Cultural Identity and Mental Health (Personal Reflection)

I was born and raised in Singapore, a little tropical island in Southeast Asia. My family is of Chinese descent, and I had the privilege of growing up in a melting pot of different cultures and values. I moved to Australia when I was doing my psychology postgraduate course, and experienced a whole new culture. Doing most of my clinical training in Australia, I was exposed to how vastly different the mental health care system is in Australia and Singapore. This prompted to me to reflect on how a lot of research on mental health diagnoses and treatment mainly stemmed from Western philosophy. It was a challenge navigating how the most highly researched and evidence-based approaches to mental health might not necessarily take into account the intricacies of how different cultures may influence the presentation of mental health symptoms, and what might be the best way forward to treat clients who have grown up with different ideologies and way of life.

This is a reflective piece on how cultural identity COULD influence aspects of mental health. Given my cultural background, it mostly stems from an Asian perspective, but could also be applicable to individuals of different cultures and religions. It is worth noting that even though our cultural values influence our way of life, including how we think, feel, make sense of physical sensations, and drive behaviours, the culture of one’s FAMILY is just as important.

The aim of this article is to get you to reflect on how your own cultural and family expectations have influenced your perception to triggers, sense of self and coping mechanisms.

• Emotional expressivity

Emotional expressivity is the extent to which an individual displays, expresses and communicates emotional states through verbal and non-verbal ways. Family and cultural values play the biggest role in this. In Asia, families tend to have low emotional expressivity, particularly towards “negative” emotions (I dislike the term “negative” to describe emotions as every emotion has a function, but for the purpose of this article I shall keep the term). Asian cultures, including those in China, Japan, and Korea, tend to prioritize social harmony, collective identity, and self-control. In these cultures, emotional expressivity is often more subdued and regulated. Suppressing emotional displays in public is considered more appropriate and respectful.

An interesting study on preschoolers from US, China, and Japan (Ip et al., 2021) found that children from US showed more “negative” emotion expressions when they received a disappointing gift compared to Chinese and Japanese preschoolers. This is likely an effect of cultural and parental socialisation, highlighting that children as young as preschoolers internalise messages of cultural expectations, which influences their emotional expression.

For families with low emotional expressivity (not just applicable to Asian families), individuals tend to be more hesitant to talk about their emotions, or even have difficulties identifying how they feel. This sometimes makes talk therapy difficult to engage in initially, as it can feel confronting to the individual when asked to speak about their internal experience and emotions a difficult task. With more practice and understanding how one’s early experiences and background affect their emotional expressivity, clients tend to gain more insight and are able to express themselves in a more effective manner.

• Relationship with anger

  Related to emotional expressivity is the expression of anger. Individuals tend to be more comfortable talking about anger as an emotion compared to sadness or grief. It somehow feels less vulnerable to talk about anger compared to other emotions. For individuals with low emotional expressivity comes emotional inhibition. Without an awareness of how to effectively regulate one’s anger, anger tends to either:

  (a) be suppressed in an unhealthy manner. Repressed or suppressed anger, where individuals deny, dismiss, or avoid their anger, can also impact mental health negatively. Unresolved anger that is not appropriately addressed may lead to feelings of resentment, bitterness, and increased psychological distress.

  (b) arise in unhelpful coping mechanisms through aggression, violence, or self destructive tendencies. Frequent outbursts of anger, chronic hostility, or unresolved anger can contribute to stress, relationship difficulties, and even physical health problems.

  What is your relationship with anger like? How do you cope with anger when it arises? Is it similar to the manner one of your family members cope with their anger?

• Avoidance

  Cultural norms play a significant role in shaping how emotions are perceived and expressed. In some cultures, there may be an emphasis on emotional restraint, where individuals are expected to control and suppress their emotions, particularly negative or vulnerable ones. This can lead to a tendency to avoid or downplay emotional experiences.

  I remember feeling extremely uncomfortable speaking to a psychologist for the first time. I would tell her about the issues I was facing, but appeared almost like I was reading a story off a book, or telling someone else’s story. While I was speaking about something terrible, I looked almost “blank”, speaking of the incident with little to no emotion. This is an example of emotional detachment, which is a state of disconnection or distance from one’s emotions. While I was able to speak about how I was feeling and what I was experiencing, I found it difficult to connect with my emotions at the time. With more practice, this came a lot naturally to me, but it was a struggle at first for me.

  Cultural expectations regarding gender roles can also influence emotional expression and avoidance. In some cultures, there may be societal expectations for men to display emotional stoicism and avoid vulnerability. This can contribute to the avoidance of emotions and limited emotional expression in men.

