Chinese Culture and Compatibility with Relational Psychoanalysis
Chinese culture has changed rapidly over the last 50 years and has increasingly embraced psychodynamic therapies in the face of mental health challenges (Snyder, 2011). Although psychoanalytic theory was constructed from a Western perspective, there are parallels between Buddhist practices cultivated to know the mind and the exploration that occurs in psychoanalysis. There are also important cultural differences that can inform the way psychodynamic therapies are practiced with Chinese people. I will explore the psychodynamics of Chinese people from historical and cultural contexts, suggest that the contemporary relational model might be an especially culturally relevant way of thinking about the mind, and discuss clinical implications for working with Chinese clients.
Cultural and Historical Contexts
To understand psychodynamics in Chinese people, it’s useful to discuss a recent history. From the fall of the Qing Dynasty in 1911 through the Cultural Revolution which ended in 1976, people in China experienced the collective traumatic events of widespread civil war, war with Japan, famine, political persecution, and violence (Osnos, 2011). More than 90 million people died from these events. From 1949 to 1976, psychoanalysis and psychological research on the impact of these events were banned, and mental health treatment amounted to reading Mao’s Little Red Book and political reeducation (Phillips, 2013). In the 1980s after Deng Xiaoping came to power, people returned to school and work alongside their torturers in the great forgetting. Soon thereafter, the economic boom rapidly transformed China into a brutally competitive market economy (Osnos, 2011). In China, this historical “trauma remains undiscussed and undiscussable” (Scharff, 2016).
In China, there’s been an increased interest in psychoanalysis. The China American Psychoanalytic Alliance (CAPA) has been providing psychoanalytic training over Skype to academic psychologists and mental health professionals (Snyder, 2011). As psychoanalytic theories were applied to understanding Chinese people, points of cultural difference between Chinese culture and the West emerged. In contrast to American culture which is highly individualistic and values separation and individuation, Chinese culture is collectivistic and centered around the family. According to Bond & Hwang (as cited in Ying, Lee, & Tsai, 2011), Confucian philosophy emphasizes “a relationship-based definition of self, the structural and hierarchical nature of relationships, and the fulfillment of social obligations as the basis for societal harmony and order.” A long history of authoritarianism from the imperial dynasties that continues into the present day enforces the idea of respect for authority both in society and in the family, where a child’s goal is to fulfill their parent’s desires rather than their own (Ying et al., 2011).
Differences between Western and Chinese culture can be seen the different ways that the Oedipus conflict is resolved. In the Freudian version of Oedipus, the child desires the mother but fears castration by the father. Ultimately the Oedipus conflict is resolved when the child finds an object of desire outside of the family (Mitchell & Black, 1995). According to Tang & Smith (as cited in Yap, 2016), at the end of the Chinese version of the myth, the parents “overcome the child.” Moreover, Yuan (2001) suggests that Oedipus in Chinese culture would take on a different form, as the “Chinese mother would organize the family roles and prevent incest by keeping distance from the child and leading him to the symbolic place of the father” (as cited in Yap, 2016). Oedipus would be resolved when the child becomes like the father and puts the family’s needs before their own.
Chinese people adapted defenses to cope with authoritarian family and societal structures. According to Zhong (2011), the most common defense is a split between social and internal life, where an agreeable attitude is shown on the surface while disagreeable thoughts are held inside. Submission of desires and aggressive feelings are driven by a “fear of being abandoned or destroyed by the authorities or the family.” Confucianism, Daoism, and Buddhism were used as forms of social control that provided coping mechanisms for these psychic conflicts (Zhong, 2011). The Buddhist concept of reincarnation helped the Chinese “chi ku” (eat misery) in this life for the sins of their past life or for happiness in their next life, a sentiment especially common amongst my female family members.
