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Some aspects of mental illness among recent immigrant Chinese : a comparative case study of Chinese male… Lee, Jung Ok 1961

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SOME ASPECTS OP MENTAL ILLNESS AMONG RECENT IMMIGRANT CHINESE A comparative case study of Chinese male patients, immigrant and Canadian-horn, hospitalized at P r o v i n c i a l Mental Hospital and Crease C l i n i c , B. C , 1950 - I960.  by  JUNG OK LEE  Thesis Submitted i n P a r t i a l F u l f i l l m e n t of the Requirements f o r the Degree of MASTER OP SOCIAL WORK i n the School of Social Work  Accepted as conforming to the standard required f o r the degree of Master of Social Work  School of S o c i a l Work 1961 The University of B r i t i s h Columbia  c  In presenting  t h i s thesis i n p a r t i a l fulfilment of  the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for reference  and study.  I further  agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the Head of my Department or by his representative.  It i s understood  that copying or publication of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission.  Department of SCHOOL OF SOCIAL WORK. The University of B r i t i s h Columbia, Vancouver 8, Canada. Date A p r i l 26. 1961.  ACKNOWLEDGMENTS  I wish, t o express my thanks t o Dr. P. G. Tucker, Superintendent o f the P r o v i n c i a l Mental H o s p i t a l and Crease C l i n i c ,  f o r h i s a s s i s t a n c e on the p r o j e c t .  I would a l s o l i k e t o acknowledge my a p p r e c i a t i o n t o Dr. Leonard C. Marsh, o f t h e F a c u l t y o f the School o f S o c i a l Work, f o r h i s k i n d  encouragement.  I p a r t i c u l a r l y acknowledge, w i t h g r a t i t u d e , the s u p e r v i s i o n and c o u n s e l o f Miss Frances McCubbin o f t h e F a c u l t y , without whose s u p p o r t i v e guidance t h i s t h e s i s would not have been p o s s i b l e .  TABLE OP CONTENTS Chapter 1.  Immigration and Adjustment? Problems o f the Chinese  The S p e c i a l  Immigration d e f i n e d . B a s i c problems o f a l l immigrants. S p e c i a l problems o f Chinese immigrants. Comparative a s p e c t s o f the c u l t u r e s o f the Chinese and Canadians. P s y c h o l o g i c a l d i f f i c u l t i e s i n a new culture. Some p r i n c i p l e s o f mental h e a l t h . The s o c i a l worker's r o l e i n the mental h o s p i t a l . Scope and method o f the study Chapter 2.  The Assessment  o f "Adjustment"  The assessment of "adjustment". E x p e r i m e n t a l r a t i n g - s c a l e . P e r s o n a l i t y c o n s t i t u e n t s o f the patients. Capacity f o r s o c i a l i z a t i o n . Economic f e a t u r e s . D i f f e r e n t i a l s between immigrant and Canadian-born Chinese p a t i e n t s Chapter 3.  Some R e p r e s e n t a t i v e Oases  Two immigrant Chinese. I m p l i c a t i o n s o f the c a s e history: economic, s o c i a l , and p s y c h o l o g i c a l a d j u s t ment. A Canadian-born Chinese. I m p l i c a t i o n s of the case-history: dual-culture d i f f i c u l t i e s . A comparat i v e summary Chapter 4.  P o l i c y and Treatment  Implications  Adjustment d i f f i c u l t i e s o f p a r t i c u l a r groups. Hypotheses re-examined. Re-examination o f the problem of communication w i t h the immigrant Chinese. F u r t h e r a s p e c t s o f r e s e a r c h among the Chinese. Recommendation f o r improved treatment s e r v i c e s . Recommendations f o r further research  Appendices: A. B.  Working sheet used f o r Case Data Bibliography TABLES  Table 1.  Intended o c c u p a t i o n s o f Chinese immigrants to Canada - 1947 - 1959  Table 2.  R a t i n g s c a l e o f adjustment, used i n t h i s study  Table 3.  Summary o f r a t i n g s  ii. /  ABSTRACT  Thus study seeks a c o n t r i b u t i o n to the unders t a n d i n g of the problems o f immigrant Chinese by comparing them w i t h Canadian-born Chinese. I t i s almost i m p o s s i b l e to understand the ways and customs o f the Chinese without some i n s i g h t i n t o t h e i r c u l t u r e . But to understand the adjustment problems o f t h i s m i n o r i t y group, t h e i r c u l t u r a l background must be d i s c u s s e d i n comparison w i t h the N o r t h American c u l t u r e . The study i s focussed upon a s m a l l group, both immigrant and Canadian-born, whose f a i l u r e t o "make good" i n Canada i s s i g n a l i z e d by t h e i r admission t o a mental h o s p i t a l . For ease-study, e i g h t e e n immigrant Chinese p a t i e n t s and a comparative group of n i n e Canadianborn Chinese p a t i e n t s were s e l e c t e d . Data was obtained from c l i n i c a l f i l e s r e c o r d e d by d o c t o r s , p s y c h i a t r i s t s , n u r s e s , s o c i a l workers and o t h e r members o f the treatment team. A r a t i n g s c a l e was d e v i s e d to h e l p a s s e s s the major f a c t o r s i n adjustment t o l i f e , s u b d i v i d e d i n t o (a) p e r s o n a l i t y c o n s t i t u e n t s , (b) s o c i a l f a c t o r s , and (c) economic f a c t o r s ; t h i s i s then used to examine and compare the s o c i a l f u n c t i o n i n g o f each group. To s u b s t a n t i a t e the f i n d i n g s and t o p r e s e n t a c l e a r e r p i c t u r e o f the c a u s a l f a c t o r s , three i l l u s t r a t i v e cases a r e p r e s e n t e d i n d e t a i l - one Canadian-born Chinese, and two immigrant Chinese p a t i e n t s , i n the r a t i o o f the number s t u d i e d . Each case i s a p p r a i s e d i n the same three a r e a s : p e r s o n a l i t y c o n s t i t u e n t s , s o c i a l f a c t o r s , economic factors. C o n t i n u a l l y u n s a t i s f a c t o r y employment and the b a r r i e r s t o communication c r e a t e d by c u l t u r a l c o n f u s i o n show up among the f a c t o r s a t work. Problems o f communication, s o c i a l i n t e g r a t i o n and c u l t u r a l c o n f l i c t are brought i n t o c l e a r e r l i g h t as c o r r e l a t i v e s o f mental i l l n e s s , and the s i g n i f i c a n c e of these f i n d i n g s i s a p p r a i s e d .  SOME ASPECTS OP MENTAL ILLNESS AMONG RECENT IMMIGRANT CHINESE  CHAPTER I IMMIGRATION AND ADJUSTMENT: THE SPECIAL PROBLEMS OP THE CHINESE Immigration i s a physical t r a n s i t i o n involving the abandonment of one s o c i a l setting and the entrance into another which may, or may not, be completely d i f f e r e n t from the e a r l i e r one. At times, an immigrant w i l l f e e l strange, somewhat distressed, helpless and remote from everything that was f a m i l i a r to him, even though he i s l i v i n g i n the midst of h i s own r a c i a l group but of a d i f f e r e n t i n the new country.  generation  We know that human beings are never  i d e n t i c a l despite the fact that they may have the same phys i c a l make-up and speak the same language.  On the other  hand, the immigrant may experience challenge, hope and i n s p i r a t i o n towards the development of h i s goal or f u l f i l l m e n t of l i f e i n the new country. Basic Problems of A l l Immigrants "The t y p i c a l immigrant s e t t l i n g i n any country i s faced with grave problems of adjustment",  such as those of  language, customs, employment and new s o c i a l r o l e s .  