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Journal
of
Applied Rehabilitation Counseling
Disability and the Asian Culture
KennyK. Van
Michael
P.
Accordino
Daniel
L.
Boutin
Keith
B.
Wilson
Abstract -- Contemporary demographics reveal that the Asian Population is the fastest grow-
ing minority
in
the
u.s.
Thus, vocational rehabilitation counselors must be prepared to face
cultural dynamics that can influence outcomes
in
the treatment process. While many people
may view Asians as a homogenous population, people who are
of
Asian descent come from
many places including, but not limited
to
Cambodia, China, India, Japan, Korea, Malaysia,
Pakistan, the Philippine Islands, Thailand, Vietnam and Asian/Pacific Islander population.
The present study provides information about the Asian culture relative
to
people with dis-
abilities and seeks to give clinicians more tools
to
apply when working with people who are
of
Asian descent. Asians represent 4.8%
of
the civilian non-institutionalized population. Since
the Asian/Pacific Islander population
is
a large racial ethnic group
in
the
u.s.,
it is important
to
understand how vocational rehabilitation counselors educate them
to
live
in
their new
land.
T
he
Asian population is one
of
the fastest-growing racial
groups in the U.S. with the growth rate
of
Asians with
disabilities steadily increasing.
In
the context
of
cultural differences, Asians with disabilities may avoid
or
refuse some services from rehabilitation agencies because
negative family issues may not be shared beyond family
members in a traditional aspect
of
Asians. Tradiliullal
Asian parents were educated that family is the central and
primary unit and emphasize loyalty within the family
(Committee
of
100, 2001). Therefore, Asians consider a
family member with a disability as a family problem.
Because Asians believe that disability is shameful and
represents family failure, such issues are hidden from the
public and only handled within the families.
Asians are defined as people who are originally
from the Eastern Asia, Western Asia, Southeast Asia,
or
the
Indian subcontinent. The most common countries repre-
sented are Cambodia, China, India, Japan, Korea, Malaysia,
Pakistan, the Philippine Islands, Thailand, and Vietnam
(U.S. Census Bureau, 2003).
In
this review, two groups
of
Asians are selected: Chinese (including people from main-
land China, Taiwan, and Hong Kong) and South Korean.
History of Asian Immigration in the United States
During the 1800s, most
of
the Chinese living in the
U.S. worked as merchants, domestics, farmers, and grocers
4
in mainland China. The Chinese believed that the Gold
Rush could bring them fortune; therefore, they came to the
U.S., hoping to return home with wealth. Beginning in
1865, the businessman
of
Transcontinental Railroad project
used the Gold Rush as an attraction to entice many Chinese
to work in the railroad industry. The Chinese Exclusion Act
or
1882 sigllcu by Plcsident Chester
A.
Althur prohibited
all immigration
of
Chinese laborers; therefore, Chinese
workers became part
of
an isolated community. As a result,
the first generation Chinese immigrants built their own
community
by
promoting small business ownerships in vo-
cational sectors including restaurants, laundry, and
merchandise retail (Le, 2009).
In
1965, the Immigration and Nationality Act
opened the door for millions
of
Asians to immigrate (Le,
2009). Thus, Asians tended to reside in metropolitan areas
in the U.S. Due to labor market discrimination, Asian
Americans chose to
be
self-employed and often earned a
higher salary than other ethnic groups. In terms
of
profit-
ability, most Asian Americans hired their relatives as a
cheap labor source and many
of
these relatives had to work
very long hours. Because
of
the language barrier, the Asian
family member often did not understand American laws and
business regulations and were hired as cheap labor, usually
working without benefits, insurance
or
knowledge
of
job
safety (Le). This review
of
literature has been divided into
the following five sections: (a) Asian demography and re-
Volume 45, Number
2,
Summer 2014
habilitation, (b) Traditional Chinese views
of
disabilities,
(c) attitudes toward people with disabilities, (d) a South Ko-
rean view
of
disabilities, and (
e)
changing views
of
Asians
toward individuals with disabilities.
Asian Demography and Rehabilitation
According to the Asian and Pacific Islander Ameri-
can Health Forum (2008), more than 63%
of
Chinese Amer-
icans are foreign-born, 23% do not speak English fluently,
and 72.5% speak a language other than English at home.