During the Communist and Cultural Revolution, the entire country experienced widespread violence. In a qualitative study, Plänkers (2011) interviewed 6 first generation survivors who were adults during the Cultural Revolution and 6 second generation survivors who were children during the Cultural Revolution to study its intergenerational effects. Almost all the first generation survivors described “traumatic childhoods from early separations from primary objects or severe poverty.” During the Cultural Revolution, they witnessed suicide and violence towards previously respected members of society, experienced public humiliation, were persecuted and arrested, and sometimes perpetrated the violence themselves. They all showed symptoms of PTSD including “recurring thoughts and memories, hyperarousal, and avoidance.” Five out of six participants in from the second generation held strong negative feelings for their mothers, describing them as “cold, distant, with disappointment and hate” and positive feelings for their grandmothers, indicating a primary object split that was never integrated. All of the interviewees suffered in different ways because their traumatized parents were unable to empathetically attune to them. Many of them also re-enact the way their parents treated them in their current relationships with their own children, reinforcing the traumatic effects of the Cultural Revolution in yet another younger generation (Plänkers, 2011).
During the 1980s, 130 million people migrated from the countryside to the city for jobs, leaving 60 million children growing up away from the care of one or both of their parents (Osnos, 2011). Early childhood separation has been shown to potentially result in insecure attachment styles and increased risk for traumatization (Plänkers, 2011). According to Fong (as cited by Scharff, 2016), recently there’s been rapid social change with often contradicting influences from Confucianism, Socialism, and Capitalism. Communists favored loyalty to party over family and upheld the equality of women in a society with strong patriarchal, family-centered traditions. The One Child Policy that was enacted from 1979 through 2015 resulted in an aging population and skewed gender ratio with large numbers of single men. As family systems encounter these changing societal structures and norms, conflicts will inevitably arise. According to Scharff (2016), “parents give their children mixed messages, often urging them to look out for themselves while at the same time imploring them to honor the old value of putting the family first.” In couples therapy, it’s common for women to want more autonomy and equality, while their male partners want to maintain their privileged positions in the household (Scharff, 2016).
The Relational Model of the Mind
Because the positioning of self in the context of relationships is so important in Chinese culture, I think that the relational model of the mind is especially relevant to Chinese people. The relational school builds off Sullivan, who introduced the social model of the mind made up of interactions between self and others. Instinctive libidinal and aggressive drives exist, but meaning is made and personality is formed in response to how anxiously early caretakers respond to them rather than the drives themselves (Mitchell & Black, 1995). Mitchell (1988) synthesized ideas from Freudian drive theory, object relations theory, and the interpersonal school in the concept of the “relational matrix,” where “the interpersonal and the intrapsychic realms create, interpenetrate, and transform each other in a subtle and complex manner.” Intrapsychic tension arises from how caretakers attune to children early on but also in relational configurations both between a single important relationship and between different relationships and identities (Mitchell, 1988).
According to Bromberg (1996), psychoanalysts have increasingly moved toward a view of the “decentered self,” which consists of multiple, discontinuous self-states that develop through different interpersonal relationships. Dissociation between different self-states is an normal, adaptive function that helps people maintain a “healthy illusion of cohesive personal identity” or wholeness (Bromberg, 1996). Slavin and Kriegman (1992) argue that from an evolutionary perspective, the most important function of the psyche is to maintain a sense of self-cohesion across multiple versions of self. Suffering is experienced when conflicts between different self-states are too strong for dissociative defenses to handle. The nature of treatment is to build awareness of different self-states and develop a capacity to tolerate the conflicts between them (Bromberg, 1996). This seems especially compatible with the Chinese idea of contradiction in Daoism, where the normal state of reality is seen as not clear but filled with opposing forces and inconsistencies (Xinyan, 2007). The Buddhist ideas of non-self and impermanence are also consistent with the idea that there’s not a single, coherent self.
