Cross-cultural Adjustment & Mental Illness

1. Cross-cultural Adjustment &Mental Illness Mei Liu, M.A. Certified Canadian Counsellor Canadian Counselling and psychotherapy association

2. Workshop Objectives • Understand the natural process and issues in cross-cultural adjustment • Learn how to use self-validation for cross-cultural adjustment • Recognize common mental illnesses • Know when and how to seek professional help in the community

3. PART ONE Cross Cultural adjustment • Cultural Identity development • Cultural Dislocations • Cultural Conflicts • Self-Validation

4. Racial Identity Development Definition: The process of developing rejection or/and acceptance toward own and dominant cultures, as well as other minority groups • Not everyone will go through the same stages of development

5. Cultural Identity Development Five Stages: (Sue & Sue, 1990) • Conformity • Dissonance • Resistance and Immersion • Introspection • Integrative awareness

6. Cultural Identity Development Conformity Stage: • Self-depreciating toward self & own culture • Appreciation toward dominant culture • Discrimination toward other minority groups

7. Cultural Identity Development Dissonance Stage: • Conflict between depreciation and appreciation toward self and own culture • Conflict between depreciation and appreciation toward majority culture • Conflict between dominate-held view of racial hierarchy toward other minority group

8. Cultural Identity Development Resistance & Immersion Stage • Develop appreciation toward self and own culture • Develop depreciation toward majority culture • Developed empathy but also ethno-centrism toward other majority groups

9. Cultural Identity Development Introspection Stage: • Examine basis of appreciation toward self and own culture • Examine basis of depreciation toward majority group • Examine own ethno-centrism toward other minority group

10. Cultural Identity Development Integrative Awareness Stage: • Develop a positive attitude, sense of self, and confidence toward self & own culture. • Develop appreciation and openness to certain positive traits of majority culture • Develop appreciation toward other minority group and willingness to reach out to them

11. Cultural Conflicts Two types of Cultural Conflicts • Conflict with the new culture • Conflict arising with own culture after being exposed to new culture.

12. Cultural Conflicts Four states of conflicts: • Low cultural conflict • Host cultural conflict • Home cultural conflict • Bicultural conflict

13. Cultural Dislocation • A subjective experience of feeling displaced or not at home a in given socio-cultural environment (F. I. Ishiyama, 1995) • Lack of validation or under-validation of self or the ethnic self in the host culture

14. Cultural Dislocation Three Domains: • Unfamiliarity and disorientation in a new environment – decreased social competency • Uprooted-ness and homesickness • Identity crisis

15. Self-Validation in New Environment • Based on Dr. Ishiyama’s work • A useful concept in helping self and others through the cross-cultural adjustment process • Explore past and current sources of validation to grieve losses and establish new strength and identity

16. Self-Validation in New Environment Themes of Validation • Security, Comfort & Support • Self-Worth & Self-acceptance • Competence & autonomy • Identity & belonging • Love, Fulfillment and Meaning in life.

17. Validationgram Sources of validations: • Relationships • Places • Things • Activities

18. Validationgram Things Relationships Self Increasing importance Activities Places

19. PART TWO Mental Illness • Schizophrenia • Mood Disorders – Depression & Bipolar • Anxiety Disorders Contributing Factors Mental Health Resources

20. Mental illness Definition: • A diagnosable disorder that significantly interferes with one’s thinking, emotion, behaviours, and social interactions. Diagnostic Standards: • North America: DSM • Europe: ICD

21. Mental illness & Cultural Perspectives • Different cultures might have different interpretations. • A high degree of consensus about the diagnosis of mental illness among many countries. • Diagnosis/label not as important • How symptoms affect functioning is the best indication for intervention.

