, is defined as the "absorption of the immigrant within the social and cultural framework of the new society". Social and cultural rules and new roles may be learnt at this stage (4). The initial stage of migration may have comparatively lower rates of mental illness and health problems than the latter stages, due to the younger age at the initial stage of migration and the problems with acculturation and the potential discrepancy between attainment of goals and actual achievement in the latter stages (7). It is worth noting that the stages are often not discrete and merge into one another.
It has been hypothesized that social adjustment and the prevalence of mental illness in migrants may be influenced by the duration of the relocation, the similarity or dissimilarity between the culture of origin and the culture of settlement, language and social support systems, acceptance by the 'majority' culture, access and acceptance by the expatriate community, employment, and housing (4). If the individual feels isolated from his or her culture, unaccepted by the 'majority culture' and has a lack of social support, a consequent sense of rejection, alienation and poor selfesteem may occur. During the stages of migration, there may be factors that predispose individuals to mental disorders. Pre-migration factors include the personality structure of an individual, forced migration, and persecution, among others. Migration factors include bereavement, culture shock, a discrepancy between expectations and achievement, and acceptance by the new nation are potential post-migration factors (8,9). These factors can be thought of as vulnerability factors along with biological, social and psychological variables. For example, personality structure can be thought of as a biological factor as well as in cultural terms. Personality is influenced by cultural factors and influences patterns of child rearing, responding to stress and accepting social support. National character and personality factors are interlinked.
Bhugra (6) reviewed four hypotheses explaining the relationship between migration and mental illness, specifically the higher rates of schizophrenia among some migrant groups in the UK, and proposed a fifth hypothesis. His hypothesis argues for an ethnic density effect on the rates of mental illness in migrant groups. Additionally, individuals who migrate from collectivistic or socio-centric societies, who themselves are socio-centric, into individualist or egocentric societies may experience feelings of alienation and mental distress, with consequent difficulty in settling into the new society. Social change, assimilation and cultural identity may be significant factors in the relationship between migration and mental illness (6,7).
The loss of one's social structure and culture can cause a grief reaction, as has been described by Eisenbruch (10,11). Migration involves the loss of the familiar, including language (especially colloquial and dialect), attitudes, values, social structures and support networks. Grieving for this loss can be viewed as a healthy reaction and a natural consequence of migration; however, if the symptoms cause significant distress or impairment and last for a specified period of time, psychiatric intervention may be warranted. Eisenbruch (11) has defined cultural bereavement as "the experience of the uprooted person - or group - resulting from loss of social structures, cultural values and self-identity: the person - or group - continues to live in the past, is visited by supernatural forces from the past while asleep or awake, suffers feelings of guilt over abandoning culture and homeland, feels pain if memories of the past begin to fade, but finds constant images of the past (including traumatic images) intruding into daily life, yearns to complete obligations to the dead, and feels stricken by anxieties, morbid thoughts, and anger that mar the ability to get on with daily life".
The expression of such bereavement is influenced by many factors, among which are social, cultural and economic. In a study of the palliative care experience of Bangladeshi patients and their carers in east London, recent migration, linguistic barriers, religious beliefs and financial issues impacted the ability to optimise pain control in patients and the grieving process of family members; burial of the deceased in Bangladesh and social support from family and friends were potentially helpful in the grieving process (12). The importance of culture in the expression of grief was highlighted by a case report of bereavement in an Ethiopian female refugee. Her symptoms of grief were complicated by her inability to perform her culturally sanctioned purification rituals because of her relocation. Compounding her problem, she was erroneously diagnosed at various times due to the use of Western derived diagnostic criteria and a lack of appreciation of the cultural differences in the presentation of grief by clinicians (13). The symptoms of cultural bereavement may be misdiagnosed due to problems with language, culture and the use of Western diagnostic criteria in non- Western peoples. Schreiber (13) noted that traditional healing and purification rituals as well as supportive psychotherapy, after the correct diagnosis was made, were essential in the treatment of this patient's syndrome.
Western constructs of bereavement may prove to be of only partial or limited value in explaining expressions of grief when applied to people from other cultures; however, this is an area worth further study. All human beings get bereaved, but the cultural norms are essential in dealing with bereavement. Western views of bereavement include the progression through stages of grief, psychoanalytic theories of loss, and behavioural theories. Davies and Bhugra (14) refer to Bowlby's contribution to the understanding of loss and the function and course of grief. In application of his attachment theory, Bowlby described four phases of mourning, including numbing, yearning and anger, disorganization and despair, and reorganization. Psychoanalytic theorists have described the role of the unconscious and ambivalence in grief; abnormal grief reactions are felt to be unconsciously driven and involve ambivalent feelings to the lost object with resultant depressive symptoms including significant decline in self-esteem (15,16).
The DSM-IV notes that the "duration and expression of 'normal' bereavement vary considerably among different cultural groups". A major depressive episode is diagnosed, instead of bereavement, if symptoms of depression are present two or more months after the loss or the following symptoms are present: a) guilt about things other than actions taken or not taken by the survivor at the time of the death; b) thoughts of death other than the survivor feeling that he or she would be better off dead or should have died with the deceased person; c) morbid preoccupation with worthlessness; d) marked psychomotor retardation; e) prolonged and marked functional impairment; and f) hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person. These symptoms are based on a Western construct for the diagnosis of abnormal grief and as such do not take into account different cultural expressions of grief. In many cultures, it is normal to be visited by spirits and ghosts, and people of non-Western culture may describe conversations with supernatural spirits. The importance of placing these expressions of grief in the appropriate cultural context is essential in differentiating between abnormal and normal reactions to loss. Inappropriate diagnoses of psychotic disorders, post-traumatic stress disorder (PTSD) and mood disorders have been made in people of non-Western backgrounds when clinicians ignore cultural differences in the expression of grief. The misdiagnosis and subsequent inappropriate treatment will at best not address the issue for the affected person and, at worst, cause harm.
