ArticlePDF Available

Cultural Psychiatry and Minority Identities in Japan: A Constructivist Narrative Approach to Therapy

Authors:

Abstract

Clinical work with minorities in Japan is a relatively new and rapidly growing field. An influx of migrants from the 1970s has required psychiatrists to work with culturally different patients, yet few are experienced or trained in this area. With an even more radical population change imminent, skills in working with people of diverse cultural backgrounds are becoming a pressing need. While psychiatry in Japan has long been concerned with culture, only very recently has this concern involved differences among Japanese. Psychotherapy with both new migrants and individuals from more traditional minority backgrounds involves issues of acculturation and identity. A clinical approach based on a theoretical orientation of constructivistic narrative therapy can be usefully applied to multicultural situations. A case is presented in which this approach is employed in assisting a Korean-Japanese youth to deal with identity struggles.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Cultural psychiatry and minority identities in Japan: A constructivist narra...
Stephen Murphy-Shigematsu
Psychiatry; Winter 2000; 63, 4; Health Module
pg. 371
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
... Therapists may also need to provide psychoeducation on the process of accul-malize clients' feelings. Additionally, narrative therapy may be an effective tool in addressing acculturation and identity issues (Murphy-Shigematsu, 2000). In particular, therapists can use strength-based interventions to help clients understand the uniqueness of their cultural heritage, externalize the problem by naming and telling their story, and raise their awareness of their own identity development and confusion, thereby re-authoring conversations to help Chinese immigrants resolve their identity struggles. ...
... [2] ...
Article
Full-text available
Endometrial osseous metaplasia is a rare clinical entity. It causes infertility and occurs in more than 80% of cases after an abortion. Various theories have been proposed and the most accepted theory is metaplasia of the stromal cells into osteoblastic cells that produce bone. This disease may be misdiagnosed. However once diagnosed, the complete removal of bone spicules by hysteroscopy allows, in most cases, fertility to be restored. We present the case of a 36-year-old patient nulliparous with a history of abortion for eight years who consulted May 5, 2008 to become pregnant. Detailed examination showed chronic endometritis with bone metaplasia as a possible cause of her infertility. Seven months after complete removal of bone fragments by hysteroscopy, the patient had a spontaneous pregnancy with normal development. She gave birth to a male infant weighing 3,000 g with an Apgar score of 9 at 1 and 5 min. Delivery and postpartum were normal.
... [2] ...
Article
Full-text available
Leimyomatosis peritonealis disseminata (LPD) is a benign tumor of smooth muscle tissue. It is rare and is characterized by the development of multiple peritoneal nodules mimicking peritoneal carcinomatosis. We report a case of LPD diagnosed in a 35-year-old patient, G4/P1, without any major gynecological history. The patient underwent an elective cesarean section at 42 weeks, during which numerous peritoneal nodules ranging in size from 0.1 to 0.5 cm were found. Microscopic examination showed a proliferation of smooth-muscle cells without mitosis or atypia or necrosis.
... Others have suggested that discourse analysis has proven itself especially compatible with the approach (Gardner & Poole, 2009). Second, there is little research on the practice of narrative therapy with oppressed communities (Biever, Bobele, & North, 1998; Murphy-Shigematsu, 2000; Semmler & Williams, 2000). Although there has been some application of narrative approaches with indigenous groups in Australia (Pease, 2002), little has been written on how the approach might work for those living in poverty and/or coping with what some label as disabilities (Kropf & Tandy, 1998; Man-Kwong, 2004). ...
Article
Full-text available
In this article, the authors report on a qualitative study that explored the use of narrative therapy with a diverse group of older adults dealing with mental health and substance misuse issues. Narrative therapy supports individuals to critically assess their lives and develop alternative and empowering life stories that aim to keep the problem in its place. Although the literature suggests this is a promising intervention for individuals, there is a lack of research on narrative therapy and group work. Aiming to address this gap, the authors developed and researched a narrative therapy group for older adults coping with mental health and substance misuse issues in Toronto, Canada. Taking an ethnographic approach, field notes and interviews provided rich data on how, when, and for whom, such a group could be beneficial. Findings contribute to the literature on group work, older adults, and narrative therapy.
... However, the complexity of development requires a more flexible approach such as one based on social constructivist ideas that inform a view of identity development as fluid, dynamic, and constructed in a relational context (Yi and Shorter-Gooden, 1999). Studies of identity in minorities in Japan are currently being done by such a narrative method that challenges the notion of a singular developmental course, and instead accepts and illustrates the validity of multiple developmental scenarios (Murphy-Shigematsu, 2000, Forthcoming). ...