22. Schizophrenia Positive symptoms: • Hallucinations: Distortion in five senses/perceptions: hearing voices, seeing things. • Delusions: Beliefs that is out of touch of the reality, especially paranoia. i.e. other are plotting to hurt them; super power • Disorganized speech

23. Schizophrenia Negative Symptoms: • Withdrawal/isolation • Lack of motivation • Flat affect (dull expression) • Neglect hygiene or personal care

24. Schizophrenia Features • Is not split or multiple personality • 1% of population has schizophrenia • Onset usually is around late teenage and early 20s • Females have a later onset • No cure but can be treated

25. Mood Disorders • Normal mood fluctuations

26. Two Major Types of Mood Disorders Mood episodes Manic Episode Depressive Episode Depressive Episode Major Depressive Disorder Bipolar Disorder

27. Major Depressive Disorder Symptoms (Depressive Episode): • Depressed mood most of the day • Markedly diminished interest or pleasure • Significant changes in appetite and weight • Sleep disturbance • Fatigue of loss or energy • Feeling of worthlessness or excessive guilt • Poor concentration and memory • Recurrent thoughts of death or suicidal ideation

28. Major Depressive Disorder Intervention • When symptom last for at least 6 weeks. • Interfere with functioning, i.e. school, work and relationships • Difficult to resolve with social support, rest, exercise, leisure or diet change. • When there is suicidal ideation/plans

29. Bipolar Disorder Features: • Mood swings – between Manic and depressive episodes • Depressive episodes lasts longer than Manic episodes • Risk of suicide increases during a depressive episode • Rule out drug use for an manic episode

30. Bipolar Disorder Manic Episode symptoms: • Increased rate of speech and thought process • Poor concentration; easily distracted • Decreased sleep and appetite • Many projects begun but not completed • Lack of self-control; impulsive behaviour, i.e. increasing spending • Boastful, arrogant, intrusive; impatient • Possible psychosis

31. Bipolar Disorder Intervention • Both episodes need medical intervention • Sometimes hospitalization required • Counselling or peer support alone is not sufficient • Need to learn how to manage the illness

32. Anxiety Disorders • Anxiety is a normal reaction to stress • Most of time anxiety will pass, and normal functioning is resumed • Defined as a disorder when a certain group of symptoms are present • Each disorder has dominant symptoms but they all are a form of anxiety.

33. Common Anxiety Disorders • Generalized anxiety disorder • Panic attack • Obsessive compulsive disorder (OCD) • Phobia: social or specific phobia • Post-traumatic stress disorder (PTSD)

34. Anxiety Disorder Intervention • Is a problem when: - Anxiety is out of proportion - Anxiety interfere with daily functioning - One starts avoid feared situations - One uses drugs & alcohol to cope

35. Mental illness • Is not a personal weakness • Can be treated • Often caused by multiple factors • Bio-psycho-social-spiritual model

36. Bio-Psycho-Social-Spiritual Model Biological factors: Genetics Heredity: family history of mental illness Medical conditions, i.e. thyroid problems Brain chemicals, i.e. dopamine, serotonin Daylight exposure

37. Bio-Psycho-Social-Spiritual Model Psychological Factors: • Coping styles • Self-esteem & self-worth • Self-efficacy • Attributions • Attitudes

38. Bio-Psycho-Social-Spiritual Model Social Factors: • Current stressors • Financial difficulties/poverty • Social network & support • Change in social environment and adjustment • Social competency

39. Bio-Psycho-Social-Spiritual Model Spiritual factors: • Spiritual beliefs • Meaning/purpose in life • Relationship with the greater world

40. Mental Health Resources • Family doctors (GP) & Private psychiatrists • School counsellors • Community mental health teams & Specialized programs • Mental health emergency services • Suicide prevention program • 911

41. Community Mental Health Teams • Provide mental health treatment and rehabilitation outside of hospitals • Consist of psychiatrists, nurses, social worker, counsellor, occupational therapist, vocational therapist, health care worker. • Accept the most severe cases • Accept direct referrals • Free of charge

42. Community Mental Health Programs Vancouver Coastal Health • General Inquiry: 604-736-2033 www.vch.ca “Adult Mental Health program” • Mental Health Emergency Services 604-874-7307

43. Community Mental Health Programs Fraser Health: • General Inquiry: 604-587-4600 www.fraserhealth.ca “Adult Mental Health program” • Mental Health Emergency Services 1-877-384-8062

44. Urgent Mental Health Services • 911 • Suicide Prevention Program 604-872-3311 • Crisis lines (Front of Yellow Pages) • The Red Book 604-875-6381 (Non-urgent resources)

45. “ Sometimes it is more important to know what kind of person has a disease that what kind of disease a person has” Sir Wm. Osher