Eisenbruch (10), in his work with Southeast Asian refugees, devised a cultural bereavement interview as a means to help with the validity of the diagnostic interview, clarify the "structure" of the grief reaction, and start the process of healing for the affected individuals. The interview takes into account the language and cultural constructs of the bereaved individual. During the interview, the clinician explores the following: a) memories of family, based on the construct of thoughts and perceptions of the past; b) continuing experience of family and the past, including ghosts and spirits, based on the construct of communication with the past; c) dreams, guilt, clarity of recall of the past and structuring of the past in the homeland, based on the construct of survivor guilt; d) experiences of death, based on the construct of the violence of separation or death and the absence of leave-taking; and e) response to separation from homeland, based on the construct of anger and ambivalence (10). The cultural bereavement interview incorporates exploration of religious belief and practice, stressing the importance of 'traditional' treatments in the bereaved immigrant population. As noted above and continuing Schreiber's (13) notion, the collaboration of the Western psychiatrist with a traditional healer can represent for affected individuals the best treatment approach, which is one that embraces and integrates the non-Western belief system when using Western psychiatric approaches.
Bereavement has been associated with psychotic, anxiety and mood disorders; however, this association is complicated due to the misinterpretation of the cultural expressions of grief by Western trained clinicians and the Western diagnostic criteria of psychiatric disorders that may not be applicable in people of different cultural backgrounds. Undoubtedly, people who have migrated due to political upheaval or war may have witnessed or participated in combat and torture; thus, affected individuals may have PTSD and bereavement, as these diagnoses are not mutually exclusive. Culturally appropriate mani- festations and expressions of bereavement may include Western constructs of PTSD and psychosis, including hearing voices, seeing ghosts and feeling the presence of the dead; therefore, it is important to recognize the symptoms of bereavement within the cultural constructs of the affected individual and be open to the possibility of additional psychiatric disorders. Cultural bereavement is an important aspect in the understanding of the migrant's experience. Our hypothesis is that such an experience will be mediated through and influenced by cultural identity. The concepts of individual identity are likely to affect the understanding as well as working through the bereavement process.
It is important to define basic sociologic terms of identity to understand cultural identity. Culture is learned and passed through generations and includes the beliefs and value system of a society. Culture has been described as features that are shared and bind people together into a community (17). Identity is the totality of one's perception of self, or how we as individuals view ourselves as unique from others. Bhugra (6,7) notes that racial, cultural and ethnic identities form part of one's identity, and identity will change with development at a personal as well as at a social level along with migration and acculturation. Social identity can be thought of as the culturally defined personality characteristics, which are ascribed to social roles, such as the role of being a father, mother, friend, employer, employee, etc. Ethnicity is a source of social identity. Ethnic groups are composed of people who may or may not share the same race but do share common cultural characteristics, including history, beliefs, values, food and entertainment preferences, religion and language. Ethnicity typically incorporates both race and culture (17). Race is based on biologic constructs, such as sharing certain physical attributes; it may or not be also a social and political construct (17). For example, people from the West Indies, Africa and parts of North and South America may share the same race but have different beliefs, value systems, social norms and idioms of distress.
Bhugra (6) notes that components of cultural identity include religion, rites of passage, language, dietary habits and leisure activities. Religious rituals and beliefs, even if not followed as an adult, make up a key component of an individual's cultural identity. Religion can preserve values within the community and foster a sense of belonging. Rites of passage are important in the development of an individual's cultural identity; following these rites or rituals is bound to influence the degree to which an individual will be accepted within the cultural group. Language, both written and spoken, is a cultural marker. Bhugra (7) writes of the importance of linguistic competence and economic stability as determinant factors prompting individuals to eventually leave their non-dominant cultural group, which typically is geographically bound, and venture into the dominant culture. Attitudes to food and food preparation, including religiously driven taboos and the symbolism of food, are a component of cultural identity that can be influenced by religious teachings. Leisure activities, including music, movies, sports, and literature, are important components, along with language and religion, in allowing an individual to feel part of their culture while living in a place with a different culture and may or may not change during the acculturation process. Social and cultural qualities and attitudes are typically more resistant to change and are usually last to adjust during acculturation (18).
Psychosocial changes experienced by immigrants include assimilation, which can be viewed as a process by which cultural differences disappear as immigrant communities adapt to the majority or host culture and value system. An individual's cultural identity may be lost during the assimilation process as he or she moves within the host society. Acculturation, a process that may be voluntary or forced, requires contact between culturally divergent groups of people and results in the assimilation of cultural values, customs, beliefs and language by a minority group within a majority community (8). During the acculturation process, both the immigrant and host cultures may change. Changes in attitudes, family values, generational status and social affiliations can occur in both the majority and minority cultures as the two interact; however, typically one culture dominates (7).
Cultural changes in identity can be stressful and result in problems with self-esteem and mental health. Contact between the immigrant, or minority, community with the dominant or host community may lead to assimilation, rejection, integration or deculturation (8). Rejection, in which the individual or minority group withdraws from the majority group, can lead to apartheid or segregation in extreme cases. Deculturation, in which the individual or minority group experiences a loss of cultural identity, alienation and acculturative stress, can lead to ethnocide (6). Post-migration stresses include culture shock and conflict, both of which may lead to a sense of cultural confusion, feelings of alienation and isolation, and depression (8). Host societies' attitudes, including racism, compounded by stresses of unemployment, a discrepancy between achievement and expectations, financial hardships, legal concerns, poor housing and a general lack of opportunities for advancement within the host society, can lead to mental health problems in vulnerable individuals.