Article
This article examines the identity and acculturation experience of Muslim foreign workers in Japan. The psychological impact of prolonged stay in a foreign country was studied by eliciting narratives of experiences of 24 male foreign workers from Bangladesh, Pakistan, and Iran who had been in Japan more than 5 years. By analysing the narratives they produced, three different styles of stories emerged which explained their experiences and their attempts to maintain or construct a sense of identity. Accepting the dominant narrative of Japanese society and describing oneself as ‘almost like Japanese’ was one way. Another strategy stressed the rejection of the dominant narrative as well as attempts to maintain the original narrative of the self as educated and active young men. The third narrative showed how individuals re-defined themselves as Muslim by incorporating religious identity into a central part of their self-concepts, and asserting its pervasive effect on all aspects of life. This study provides a perspective for acculturation research focused on social elements of identity, and derived from experiences in a relatively mono-cultural society recently opening to immigration and in which there is a prevailing ideology of assimilation. Copyright
Article
Postmodern approaches, specifically those based on ideas from social constructionism such as narrative therapy and solution-focused therapy, are currently being used in a variety of contexts and with multiple cultures. The authors suggest ways in which narrative therapy and solution-focused therapy may appropriately be used with Latino/a populations. The authors review basic tenets and techniques of both narrative and solution-focused therapy emphasizing their application to Latinos/as.
Article
Full-text available
Aim : This study was performed to examine the association between nursing students’ knowledge and interest regarding foreign resident medical health challenges and experience of international exchange as part of an evaluation of global health educational programs. Methods: An anonymous self-administered structured questionnaire survey was conducted among 78 nursing students in their 4th year of study at a university in August 2015. The questionnaire elicited responses related to knowledge and interest regarding foreign residents’ medical health challenges in Japan, likelihood of caring for foreign nationals as nurses, and experience related to international exchange. Results: Among68(91.9%) study participants, 23(33.8%) responded they were aware of medical health challenges of foreign residents. There were significant differences in knowledge and interest scores regarding foreign residents’ medical health challenges according to experience of international exchange (Mann–Whitney U test, P=0.003). The Spearman’s rank correlation coefficient between level of interest regarding foreign residents’ medical health challenges in Japan, as measured using a visual analog scale( VAS), and international exchange experience score was 0.315(P=0.009). Conclusions: The majority of nursing students understood the likelihood of caring for foreign nationals in medical health service provision, although they did not have interest in the associated issues. Nursing students that participated in international exchange tended to show greater interest in international/global issues, including foreign residents’ medical health challenges.
Article
Full-text available
Various factors including social isolation and financial worries put older adults at risk for addictions. Indeed, older adults are the largest consumers of medication, and alcohol consumption is rising. Yet interventions are limited and problems often go unreported. Unearthing “problem” stories in people’s lives (i.e., “the addiction story”) and retelling them in more empowering ways, narrative therapy offers a viable therapeutic alternative, and research on narrative therapy has proven encouraging. However, little is known about narrative therapy with older adults and with addictions. Seeking to address these gaps, an ethnographic study was conducted in Toronto, Canada, with a group of older adults receiving narrative therapy for addictions. Findings suggest that the therapy was “helpful” and participants were able to reduce or halt their substance misuse. Most important, aspects of narrative therapy such as storytelling may be particularly well suited to older adults, offering powerful possibilities for applied gerontology.
Article
The paper analyzes public policy and public opinion responses toward immigrants in Germany and Japan, two countries whose immigration policies have relied on blood purity (jus sanguinis). The paper retraces the rationale for jus sanguinis and contends that it was adopted at the turn of the century in both countries out of political convenience. The principles and goals of immigration policies are compared cautioning that better principles must not mean better outcomes.It is reiterated that Germany has made a politically motivated move away from the ethnic monocultural concept, whereas Japan still hangs on more or less to the old model of silent and subtle assimilation. The more dissuasive Japanese model of tight immigration control, deportation and monocultural assimilation isthen compared to the more permissive German immigration model. A comparison of identity discourses in the form of Japanese Nihonjinron and German Leitkultur shows that both countries struggle with identifying and asserting their core values and that this has a negative impact on integration issues. The paper concludes that Germany has failed to bear the full consequences of its ambitious plans by taking into account the values, beliefs and worldviews of its immigrants, whereas Japan continues to treat immigrants as temporary guests denying any need for long-term integration.
Article
The objectives of this research were to examine the current status of perioperative treatment among foreigners, to elucidate the health status/outcome disparities that contribute to ethnic differences, and to recommend counter-measures to rectify these ethnic disparities. The authors identified 36 non-Japanese and 111 Japanese females who underwent gynecological surgery from 2004 to 2009 at a single institution. Electronic medical records were reviewed and telephone survey was conducted in order to obtain patient background, preoperative, operative, and postoperative data. The non-Japanese group showed significantly larger number of uninsured, shorter length of stay (LOS), higher rate of emergency surgery, and higher cases of spinal anesthesia. There were significant differences in length of residency in Japan and LOS among four foreign countries. Seventy-nine percent of patients contacted by phone understood informed consent from doctors, 73.7% understood explanation in operating room (OR), and 84.2% understood explanation from anesthesiologists. This research was the first survey of the ethnic disparities in perioperative management among foreign patients treated in Osaka. The authors have demonstrated differences in operative method, emergency surgery, anesthesia, and American Society of Anesthesiologists physical status (ASA-PS) due to the difference in disease structure, language, and culture. It is recommended that the barriers between non-Japanese patients and medical staff are rectified during the perioperative period when mutual understanding is needed the most.
