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Priory Lodge Education Limited, 1996-1999.
Last Amended: 27/03/99

Meeting the needs of ethnic minority children

Dr. Kedar Nath Dwivedi, MBBS MD DPM FRCPsych

Consultant Child, Adolescent and Family Psychiatrist, Northampton, UK

Just like babies, cultures also grow and mature. So in a multicultural society we may have people belonging to cultures that may be many thousands of years old, living side by side with people belonging to cultures that are just a few centuries old. These cultural developmental differences may manifest in many different ways (Dwivedi, 1996a). Let us briefly take just one example, that of independence, as the most cherished ideal in the western culture. It permeates every aspect of life including the workings of various social institutions, practice of psychotherapy and family functioning such as dealing with old age, marital relationships, parenting and so on. Parents are often at pains to make sure that their children become independent as soon as possible, starting with a separate sleeping arrangement for the baby.

In some other cultures , for example, in the Indian culture, it is dependability which is the cherished goal and permeates through all aspects of social institutions and family life. Parents feel really proud when in their old age they see their children having grown up as truly dependable beings. Parenting of young children takes place in an atmosphere of indulgence, physical closeness, common sleeping arrangements, immediate gratification of physical and emotional needs and a very prolonged babyhood so that the growing child deeply experiences the dependability of parents, extended family and the community (Roland 1980)

As the children move towards their latency period they are then helped to heighten their sensitivity to other people's feelings and to improve their capacity for containing and regulating their own feelings (Dwivedi, 1993a). In such a cultural context acting upon ones feelings without due regard to others is seen as a sign of emotional immaturity. Also, self expression or expression of opinions that define and heighten the sense of ones self is not seen as a desirable goal. This attitude of aiming to transcend 'self cherishing' is derived from a well formulated philosophical system that lies at the heart of such a culture's wisdom. For example, 2500 years ago the Buddha realised that the sense of 'self' is a product of illusory mental processes (Dwivedi, 1990, 1994a, 1994b, 1994c). These mental events, according to the Buddha, take place in terms of khanas or mind moments, there being 17 x 1021 , such khanas within the wink of an eye. It is the rapidity of the mental processes that creates the illusion of continuity, the sense of 'I', the sense of solidity of relationships, feelings and so on. When we see a stationary ceiling fan, we see three distinct blades which can create the illusion of merging into one in a fast moving fan. Similarly when we watch a cartoon film we see beings and their movements although, these are only still drawings that are projected too fast on the screen.

Attachment to this sense of self, self grasping or self cherishing, is therefore, natural and inherent in our lives and we are always busy taking things personally, flagging our selves up with self expression, self assertion, autonomy, independence and heading towards narcissism. And it is this natural tendency, produced by the illusory processes, that is the root cause of all our sufferings. But, it is not easy to cut through these illusory processes. In order to become disillusioned or enlightened, an extra effort is needed to resist this very strong current of flow. These efforts, in every aspect of life, ranging from meditative practices to getting on with extended family life, are therefore highly valued in such a cultural context. The natural tendency of love is to flow towards ones own; ones own husband, wife, child and so on. But, an extended family may contain many nuclear families and can only survive if this love is redirected across nuclear boundaries. This in turn offers opportunities for training in and practising for transcending narcissistic tendencies. In such an extended family system you will find parents who will offer affection, food, play materials and so on to other's children in the extended family before offering to their own. They may even refer to your child as their child and their child as your child. Also, the ideology that 'love grows in hiding' takes away the pressure to show or prove ones love.

You can now picture a family therapy scene where the therapist is conditioned to look for the overt affectionate behaviours within the session as evidence of love between the family members while the family is conditioned to express their deep love for each other by hiding it, especially in front of onlookers! Or you can imagine an assessment of parenting situation where the parents and the professionals have different values attached to commercial play materials or transitional objects.

We can think of people who might judge the feelings of the parents towards their children by the kind of names they give to their children. We can always find children who tease or bully other children because of their awkward names leading to a damage to their self esteem. But let me tell you about names such as 'Ghurahu' or 'Katwaru' which literally mean heaps of rubbish! Such names have been given by parents in India to only those children who have been the most precious, and throughout their lives they are regarded as such.