Acculturation may help the culturally bereaved individual to gain a semblance of equilibrium. Migrants who experience the loss of their culture and guilt over leaving their homeland may find that, as the acculturation process proceeds, a sense of belonging in their new homeland occurs. The majority culture may seem less threatening and more inviting as the individual becomes more linguistically and socially fluent in this new culture. Social sup- port can ensue in the forms of friendships, employment opportunities, and medical care. Integration and assimilation can help reduce feelings of loss and grief as the migrant starts to incorporate aspects of the majority culture. In acculturation, the interaction of the migrant's culture with the majority culture of the new homeland is a dynamic and reciprocal process that can result in changes in the broader cultural group, enhancing the ability of people of the dominant culture to better appreciate and understand aspects of the immigrant's culture and recognize some of the needs of those who have migrated.
Migrating people come from diverse cultural backgrounds, with already formed cultural identities. As noted above, cultural identity is influenced by various factors both during and after the migration process, and cultural bereavement is a potential inherent consequence in people who have migrated. Cultural identities interact, as people who have migrated come into contact not only with people of the majority culture but also with immigrants of both similar and disparate cultures. Resultant feelings of a sense of belonging and comfort or a sense of alienation and distress may occur. Bhugra and Jones (9) proposed that various personal and relational factors during the migration process impact the mental well being of migrating people. During the post-migration phase, personal factors of importance in coping with adversity include cultural identity, social support networks, self-esteem, and self-concept. Achievement, racism, ethnic density, social isolation and unemployment are among the relational factors of importance in migrants during the post-migration phase (7,9).
Ethnic density, the size of a particular ethnic group in proportion to the total population in a specified area, may be a factor that influences the rates of mental illness in ethnic minorities. Additionally, a sense of alienation may occur if the cultural and social characteristics of an individual differ from those of the surrounding population, whereas a sense of belonging tends to occur if the individual and surrounding population have similar cultural and social characteristics. Bhugra (6) writes of the importance of ethnic and cultural congruity, interaction patterns and cultural identity in the genesis and maintenance of mental distress in migrants. Cultural congruity may be thought of as the congruence or dissonance of an individual's culture, beliefs and expectations with the surrounding population. The surrounding population may be made up predominantly of people from the same or different cultural background compared to the migrant. An increase in ethnic density may improve the social support and the adjustment of some individuals who have migrated, yet increase distress in others, in particular if there exists a cultural conflict between the individual and his culture of origin (9). This may account for some of the conflicting results from studies of the relationship between ethnic density and the incidence of mental illness in ethnic minority groups. For example, an inverse correlation between the incidence of schizophrenia in non-white ethnic minorities in London and the proportion of those minorities in the local population was found; it was hypothesized that increased exposure to or a lack of protection from stress may increase the rate of schizophrenia in non-white ethnic minorities (19); however, a previous study failed to support the ethnic density hypothesis for the increased incidence of schizophrenia in immigrant groups to England (20).
In a review of multiple studies, Shah (17) found that common mental disorders were more prevalent in people of ethnic minority groups who lived in areas of low density of their own ethnic group. His findings showed that common mental disorders were at least as prevalent in ethnic minority groups as in the indigenous population and, in some ethnic minority groups, more prevalent. Depression may be more prevalent in the Caribbean and African populations compared to the majority population, with phobias more common in Asian groups. Risk factors for common mental disorders in ethnic minority groups include poverty, unemployment, migration before the age of 11, racism, a perceived lack of social support, social isolation, absence of a confidante and absence of parents in law (17). The incidence of schizophrenia was higher in an urban area of south-east London compared to rural areas in south-west Scotland, due to the larger proportion of non-white ethnic minority groups living in the urban area compared to the rural area (21), with an overall increase in the incidence of schizophrenia in south-east London between 1965 and 1997 (22).
It is important to consider the nature of the society an individual has migrated from and to, and the social characteristics of the individual who has migrated, in determining how well a person will adjust during the migration process. Socio-centric, or collectivistic, societies stress cohesiveness, strong ties between individuals, group solidarity, emotional inter-dependence, traditionalism and a collective identity. Egocentric, or individualistic, societies stress independence, loose ties between individuals, emotional independence, liberalism, self-sufficiency, individual initiative, and autonomy. Bhugra (6) has hypothesized that individuals who migrate from predominately sociocentric, or collectivistic, societies into a society that is predominately egocentric, or individualistic, are likely to have problems adjusting to the new culture, especially if the individuals are socio-centric in their own belief system. A consequent lack of an adequate social support system, a disparity between expectations and achievements and a low self-esteem may result from this dissonance in culture between the individual and the surrounding population. An increase in ethnic density may help decrease the distress of the individual in this situation, especially by providing a social support system. For example, a person who migrates to the United States, a predominately egocentric society, from Vietnam, a predominately socio-centric society, may feel isolated and alienated, especially if the individual is socio-centric in outlook. Feelings of isolation and alienation may be decreased, and social support improved, if other people from Vietnam, with socio-centric views, surround this person in the area of resettlement; however, the socio-centric individual may remain on the periphery of his/her new homeland's society since linguistic and social fluency of the dominant culture may not be attained. Cultural bereavement may also be minimized if the immigrant is able to maintain ties to the culture of origin, either through increased ethnic density, improved social support or maintenance of religious beliefs and practice. On the other hand, individuals who migrate from a predominately socio-centric culture into a society that is predominately egocentric in nature may experience little in the way of problems, and a relatively easy transition to the new culture, if the person who has migrated is mostly egocentric, or individualistic, in his/her outlook. In this case, an increase in ethnic density may be disadvantageous and exacerbate or cause cultural conflict and mental distress.