Since the early 1980s, approximately 850,000 people have
annually come to the U.S. from other countries. The esti-
mated foreign-born population
of
the U.S. in 2009 was 37.3
million (9.9 million were Asian, 2.4 million are Chinese, 1
million are Korean). According
to
the U.S. Census (2010),
14.7 million Asians were living in the U.S., with 45.5% lo-
cated in the West, 21.9% in the South, 11.8% in the Mid-
west, and 20.9% in the Northeast. Asians represent 4.2%
of
the civilian non-institutionalized population. The Asian
population is one
of
the fastest growing racial groups
in
the
U.S. from 2000 to 2010; furthermore, the rate
of
the popula-
tion continues to increase. Moreover, Asians with disabili-
ties may refuse any kind
of
services from rehabilitation
agencies because
of
cultural differences from other races.
Rehabilitation services include physical, occupa-
tional and speech language therapists, vocational rehabilita-
tion personnel, rehabilitation technology specialists,
rehabilitation physicians and nurses, special educators,
staff
of
centers for independent living and community ser-
vice providers (Johnstone, 2001). A disability can be a
challenge regardless
of
race and ethnicity. Since most
Asian countries such
as
China and Korea have over thou-
sand years
of
history, they have a strong negative founda-
tion to judge disabilities. For a new Asian immigrant the
challenge is often magnified because the Asian culture dif-
fers greatly from western culture. In addition to difficulties
with languages, housing, and employment, new immigrants
tend to experience a language barrier. Consequently, they
may have difficulty understanding and accessing
rehabilitation services.
Traditional Chinese Views
The most influential philosophical and religious
beliefs affecting the Chinese are Confucianism and Taoism.
The focus
of
Confucian society is on keeping relationships
stable, which affects social harmony and order. Social har-
mony
is
important for the expression
of
ones' opinions and
values. When people
of
Chinese descent begin their fami-
lies, they base its foundation on the five cardinal relations in
harmonious interdependence, which include aspects of: (a)
sovereignty and subject, (b) father and son, (c) elder and
younger brother, (d) husband and wife, and, (e) friend and
friend (lenni, 1999). Thus, Chinese have a strong family
structure in which elderly males hold the family authority.
Senior family members are superior to junior generations
and newly married couples are expected to live with the
family
of
the groom. Elderly family members want the
5
family to stay together in order to maintain future existence
(Lau, 1996).
Taoism is based on the two principles
of
following
natural laws and the Way (or Tao)
as
well
as
being humanis-
tic (i.e. kind, polite, considerate) by following human laws.
The belief
of
Taoism
is
duality
of
all things
in
the universe
(i.e. Yin and Yang), the dialectic
of
change and the impor-
tance
of
balance. Harmonious interactions exist between
Confucianism and Taoism,
as
both are part
of
ancient and
contemporary China. The philosophies provide the plank
for social order and responsibility. The idea
of
disability is
seen to be disharmony, therefore, hardly tolerable among
the Chinese (lenni, 1999).
The Effects
of
Stereotypes and Superstitions
Because
of
this strong need
to
maintain the family
structure, people with disabilities often face particular chal-
lenges (Lau & Kwok, 2000). In the Chinese culture, most
people with disabilities experience discrimination and are
treated with prejudice. People with a disahility have been
judged based solely on the outside appearance and attitudi-
nal stereotypes are passed on from generation
to
generation.
People with disabilities are often seen
as
outcasts
of
society
and having little worth
as
citizens in the Chinese culture. In
many Asian countries, people with disabilities are still re-
garded
as
incapable to be educated and functioning mem-
bers
of
society. Therefore, people with disabilities are often
forgotten and fall through the cracks (lenni, 1999). Even in
the U.S., people with disabilities in the Chincsc culture arc
discriminated against and treated
as
second-class citizens.
Traditional views often rely on superstitions that
disability is a form
of
punishment, promoting the idea that
having a disability may be considered a tragic experience.
Therefore, parents may hide a child with a physical disabil-
ity because the traditional Chinese may be judgmental
to
physical disabilities. Traditional Chinese who have strong
religious beliefs might also generalize negative judgments
to
the whole family because they believe that the disability
was caused by family members who have committed bad
deeds in the past or present (Mente, 2000). Therefore,
as
a
result
of
this rationale, the family
is
deemed
to
have a nega-
tive fate as well
as
shame (Choi & Choi, 2002). The percep-
tions that traditional Chinese hold about disabilities come
from superstitions within the culture (Hur & Hur, 1999).
