Without any doubt, the 21thcentury has transferred the world into a new era where a multicultural and multiracial civilization determines human social values. According to the statistics, 4.3% of the USA population is represented by the Asian community (American Psychiatric Association, 1994). Genetically, the Asian group is divided into three subgroups: Asian Americans (Japanese, Koreans, Filipinos, and Chinese), Asian Pacific Islanders (Oceanian Americans: Hawaiians, Guamanians, and Samoans), and Southern Asian Americans (Laotians, Cambodians, and Vietnamese). Asian Americans comprise the most numerous and growing group of the American population. This population had risen from 1 million to 8 million by 2000. Historically, Asian Americans were the first Asian colonizers in the USA and they arrived to this country approximately 150 years ago. The 1965 Immigration Act facilitated the immigration process of Asians to the USA.
Unfortunately, comparing to the native American citizens, this group suffers more from depression that may cause suicide and further lead to death. Statistically, depression affects over 18-21 million Americans, most of whom belong to the Asian American ethnical group. This can be amplified by the fact that the Asian American female population of 18-65 years old has the highest rate of self-murder. Moreover, Asian American students have higher level of depressive symptoms than other ethical groups. They always report about their race discrimination, outrages, and violence. In this case, depression is explained by the lack of love and attention. In Asian American families, the concept of parental love is absolutely dysfunctional and incapable while parents do not show their love and care for their children. Consequently, it leads to the suicidal ideation. Additionally, Asian Americans are usually treated in inpatient and outpatient settings due to their cultural beliefs that nature can cure their pain and bring happiness into their lives (Lu & Friedman, 2010).
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It is necessary to mention what depression is as well as its basic peculiarities and consequences. Depression is a disorder that is characterized by the following symptoms: irritable mood, low interests in activities, thoughts of guilt, death and suicide, pronounced changes in sleep and appetite, agitation, headaches, chronic pain, and internal mental destruction. It is necessary to point out main issues that have significantly influenced Asian Americans and led to depression. First of all, these are cultural and social issues. Going thousands of years into the past, the only way not to be poor was to become a well-known and respectful member of the social community. In this case, Asian Americans were forced to work hard in order to get a good position and job in the American society. All awards that the person gained belonged to his/ her family, but not to this person. In this case, the person did not feel support from the family, so it led to the personal discouragement and major depression (Marin & Escobar, 2008).
The second issue is oppression and racism. These problems were observed during the period from 1850-1945 when Asians came to the USA with the purpose of working in gold mines and building the railway communication. At the period of “sneaky and sinister”, Asian immigrants were discriminated: they were not allowed to have private farms, lands, or to bring their children and wife to the USA. Moreover, children of the Asian Americans during World War II felt psychological effects of the internment. Asian Americans suffered from the transgenerational trauma that was explicit in the consequences of war, famine, economical, political, and social upheaval. Nowadays, racism and social discrimination of the Asian Americans still exist. In this case, while treating Asian Americans, private psychologists should take into account historical peculiarities, racism, and discrimination that Asian Americans have faced in the United States. Furthermore, treatment providers should be knowledgeable about the influence of war and transgenerational period on this group (Kirmayer & Jarvis, 2006).
Thirdly, cultural shock and post-migration experience have considerably influenced the psychological view of Asian Americans. While moving to the USA, Asian immigrants completely changed their habitual environment and put themselves into a new, strange, and unpredictable surrounding. Moreover, language barriers and homesickness played significant role in spreading depression among the Asian Americans. Additionally, the big stress for this ethnic group was a lack of family support while they found themselves in a new environment where a complex family community was totally changed into a separated family unit. In this case, families became isolated. They were afraid of establishing new culture, customs, and traditions in an absolutely new country.
The forth issue is acculturation that is apparent in the level of Asian Americans’ adaptation to new land and society. In this context, Asian Americans were forced to deny their culture and become Americanized. This aspect influenced the way of thinking of this ethnic group and some of them still have an insight struggle of their personal identification between American-ego and Asian-ego. The fifth issue that impacts the Asian Americans’ depression is financial stress. Many investigations have demonstrated that the cause for major depression is unemployment. There are two types of stress related to unemployment. One of them is “downward mobility” that significantly underestimates insecurity, self-esteem, and self-confidence. The other is demonstrated by a model of a “glass ceiling” that shows how ethnic belonging makes a barrier in the colleagues’ relationship and leads to discrimination at work. Both types of stress cause frustration, moral lapse, and job dissatisfaction. Additionally, traditional Asian American parents’ type of work also causes depression. On the one hand, the intense relationship can be observed when members of the family spend long hours together. On the other hand, in an “astronaut family” (when one parent lives in the USA and the other one is in the home country) family members suffer from the lack of communication (Li & Wang, 2008).