So, the mature cultures' influences can mediate through child rearing practices, greater inner emotional strength, supportive social structures and help giving networks, and can offer better protection against mental health problems in children and their families (Kallarackall and Herbert, 1976, Hackett et al 1991, Roberts and Cawthorpe, 1995).

. So far, the point that I have tried to make is that different cultures at different developmental stages may have different levels of concerns such as that with individual self, the nation, the human race, all sentient beings, ecology, the globe, the cosmos, enlightenment and so on.

When we are little we might see our parents to be the most wonderful beings on this earth but as we grow, it begins to dawn upon us that as we thought our parents to be the best , similarly other children might have thought their parents to be the best. With maturation therefore there comes an appreciation of and respect for differences in perspectives. When a tree is fully mature and bears fruits, it bows down and becomes more humble.

Living in a multicultural context, in the midst of different cultural perspectives and different levels of concerns can be truly complementary and enriching but intolerance can make the experience damaging instead.

We can look at triadic relationships from the view point of attitudinal balance theory (Dwivedi, 1996b, Heider 1958). which deals with triadic relationships. Accordingly the relationships are supposed to be in a state of:

balance (stable) if imbalance if
all the dyads are +ve

*all the dyads are -ve

*any two dyads are -ve and one is +ve

any two dyads are +ve and one is -ve.

Figure One: State of Balance


Figure Two: State of balance

Figure Three: State of balance

Figure Four: State of Imbalance

Figure Five: A State of Imbalance trying to become Balanced

Figure Six: State of Imbalance

Figure Seven: State of Imbalance

Figure Eight: States of Balance

If we take the example of a triadic relationship between father, mother and child, it can be in a state of balance when (a) all the three love each other, so that there is no pressure from within the system for change and each relationship is supportive of the other relationship within the system (Figure 1), (b) all the three hate each other, although this is a vacuous balance, each relationship still supports the other relationships within the system (Figure 2), or (c) any two of the dyads are negative and one positive, for example, mother and the child may love each other but both hate the father who hates them in turn (Figure 3).

If, however, two relationships are positive and one negative, the system is in a state of imbalance. For example, if both parents love the child who loves them both but the parents themselves hate each other (Figure 4). In such a situation there is a strong likelihood of internal pressure from within the system for relationships to change. The child may wish for the parents to change their attitude and become positive towards each other. Similarly the parents may put pressure on the child's relationship with the other parent to turn into a negative (Figure 5). Any of these changes will be able to balance the system.

The same principle can be applied to the relationships between the parent, professional and some aspect of culture. If it is an aspect of the culture that the parent considers it to be the most essential ingredient for proper growth and development and the professional considers it to be most obstructive to proper growth and development, they may be entrenched in their attitudes towards it. If the relationship between the professional and the parent is positive, it is not likely to last long, because it is in a state of imbalance (Figure 6). They may wish for the other to see some sense and change their attitudes but if that does not happen their relationship towards each other may then become negative in order to balance the system.

Similarly the relationship between child, professional and culture, towards which the professional has a fixed negative attitude can only be balanced either by the child changing their attitude (in the negative direction) towards that aspect of the culture or towards the professional or both (Figure 7). If the child's commitment to the cultural aspect is not yet strong enough, this is more likely to become negative.

If we combine the two triads, and assume that the parent and the professional have fixed opposite attitudes towards that cultural element, the options for stability are either (a) child and professional having a positive relationship but being negative towards parent and the culture or (b) child and parent having a positive relationship with a positive attitude towards the culture but negative relationship with the professional (Figure 8)

Children from the ethnic minorities are exposed to stresses that can affect any child, for example, that of demanding school work, getting on with other family members, health issues, life events, social conflicts and financial matters. In addition, the children from ethnic minorities can also experience two other sources of stress, one related to racism and the other to their dislocated family background (Dwivedi, 1993b, 1996c, 1996d).