• Unrelenting standards

  While all the points I’ve made so far is not necessarily limited to an Asian context, this one is definitely applicable to so many clients I have seen or people I have met from all over the world.

  Unrelenting standards refer to excessively high or perfectionistic expectations that individuals set for themselves in various areas of life, such as work, relationships, or personal achievements. These standards are often rigid, inflexible, and unrealistic, leading individuals to continually strive for perfection and experiencing distress when they perceive themselves as falling short. The relationship between unrelenting standards and mental health can be significant.

  Unrelenting standards are closely associated with perfectionism, which involves a strong desire to meet impossibly high standards and a fear of making mistakes or being judged. Perfectionism is linked to increased levels of anxiety, as individuals may constantly worry about meeting their own unrealistic expectations and fear the consequences of falling short.

  When individuals consistently fail to meet their unrelenting standards, they often engage in self-critical thinking. If you are constantly thinking of “I must” and “I should” sentences, this puts a huge burden on yourself. This self-criticism can erode self-esteem and lead to negative self-perceptions. The constant self-judgment and feelings of inadequacy associated with unrelenting standards can contribute to low self-worth and feelings of depression or worthlessness.

  The relentless pursuit of perfection and constant striving can lead to chronic stress and burnout. Individuals with unrelenting standards may neglect self-care, prioritize work or achievement above all else, and push themselves to the point of exhaustion. This can result in emotional exhaustion, physical health problems, and overall reduced well-being. I relate to this so much - Singapore has an extremely competitive education system and an unhealthy focus on the “hustle life”. Sadly, it was only in 2017 that I first heard the term “self-care”, and have made a huge attempt to weave this into my life as much as possible. Although the perfectionist in me is constantly thinking about the next thing on my to-do list, the self-compassionate part of me is telling me to take a break, or my body will decide to take one for me. Do not let yourself get burnt out to start resting and taking care of yourself.

• Propensity to seek help

  Cultural beliefs and attitudes towards mental health can vary widely. In some cultures, there may be a stigma associated with mental illness or seeking help for psychological concerns. Mental health issues might be seen as a sign of weakness, personal failure, or spiritual/moral deficiency. These cultural beliefs can discourage individuals from reaching out for professional support due to fear of judgment, shame, or social repercussions.

  For many years, I hesitated to tell others that I was seeking help for my own mental health. There was a huge stigma associated with help seeking in Asia. This anxiety was also fuelled by the fact that I am a psychologist, and was afraid of the judgment I might receive from others. Moving to Australia, I found that individuals here were much more open with stating that they are seeking help for their mental health compared to back home. Undergoing clinical training, having supervisors validate (and encourage) us to check in with mental health professionals, hearing of fellow psychologists/friends’ own therapy experiences, and seeing clients be open about their own therapeutic journey to their loved ones made me a lot braver in sharing my own journey.

  There is a shift in the perception of seeing a psychologist in many cultures, with more individuals and young people sharing their healing journey and normalising the process of seeking help to improve your life (which is awesome!).

• Setting boundaries

  Setting boundaries is an essential aspect of maintaining good mental health and overall well-being. Boundaries are personal limits and guidelines that define how individuals engage with others, handle responsibilities, and protect their own physical and emotional needs.

  In some cultures/families, setting boundaries can be a difficult task. Asian families tend to be enmeshed, with family expectations of each individual that upholds the social fabric of the family. In Asia, individuals tend to also live with their nuclear family until they get married, which could make setting boundaries harder.

  Boundaries are crucial for maintaining healthy relationships with others. Clear boundaries help individuals communicate their needs, expectations, and limits, fostering respectful and balanced interactions. They enable individuals to express their preferences, assert personal boundaries, and establish mutual respect in relationships. Healthy boundaries can contribute to stronger connections and reduce the risk of unhealthy dependencies or codependency.

These are some ways that cultural/family values can influence an individual’s sense of self, relationship with others, how they view mental health. It's important to note that cultural influences are not deterministic, and individuals within a culture can have different experiences and approaches to mental health. Furthermore, cultural attitudes and practices are not fixed and can evolve over time. Promoting emotional well-being within different cultural contexts requires a balance between respecting cultural norms and values while also recognizing the importance of healthy emotional expression and processing. Culturally sensitive mental health support can help individuals navigate their emotions in a way that aligns with their cultural background while also addressing any potential negative consequences of emotional avoidance.

The next post will consist of some questions to further assist you in reflecting about your attitudes towards emotions. Having insight into your emotions is a core part of therapy, which can aid you and your psychologist in discussing the best method to identity your emotions and learn helpful coping mechanisms when difficult emotions come up.