In Chinese people, I believe that self-states develop not only in relationships but also in accordance to the different roles that they play in the family and in society. These roles are imparted through relationships with family members, authority figures, and peers. The importance of roles is seen in Confucian emphasis on obligation and the hierarchical nature of relationships and is also apparent through differences between English and Chinese language. In English, for instance, there are words like “aunt,” “uncle,” “grandmother,” and “grandfather” to describe members of your extended family. In Chinese, there specific words that indicate a “grandmother on your mother’s side,” “dad’s second oldest sister,” and so forth. Roles are held together and societal harmony is maintained by standards of correct behavior, and Chinese people are expected to “anticipate the needs of the other without being told” (Yap, 2016). Children develop strong self-representations with good and bad self-images of themselves in the roles of a woman, man, daughter, son, mother, father, student, worker, and so forth.
In a qualitative study on how Chinese immigrants in Canada experience postpartum depression, Morrow, Smith, Lai, & Jaswal (2008) found that Chinese women described their symptoms in the context of interpersonal relationships. In situations when only the husband’s family came to visit, the women felt that they could not speak about their needs or express their unhappiness to their mother-in-laws because they saw their role as serving the mother-in-law. Their mother-in-laws saw their role as supporting their sons and the new baby. Without their own mother present to support them, these women were experiencing intense conflict between fulfilling their needs and performing their roles as a daughter-in-law and new mother (Morrow et al., 2008). The experience of childbirth and immigration, which resulted in disruptions in important extended family support structures among other challenges, caused a traumatic disjuncture of the women’s sense of coherence.
Immigration to the United States
According to Akhar (1995) the determinants of psychological outcomes following immigration can depend on many factors including the reasons for leaving and degree of choice about leaving, opportunities to revisit home, the magnitude of cultural difference, capacity to separate and adapt to new situations, the receptiveness of people in the new culture, and the degree to which immigrants can resume their careers. He equates the experience of immigration to a third separation-individuation process, similar to that of a toddler or adolescent, where the “immigrant is vulnerable to splitting of the self and object representations along libidinal and aggressive lines.” Immigrants may idealize their homelands and devalue the new culture, failing to mourn the loss of their old identity and integrate both cultures into their identity (Akhar, 1995).
In a collective culture where separation-individuation is not as emphasized, however, relational perspectives might be more relevant. Harlem (2010) views immigration as a “challenge of maintaining self-coherence in the context of inherent multiplicity,” where the immigrant dissociates or de-links from some self-states and develops new self-states in relationship with the new country. If trauma is present in this process, the immigrant might become lost between the states (Harlem, 2010). As immigrants encounter different relationships and cultural expectations in the public and private spheres of their lives, they move in and out of different self-states.
As Chinese women moved to the US, they encountered new gender roles and cultural expectations. I found that “A Flawless Science” by Yiyun Li, an immigrant from China who now lives in New Jersey, captures many of the dynamics in Chinese immigrant families that also parallel dynamics that I noticed in many Chinese families I knew growing up. Min, the main character in the story, is a Chinese woman who suppresses her desires for the sake of harmony in relationships. Early in life, Min’s father dies in an accident. She and her mother are always expected to be solemn in public, fulfilling their roles of widow and orphan, but they shared secret laughs in private. This shows the importance of the in-group vs. out-group self-states where people are more free to express themselves within the family structure but must save face by acting in accordance with expectations of their roles in public.
Min marries a Chinese man through an arranged marriage and comes to America to be with him. She develops intense aggression towards men in her life, her husband, her son, the professor who inappropriately makes moves on her, has fantasies about hurting them, and sometimes wishes that they would die. She holds her tongue when she disagrees so that she can uphold her internalized role as a “flawless daughter-in-law, wife, and mother.” As she becomes involved in her children’s school, Min becomes friends with a woman named Sandra. Both their husbands supported Trump, while both women supported Clinton in the election. Sandra complains about her husband’s support of Trump and tells Min about their fights. In accordance to the Chinese cultural norm of “keeping family dirt within the family,” Min does not tell Sandra that her husband also supported Trump (Zhong, 2011).