The  mature immigrant has brought with him h i s c u l t u r a l heritage,  Davie, M. R., World Immigration, The MacMillan Company, New York, 1949, p. 461.  - 2 -  including h i s language and customs, h i s i d e a l s and h i s p h i l o sophy of l i f e , a l l of which have influenced the formation of his  thought as well as h i s development through the l i f e span.  As i n the case of most immigrants, he must now learn a new language, as well as new customs and laws.  For some, the  language may he e n t i r e l y new, having no s i m i l a r i t i e s i n character with h i s native tongue.  Adult immigrants experience gre-  ater d i f f i c u l t i e s i n learning new languages than do immigrant children.  "Young people can, under certain circumstances,  make r a d i c a l and complete changeover rather quickly".'  "Even p  the  B r i t i s h e r at f i r s t f e e l s himself a stranger i n Canada",  he who has very few, i f any language d i f f i c u l t i e s . The adult immigrant has been brought up i n a native mode of thinking; that i s , h i s thoughts i n r e l a t i o n to p o l i t i c s , i d e a l s of l i f e and l o y a l t y to h i s native country are rooted within him.  He knows that he must be l o y a l to the new  country but he w i l l , at the same time, continue to f e e l some patriotism toward h i s native country.  l o y a l t i e s can only be  acquired i n terms of l i v i n g them, they cannot be acquired through a w i l l to do so. Persons who can change t h e i r l o y a l t i e s as r e a d i l y as their geographical l o c a t i o n may well be undesirable immigrants.  Yet, often, when an immigrant i s  1 Stress, Master of Social Work thesis, University of B r i t i s h Columbia, 1959, p. 2.  - 3 -  n o t i c e d t o t h i n k o r behave d i f f e r e n t l y , one may be quick to judge him w i t h thoughts  such as 'They came here to l i v e ,  so they had b e t t e r l e a r n t o l i v e as we do. ' Although the immigrant may be aware o f ways i n which h i s mode o f l i v i n g d i f f e r s from t h a t o f the people o f the new country, he cannot d i s c a r d o l d h a b i t s and take on new h a b i t s q u i t e so e a s i l y when he has been i n f l u e n c e d by c e r t a i n h a b i t s i n h i s formative years.  Integration i s a  type o f l i v i n g where the immigrant does n o t completely  lose  h i s i d e n t i t y but becomes an a c t i v e p a r t i n the f l o w o f l i f e of the new country.  "For some i n d i v i d u a l s t h i s may be a 1  g r e a t t a s k ; f o r o t h e r s i t may be a t r a u m a t i c event." c u l t u r a t i o n appears  t o depend upon three main f a c t o r s t  s o n a l i t y , economic and s o c i a l f a c t o r s .  Each o f these  Acperfac-  t o r s w i l l be d i s c u s s e d i n d e t a i l i n the f o l l o w i n g chapter. " A s s i m i l a t i o n means t o i d e n t i f y o n e s e l f w i t h  2 e v e r y t h i n g i n the lew Country" age and t h i n k i n g . acceptance  :  i t s laws, customs, l a n g u -  I t i s a b s o r p t i o n i n t o the new country and  of what he sees without c r i t i c i s m and without a c -  t u a l l y t a k i n g p a r t i n the i n t e g r a l a c t i v i t y o f t h a t country. The process o f a s s i m i l a t i o n o f the a d u l t , g e n e r a l l y , i s g r a d u a l , and p o s s i b l y i n no case i s i t complete i n every aspect, Damm, op. c i t . , p. 2. Van Kooten, op. c i t . , p. 49.  - 4 -  during h i s l i f e t i m e . as t h r e e g e n e r a t i o n s  I t has been s a i d t h a t i t takes as l o n g f o r a complete t r a n s i t i o n .  Assimila-  t i o n i s o f t e n demanded immediately o f the immigrant by the average c i t i z e n o f the new country,  but t h i s i s "not only •i  u n d e s i r a b l e but p s y c h o l o g i c a l l y i m p o s s i b l e . "  However,  there a r e always those people who w i l l t r y to perform the i m p o s s i b l e , who a r e determined to change o v e r n i g h t . " A l l t h a t such a person has done i s t o r e p r e s s h i m s e l f , what he t h i n k s he has removed.  Then he t r i e s to l i v e what he does  2 not r e a l l y know and what he h i m s e l f i s not."  Such a person  c r e a t e s d i f f i c u l t i e s which cause him t o f e e l f r u s t r a t e d and insecure.  T h i s deep sense o f i n s e c u r i t y , i n t u r n , can l e a d  to mental i l l  health.  H i s a s s i m i l a t i o n , o f course, would  depend g r e a t l y upon h i s m o t i v a t i o n t o m i g r a t e . may r e s u l t from inadequacies  The reasons  or i n a b i l i t y t o r e a c h h i s l e v e l  o f a s p i r a t i o n i n h i s own c o u n t r y .  Another reason may be t h a t  f i n a n c i a l gains f o r the p r o v i d e r o f t h e f a m i l y might be ant i c i p a t e d i n the new l a n d . M o t i v a t i o n t o Emigrate An i n d i v i d u a l c o n s i d e r i n g m i g r a t i o n might e x p e r i ence many ambivalent f e e l i n g s about l e a v i n g h i s homeland and o l d f r i e n d s t o f a c e an e n t i r e l y new environment.  He probably  wonders whether the a t t r a c t i o n of the New World i s as great ' Van Kooten, op. ext., p. 51. I b i d . , p. 61.  - 5 -  as he t h i n k s , and reads, t h a t i t i s . He may wonder t o o , about  the extent t o which people o f h i s n a t i o n a l o r r a c i a l  o r i g i n a r e a c c e p t a b l e i n the new c o u n t r y . Some people migrate because o f f a m i l y d i s p u t e s which l e a d t o a f e e l i n g o f inadequacy  w i t h i n the f a m i l y c i r -  cle  a g a i n s t the f a m i l y .  and t h i s may be a form o f revenge  The New World, noted f o r i t s many o p p o r t u n i t i e s t o succeed, may g i v e t h e migrant new i d e a s o f success and f e e l i n g s o f c a p a b i l i t y , which w i l l u l t i m a t e l y be r e c o g n i z e d by the f a mily.  On the other hand, the immigrant  may be a very capab-  l e and i n d u s t r i o u s man who i s unable t o reach h i s l e v e l o f a s p i r a t i o n through c o m p e t i t i o n i n h i s own country, y e t he hopes t o a t t a i n an even h i g h e r g o a l elsewhere.  Again, he  may be a c a r e f r e e i n d i v i d u a l l o o k i n g f o r adventure  and know-  ledge o f another c o u n t r y . There a r e a l s o desperate d r i v e s which motivate an emigrant  such as those o f poverty or p o l i t i c a l s t r e s s .  emigrant, h e a r i n g of the 'high l e v e l o f l i v i n g '  The  and 'land o f  abundance' i s a t t r a c t e d by t h i s f e a t u r e alone i f he i s c u r r e n t l y f a c e d w i t h p o s s i b l e s t a r v a t i o n or p o l i t i c a l nation.  Political  discrimi-  s i t u a t i o n s may have become i n c r e a s i n g l y  more d i f f i c u l t f o r him, a s i t u a t i o n which i s found i n many countries  today. Most immigrants  language,  a r e , i n a sense, i g n o r a n t o f the  customs and laws o f a new country, - "ignorance  means weakness and exposure to e x p l o i t a t i o n " caused g r i e f f o r many immigrants.  - and t h i s has  The g r e a t e s t  immediate  concerns o f the newcomer are f o r food, l o d g i n g and ment.  employ-  Some immigrants have been met a t the p o r t o f entry by  t h e i r countrymen who have p r e v i o u s l y immigrated.  These coun-  trymen have been known to take advantage o f the newcomers, o f t e n s e l l i n g them f r a u d u l e n t i n s u r a n c e or p o s s i b l y a s k i n g f o r a h i g h f e e f o r s e c u r i n g employment f o r them. P r e p a r a t i o n f o r Immigration Many immigrants come from r u r a l backgrounds, "yet 2 they s e t t l e i n the c i t i e s where l i f e i s more complex," where job o p p o r t u n i t i e s are not compatible w i t h t h e i r ment background and t r a i n i n g .  and employ-  T h i s adds t o t h e i r problems  o f adjustment, as they must o f t e n l e a r n t o do u n f a m i l i a r work.  A t times, an immigrant might have to lower h i s s o c i a l  s t a t u s i n o r d e r t o f i n d employment.  P r o f e s s i o n a l people,  s k i l l e d and s e m i - s k i l l e d workers tend to f i n d a p p r o p r i a t e ployment sooner than those o f the u n s k i l l e d l a b o u r i n g  em-  class.  One o f the p s y c h o l o g i c a l f a c t o r s which an immigrant should c o n s i d e r i s the l e a r n i n g o f new  s o c i a l r o l e s , not o n l y i n r e -  l a t i o n s h i p to h i s o c c u p a t i o n but as a c i t i z e n as w e l l . f o r t u n a t e l y , the immigrant i s i n i t i a l l y  Un-  considered more or  l e s s homeless and a second r a t e c i t i z e n by the g e n e r a l p u b l i c . Davie, op. c i t . , p. 461. 2 loc. c i t . 1  - 7 -  These attitudes occur, perhaps, because of h i s behaviour, speech, and dress which make him more e a s i l y recognized as an immigrant.  The immigrant must i d e n t i f y himself i n a  primary s o c i a l role as an immigrant before extending h i s act i v i t i e s beyond the primary stage into the absorbing society and developing a capacity to i d e n t i f y with i t .  Only as f a r  as the absorbing s o c i a l structure develops and continues to function smoothly may  the i n s t i t u t i o n a l i z i n g of the immi1  grant's behaviour be said to be achieved.  He must also  r e a l i z e that no matter how personally well equipped an immigrant he may  seem to be, to meet the Hew World he w i l l  s t i l l be faced with the i n i t i a l task of meeting the unknown, and of passing through t r a n s i t i o n a l phases of acceptance, recognition, integration and assimilation. Many immigrants f e e l unaccepted, alone, forsaken and l o s t i n the new i s i n t o t a l l y new him.  country and t h i s i s only natural as he  surroundings and nothing i s f a m i l i a r to  As he f a m i l i a r i z e s himself with the language and be-  comes a r t i c u l a t e i n i t s use, i t i s up to him to lay some of the groundwork f o r himself: recognized and accepted.  f o r being better understood,  He must learn too, to recognize  and accept the role expectations others have of him. These, then, are some of the problems which Eisenstadt, S. 1., The Absorption of Immigrants, The Free Press, Glencoe, I l l i n o i s , 1955, p. 8. 1  - 8 -  c o n f r o n t any immigrant the s p e c i f i c background problems  from any country.  With these i n mind,  o f immigration, w i t h i t s a t t e n d a n t  o f the Chinese who  emigrated to Canada, can be  considered. S p e c i a l Problems  o f the Chinese Immigrants  The f i r s t i m m i g r a t i o n o f Chinese i n t o B r i t i s h  Co-  lumbia i s not on r e c o r d but t h e r e i s evidence t h a t some came from the S t a t e o f C a l i f o r n i a , and took p a r t i n the Gold Rush  1 of the P r a s e r R i v e r i n 1858. was  A c c o r d i n g to C. H. Young,  it  estimated t h a t two thousand came to the g o l d f i e l d s .  se Chinese, mostly s i n g l e men,  The-  had come, f o r the most p a r t ,  from the p r o v i n c e of Kwang-Tung, i n the v i c i n i t y o f Canton; they belonged to the c o o l i e or farm l a b o u r e r c l a s s and had a low standard o f l i v i n g .  They a d j u s t e d t o the l a b o u r i n g c l a s s  i n Canadian c i t i e s whose members were p r i m a r i l y engaged i n i n d u s t r i a l work.  Those who  were not absorbed i n t o i n d u s t r y  found work i n c a f e s or as household h e l p . households was  Employment i n  a i d e d by the f a c t t h a t the Chinese are noted  f o r t h e i r f a i t h f u l n e s s , obedience and s e r v i l i t y . the immigrants  A few o f  a d j u s t e d to the r u r a l d i s t r i c t s and continued  farming, an o c c u p a t i o n w i t h which they were f a m i l i a r i n t h e i r native  land. The conspicuous f e a t u r e s o f the Chinese  immigrants  Young, C. H., The Japanese Canadians, The U n i v e r s i t y o f Toronto P r e s s , Toronto, 1938, p. 22b. 1  - 9 -  were their physical c h a r a c t e r i s t i c s , such as colour, orient a l f a c i a l features, t h e i r food, b e l i e f s , including t h e i r s o c i a l celebrations and the " t r i v i a l i t i e s such as h i s e r s t while p i g t a i l or h i s gait i n walking,"'' t h e i r language, and habits of dress,  ( i n the early days the Chinese who  came to  t h i s country possessed a c e r t a i n dog t r o t type of walk.)  The  uniqueness of their speech and writing and t h e i r a t t i r e , (part i c u l a r l y that of the women, with their baggy trousers and small bound feet) were a l l objects of r i d i c u l e .  Their super-  s t i t i o n s and b e l i e f s caused the Canadians to think of them as being very strange.  On important s o c i a l occasions the Chinese  exploded firecrackers and had a special preference f o r decor a t i n g objects and buildings i n red.  They "watched designs  formed by joss sticks tossed by the p r i e s t s f o r i n d i c a t i o n of 2 the d i r e c t i o n where Lady luck l a y . "  I t would seem that a l l  of these customs were looked upon as strange and r i d i c u l o u s and a sense of discrimination developed which added to the d i f f i c u l t i e s of adjustment f o r the Chinese. The e a r l i e r Chinese immigrants were "more painstaking, industrious and persevering, they were successful i n the placer mines and time and again they made mines pay which the hasty impatient whites thought were not worth working."^ Taft, D. R., and Bobbins, R., International Migrations, The Ronald Press Co., New York, 1955, p. 5b2. Loc. c i t . ^ Davie, op. c i t . , p. 309. 1  .- 10 -  Envy soon l e d to competition and to exploitation.  With the  increase i n number of Chinese immigrants, a head tax of $500 was imposed upon them i n the State of C a l i f o r n i a , with the hope of decreasing the number of newcomers.  Many Chinese  were exploited by t h e i r own people who paid their passages to the new land,, then controlled the l i v e s of such immigrants u n t i l repayment was made.  I t i s possible that such s t r e s s f u l  situations as t h i s l e d them to work f o r very low wages or at work of any kind, i n order to pay f o r t h e i r freedom. One of the reasons the Chinese were d i s l i k e d was because of the "absence of women to maintain homes ... which made f o r bad housing conditions."  I t was thought also that  the number of drug addicts increased with the i n f l u x of the Chinese and t h e i r opium smoking.  