Article
Full-text available
Japan is a society with many ethnic and social minority groups and a large majority population of heterogeneous origins. Anthropological evidence describes a migration from Southeast Asia and later from East Asia, probably over land bridges that once existed. The early settlers in the Jomon era included the Ainu and Ryukyuan peoples, and were followed by immigrants of the Yayoi era. The Ryukyuans lived in Okinawa and the other Ryukyu islands, and had their own distinctive language and culture and strong ties with China before their independent kingdom was forcibly incorporated into the expanding Japanese nation. The Ainu maintained their ethnic characteristics by moving north, but the Yayoi-era people either exterminated or absorbed the Jomon people with whom they came into contact. It was these Yayoi people who eventually formed the Yamato state in the fifth century. Invasion and migration from China and Korea continued until the ninth century, by which time nearly one-third of the aristocratic clans in the Chinese-style Heian capital (present-day Kyoto) were of Korean or Chinese ethnicity. Immigrants were well received as they were recognized as bearers of a superior cultural tradition, not only as nobility but as craftsmen, priests, and educated professionals. Their traditions in literature, art, and religion were absorbed and became a foundation on which much of Japanese culture was based (Sansom 1958). The sixteenth-century plunder of Korea by military forces under Hideyoshi included the capture of artisans and scholars who were brought to Japan en masse for their advanced skills in pottery and printing. In more recent times, large numbers of people from Korea and Taiwan, who were at that time colonial subjects and Japanese nationals, settled in Japan or were pressed into prewar or wartime labor there. Despite efforts to repatriate them after the war, many stayed in Japan but lost their Japanese nationality when the postwar San Francisco Peace Treaty of 1952 designated them as foreigners. The Allied Occupation brought hundreds of thousands of people to Japan, mostly American men, and the maintenance of military facilities has led to the continued presence of a significant number of American
Article
Full-text available
A constructivist narrative approach to ethnic identity development is proposed as an alternative to traditional stage models of ethnic identity. Instead of conceptualizing identity as a linear, sequential unfolding, ethnic identity is seen as a narrative, shaped by contemporary and historical exchanges with one's family, friends, institutions, and the broader culture. It is argued that a constructivist narrative approach is more effective than the stage-model approach in capturing the diversity of identity-shaping experiences that define the lives of people of color. Several guidelines are proposed for utilizing a constructivist approach to ethnic identity, also called the ethnic self-narrative, in psychotherapy. The proposed approach to ethnic identity is illustrated through a case study of a Korean American male client suffering from trauma related to interethnic conflict with African Americans. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Full-text available
Predicated on a postmodern epistemology, constructivist theories emphasize the proactive, self-organizing features of human knowing and their implications for psychotherapy. This article outlines the potential contributions of 4 clinical lineages sharing a constructivist philosophy--personal construct theory, structural--developmental cognitive therapy, narrative reconstruction, and constructivist family therapy--and briefly reviews emerging trends in psychotherapy research compatible with this perspective. Although current constructivist approaches confront problems as well as prospects, they represent a growing force within psychotherapy, contributing to the sophistication of psychological theory, the diversification of clinical research, and the extension of therapeutic technique.
Article
Full-text available
Psychotherapeutic work in Japan with minority populations requires an understanding of their specific social and cultural context. Clinical case studies of individuals of burakumin, Korean, and mixed ancestry illustrate the complex issues of prejudice, discrimination, legal contraints, state ideology, and popular mythology of homogeneity that each brings to counseling. Clinical approaches, guided by a multicultural counseling and therapy framework, are discussed.
Article
This article is an attempt to expand the descriptive characteristics of the Cross model by discussing a theory of psychological Nigrescence that hypothesizes the changes in racial identity that a Black person can experience at various points in the life-cycle process. In this discussion, I will attempt to describe how various stages of racial identity are manifest at three periods of life: late adolescence/early adulthood, middle adulthood, and late adulthood. I will conclude with a discussion of the implications for counseling Blacks who display varying degrees of racial identity attitudes.
Article
Examines the development of racial consciousness and advances a model that proposes separate stagewise processes for Blacks and Whites. Hypothesized counseling predispositions for each of these stages are formulated with implications for same- and cross-race dyads. The model is based on the premise that all people, regardless of race, go through a stagewise process of developing racial consciousness wherein the final stage is an acceptance of race as a positive aspect of themselves and others. Nevertheless, although the process of acquiring an internalized racial consciousness may be similar for Blacks and Whites, the content or theme of the process is likely to be different because of the different socialization experiences that accompany race in the US. (PsycINFO Database Record (c) 2012 APA, all rights reserved)