The proportion of ethnic minorities in the UK has been increasing at least in part due to the migration of individuals from all over the world. Migration is a complex process, involving a heterogeneity of causes, experiences, cultural adjustment and stages, that influence the mental health of migrants. The stresses of the migration process itself combined with a lack of social support, a discrepancy between achievement and expectations, economic hardships, racial discrimination and harassment, and a lack of access to proper housing, medical care, and religious practice can lead to poor self-esteem, an inability to adjust, and poor physical and mental health. Social and cultural factors have been implicated in the aetiology of mental illness in immigrants and refugees, and further study is needed to better understand the role of culture as pathogenic or patho-protective (7).
Cultural bereavement, a paramount aspect of the migrant's experience, is influenced by, and mediated through, the interplay of the migration process, cultural identity and cultural congruity, along with biological and psychological factors. To appropriately guide diagnosis and treatment interventions, mental health practitioners must appreciate and recognize the socio-cultural factors that influence the manifestation of grief in people who have migrated. Cultural identity and congruity will affect the ability of the affected person to understand and work through the grieving process, and disturbances of identity and congruity are likely to lead to a pathologic, or complicated, bereavement.
Rates of depression, phobias and schizophrenia are elevated in some migrant groups. The understanding of race, ethnicity, social isolation and a lack of social support, racism, unemployment and poverty, poor housing and a lack of access to appropriate medical care is important in explaining the increased rates of mental illness in ethnic minority groups. Additionally, cultural congruity and ethnic density, cultural identity, and biological and psychological factors are likely important influences in the development of mental illness in migrants. With further study, a better understanding of the complex interplay of these potential vulnerability factors may eventually lead to preventative measures and lessen the burden of mental illness in this growing population.
1. Bhugra D. Bhui K. Cross-cultural psychiatry: a practical guide. London: Arnold; 2001.
2. Nazroo J. Ethnicity and mental health: findings from a national community survey. London: Policy Study Institute; 1997.
3. UK Office of National Statistics. Census, April 2001. London: UK Office of National Statistics; 2001.
4. Bhugra D. Acculturation, cultural identity and mental health. In: Bhugra D, editor; Cochrane R, editor. Psychiatry in multicultural Britain. London: Gaskell; 2001. pp. 112–136.
5. Berry J. Poortinga Y. Segall M, et al. Cross cultural psychology: research and applications. Cambridge: Cambridge University Press; 1992.
6. Bhugra D. Migration, distress and cultural identity. Br Med Bull. 2004;69:1–13.[PubMed]
7. Bhugra D. Migration and mental health. Acta Psychiatr Scand. 2004;109:243–258.[PubMed]
8. Bhugra D. Ayonrinde O. Depression in migrants and ethnic minorities. Advances in Psychiatric Treatment. 2004;10:13–17.
9. Bhugra D. Jones P. Migration and mental illness. Advances in Psychiatric Treatment. 2001;7:216–223.
10. Eisenbruch M. The cultural bereavement interview: a new clinical research approach for refugees. Psychiatr Clin North Am. 1990;13:715–735.[PubMed]
11. Eisenbruch M. From post-traumatic stress disorder to cultural bereavement: diagnosis of Southeast Asian refugees. Soc Sci Med. 1991;33:673–680.[PubMed]
12. Spruyt O. Community-based palliative care for Bangladeshi patients in east London. Palliative Medicine. 1999;13:119–129.[PubMed]
13. Schreiber S. Migration, traumatic bereavement and transcultural aspects of psychological healing: loss and grief of a refugee woman from Begameder county in Ethiopia. Br J Med Psychol. 1995;68(Pt. 2):135–42.[PubMed]
14. Davies D. Bhugra D. Models of psychopathology. Berkshire: Open University Press; 2004.
15. Freud S. The standard edition of the complete psychological works of Sigmund Freud. Vol. 14. London: Holgarth Press and Institute of Psycho-Analysis; 1953. Mourning and melancholia.
16. Freud S. The standard edition of the complete psychological works of Sigmund Freud. Vol. 13. London: Holgarth Press and Institute of Psycho-Analysis; 1953. Totem and taboo. [PubMed]
17. Shah A. Ethnicity and the common mental disorders. In: Melzer D, editor; Fryers T, editor; Jenkins R, editor. Social inequalities and the distribution of the common mental disorders. East Sussex: Psychology Press Ltd; 2004. pp. 171–223.
18. Bhugra D. Bhui K. Mallett R, et al. Cultural identity and its measurement: a questionnaire for Asians. Int Rev Psychiatry. 1999;11:244–249.
19. Boydell J. Van Os J. McKenzie J, et al. Incidence of schizophrenia in ethnic minorities in London: ecological study into interaction with the environment. Br Med J. 2001;323:1336–1337.[PMC free article][PubMed]
20. Cochrane R. Bal SS. Ethnic density is unrelated to incidence of schizophrenia. Br J Psychiatry. 1988;153:363–366.[PubMed]
21. Allardyce J. Boydell J. Van Os J, et al. Comparison of the incidence of schizophrenia in rural Dumfries and Galloway and urban Camberwell. Br J Psychiatry. 2001;179:335–339.[PubMed]
22. Boydell J. Van Os J. Lambri M, et al. Incidence of schizophrenia in south-east London between 1965 and 1997. Br J Psychiatry. 2003;182:45–49.[PubMed]
Articles from World Psychiatry are provided here courtesy of The World Psychiatric Association
When people think about the American culture, images of Coca-Cola, hot dogs and baseball games come to mind. However there is a deeper side to American culture than Hollywood and Disney World.
