Abstract
This chapter begins with a discussion of issues involved in making cross-cultural generalizations about therapy (e.g., etics and emics; cultural differences in conceptualizing and dealing with unacceptable behavior). It then discusses six themes that bring some order to the myriad of practices around the world. These are as follows: the effects of industrialization and globalization; implications for clinical practice stemming from social structure, economics, and power; cultural factors in defining problem behavior and solutions; the interactional perspective originating in systems theory; the effects of expectancy and placebo on producing and changing problem behavior; and the cross-cultural applicability of principles of learning and cognition.
Let us imagine how a modern university hospital might look to anthropologists from Mars studying healing shrines in an industrialized society. They would learn that the local medical school is reputed to be a site of amazing cures…certain areas were open to the public and other areas…were reserved exclusively for the performance of arcane healing rituals…These special-purpose rooms contain spectacular machines…Those who tend and control these machines speak a special language that is unintelligible to the layperson and prominently display on their person healing amulets and charms…The operating rooms are the holy of holies…So jealously guarded are the mysteries of the operating room that patients are rendered unconscious before they are allowed to enter them.
In evaluating the reports of the cures that occur in such a shrine, anthropologists might be as impressed with the features that mobilize the patient’s expectant faith as with the staff’s rationale for the treatments administered.
Jerome D. Frank and Julia B. Frank, Persuasion and Healing (1991, pp. 108–109)
An earlier version of this chapter appeared in pp. 67–81 of the 2004 book co-edited by Uwe P. Gielen, Juris G. Draguns, and me, the Handbook of culture, therapy, and healing. It was published in Mahwah, NJ by Lawrence Erlbaum Associates, Publishers. © 2004 by Lawrence Erlbaum Associates, Publishers, and is used with permission.
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Notes
- 1.
A controversial book that might take exception to this statement is Donald Brown’s Human Universals (1991). Many of Brown’s proposed universals can be disputed, and others—his “near universals”—could also be called “non-universals.” Even if one were to accept many of his proposed universals, however, they are at such a level of generality––for example, the existence kin categories—as to be irrelevant to therapy. Evolutionary psychologists such as Pinker (2002) make claims in some ways similar to Brown’s. The point is not that biology has no influence, but that humans’ evolved abilities for language and behavioral plasticity are much more significant than purportedly universal traits. A focus on the variability of behavior—including cultural variability—is especially relevant for therapists, who are interested in changing behavior.
- 2.
The possibility of memes as a mechanism for cultural transmission was discussed in Chapter 2.
- 3.
Naturally, should any genes be shown to have specifiable effects on specific behaviors, it would be of great interest. However, humans have only about 23,000 genes, nearly all of which are shared with chimpanzees (Marks, 2003). The discovery of genetic switches (discussed by Alberts et al., 2002) makes it likely that a search for environmental effects on specific switches that in turn affect particular genes will be more productive than a search for genes for specific behaviors.
- 4.
Because most of the author’s cross-cultural experience, including most cross-cultural clinical experience, has been in Brazil, most of the examples presented in this chapter are Brazilian ones. Those interested in additional discussion of therapy-related topics in a Brazilian context can find them in Culture and Therapy: An Integrative Approach (Fish 1996).
- 5.
an imperfect ethnocentric analogy (imperfect because Brazilians take their soccer very seriously) would be of a major league baseball game with wild parties going on in the dugouts, and the batter, with lipstick on his face, blowing kisses to the fans between pitches. Perhaps it is this dual consciousness, along with the lack of a firm separation between work and play, that led Charles De Gaulle to remark haughtily that Brésil n’est pas un pays sérieux (Brazil is not a serious country). Brazilians, on the other hand, view Americans and their inability to simultaneously hold conflicting ideas or go around irrational rules as rigid, inflexible, and lacking in creativity.
- 6.
An important exception to this generalization is the large and increasing number of homeless children in many countries who grow up among and can be said to be raised by homeless peers. In those cases where social institutions intervene to help these children (as opposed to imprisoning or killing them), the pattern seems to be to remove them from the streets or to provide services for them despite their homelessness. I am not aware of programs of systemic therapy aimed at improving the child-rearing function of informally constituted groups of street children.
- 7.
Therapy researchers (Lambert, 1992; Lambert & Bergin, 1994; Wampold, 2001) also point to shared relationship elements in diverse treatments, such as therapist empathy and warmth, as well as to individual characteristics of the therapist (Beutler, Machado, & Neufeld, 1994; Wampold, 2001) as explanations for the positive effects of diverse treatments. It is also possible that much of the therapeutic impact of the relationship or therapist characteristics can be explained by their effects on client expectancies.
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Fish, J.M. (2011). Common Elements in Therapy and Healing Across Cultures. In: The Concept of Race and Psychotherapy. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7576-8_7
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