Furthermore, traditional Chinese culture dictates that
fe-
males are assumed to be less intelligent than males. Chi-
nese American females with a disability are often unsure
of
how they will be treated by the American culture since their
own culture has often demeaned them (Choi & Choi).
Parental Expectations
Chinese parents who have children with visible dis-
abilities tend to want their children
to
be the best even
though they may struggle to compete. Sometimes, children
with disabilities may be sheltered by their parents. For in-
stance, at certain functions where many first generation
Chinese Americans get together, parents would try
to
hide
Journal
of
Applied Rehabilitation Counseling
in order to "protect" their children, because parents
of
chil-
dren with disabilities fear that the elders would not under-
stand
or
accept someone who has disability.
High expectations are often placed on Asian chil-
dren who are able-bodied. Young adults feel constant pres-
sure from their Chinese families to be more successful than
their peers academically. In contrast, American parents
may give more freedom to their children to choose in order
to develop the child's potential in different areas. Chinese
parents rarely consider that it can be damaging to their child
when they send messages that failure is not an option (Lau,
1996). Chinese children may feel pressure to consistently
"be
the best" in order to prevent disappointing their parents.
Children have gone as far as making important life deci-
sions, such as their work and life plans in order to satisfy
their parents. Asian children also may pursue the dreams
of
parents, and not their own. Consequently, the constant ten-
sions and the pursuit
of
goals that are not their own may
lead to burnout and eventually academic
or
vocational
failure in children (Lau, 1996).
Attitudes Toward People with Disabilities in the
Chinese Culture
Cultural differences between Chinese and Ameri-
cans affect
how
each forms attitudes toward people with
disabilities (Chan, Lam, Wong, Leung, & Fang, 1988;
Chan, Lee, Yuen, & Chan, 2002; Tsang, Chan, & Chan,
2004; Wang, Chan, Thomas, Larson, & Lin, 1997; Wang,
Thomas, Chan, & Cheing, 2003). Chan et aI., (2002) exam-
ined Chinese high school and college students and found
that they have less positive attitudes toward either mental
or
physical disabilities than American students. Students in
Hong Kong and Taiwan reported more negative attitudes
toward people with physical disabilities than toward people
with developmental disabilities.
On
the other hand, the
U.S. government enforces the Americans with Disability
Act, which offers support to and prevents discrimination
against students with disabilities (Blackseth, 2011), thus
U.S. students tend to be more positive toward individuals
with special needs in comparison to Chinese students.
Chan et ai. (2002), using the Attitudes Toward Dis-
abled Person Scale (ATDP, 2002), surveyed first year col-
lege students in Chinese and American universities; the
results showed that, on average, American students scored
10
points (0.5 standard deviation) more positive than Chi-
nese students. Wang et ai. (2003) analyzed the attitudes
of
American and Taiwanese college students toward people
with disabilities. Wang et ai. found that both groups most
often preferred females with milder disabilities at a younger
age and with higher education. Furthermore, most Ameri-
can students tended to be more accepting
of
people with de-
velopmental disabilities, and Taiwanese students tended to
be more accepting
of
people with physical disabilities.
Chinese attitudes toward people with disabilities
have been changing because
of
education offered in acade-
mia. However, not all college majors have a positive effect
on attitudes toward disability. Chan et ai. (2002) compared
undergraduate occupational therapy and business students
in Hong Kong, and found that first year students in both ma-
jors had similar attitudes toward disabilities.
By
the end
of
the first year, occupational therapy students showed more
positive attitudes than business students toward individuals
with disabilities.
A South Korean View
of
Disabilities
Traditional South Korean culture values harmony
with order, contrasting with American mainstream culture
that stresses individualism (Hur & Hur, 1999). South Kore-
ansvalue
harmony within family, community, and society.
They are influenced
by
Confucianism and strong ties to
family. In addition, South Koreans value education, hard
work, and possess high ambition to excel. Traditional
South Korean values include filial piety, respect for elders,
benevolence, loyalty, trust cooperation, reciprocity, and hu-
mility. While there may be some similarities between the
American and South Korean cultures, it is clear that South
Koreans may value community and harmony within the
family more than a non-Asian family in the U.S.