Individualism is a core of American culture and the main value in America. It has been influencing all the fields of society, economics, politics and culture. It has played an enormous and far-reaching effect to shape the character of the American nation.
In an era of globalization, it is necessary to interact various cultures with different types of characters for our comic book corporation. In this paper, I would like to analysis American individualism culture in order to integrate the culture into a Japanese character.
Key concepts: value, personality, responsibility, education, freedom, family, society, memory, identity, innovation,
Key value of individualism
Individualistic cultures in America are self-centred and emphasize mostly on their individual goals. It is the view that each person has moral significance and certain rights that are either of divine origin or inherent in human nature. Each individual exists, perceives, experiences, thinks, and acts in and through his own body and therefore from unique points in time and space. (Younkins, 1998)
They believe each individual’s life belongs to himself and he has an inalienable right tolive it as he sees fit, to act on his own judgment, to keep and use the product of his effort, and to pursue the values of his choosing. This is the ideal that the American Founders set forth and sought to establish when they drafted the Declaration and the Constitution and created a country in which the individual’s rights to life, liberty, property, and the pursuit of happiness were to be recognized and protected. (Biddle, n.d.)
Major differences between individualism and collectivism
An individualistic culture based on the tenants of freedom, individualism, and self-reliance. In this culture, people are considered “good” if they are strong, assertive, and independent. This contrasts with collectivistic cultures where characteristics like being self-sacrificing, dependable, generous, and helpful to others are of greater importance. Therefore, most people who grew up in American are thought to be individualists, motivated by what is good for them personally, and independent and self-reliant. Most people who grew up in Japan, on the other hand, are thought to be collectivists, motivated by the good of the group, relying on others and placing priority on the group rather than self.
Most Japanese pay attention to the importance of the family, the hierarchical structure of social life, the cultivation of morality and self-restraint and the emphasis on hard work and achievement. Japanese culture describes the human characteristic of on a deep level thinking in a way where the social institution or group, such as a family, workplace or even entire society, is prioritized higher than the individual self when compared to an individual who is more individualistic. Collectivistic individuals are likely to more often value highly what is best for the social institutions that he or she belongs to over personal ambitions and goals when compared to an individual who is more individualistic. In this sense, it is more common for an individual who is more collectivistic to sacrifice own ambitions for the sake of a group’s best.
In individualist cultures, individual uniqueness and self-determination is valued. A person is all the more admirable if they are a “self-made man” or “makes up their own mind” or show initiative or work well independently. Collectivist cultures, on the other hand, expect people to identify with and work well in groups which protect them in exchange for loyalty and compliance. Individualist cultures tend to believe that there are universal values that should be shared by all, while collectivist cultures tend to accept that different groups have different values.
Ethically speaking, there are a number of problems with collectivism. For instance, because the collective is seen as having an importance higher than the individuals that make it up, those same individuals are asked to sacrifice for it. It is created into an intrinsic value, and destroys one’s ability to rationally pursue one’s own self-interest. It also interferes with justice. Justice is concerned with making moral judgments about other people and acting accordingly. But collectivism destroys proper moral judgment by attributing value choices to the whole group, instead of the person making the choice.
Individualism is the proper approach to this problem. Moral judgments are made by moral agents. The person making the decision gets credit or blame for it. Values are agent-relative, and the person makes his choices by seeing how the value impacts his life. It is the individual that ethics is concerned with, and collectivism just obscures this point.
In some situations such as how likely someone is to ask a bus driver to wait for an acquaintance who is late for the bus can be effectively connected to individualism vs. collectivism; naturally someone more collectivistic would be less likely to ask the driver to wait since he or she would likely prioritize the other passengers of the bus as a form of social institution higher. A more individualistic person, on the other hand, would be more likely to be more concerned of his or her personal company, the acquaintance who would otherwise have to wait for the next bus. (Rudenstam, 2012)
The differences between individualism and collectivism can often have different impacts on the amount of time a given task may take. For example, a market research firm conducted a survey of tourist agencies around the world. The questionnaires came back from most countries in less than a month. But the agencies in Japan took months to do it. After many requests, it was finally done. The reason was that, American tourist agencies assigned the work to one person, while the Japanese delegated the work to the entire department, which took longer. The researchers also noticed that the replies from the Japanese always came from a different person. (“Cultural Differences – Individualism versus Collectivism”, n.d.)
Individual Choice and Personal Responsibility
One of the most attractive character of American individualists is their independent personality. The individualistic view of people as independent units leads to emphasis on a range of self-oriented values and skills that support independent living. These values include self-sufficiency, self-determination, self-advocacy, self-competence, self-direction, self-efficacy, self-regulation, self-reliance, and self-responsibility. On the other hand, Japanese people as interdependent leads to emphasis on group-oriented values and skills that contribute to effectively filling roles within the family or other group. Instead of living independently or going away to college, the young adult may be expected to remain at home and fulfill roles within the family.
In the education of the United States, the American have trained young children’s
personality, encourage and motivate children self-reliance ever since their childhood. As if American children have to make money by themselves as long as they are 18 years old, while senior citizens are also quite used to living alone instead of sharing the house with their children.
From the earliest age in America, children are encouraged to develop their sense of individual identity, achievement, and responsibility. Many Americans give their newborn babies their own room and crib from the first day they come home from hospital. As the baby grows, every individual achievement is celebrated and encouraged at the youngest possible age, such as feeding himself, dressing himself, walking to a neighbour’s house, talking on the phone politely, etc.