In forming a relationship with Sandra, however, Min encounters conflicts between her multiple self-states — the part of herself that wants to express her desires, the part of herself that wants to be a good wife, and the newer part of herself that has been influenced by American cultural norms. When Min’s husband puts her down and tells her not to discuss politics with their daughters, Min thinks of what Sandra would do and fantasizes about speaking back. She decides not to speak up, but feels “a vindictive joy that the girls already knew to keep the truth about him from the world” and fantasizes about when her daughters will become teenagers and speak against him for her (Li, 2018).
Families may see acculturation to Western gender roles as a threat to traditional familial roles and cultural norms, which can cause conflict within the family system. Chinese immigrants in the United States face challenges in adjusting to Western influenced cultural norms that seem parallel to changes in modern China following the Cultural Revolution and economic reform. Rather than viewing these different cultures as objects that need to be integrated by the ego into a hybrid, cohesive identity, psychoanalysis can help clients become aware of these conflicts and better “stand in the spaces between self-states” (Harlem, 2010).
Clinical Implications
There has been a number of papers written about the clinical implications of working with Chinese clients. In a literature review of treatment considerations, Yap (2016) lists strategies such as not advocating for separation-individuation, taking a supportive and empathetic stance, actively exploring dynamics in the family, taking a more directive approach because clients will see the therapist as the authority figure, and deemphasizing transference because their other relationships will be more important than the therapist-client dyad. Zhong (2011) presented a case of a female client who struggled with similar challenges as Min of not being able to express her desires and resentment towards her husband. She quit therapy after 10 sessions because “she worried that the therapy might challenge her beliefs and change the stability of her life.” Zhong was trained in the more classic, ego psychology tradition by Plänkers and frequently feels conflict between exploring a client’s defenses to try to help the client individuate vs. showing more empathy in therapeutic settings (Zhong, 2011).
It is still early in the use of psychoanalysis in China, and there is very little literature about applying relational models to psychotherapy with Chinese people. The literature that does exist is theoretical, based on Chinese cultural ideals rather than the ways these ideals are expressed in practice. According to Yap (2016), Chinese people might not take to more individualistic, ego psychology ways of working. They may relate to the idea of a single self as “not me” or view the separation-individuation model as too threatening to their relationships, as Zhong’s client indicated when she decided to quit therapy. In a more relational way of working, the therapist should accept all self-states of the client and model not knowing by tolerating their own multiple selves in relation to the client (Yap, 2016).
In a psychoanalytic dyad between the therapist and a Chinese client, there will likely be tension around the hierarchical nature of the relationship. The Chinese client might want the therapist to give them advice or end up engaging in “false-self therapy,” where they perform progress for the therapist an enacts the role of “a subordinate [that] often requires them to both take on their superior’s wishes and to allow them to save face.” Yap’s advice here is for the therapist to surrender to the hierarchy, which can help the therapist communicate the frame of therapy, use the hierarchy to help the client feel comfortable, and accept the client’s subjectivity. This acceptance of hierarchy will help build a therapeutic alliance (Yap, 2016).
Instead of resolving intrapsychic conflicts and facilitating separation-individuation, the relational way of working helps clients accept the tensions between their multiple self-states and surrender to the unknown. This idea is compatible with the Daoist philosophy of “not being” and acceptance, which can easily be seen as resulting in passivity. However, I don’t think that the acceptance of our self-states necessarily equates to acceptance of the conditions of our lives. Acceptance can give clients the clarity they need to act with intention, self-compassion, and authenticity.
Conclusions
There has been debate in the field about whether the differences between Chinese culture and Western culture makes psychoanalysis incompatible with Chinese culture (Snyder, 2014). I believe that the relational model of the mind is highly compatible with Chinese culture, perhaps even more so than with American culture. In this paper, I made some statements about Chinese culture informed by the literature but colored by my own experiences of being an American-born daughter of Chinese immigrants. Every psychoanalytic encounter is different, and it’s important to recognize the diversity among Chinese people. Having a historical and cultural understanding is useful, and having an open, curious, and accepting stance when encountering clients from one’s same cultural background as well as clients from different backgrounds is more important.
References
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