Their gambling was also a  source of disapproval by Canadians. The early immigrants engaged i n the Gold Rush had no i n t e n t i o n of s e t t l i n g permanently; t h e i r intention was to save t h e i r earnings and return to t h e i r homeland when they had saved from $500 to $1,000.  Even with intensive saving,  they appeared to l i v e i n some degree of comfort on the basis of the standards of t h e i r own country. trine of s o c i a l structures  The Confucious doc-  that "a man does not t r a v e l to  distant places when h i s parents are l i v i n g , and i f he does,  Taft & Robbins, op. c i t . , p. 564.  - 11 -  lie must have a d e f i n i t e destination,"  may  have contributed  to t h e i r lack of integration i n t o the ways of a foreign land. The Chinese were discriminated against for t h i s practice s i n ce i t was  f e l t that they were exporting the wealth of the  country rather than spending i t where they earned i t . Since the Chinese language i s completely unlike the Canadian language, i n t e g r a t i o n was more d i f f i c u l t .  As  mentioned e a r l i e r , adults experience greater d i f f i c u l t y i n adapting  to new  cultures, and most of the early Chinese im-  migrants were adults.  Furthermore, integration may  have been  d i f f i c u l t because of discrimination which handicapped t h e i r choice of employment.  The Chinese were c r i t i c i z e d f o r t h e i r  lack of i n t e r e s t i n a s s i m i l a t i o n and "duties of c i t i z e n s h i p 2 which the Americans denied them." i n a s s i m i l a t i o n may  Their lack of i n t e r e s t  have been attributable to the fact that,  as a minority group, they were eager to group together f o r s o c i a l l i f e and to strengthen  t h e i r morale.  Consequently,  with the a r r i v a l of more of t h e i r countrymen, t h e i r customs and habits were reinforced and renewed, and integration f u r ther deterred.  Such factors, along with r a c i a l discrimina-  t i o n , would contribute to the establishment Chinese communities i n Canadian c i t i e s .  Co.,  These f a c t s , as  Lin, Yutang, My Country and My People, The John New York, 1939, p. 180.. Taft & Robbins, op. c i t . , p. 565.1  Day  of predominantly  2  - 12 well as the recent curbing of Chinese immigration may have confirmed i n the minds of the Chinese the country's disapproval of them which, i n turn, would contribute to manifestations of withdrawal and stress. With the amendment of Canada's Immigration Policy on Chinese immigration i n 1947, which allowed "the admission of wife (or husband) and unmarried children under 21 years of age", there followed a great i n f l u x of immigrants.  This  was a d i r e c t r e s u l t of the relaxation of Canadian immigration p o l i c y , which permitted many more Chinese to escape the p o l i t i c a l uproar and the stresses of overpopulation and economic need i n t h e i r own country.  Hoping to f i n d a new and better  homeland, the Chinese found themselves instead i n a strange and insecure  environment.  The unskilled laborer, who had l i t t l e to contribute to the highly i n d u s t r i a l i z e d society of Canada, had p a r t i c u l a r d i f f i c u l t y i n adjusting to a new economic system and sometimes developed s u s c e p t i b i l i t y to mental i l l n e s s i n h i s e f -  2 f o r t s to adapt.  According to Hollingshead's  hypothesis on  mental i l l n e s s and class structure, i t would appear that there i s a higher frequency of mental i l l n e s s i n the working c l a s s . 1 Corbett, D. C , Canada's Immigration Policy, University of Toronto Press, 1957, p. 29. Hollingshead, A. B., and Redlich, P. C , S o c i a l Class and Mental I l l n e s s , John Wiley & Sons, Inc., New York, 1958, p. 198.. 2  - 13 -  However, many factors such as class, sex, age, race, marital status and r e l i g i o u s a f f i l i a t i o n enter into the picture and a l t e r these g e n e r a l i t i e s .  As shown i n Table 1 (intended  Occupations of Chinese Immigrants To Canada, 1947 - 1959, of which more than 80$ are i n B r i t i s h Columbia), there i s a f a r greater number of miscellaneous and general labourers than of professionals and merchants, s k i l l e d and semi-skilled workers or c l e r i c a l  workers.  - 14 -  TABLE 1 INTENDED OCCUPATIONS OP CHINESE IMMIGRANTS TO CANADA, 1947 - 1959  Occupational 1947 group -1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 TOTAL Professional or merchant  12  10  23  29  24  31  94  58  41  49  171  542  Clerical  0  2  5  17  10  8  70  53  35  28  41  269  Farming  1  8  11  12  2  28  59  86  32  23  11  273  Skilled  2  5  9  7  8  33  50  49  26  21  30  240  skilled  7  5  18  38  2  26  9  7  4  6  5  127  Labourers  5  26  357  751  785  337  345  598  210  275  240  3929  51  136  517  398  194  455  762  84  97  93  98  2885  Dependent children  466 1103 1159  564  388  431  449  385  304  681  742  6672  Dependent mothers  342  603 497  516  607  737  773  913 1439 1243  8116  TOTAL  886 1741 2702 2313 1929 1956 2575 2093 1662 2615 2581 23153  Semi-  Miscellaneous  Source:  446  S t a t i s t i c s Section, Department of Citizenship and Immigration  - 15 -  I f H o l l i n g s h e a d s h y p o t h e s i s i s v a l i d , the number o f p o t e n t i a l 1  mentally i l l  people i s g r e a t e r than i f the number o f immig-  r a n t s were composed o f the l a t t e r group o f workers. C u l t u r a l Background o f Chinese The  Immigrants  Chinese immigrant's customs and ways o f l i v i n g  were q u i t e d i f f e r e n t from those o f Canadians, a t the o u t s e t . But t h i s d i f f e r e n c e was emphasized because o f the absence o f Chinese women who would have i n s i s t e d on a h i g h e r of l i v i n g than t h a t achieved by s i n g l e men.  standard  The Chinese men  accepted accommodation considered i n t o l e r a b l e by white men, hence " r e c e i v i n g mixed r e a c t i o n s o f welcome as cheap l a b o u r and o p p o s i t i o n as ' u n f a i r ' c o m p e t i t o r s . "  A glance a t the  c o n d i t i o n under which the white working man and the Chinese competed showed the u n f a i r n e s s o f the c o m p e t i t i o n . d i a n i s expected  The Cana-  t o d i s c h a r g e the o r d i n a r y d u t i e s of c i t i z e n -  ship to h i m s e l f , h i s f a m i l y and h i s country; r e n t must be p a i d , food p r o v i d e d and the f a m i l y d e c e n t l y c l o t h e d .  Y e t he  i s p u t i n c o m p e t i t i o n w i t h one who does not assume any o f these d u t i e s , as i n many Chinese women a t a l l .  communities t h e r e were no  T h e i r own mode o f l i v i n g was r e t a i n e d , m o d i f i e d  only s u f f i c i e n t l y t o meet the economic and l e g a l demands made upon them.  T a f t & Robbins, op. c i t . , p. 561.  - 16 -  Parent-Ohild Relationships In the c u l t u r e o f the Chinese, the f a t h e r - s o n r e l a t i o n s h i p i s h i g h l y g l o r i f i e d and f i l i a l p i e t y i s demanded.''  The i d e a o f s o l i d k i n s h i p among members o f a group i s  cultivated.  