Poor wages, night shifts, long working hours, overcrowding and bad housing all increase the risk of health problems and impact on their children's psychological development (Braun, forthcoming, 1997). Racism can lead to direct or indirect racial discrimination, abuse, inequality and disadvantage as regards employment, housing, educational and training opportunities, access to health care, welfare, local amenities, environmental quality and to the undermining of their culture, identity and self image. It may leave children and their families feeling hopeless when they experience bullying and racial abuse in schools, play grounds and other places. Racism denigrates and dehumanises communities leading to lowering of their self esteem, sense of worthlessness and depression (Fernando, 1988).

Shama Ahmed (1986) has highlighted that the very fabric of British society is permeated with cultural imperialism manifesting itself in history books, media, education, social work and psycho-therapy literature and so on, leading to subconscious assumptions about the superiority of western child rearing practices and denigration of others. Ethnic minority cultures are often described in ways that make them seem bizarre or backward (Mares et al 1985).

Even the most well meaning professionals having been conditioned in such a value system may see relationships, for example, in an eastern extended family, as rather 'oppressive' and stifling. They may even split off the abusive aspects from their Victorian cultural pasts and project onto the ethnic minorities. Many become passionately involved in rescuing Asian youngsters from their so called 'primitive' and 'oppressive' family values.

The second source of stress for the ethnic minorities is their disrupted extended family background. In a culture where the emotional support from ones extended family, especially in times of stress is the essential ingredient of any coping strategy, the fact of migration and dislocation deprives many ethnic minority families from that healing support. Such a fragmentation of social structure also makes them vulnerable to losing their cultural strength.

Lack of adequate resources to meet the mental health needs of any population (Dwivedi, 1996e) has not helped the development of services for ethnic minority populations either. There is a poor service uptake of child mental health services by the ethnic minority families. This may be because of a variety of factors such as the clash of cultural values, lack of awareness of the role of professionals or lack of faith in such services; a sense of alienation, communication difficulties and so on. The mental health professionals may set up services that may not be culturally sensitive to ethnic minorities and wait for them to come. Then when they do not come, the professionals wonder why (Sue and Sue 1990). They may act as if the minority communities never had any thing like psycho-therapeutic approaches until the western science came along and invented it. Many cultures have an extensive body of therapeutic knowledge and practices as regards relationships, feelings and mental health (Dwivedi, 1980, 1997). For example, in the Indian literature of 500 BC there is a very sophisticated and advanced systematic treatment of the nature of consciousness, something that began to happen in the modern western science in the 19th Century (Reat 1990). Padmal de Silva (1984) has compiled an interesting account of many of the therapeutic interventions available in the Buddhist literature.

The situation is further compounded by the limited emotional availability of many of the caring professionals to ethnic minority families (Dayal, 1990). Some may fail to respond on the grounds that they can not understand the cultural ways of such families. Others may be full of 'culturistic pseudo-insight' (Devereux, 1953) and look for quick 'cultural conflict' type of explanation or may conflate cultural differences with psychopathology leading to deep damage to the ethnic minority children's self identity.

In the context of a loss of emotionally supportive social structure of the extended family and the fragmentation of a help giving network, the youngsters at times of distress do need to turn to their peers and professionals. However, in order to elicit a sympathetic response and emotional support the youngsters present to the professionals and peers in a way that is more likely to elicit it, that is, in terms of fear of arranged marriage, restrictive parental practices and so on (Ahmed 1986). Self poisoning by a number of adolescent Asian girls ,for example, as a product of projective identification, according to Goldberg and Hodes (1992) symbolises the acting out of the view of the dominant group that the minority is 'harmful or poisonous'.

Therefore, meeting the needs of ethnic minority children requires setting up of community outreach work, interpreter and translation services and culturally sensitive therapeutic family and other work and also giving voice to subjugated narratives. Also professional development needs to incorporate the perspective of difference and diversity aiming not only to raise cultural awareness by gaining knowledge but also cultural sensitivity through experiences that challenge ones respective cultural identities and their influence on understanding and acceptance of others.

