Value Issues Involving Western Psychoanalysts With Asian Patients

In our psychoanalytic work, it is only when we are confronted with a patient from a culture radically different from our own that we realize we are constantly gauging patients' associations and ways of relating to us and others against a backdrop of what is appropriate or not on a normality-psychopathology continuum. We base these evaluations on our implicit understanding of what goes or doesn't go within our own culture. We assume prevailing norms to be universal, although we may be open to variations among a wide variety of U.S. patients we see. Most of us rarely even reflect about this because we simply go about making our evaluations automatically without a problem.

When a U.S. psychoanalyst with European origins works with a patient from a radically different culture, such as Indian or Japanese, one is faced with the realization that our implicit understandings and judgments might not work. An analyst might then find himself or herself at sea, not knowing what is or isn't normal or skewed. That is, unless one falls back on U.S. cultural norms of individualism that are integral to psychoanalysis today as a universal yardstick. In this case, what I would term colonial attitudes toward Asians may very subtly surface in the analyst. Certain Asian norms of dependency and interdependence, deference to superiors, and communication by innuendo are then viewed as inferior to U.S. psychoanalytic norms involved in separation-individuation, autonomy, self-assertiveness, and verbal articulateness. We often do not reflect that our norms are profoundly related to the modern Western culture of individualism in its U.S. variant.

It is therefore a constant challenge not only to develop new understandings of what goes or doesn't go in patients from Asian cultures, but also where there is skewed development and/or psychopathology within this other cultural/psychological continuum. Even such basic