More specifically, in the early morning, the mother puts baby infant daughter into the high legs chair and then to prepare breakfast. Mother selects different baby cereals and pasta. Every kind of packing and colours are distinct. Baby has to choose their favourite colour. This is a good way to encourage children to form their own views and make decisions. It is a training methods American use to educate their children and cultivate the unique personality of children. The United States attaches great importance to the eduction of the student’s personality development, pays attention to the cultivation of creativity, imagination and encourage students to have their own personality.
Moreover, when every individual achievement of childhood is celebrated and rewarded, it should be no surprise that generational conflicts start to come up in early teen years. Parents struggle to tame the “independence monster” they have helped to create, while the teenagers want to continue the individualistic path they have started on. Now their choices and achievements start to have more serious consequences. They have to make numerous decisions that might have major implications and effects on not just the individual, but the family, such as driving, dating, and college education.
Cultural also influences on human’s memory perspective. Different cultures can shape different memories of the past and influence the expectations about the future. As a result, American children’s memories tend to be expressive, detailed and lengthy, and they focus on the child as being the protagonist in the narrative and present the child in a positive light. In contrast, Japanese children’s memories were found to be general, skeletal, less emotional, more neutral in their expression, and focused on routine events, on collective activities, on social interactions, on others or relations with others.
In addition, American college students’ memories were discrete, focused on specific events, and the individual’s feelings, whereas Japanese college students’ memories were more general, about routine activities, and focusing on family and in-groups. Americans also stressed personal preferences and autonomy in lengthier narratives than the ones reported by the Japanese. (Zharku, 2011). These patterns are seen because individualism culture promotes autonomy and puts an emphasis on the individual’s qualities, and children in this culture are encouraged to stand out and talk about themselves.
Liberty and justice for all
The United States is known for having a strong bent towards individualism because it was founded by people who sought the freedom to practice whatever religion they chose. Those who prefer individualism often site fear of governmental control over their life decisions as reason for that inclination. An individualistic society depends upon the values of freedom and independence.
American historical traditions place a high value on individual freedom, on personal rights, and on allowing each person to “do her own thing.” In American individualistic culture it is difficult, perhaps impossible, to convince people that they should sacrifice some of their freedom, some of their personal goals and some of their self-interest.
Freedom is the natural condition of the individual. From birth, each person has the potential to think his own thoughts and control his own energies in his efforts to act according to those thoughts. People can initiate their own purposive action when they are free from manmade restraints—when there is an absence of coercion by other individuals, groups of people, or the government.
The American premise of “liberty and justice for all.” “All men are created equal” is one of the most famous quotations from the Declaration of Independence, and the value of equality is considered fundamental to the American spirit. This is evidenced by an explicit emphasis on equal rights in all aspects of American society and government.
Politically, individualists also claim that each individual has a right to his own life and happiness. But it also means uniting with other citizens to preserve and defend the institutions that protect that right. A belief in individualism also implies that they believe that the government should bud out of they individual affairs.
The individualistic political culture sees politics as a marketplace of competing individual interests who use the political system to better their own causes. Politicians and citizens are not interested in achieving a “good society” or furthering the common good, rather they are focused on private concerns. (Leckrone, 2013)
As a result, American unity is built on the individual’s pursuit of values. This pursuit requires a large amount of independence, initiative, and self-responsibility. A nation of individuals does not sacrifice for each other; individuals trade with each other in mutually beneficial ways. A nation of individuals does not seek to make every one responsible for each other; individuals are only responsible for themselves.
When governments and institutions that provide for our security and prosperity are threatened that individuals come together to protect them, and that they do it well. Because of their abilities in their private lives—for instance, their abundant self-responsibility and their initiative—these individuals have a great capacity to rise to the occasion and defend what is of great importance and value to them.
In this sense politics can be regarded as a ‘business’ for the Japanese character like any other that competes for talent and offers rewards to those who take it up as a career. He believes that an officeholder’s primary responsibility is to serve himself and those who have supported him directly, favouring them even at the expense of others.
Social status and social identity
Most Americans are fairly indifferent to the identity of social rank and belong themselves to the middle class. The idea of quality in the U.S. assumed that everyone has equal opportunities rather than social positions. That means each person has equal chance to achieve his success.
Meanwhile, the right to privacy is a notion that runs deep in American culture. It’s something to be both respected and defended, and is considered fundamental to a free society. It is sometimes difficult to ascertain the boundaries of the privacy. Three questions that seem to violate the privacy rule are: How old are you? How much money
do you make? and How much do you weigh? Americans may even hesitate to ask these questions to close friends.
In general, one of the first questions that Americans ask each other when they meet is, “What do you do?” This is a common question because most people in the U.S. define who they are by the work they do. In Japanese cultures, people might define themselves in relation to family lineage and social status. The community or the nation is valued above the individual and an individual’s role in the political and economic life of his community is largely determined by his membership in a specific class or caste. But for many people in the U.S., “you are what you do.” Work is a central part of a person’s identity.
In many collectivistic cultures, people of high social status may be seen as holding important cultural and technological knowledge. This knowledge may have traditionally been memorized and transmitted orally. Much of this knowledge may be reserved only for people who have passed ceremonial milestones or belong to a restricted group, so that they can effectively fill their social roles. It may be considered disrespectful for children to express their opinions to or ask many questions of their elders. Instead they may be expected to absorb and then reflect back the knowledge provided to them by their elders, who determine when youngsters are ready to learn. In individualistic cultures, it is more likely that children are encouraged to form and express opinions and to seek knowledge at a pace they self-determine. An important individualistic value is that knowledge should be freely available to anyone who wants it.