REFERENCES

Ahmed, S. (1986) Cultural racism in work with Asian women and girls. In S. Ahmed, J.Cheetham & J. Small (Ed's) Social Work with Black Children and their Families, pp 140-54, London: Batisford

Braun, D.(forthcoming, 1997) 'Parent education programmes'. In K.N. Dwivedi (Ed.) Enhancing Parenting Skills. Chichester: John Wiley

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de Silva, P. (1984) 'Buddhism and Behaviour Modification' Behaviour Research and Therapy, 22 (6): 661-78

Devereux,G. (1953) 'Cultural factors in psychoanalytic therapy' Journal of American Psychoanalytic Association 1, 629-55.

Dwivedi, K.N. (1980). 'Indian Notions in Counselling Situations'. B.A.C. Counselling News, No. 32 : 10-14

Dwivedi K.N. (1990). 'Purification of Mind by Vipassana Meditation'. In: J Crook and D Fontana (Eds.). Space in Mind. Shaftesbury. Elements, Chapter 7 : 86-91.

Dwivedi, K.N. (1993a) 'Emotional Development'. In: K.N. Dwivedi (Ed). Group Work with Children and Adolescents. London: Jessica Kingsley.

Dwivedi K.N. (1993b). 'Coping with Unhappy Children who are from Ethnic Minorities'. In: V.P.Varma (Ed). Coping With Unhappy Children. London. Cassell Ch. 11 : 134-151.

Dwivedi, K.N. (1994a) 'Mental Cultivation (Meditation) in Buddhism'. Psychiatric Bulletin. 18: 503-504.

Dwivedi, K.N. (1994b) 'The Buddhist Perspective in Mental Health'. Open Mind, 70: 20-21.

Dwivedi, K.N. (1994c) 'Social Structures that Support or Undermine Families from Ethnic Minority Groups: Eastern Value Systems'. Context. 20: 11-12.

Dwivedi, K.N. (1996a) 'Culture and Personality'. In: K.N. Dwivedi & V.P. Varma (Eds) Meeting the Needs of Ethnic Minority Children. London: Jessica Kingsley.

Dwivedi, K.N.(1996b) 'Introduction', In: K.N.Dwivedi and V.Varma (Eds) Meeting the needs of ethnic minority children. London: Jessica Kingsley

Dwivedi, K.N. (1996c) 'Children from ethnic minorities'. In: V. Varma (Ed.) Coping with Children in Stress. Aldershot: Arena Publishers.

Dwivedi, K.N. (1996d) 'Race and the Child's perspective'. In: R. Davie, G. Upton, & V. Varma (Eds) The Voice of the Child: A Handbook for Professionals. London: Falmer Press.

Dwivedi, K.N. (1996e) Services to meet the mental health needs of children. Child Psychiatry On-Line. First Published June 1996, Version 1.0

http://www.priory.com/journals/psych/service.htm.

Dwivedi, K.N. (1997, forthcoming) 'Management of Anger and some Eastern Stories' in K.N.Dwivedi (Ed.) The Therapeutic Use of Stories. London: Routledge.

Fernando, S. (1992) Race, Culture and Mental Health. Macmillan.

Goldberg, D. & Hodes, M. (1992) The poison of racism and the self poisoning of adolescents', Journal of Family Therapy, 14, 51-67

Hackett,L, Hackett, R and Taylor, D.C. (1991) Psychological disturbance and its association in the children of the Gujarati community. Journal of Child Psychology and Psychiatry, 32:851-6.

Heider, F. (1958) The psychology of interpersonal relations. New York: John Wiley.

Kallarackal, A.M. and Herbert, M. (1976) 'The happiness of Indian Immigrant Children' New Society 26 February 422-4.

Mares,P., Henley, A. & Baxter, C (1985) Health care in multicultural Britain. Cambridge: Health Education Council and national Extension College.

Reat, N.R. (1990) Origins of Indian Psychology. Berkeley, California: Asian Humanities Press

Roberts, N. and Cawthorpe, D.(1995) Immigrant child and adolescent psychiatric referrals: A five year retrospective study of Asian and Caucasian families. Canadian Journal of Psychiatry, 40: 252-256.

Roland, a. (19800 'Psychoanalytic perspectives on personality development in India'. International Review of Psychoanalysis, 1:73-87.

Sue, D.W. & Sue, D. (1990) Counselling the Culturally Different, New York: John Wiley

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Priory Lodge Education Limited, 1996-1999.
Last Amended: 27/03/99