China has a r r i v e d a t the p o i n t o f t r a d i t i o n and  p o s i t i o n i n which the f a m i l y r e v o l v e s around the husband and w i f e "while the Canadian f a m i l i e s tend to be c h i l d - c e n t e r e d . " The N o r t h American c u l t u r e l o o k s t o the f u t u r e , and the parent s a c r i f i c e s f o r the c h i l d , p a r e n t s a c q u i r i n g f o r t h e i r  children  advantages which they themselves d i d n o t have. I t would appear t h a t the Chinese do n o t segregate c h i l d r e n from a d o l e s c e n t s ; they are a l l c o n s i d e r e d c h i l d r e n u n t i l such time as they b e g i n t o assume some f a m i l y r e s p o n s i b i l i t y by working the f i e l d s or going out t o work i n o t h e r occupations. the  The temporary r e b e l l i o u s n e s s o f the youth o f  N o r t h American c u l t u r e , r e s u l t i n g from such f a c t o r s as  industrialization, ciplined the  i s q u i t e i n c o n t r a s t to the d o c i l e ,  behaviour o f Chinese youth.  One o f the f i r s t  disthings  Chinese c h i l d l e a r n s i s the s o c i a l o b l i g a t i o n s between  man and man, s e l f c o n t r o l and c o u r t e s y f o r mutual and r e s p e c t f o r h i s e l d e r s .  This emphasis  adjustment,  upon r e s p e c t and.  o b l i g a t i o n o f t e n d e p r i v e d young men o f a sense o f e n t e r p r i s e and i n i t i a t i v e .  I n the North American  c u l t u r e , on the o t h e r  T a f t & Robbins,. op. c i t . , p. 3 0 9 . Van Kooten, op. c i t . , p. 17.  - 17 -  hand, the c h i l d i s , to a large extent, under the authority of the parents u n t i l he i s twenty-one years old, after which he assumes;, independence and moves out with a sharp break i n family t i e s . are l e f t  As the children leave one by one,  the parents  alone*. A man who becomes f i n a n c i a l l y successful i n the  world and who has been brought up i n a t r a d i t i o n a l Chinese family would buy h i s father a new home but the successful man brought up i n the North American culture "would surely buy  1 himself the house,"  possibly helping h i s father f i n a n c i a l l y ,  perhaps i n a home f o r the aged.  The elders i n the Chinese  family are so respected that "marriage i s contracted through 2 the hands of parents,!  1  unlike the " f a l l i n g i n love" of coup-  l e s i n the Canadian culture, and the mutual decision to marry without regard f o r parental  opinions.  Status of Women There also existed inequality of women i n China.. For example, her opinion about the marriage or about her husband keeping a concubine was not sought, nor was there r e s pect f o r her p o s i t i o n i n the family lineage.  North American  women often supplement family income f o r a better standard of l i v i n g and i n order to have an independent l i f e of t h e i r own. Wilensky, H. 1., and Lebeaux, C. N., I n d u s t r i a l Society and Social Welfare, Russell Sage Foundation, New York, 1958. p. 73.. Lin, op. c i t . , p. 180. 1  2  - 18 -  The husband-wife r e l a t i o n s h i p i s based on love, l o y a l t y and companionship and the wife may help her husband i n h i s business on a s o c i a l l e v e l .  A good wife i s a companion with  extra f a m i l i a l a c t i v i t i e s , whereas i n the Chinese family, the husband-wife relationship exists but i s secondary to the parent-child r e l a t i o n s h i p , "the i d e a l wife being a h e l p f u l wife and a wise mother".  She has her p o s i t i o n of wifely  duties of which she i s f u l l y aware.  Chastity i s a virtue i n  both cultures; however, divorces and b i r t h control are unusual i n China while both practices are prevalent i n the North American culture.  China today, under Communistic influences, 2  " i s reported to be changing precipitously," tems.  i n family  sys-  This can also be said of Chinese immigrants i n Canada,  especially the Canadian born of Chinese-born parents.  Ex-  cept f o r physical c h a r a c t e r i s t i c s , many Canadian-Chinese think, act, speak and eat as other Canadians do. Family l i f e for "the t r a d i t i o n a l large Chinese f a mily has been p a t r i l i n e a l , p a t r i l o c a l and l a r g e l y patriar-. 3 chal."  In China, the aged members of the family, which ex-  tends to include distant r e l a t i v e s , are objects of respect. I t would seem that many aged Canadians are l e f t to care f o r themselves with infrequent  v i s i t s by t h e i r children.  Taft & Robbins, op. c i t . , p. 563. Loc. c i t . Taft & Robbins, op. c i t . , p. 309.  This  -  19  a t t i t u d e towards the aged may  -  w e l l he cause of s e r i o u s con-  cern hy the e l d e r s of the Chinese immigrant groups. Psychological D i f f i c u l t i e s  i n Cultural  "Although, i n f i n i t e up  allows  Adaptation  v a r i e t y i n p e r s o n a l i t y make-  f o r a wide scope of d e v i a t i o n i n i n d i v i d u a l beha-  v i o u r , i t i s g e n e r a l l y accepted t h a t a p s y c h o l o g i c a l l y s t r o n g and set, and ally  c o n s t i t u t i o n a l l y h e a l t h y person w i l l from the  he b e t t e r equipped than a dependent, i n s e c u r e , perhaps a l r e a d y  d i s t u r b e d newcomer."''  a f f e c t h i s adjustment p e r i o d .  also  Many Chinese immigrants  i n emigrating  to Canada, some  discrimination.  s u f f e r e d economically  country and  i n h i s own  suf-  comforts o f  were exposed to e x p l o i t a t i o n and  stresses of a minority  passive  initial  social roles w i l l  f e r e d g r e a t l y through d e p r i v a t i o n of food and l i f e i n t h e i r n a t i v e l a n d and  out-  The c o n s t i t u t i o n -  s t r o n g p e r s o n w i l l be able to withstand the  s t r e s s of adjustment; h i s p r e v i o u s  the  secure,  To have  then to endure  group such as t h a t o f the  Chinese  i n Canada would seem to imply t h a t such a person must be phys i c a l l y and m e n t a l l y  strong.  tain particular antipathies. t h e i r general  "Each country probably has Canadians, whatever may  be  l e v e l o f p r e j u d i c e compared w i t h t h a t o f  people seem to show t h e i r s t r o n g e s t e n t a l immigration."  The  cer-  other  prejudices against O r i -  Canadian-born Chinese l e a r n e d  Damm, op. c i t . , p. 3 . Corbett, op. c i t . , p. 3 1 .  to  - 20 -  i n t e g r a t e under s i m i l a r s i t u a t i o n s as w e l l as t h a t o f c o n f l i c t i n g aspects of dual c u l t u r a l background.  the  I t would  seem t h a t the g r e a t e r the c u l t u r a l d i f f e r e n c e s between the Canadian and  Chinese c u l t u r e , the g r e a t e r the  psychological  problem. C r i t e r i a of Mental  Health  Mental i l l n e s s i s an abnormal p s y c h o l o g i c a l manif e s t a t i o n o f the p e r s o n a l i t y .  P e r s o n a l i t y i s the  behaviour  of an i n d i v i d u a l developed from b i r t h to death by the a c t i o n o f c u l t u r e and and  society,  inter-  normal as w e l l as c r i m i n a l  a n t i - s o c i a l behaviour i s r e l a t e d to c u l t u r a l f a c t o r s .  