Moreover, ethnical division may cause depression in Asian Americans. This can be amplified by the situation when the neighborhood considerably influences and changes the cultural heritage of the Asian American families. For instance, in Chinatown, local community strongly supports Asian Americans and helps them to develop and keep their cultural values. However, those families that live in other districts feel isolation from their ethnic group and may suffer from racism, drugs, crime, and bad housing conditions (Takeuchi & Hong, 2007).
Finally, cultural values regarding the health care system may cause a serious problem of treating depression in Asian Americans. Statistically, 70% of Asian Americans do not seek help from the state service. What is the reason of such a low level of people who need professional psychological care? The problem is cultural beliefs that have isolated Asian Americans from the mental health system. Most Asian Americans believe in the yin and yang forces that balance the existence of life and death in the world. According to these beliefs, people can achieve equilibrium by keeping diet and limiting themselves in terms of pleasure. In Asian traditions, it is seen that the mental factor as the main index of health is not taken into account. Moreover, Asian American clients reflect that mental disorder is a punishment for some people’s failures. In this case, the person is obligated to suffer for his/ her faults. For this reason, Asian Americans are afraid to share their problems with a psychiatrist, while they feel ashamed for their rash actions and may expect blame from the doctor (Yeung & Kam, 2006).
Looking at the above mentioned issues that may cause depression, it is necessary to mention the appropriate treatment that will be helpful in diagnosing Asian American clients and their mental recovery. There are four main methods to treat Asian Americans: family therapy, medications, behavioral approach, and psychoanalysis. First of all, it should be taken into account that all Asians have a reflection of the entire family. That is why, the family should be a predominant element in the treatment. Family therapy does not demand that all family members participate in the session. At the first stage, it is vital to establish therapeutic relationships between a mental specialist and family members. For instance, an effective approach is to interview family members separately, to identify the patient, and then siblings. It is highly recommended that parents express their opinions and emotions freely when children do not participate in the psychoanalytical session. Children should also express their feelings freely without a fear that their parents may punish them. Consequently, parents and children will be ready to accept family therapy and show willingness to discuss their problems. At this stage, it is vital to establish credibility and belief in the effectiveness of the family therapy. Moreover, medication is determined as a helpful method in the treatment of depression. In the application of medication, it is necessary to control the dose of drugs because the structure of the body, weight, and ethnic peculiarities of the Asian Americans are completely different from the Anglo-Americans. Moreover, Asians may take herbal medicine in order to treat mental and physical problems. In this case, psychiatrist should pay attention to the side effects that can be caused by the consumption of traditional remedies and pharmaceutical pills at the same time (Marin & Escobar, 2008). Additionally, the behavioral approach analyzes the direct behavior of Asian Americans, explores their cultural and social experience, and determines main reasons that have led to depression. Finally, it is highly recommended to perform psychoanalysis in the treatment of Asian Americans. In conducting this analysis, a therapist should follow the main rule of psychoanalysis: mental organization of id, ego, and alter ego spheres of the inner world of the person. In this case, psychiatrist should ask many questions, create a convenient atmosphere (play silent music and use comfortable furniture), build trustworthy relationships, and not limit the person in expressing his/her emotions (Kalibatseva & Leong, 2011).
The last but not the least point worth mentioning is the application of cross-cultural professional practice in the treatment of Asian Americans with depression. It is very important that a health provider should be aware of specific cultural factors, such as religious beliefs, acculturation, racism, discrimination, social, political, and economic stress while treating Asian Americans. Moreover, a treatment provider should know cultural treatment models. It is vital to create the electronic charting of Asian Americans that will consist of the medical experience from the whole world concerning the cases of treating these patients. It is necessary that healthcare providers are aware of somatic and psychological methods of distress. In addition, it is crucial to implement the personal experience of discrimination and racism of the Asian Americans while providing the treatment. It is highly recommended to analyze the psychological effect of immigration, war, unemployment, and diversity of Asian American families (Yeung & Kam, 2006).
All in all, in multicultural world it is necessary to treat immigrants on the same level as native citizens. Healthcare providers should abandon their personal stereotypes while giving an effective diagnosis of Asian Americans in order to establish a high-qualified treatment. It is necessary to utilize the cultural competence in the treatment of Asian Americans with depression. It can be generalized by the fact that the effective medical cure of international citizens will be appropriate only in cases of deliberation from the cultural impact. Inner harmony and mental health will be achieved when such psychological parts of humans as id, ego, and super ego are completely healed and rightly arranged.
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