6
Demographically, South Korean Americans repre-
sent
1.1
million
of
the U.S. population (U.S. Census Bu-
reau, 2003). South Korean Americans adaptive to
American mainstream culture (Kim-Rupnow, 2001). One
of
these differences is the American emphasis on individu-
alism. Since South Koreans emphasize harmony with or-
der, they tend to
be
influenced
by
the opinions
of
family
members
or
others within the community when making de-
cisions.
If
South Korean Americans make decisions based
on their own preferences without considering others, South
Korean Americans could
be
labeled "selfish." Many South
Koreans consider themselves as extensions
of
their families
and often regard the welfare
of
family members based on
gender and age. Exchanging roles and sharing power are
not encouraged because
of
strong beliefs that order and har-
mony exist when South Koreans have clear distinctions be-
tween the roles and duties
of
men and women. This
traditional legacy often results in the husband leading and
the wife following. Children are ranked
by
age with
younger children required to respect their older siblings
(Breen, 2004).
South Koreans believe supernatural influences
cause disabilities (Hur & Hur, 1999) and tend to feel help-
less, depressed,
or
blame themselves or their ancestors
when they discover a disability in themselves
or
their fam-
ily. South Koreans tend to seek little help and leave every-
thing to fate. The person with a disability is often cared for
by parents, who usually expect their child to "outgrow"
such conditions. People who have had a scientific educa-
tion believe that disabling conditions may be overcome
with appropriate medical intervention and actively search
for medicine, therapy,
or
surgery from health professionals
(Kim-Rupnow, 2001). The
modem
views
of
South Kore-
ans are that lifelong disability is a revenge for a past wrong
doing
of
the person with the disability
or
the
of
the family.
Many South Koreans with disabilities and their families
suffer from shame, helplessness, denial, withdrawal, and
Volume
45,
Number
2,
Summer 2014
depression. Some people view acquired disability as the re-
sult
of
bad
luck
or
misfortune (National Center for the
Dissemination
of
Disability Research, 1999).
Changing Views
of
Asians Toward Individuals
with Disabilities
Western countries have influenced Asians in areas
such as housing
and
clothing. The family structure is be-
coming modernized and most young people move out after
they get married and live in small family units with only
three to four family members (Nagayama Hall & Okazaki,
2002). In the
modem
Asian families, males and females
both work and pursue careers. Females
and
males tend to
receive more equal respect than in the traditional Asian
community.
As
Asian countries are developing, people
have greater opportunities to get a higher education.
The views
of
disability are also changing.
For
ex-
ample, older generation mothers tended to lack knowledge
about physical examinations; most
of
them went without,
even during pregnancy. However, young mothers are will-
ing
to have a physical examination before and during preg-
nancy. The physical check-up is a good
way
to decrease the
chance
of
having a child with a disability (Hong Kong Gov-
ernment, 2006).
In
Hong Kong, the government delivers
more
supportive services. For example, more Hong Kong
special education schools have opened
and
teachers are
trained to teach children with disabilities. The Hong Kong
government offers financial support
by
providing a stable
place for people with disabilities to work (Hong
Kong
Paralympic Committee, 2006). These services provide
job-related training
and
counseling and at least 6 months
of
post-placement service to help the individual with disability
to settle in employment. The Department
of
Health
in
Hong
Kong
also provides antenatal service to pregnant women.
Through the antenatal shared-care program to monitor the
whole pregnancy
and
delivery process, the parents are noti-
fied
of
any defects
of
the embryo such as
Down
Syndrome;
therefore, parents have chance to "prevent" having a child
with disability (Hong Kong Department
of
Health, 2013).
Lastly,
modem
society no longer seems to view that disabil-
ity is physical
and
mental "punishment" for past
wrong
doing; however, there are remnants
of
this belief, especially
from those
in
older
generations.
Summary
Similar to all racial groups, there is variation within
and
between
Asian
cultures.
For
the purposes
of
this study,
the researchers
have
explored the perspectives
of
disability
and
human development for two specific ethnic groups
within the
"Asian"
community: Chinese
and
South Korean.
South Koreans seem to have a stronger sense
of
self-esteem
than the Chinese
(Lau
& K wok, 1997). Disability issues
still need to
be
addressed because people with disabilities
from culturally diverse backgrounds experience twice the
amount
of
discrimination than experienced
by
individuals
who
are able bodied (Tan et aI., 1999).
As
people from
across the globe become educated about disability and dis-
ability-related issues, traditional ideas should be gradually
replaced
by
more respectful and supportive perceptions.