A n t i - s o c i a l behaviour i s s a i d to have much i n common w i t h mental d i s o r d e r s . Jurgen Reusch health i n this  expresses h i s o p i n i o n on mental  way:  Today we conceive of the i n d i v i d u a l as a l i v i n g organism whose s o c i a l r e l a t i o n s are combined i n t o a complex o r g a n i z a t i o n , whose i n n e r world o f experience i s c l o s e l y r e l a t e d to h i s s o c i a l o p e r a t i o n s and whose soma mater i a l l y makes p o s s i b l e h i s v a r i o u s act i v i t i e s - such a view n e c e s s i t a t e s a more u n i t a r y approach to men - one which w i l l enable us to r e p r e s e n t phys i c a l , p s y c h o l o g i c a l and s o c i a l events w i t h i n one system of d e n o t a t i o n . If such an u n d e r t a k i n g were to be s u c c e s s f u l , i t would p r o v i d e f o r an e n t i r e l y  life,  Ackerman, H. W., The Psychodynamics of Family B a s i c Books Inc., New York, 1959, p. 8.  - 21 -  new perspective of the i n t r i c a t e relations of mind, body and socioeconomic events and would furnish a framework which would consider simultaneously the i n d i v i d u a l and h i s surrounding, both i n health and disease. Mental health today concerns not only the sick but also the entire community because the ever growing popul a t i o n and the crowded conditions of the modern c i t y have affected mental health.  life  The d i f f e r e n t forms of mental  i l l n e s s i n the various classes of population may offer some l i g h t on the relationship of class to the type of mental illness. " I f 'normal' behaviour, as defined i n our culture, i s taken as an absolute standard of reference and the behaviour of i n d i v i d u a l s conditioned to the values of another culture are compared with i t , then, of course, i t i s even possible to speak of 'group psychoses and neuroses' as mani1  fested by the individuals of the exotic society."  Diagno-  s i s of mental i l l n e s s i n other societies i s anything but simple. 2 Karl Menninger  states that "mental health i s the  adjustment of human beings to the world and to each other with a maximum of effectiveness and happiness."  E r i c h Eromm  Opler, M. K., Culture and Mental Health, The MacMillan Co., New York, 1959, p. 23. Ackerman, op. c i t . , p. 5. ^ Loc. c i t . 1  2  - 22 -  says t h a t  "from the  standpoint of f u n c t i o n i n s o c i e t y  can c a l l a person normal or h e a l t h y i f he i s a b l e f i l l h i s s o c i a l r o l e s - i f he reproduction v i d u a l we  of s o c i e t y .  ful-  to p a r t i c i p a t e i n the  standpoint of the  or normalcy as the  indi-  optimum of  happiness of the i n d i v i d u a l . " It  can be  s a i d , then, that v a r y i n g  es determine to a great health  Prom the  l o o k upon h e a l t h  growth and  i s able  to  one  s i n c e the  cultural valu-  extent the d e f i n i t i o n o f mental  components o f contentment and  v a r y from c u l t u r e to c u l t u r e .  The  happiness  World H e a l t h Organiza-  t i o n c i t e s mental h e a l t h as being the  "capacity  to e s t a b l i s h  harmonious i n t e r p e r s o n a l r e l a t i o n s . " The  concept of mental h e a l t h v a r i e s between the  c u l t u r e of the  Chinese immigrant and  hence making the d i a g n o s i s ficult.  The  t h a t of the  o f a c t u a l mental i l l n e s s more d i f -  p s y c h i a t r i s t and  s o c i a l worker must l e a r n t o  comprehend which f a c t o r s i n both c u l t u r e s may i l l n e s s and  Canadian,  l e a d to mental  at what p o i n t p s y c h i a t r i c treatment i s necessary,  i f they are to e f f e c t i v e l y h e l p the m e n t a l l y i l l o f t h i s minority  Chinese group w i t h i n Canadian  R e s p o n s i b i l i t i e s o f the  society.  S o c i a l Worker i n the M e n t a l  J e a n e t t e Regensburg  2  Hospital  states*  Ackerman, op. c i t . , p. 3. Regensburg, J e a n e t t e , " I m p l i c a t i o n f o r the P r a c t i c e of S o c i a l Casework," S o c i a l Casework, V o l . XLI, no. 1, January, I960, p. 14. 2  - 23 -  S o c i a l work seeks to enhance the s o c i a l functioning of i n d i v i d u a l s , s i n g l y and i n groups, by a c t i v i t i e s focused upon t h e i r s o c i a l r e l a t i o n s h i p s which c o n s t i t u t e the i n t e r a c t i o n between man and h i s environment. These a c t i v i t i e s can be grouped i n t o three f u n c t i o n s ; r e s t o r a t i o n o f imp a i r e d c a p a c i t y , p r o v i s i o n of i n d i v i d u a l and s o c i a l r e s o u r c e s , and p r e v e n t i o n of s o c i a l d i s f u n c t i o n . Social casework i s a method o f s o c i a l work which i n t e r v e n e s i n the p s y c h o s o c i a l a s p e c t s of a person's l i f e to improve, r e s t o r e , m a i n t a i n or enhance h i s soc i a l f u n c t i o n i n g by improving h i s r o l e performance. I n t e r v e n t i o n occurs when the person, or members of h i s group or h i s community, r e a l i z e t h a t h i s r o l e performance i s hampered or t h r e a t e n e d . The i n t e r v e n t i o n takes p l a c e through a p r o f e s s i o n a l r e l a t i o n s h i p between the worker and the person, and a l s o between the worker and other i n d i v i d u a l s whose i n t e r a c t i o n w i t h the p e r son a f f e c t s h i s r o l e performance. Since s o c i a l f u n c t i o n i n g i s the p r o duct of i n t e r a c t i o n among i n t r a p s y c h i c , somatic and s o c i a l f o r c e s , s o c i a l c a s e work i n v o l v e s a s s e s s i n g the i n t e r n a l and s o c i a l f a c t o r s which i m p a i r s or t h r e a t e n s the person's r o l e performance and h e l p i n g him t o f i n d and use the somatic, p s y c h i c and s o c i a l r e s o u r c e s a t h i s d i s p o s a l , to e l i m i n a t e or reduce m a l f u n c t i o n and t o enhance f u n c t i o n i n g in social roles. I t i s important to note t h a t Regensburg's s t a t e ment i m p l i e s The  broad i n t e r a c t i o n between people and  r e l a t i o n s between man  tween groups and  and  man,  man  and  groups.  groups, and  be-  community, are r o o t e d i n the f i r m demo-  c r a t i c b e l i e f s that nourish  our  civilization.  It i s  - 24 -  b e l i e f s such as that of freedom f o r i n d i v i d u a l development which r e s u l t i n the caseworker's f a i t h and b e l i e f i n the inherent worth and dignity of the i n d i v i d u a l and h i s r i g h t to s e l f determination. The s o c i a l worker's task i s to aid the i n d i v i d u a l to develop h i s resources to a maximum capacity of s o c i a l functioning.  He t r i e s to understand the c l i e n t ' s obstacles  i n adjusting to h i s environment and "to provide a s o c i a l climate which w i l l foster any i n d i v i d u a l search f o r s e l f •i  fulfillment."  The s o c i a l worker i n the Mental Health Ser-  vices, i n t r y i n g to understand the c l i e n t ' s problems, also helps the patient's family, r e l a t i v e s or friends to understand the patient's problems which, i n turn, w i l l a s s i s t h i s family i n understanding h i s behaviour.  Upon the patient's  return from h o s p i t a l i z a t i o n f o r example, "the worker must give him more support i n h i s e f f o r t s and even perhaps, act i v e l y intervene i n h i s environment to reduce s o c i a l or per2 sonal pressures upon him."  