Competition and innovation in business world
Innovations are defined in this paper as the new technical products, scientific knowledge, application methods, and tools that facilitate problem solving for potential adoption.
Individualistic and Collectivism is the most critical factor that affects innovation adoption(Steenkamp, Hofstede & Wedel 1999). An individualist society is characterized by reliance on personal beliefs in making decisions, and group norms are not strictly followed. On the other hand, group consensus is critical to decision making in collectivist societies (Wickliffe & Pysarchik 2001). In individualist societies, people tend to be involved in several “out-group” that affect their decisions in the long-term; while collectivist societies are linked to one “in-group” that affects their decisions in the short-term (Harris & Nibler 1998).
Japan, Singapore, South Korea, Sweden, and Taiwan are all examples of national cultures which rank as both highly institutional collective and highly innovative. Such countries have people who often value loyalty to a corporation, university or nation far more than local “tribes” or themselves as individuals. They still have to sacrifice at the expense of the individual allows their societies to take the risks and make the hard sacrifices to innovate. (Hsu,2012)
Because people in individualistic cultures can be allowed or even encouraged to make choices based on what is best individually, while people in collectivistic cultures are more likely to be expected to give priority to what is best for the group.
On the other side, individualism have a strong, significant, and positive effect on innovation. It awards social status to personal accomplishments such as important discoveries, innovations, or great artistic achievements. Because of the emphasis on the individual, Americans can be competitive, and to be called a high achiever in the U.S. is quite a compliment. Besides, individualism stress uniqueness. In American, each individual is seen as completely an marvellously unique. People are encouraged to express themselves in unique ways. Because the culture values individuality, Americans admire those who do something new and innovative. Perhaps this is one reason why a large number of new ideas including technological inventions, artistic and musical movements come from this country.
According to research that countries having a more individualist culture have enjoyed higher long-run growth than countries with a more collectivist culture. Individualist culture attaches social status rewards to personal achievements and thus, provides not only monetary incentives for innovation but also social status rewards, leading to higher rates of innovation and economic growth.
Americans love to celebrate an individual-minded U.S. culture that has produced great innovators such as Thomas Edison or Steve Jobs. In our case, the character can be assumed as a Japanese who loves to celebrate an individual-minded Japanese culture.
That spirit of individualism allowed Americans to be pioneers in fields such as science and technology—Benjamin Franklin and Thomas Jefferson were scientists and inventors—industry, entertainment, and every other field that contributes to life and prosperity.
As the world is moving toward the intense individualism under the leadership of America, the barrier to entry in business and mass communication has almost disappeared. In the business world, employees are expected to be self-reliant and display initiative. Americans are not shy about approaching their prospective counterparts in order to obtain or seek information. American individualism highly values the freedom to choose for oneself. People are assumed to have free will, and from an early age they may be reminded that each choice has consequences for which they will be held personally responsible.
Individualism is characterized by engagement in competitive tasks, by public situations, and by an emphasis on what makes the individual distinct. In American individualism, people can show that they have valued characteristics, such as mastery of certain skills or being able to perform under pressure, by competing with and doing better than others.
Individualists emphasize their success and achievements in job or private wealth and aiming up to reach more and a better job position. Especially in the USA the fight about jobs and trying to climb up in the hierarchy ladder is something very common there. It just counts to get there less caring who will left behind one. In business they try to improve their connections and to gain more value out of them, not for establishing a good relationship but just to be involved in a calculative way.
Based on personal equality, individual competition then has evolved into a life attitude throughout the daily life of the American people. In the United States, a fair social competition is protected by both political principles and organizational structures, ensuring an advantageous environment for personal equally competition.
In Japanese culture a direct confrontation will always be avoided. Expressions or phrases are used which describe a disagreement or negative statement instead of saying no. Saying ‘no’ would be tantamount to destroy in harmony in the group. The relationship between the groups or business partners is based on trust and harmony and a deep understanding of moral values. The wealth of the groups inside are more important than the individual’s.
The Japanese character in our comic book can be challenged in their ability to understand someone else’s point of view because he is part of a culture that encourages individualism now. Other than ordinary Japanese that encourages a collectivist attitude among its members, are much more adept at determining another person’s perspective.
Importance of family and group
Individualism is mostly seen in the cultures of Western Europe and North America, whereas collectivism is mostly seen in the cultures of Asia and Africa. The emphasis on one or another starts in the family, even with the very structure of the family: a large, multigenerational one emphasizes collectivism, whereas a smaller, nuclear family emphasizes individualism (Triandis, 1993).
Culture influences how decisions are made within a family. In traditional Japanese cultures, there is likely to be a social hierarchy based on gender, birth order, and age. Family elders may be highly respected, and they often have roles of authority with responsibility to make sure family members do what is best for the family rather than what is best for themselves as individuals. Elders may have final say about how far their children go in school, who they marry, or where they work. Decisions are likely to be obeyed with less questioning than is typical in individualistic cultures.
Individualism, they maintain, decreases the authority of kin. In American, the ideal is for all people to be able to freely make their own decisions. The opinions of family elders may be respected, but as youth enter adulthood, they expect and are expected to make decisions about their own lives. Individual rights encourage individual choices and so marriages are contracted on the basis of affection rather than calculation. Family life becomes conjugally centered. Democracy in the family accompanies democracy in society. The equality of husband and wife promotes their empathy and friendship. Their conjugal isolation makes their communication and companionship unique and precious.