The major issue blocking Asian access to rehabili-
tation service stems from the traditional
view
of
disabilities.
Most Asians are living in developing counties where eco-
nomic problems have blocked people from getting higher
education. As a result, the environment does not encourage
or
often permit people to gain
new
infonnation. Therefore,
the knowledge
of
the people is passed mouth-to-mouth to
the next generation. In addition, the structure
of
family
shifts power to the elderly. Family members tend to place
the greatest trust in what has
been
passed
on
to them from
their elders, who
may
have not had educational opportuni-
ties. Still, people from older generations
may
believe that
negative views
of
disability, which were passed down
through generations, continue to be valid.
Education is a crucial tool
to
change views
of
Asians especially concerning people with disabilities. Ac-
cording to a survey from a Hong Kong researcher (Chan et
al., 2002), college majors, as well as courses that view dis-
ability more favorably could affect attitudes ofundergradu-
ate students. Furthermore, the college environment has
been
more conducive to positive treatment
of
disability.
Overall, higher education can help change the traditional
views
of
students (Chan
et
aI., 2002).
Education is also one
of
the
best
interventions for
changing traditional discriminatory views and superstitions
toward disability (Schauer, 2003). The planning committee
for 2008 Paralympic games successfully scheduled events
that were held in China after the Olympic Games (Hong
Kong Paralympic Committee 2006)
and
were a good world-
wide example
of
the opportunity to change educational sys-
tems. Such an occurrence would
not
have
been
likely in a
previous generation. Knowledge dissemination will con-
tinually
be
needed to change traditional views toward
Asians with disabilities
in
the next generation.
7
Unfortunately, cultural distrust
of
the dominant
culture
may
block
Asian access to rehabilitation
in
the U.S.
This trend is especially true for
new
Asian immigrants since
most
of
them
may
have the traditional beliefs toward people
with disabilities. Interpersonally, Asians
may
tend to avoid
sharing problems considered abnormal
to
others.
They
may
also
try
to hide mental
or
physical disabilities
and
avoid
seeking help from professionals. Therefore, such problems
may
become increasingly worse
due
to denial and
camouflage.
Rehabilitation Counseling Application
When
a rehabilitation counselor is working with
clients from an Asian communities, he/she needs to incor-
porate culture and the clients' world
view
into rehabilitation
planning. Since most
of
Asian clients expect solutions from
their counselors, during the counseling process, the coun-
selor should educate Asian clients
and
explore the best way
to deal with the issues together. The counselor should also
encourage family involvement throughout the counseling
process because
of
the traditional Asian family structure.
Journal
of
Applied Rehabilitation Counseling
The key to success when working with Asian clients is to
understand Asians' belief system
as
well
as
their cultural
background. As a result, some degree
of
preparation
is
re-
quired before the initial intake. With preparation and
an
open mind, rehabilitation counselors will be able to work
more effectively with Asian clients with disabilities and
promote more favorable outcomes.
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Wang, M, H., Thomas, K., Chan, F., & Cheing,
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(2003). A conjoint
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bilitation Psychology,
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195-201.
The authors would like to acknowledge Dr. Anita N. Lee from the De-
partment
of
Health and Physical Education, Eastern Connecticut State
University for proofreading this manuscript; research advisor, Dr. Ber-
nard
J.
Graney, from the Department
of
Rehabilitation and Disability
Studies, Springfield College; and Miss Kayla Y Lin, from Wheelock
College for information collection.
Kenny
K.
Yan, MS, Vocational Serivces Specialists, Boston
Higashi School
in
Randolph, MA.
email: kyan@bostonhigashi.org
Michael
P.
Accordino, D.Ed, CRC,
LMHC,
Professor
of
Rehabilitation and Disability Studies, Springfield College
in Springfield, MA.
email: maccordi@springfieldcollege.edu
Daniel L. Boutin, PhD, CRC, CDMS, NCC, Associate
Professor, School
of
Allied Health and Communicative Dis-
orders, Northern Illinois University in DeKalb,
IL.
email: dboutin@niu.edu
Keith B. Wilson, PhD, CRC, LPC, NCC,
ABDA,
Dean,
College
of
Education and Human Services, Southern Illi-
nois University
in
Carbondale,
IL.
Correspondence should be addressed
to
Kenny
K.
Yan,
Boston Higashi School, 800 North Main Street, Randolph,
MA 02368. email: kyan@bostonhigashi.org