It is typical of an individual who is relatively individualistic to prioritize individual ambitions to a higher degree and strive to fulfill such ambitions even if it not necessarily equates working toward what is best for his or her related social institutions as wholes.
According to a survey, one who is more individualistic would be more likely to engage in a divorce when compared to a collectivistic individual, since the individual is likely to value personal well-being higher. A more collectivistic individual would conversely naturally be more inclined toward enduring the marriage for the sake of the family as a social institution. This obviously becomes most evident in families with young children where a divorce might result in negative consequences for a child’s upbringing. The United States is one of the best examples of a country with culture in which individuals often are regarded more individualistic.
Does the individual’s life belong to him, or does it belong to the group, the community, society, or the state? In Japanese cultures, individuals are not free to make their own choices; they must consult and obey their elders. The needs and considerations of family, clan, and community come first. Individualism is viewed as selfishness and rebellion. This is because most Japanese consider that the individual’s life belongs not to him but to the group or society of which he is merely a part, that he has no rights, and that he must sacrifice his values and goals for the group’s “greater good.” The group or society is the basic unit of moral concern, and the individual is of value only insofar as he serves the group.
However, the majority of American enters into society to further his or her own interests, or at least demands the right to serve his or her own interests, without taking the interests of society into consideration. People from individualistic cultures tend to think only of themselves as individuals and as “I” distinctive from other people. This is contrasted with the values from Japan, which have a group orientation. Since individualism to Americans means the freedom to “choose my own way,” make my own decisions, based on my own criteria, as well as the responsibility to personally accept the consequences of my own choices. Objectivism also supports individualism in this sense. Individualism is meant to be whether the individual is different from everyone else, or whether he makes up his own mind about things, or what-not.
But in the individualist-collectivist sense of the term, individualism just means that the individual is a separate entity, making his own choices, thinking his own thoughts, and responsible for his own choices. People are seen as independent and autonomous. The individualist does not believe in any philosophy that requires the sacrifice of the self-interest of the individual for any higher social causes.Societies and groups can differ, in the extent to which they are based upon predominantly “self-regarding” rather than “other-regarding” behaviour.
Thus, in Japanese collectivist societies people belong to ‘in groups’ that take care of them in exchange for loyalty. The society depends on group harmony and consensus.On the contrary, people in America are supposed to look after themselves and their direct family only. Some people claim an individualistic ideology as selfish and self-centred. But, in view of the individualism, this is the way of their life by which a person places his or her own desires, needs, and comforts above the needs of a broader community. This does not mean that Americans have no concern for other people, but it does mean that they give high priority to their personal ambitions. Because individualists think “the good society” is one in which individuals are left free to pursue their private satisfactions independently of others, a pattern of thinking that emphasizes individual achievement and self-fulfillment.
In this paper, I analysis the difference between American individualistic and Japanese collectivistic societies, and how they impact people’s personalities and values. Americans are one civilization held together by many cultures such as Muslims, Jews, Christians, Buddhists and other ethnic groups. Different cultures embody specific values, or thoughts or ideas that they view as important. Values play a central role in determining if a culture is individualistic or collectivistic.
In a world of increasing complexity and interdependence, we can no longer afford local cultures in a single market for our culture product. Rather, we need to exercise our capacity for developing multi-culture products that explore the interconnectedness of the world. As some of the youth in Japan attempt to appropriate parts of American culture nowadays, I also tried to create a Japanese character through grasping at the allure of this foreign aesthetic.
Andre.C. and Velasquez.M. (n.d.) Creating the Good Society. Retrieved from http://www.scu.edu/ethics/publications/iie/v5n1/
Biddle.C. (n.d.) Individualism vs. Collectivism: Our Future, Our Choice. Retrieved from https://www.theobjectivestandard.com/issues/2012-spring/individualism-collectivism/
Cultural Differences – Individualism versus Collectivism. (n.d) Retrieved from http://thearticulateceo.typepad.com/my-blog/2011/09/cultural-differences-individualism-versus-collectivism.html
Hsu.J. (2012) Study: Individualistic, Patriotic Cultures Are Most Innovative. Retrieved from http://www.nbcnews.com/id/47191107/ns/technology_and_science-innovation/t/study-individualistic-patriotic-cultures-are-most-innovative/
Leckrone.W.(2013, Dec) State and Local Political Culture. Retrieved from http://theamericanpartnership.com/tag/elazars-political-culture/
Rudenstam.O. (2012, Oct). Individualism vs. collectivism. Retrieved from http://blogs.law.harvard.edu/orudenstam/2012/10/05/individualism-vs-collectivism/
Younkins.E. (1998, Jan). Individualism and Freedom: Vital Pillars of True Communities. Retrieved from http://fee.org/freeman/detail/individualism-and-freedom-vital-pillars-of-true-communities
Zharku.I. (2011). Effects of Collectivistic and Individualistic Cultures on Imagination Inflation in Eastern and Western Cultures. Retrieved from http://www.studentpulse.com/articles/385/effects-of-collectivistic-and-individualistic-cultures-on-imagination-inflation-in-eastern-and-western-cultures
[ Untitled image of My Way].[n.d.]. Retrieved from http://davidould.net/wp-content/uploads/2013/01/individualism.jpg
[ Untitled image of Yellow umbrella].[n.d.]. Retrieved from http://wallpapers.free-review.net/wallpapers/21/Individualism.jpg
[ Untitled image of Steve Jobs].[n.d.]. Retrieved from http://www.hdwallpapersinn.com/wp-content/uploads/2014/08/steve-jobs-31.jpg
Surrey, BC, Canada
An Analysis of American Individualism Culture