The caseworker may help the d i s -  charged patient with employment so that he may achieve some independence, thereby making a contribution to the community.  " S o c i a l forces influence behaviour and attitudes of the  individual;""^  therefore, a h e l p f u l community receives gains  ' Damm, op. c i t . , p. 5. Hamilton, G-., Theory and Practice of S o c i a l Oase Work, Columbia University Press, New York, 1954, p. 23. 3 Ibid., p. 22. 2  - 25  i n return.  -  However, f o r such a harmonious s e t t i n g , the  importance of c o - o p e r a t i v e worker and  r e l a t i o n s h i p between s o c i a l  other r e l a t e d p r o f e s s i o n a l d i s c i p l i n e s must  recognized.  In order  to strengthen  be  the r e l a t i o n s h i p be-  tween the p r o f e s s i o n a l d i s c i p l i n e s , one must understand c l e a r l y the concept of h i s r o l e i n the m u l t i p l e  discipline  setting. " I n order  to be q u a l i f i e d to b r i n g any r e s u l t i n g  impact to the a t t e n t i o n o f the p u b l i c , the worker must have knowledge o f the s o c i e t y ' s  'make-up'."^  Culture plays  important p a r t i n determining those a c t i o n s which may acceptable  and  those which are u n a c c e p t a b l e .  an be  In t h i s par-  t i c u l a r f i e l d the worker must understand the complexity p s y c h o l o g i c a l nature of the g e n e r a l p u b l i c as w e l l as o f the Chinese community:  i n regard  that  t h e i r unique c u l t u r e , and what  they t h i n k c o n s t i t u t e s mental i l l n e s s . at the present  and  I t would seem t h a t  time, the o p i n i o n o f the Chinese i n Canada  to mental i l l n e s s i s t h a t i t b r i n g s shame and  dis-  grace to the whole f a m i l y , both the immediate f a m i l y and  the  extended f a m i l y . The  purpose of t h i s study i s to assess whether the  d i f f i c u l t i e s encountered by the Chinese immigrant and Canadian-born Chinese i n a d j u s t i n g to a new  Damm, op.  c i t . , p.  5.  the  culture did, i n  - 26 -  the  cases o f the sample o f p a t i e n t s chosen, c o n t r i b u t e t o  mental breakdown.  I n a d d i t i o n , an attempt w i l l be made t o  i n d i c a t e i n what ways the s o c i a l worker, w i t h h i s knowledge and s k i l l i n a s s i s t i n g people t o a d j u s t to change, h e l p the new  Chinese immigrant  might  to overcome these s t r e s s e s ,  r e g a i n or develop h i s sense of s e c u r i t y and avoid mental breakdown, o r i n the case o f mental i l l n e s s , become r e h a bilitated  w i t h i n the Canadian c u l t u r e .  Scope o f Study B a s i c a l l y , t h i s study w i l l examine the i m p l i c a t i o n s f o r those Chinese people who  c o n s t i t u t e the s m a l l  group o f r e c e n t immigrants and Canadian-born Chinese have been h o s p i t a l i z e d f o r mental d i s o r d e r and who  who  have  f a i l e d to a d j u s t s a t i s f a c t o r i l y i n a Canadian community. The study i s based upon the assumption t h a t every person i s a s o c i a l b e i n g , an i n t e r d e p e n d e n t p a r t o f a system o f human interactions.  W i t h i n the c o n f i n e s of the s o c i o - c u l t u r a l  p a t t e r n each person responds i n terms of h i s own t i o n and l i f e - e x p e r i e n c e s .  constitu-  T h i s approach of a n a l y t i c a l  study i s a l s o based on a c o n c e p t i o n o f mental h e a l t h and mental i l l n e s s which s t r e s s e s the importance o f the  life-  experiences o f the i n d i v i d u a l , h i s r e l a t i o n s to h i s own  Kluckhohn, C , and Murray, H. A., P e r s o n a l i t y i n Nature, S o c i e t y , and C u l t u r e , A l f r e d A. Knopf, New York, 1956, p. o..  - 27 -  body, h i s parents, h i s s i b l i n g s , peers, etc.  The study w i l l  examine the interdependence and cross-influence of psycholog i c a l and c u l t u r a l processes i n the s o c i a l functioning of the  i n d i v i d u a l and attempt to assess the psycho-cultural con-  flicts.  However, i t i s also designed to provide, i n some  measure, a more comprehensive knowledge of the d i f f i c u l t y experienced by the Chinese person i n meeting h i s basic needs, the  minimum requirements f o r adjustment and the possible f a c -  tors contributing to mental disorder i n both recent Chinese immigrants and those who were Canadian-bom Chinese.  Were  these patients predisposed to mental i l l n e s s , or did they f a i l to adjust to a new l i f e because of s t r e s s f u l situations of  adaptation?  Is i t an i n d i v i d u a l factor or i s i t due to  s o c i o - c u l t u r a l differences such as language and work?  The  study i s not directed toward absolute answers to s o c i a l d i agnosis, but i t s conclusions might help the professional caseworker to create a more meaningful s o c i a l diagnosis, which, i n turn, might r e s u l t i n more knowledgeable  and im-  proved casework treatment services f o r Chinese patients. The exposition may add to the professional s o c i a l  casewor-  ker's knowledge of the Chinese, p a r t i c u l a r l y those workers who deal with these recent Chinese immigrants and Canadianborn Chinese, hence proving b e n e f i c i a l to the patients  Mead, M., Cultural Patterns and Technical Change, American l i b r a r y , Hew York, 1957, p. 14. 1  - 28 -  themselves.  One b a s i c q u e s t i o n  which should be r a i s e d i s :  "What k i n d o f s e r v i c e s are a v a i l a b l e t o f a c i l i t a t e the i n i t i a l adjustment o f a newcomer?" Method and C r i t e r i a o f S e l e c t i o n To understand people o f a completely d i f f e r e n t c u l t u r a l background r e q u i r e s  some e l a b o r a t i o n .  Dissimila-  r i t i e s i n c l u d e language, customs, food, ideas o f comfort, and  p h i l o s o p h i c a l thoughts.  some p r e l i m i n a r y  Therefore,  t h i s work p r e s e n t s  c u l t u r a l d a t a i n t h i s chapter i n order to  f a c i l i t a t e understanding o f p o s s i b l e unique problems.  The  background a l s o serves to suggest f e r t i l e grounds f o r the reaping  of p o s s i b l e hypotheses.  have the purpose o f f o r m u l a t i n g  "Many e x p l o r a t o r y  studies  a problem f o r more p r e c i s e  i n v e s t i g a t i o n or d e v e l o p i n g hypotheses. s t u d i e s have the purpose o f f o r m u l a t i n g  "Many  exploratory  a problem f o r more  p r e c i s e i n v e s t i g a t i o n or d e v e l o p i n g hypotheses.  An e x p l o -  r a t o r y study may, however, have other f u n c t i o n s ;  increasing  the i n v e s t i g a t o r ' s f a m i l i a r i t y w i t h the phenomenon he wishes t o i n v e s t i g a t e i n a subsequent, more h i g h l y  structured  study, or w i t h the s e t t i n g i n which he p l a n s t o c a r r y out such a study; c l a r i f y i n g concepts; e s t a b l i s h i n g p r i o r i t i e s for further research;  gathering  information  p o s s i b i l i t i e s f o r c a r r y i n g out r e s e a r c h  about p r a c t i c a l  i n r e a l - l i f e setting;  p r o v i d i n g a census o f problems regarded as urgent by people  -  29  -  working i n a given f i e l d of s o c i a l r e l a t i o n s . " This exposition w i l l focus on the following hypotheses:  (1)  The prevalence of mental i l l n e s s amongst the  Chinese immigrants i s related s i g n i f i c a n t l y to the l e v e l of education and occupation.  (2)  Migrating people are more  susceptible to emotional disturbance than are native-born people. (4)  (3)  language d i f f i c u l t i e s create maladjustments.  Emotional disturbances are associated with extreme d i f -  ferences i n c u l t u r a l background.  (5)  Dual cultures of ex-  treme differences a f f e c t mental s t a b i l i t y . connects two major concepts of research:  Each hypothesis mental i l l n e s s and  immigration, and mental i l l n e s s and integration. The source of material f o r this study was obtained from c l i n i c a l and casework records on the f i l e s of Chinese patients h o s p i t a l i z e d i n the Grease C l i n i c of Psychological Medicine and The P r o v i n c i a l Mental Hospital at Essondale, B. C.  These hospitals which are administrated by the B. C.  Government o f f e r two types of treatment:  b r i e f therapeutic  measures i n Crease C l i n i c f o r those acutely i l l patients expected to improve within a four-month period; and continued therapeutic care at P. M. H., f o r the chronically i l l ent.  pati-  Treatment i s provided by a team of p s y c h i a t r i s t s , psy-  chologists, s o c i a l workers, psychiatric nurses, occupational  S e l l t i z , C , Johoda, M., Deutch, M., and Cook, S. W., Research Methods i n Social Relations, Henry Holt &• Co., Hew York, 1959, p. 51.  - 30 -  therapists and physiotherapists. patients are recorded b r i e f or continued team.  Their observations  of the  on the patient's f i l e and r e f e r r a l f o r  casework services i s discussed by the  The acceptance of a request f o r s o c i a l work t r e a t -  ment remains with the S o c i a l Service Department and such acceptance depends greatly upon the a v a i l a b i l i t y of workers, as well as upon the appropriateness  of the r e f e r r a l .  A small sample of nine Canadian-born Chinese p a t i ents and eighteen Chinese immigrants are studied on a comparative b a s i s .  In order to maintain uniformity, four main  c r i t e r i a were emphasized i n s e l e c t i n g the samples* (1)  Patients admitted between the period of March, 1950 to March, I960.  (2)  Patients hospitalized f o r the f i r s t time for  (3)  p s y c h i a t r i c treatment.  Male single patients between the ages of twenty to f o r t y - f i v e .  (4)  Patients who had been discharged  from  h o s p i t a l before this study was undertaken. Bachelors were chosen on the assumption that they possessed c e r t a i n personality c h a r a c t e r i s t i c s .  The immigrant group  may include some of those who experienced Communist ideology and thus were already subjected to stress and c o n f l i c t .  They  were not selected within any c l a s s i f i c a t i o n of s p e c i f i c ment a l i l l n e s s ; e.g., schizophrenic, manic-depressive, e t c .  - 31 -  Nine o f the p a t i e n t s s e l e c t e d f o r t h i s study were Canadianhorn Chinese and e i g h t e e n were r e c e n t Chinese immigrants. T h i s r a t i o was  chosen because h o s p i t a l r e c o r d s showed a  h i g h e r frequency o f immigrant p a t i e n t s . to cal  study t h i s sample o f p a t i e n t s was  The method used  examination o f  clini-  and casework r e c o r d s on t h e i r f i l e s , w i t h i n f o r m a t i o n  being r e c o r d e d on a Working Sheet as shown i n Appendix Data on these c l i n i c a l  f i l e s was  A.  obtained from the r e c o r d e d  o b s e r v a t i o n o f the p a t i e n t by v a r i o u s s t a f f members and soc i a l i n f o r m a t i o n gathered from r e l a t i v e s and a s s o c i a t e s of the  patient. A r a t i n g s c a l e was  employed  to show a c l e a r e r  measurement o f comparison between the two groups, immigrant and Canadian-born Chinese p a t i e n t s .  I t a l s o serves the pur-  pose o f showing a comparative measurement o f the i n d i v i d u a l f a c t o r s which a f f e c t mental i l l n e s s and covers the f o l l o w i n g areas: (3)  (1)  Personality constituents;  Economic  ent's f i l e  factors.  (2)  Social factors;  The f i n d i n g s r e c o r d e d i n each p a t i -  by p h y s i c i a n s , p s y c h i a t r i s t s , nurses and  social  workers have served as a b a s i s f o r o r g a n i z i n g the r a t i n g scale.  Three case examples  are subsequently p r o v i d e d to i l -  l u s t r a t e and support the r a t i n g s c a l e as w e l l as to serve as a means o f b e t t e r a p p r e c i a t i o n and u n d e r s t a n d i n g of the s i g n i f i c a n c e o f the r a t i n g  scale.  The r a t i n g s c a l e used i n t h i s study i s a  - 32 -  modification of that used by E. B. M. Damm i n her Master of Social Work thesis, 1959, University of B r i t i s h Columb i a , p. 42 - 44.  Her study was a comparative study of  German immigrant patients and Canadian patients admitted to the Crease C l i n i c of Psychological Medicine.  This scale  appeared to be generally applicable to any comparative immigrant studies and hence i s being used i n t h i s study to compare Chinese immigrants with Canadian-born Chinese.  Prom  the t o t a l material compiled on these patients, a r a t i n g scale i n d i c a t i n g factors which may have l e d to, or p r e c i pitated, mental i l l n e s s , can be formulated (Chapter  II)..  CHAPTER I I THE ASSESSMENT OP "ADJUSTMENT"  The three areas " P e r s o n a l i t y Constituents", "Soc i a l Factors", and "Economic Factors" were found to he the major areas of concern i n mental i l l n e s s .  The c r i t e r i o n  " P e r s o n a l i t y Constituents" takes i n t o account ego strength, concept of s e l f and m o t i v a t i o n .  The a t t i t u d e toward  ill-  ness i s a f a c t o r of ego strength, measuring the p a t i e n t ' s acceptance of i t or h i s complete l a c k of awareness of h i s immediate problems.  A negative a t t i t u d e to h i s s i t u a t i o n ,  f o r example, may be seen i n h i s defiance about h o s p i t a l i z a tion.  This degree o f acceptance of h i s i l l n e s s i s r a t e d on  three l e v e l s , high, moderate and low. " S o c i a l Factors" include s o c i a l and r e c r e a t i o n a l a c t i v i t i e s , r e l a t i o n s h i p s w i t h r e l a t i v e s and f r i e n d s and the number of v i s i t o r s during h o s p i t a l i z a t i o n .  A high l e v e l of  s o c i a l and r e c r e a t i o n a l a c t i v i t i e s i s shown by a p a t i e n t ' s a c t i v i t y i n current events, c l u b s , sports and organizations p r i o r to h o s p i t a l i z a t i o n and i n t e r e s t s i n s i m i l a r a c t i v i t i e s during h o s p i t a l i z a t i o n .  Those w i t h very few such a c t i v i t i e s  and those showing no d e s i r e to p a r t i c i p a t e s o c i a l l y , were given 'low' r a t i n g s .  S o c i a l a c t i v i t y i s r e f l e c t e d to a  great degree i n the p a t i e n t ' s r e l a t i o n s h i p s w i t h r e l a t i v e s  - 34 -  and f r i e n d s .  I t c o r r e l a t e s w i t h the frequency o f v i s i t o r s  whether r e l a t i v e s or f r i e n d s .  The r a t i n g s c a l e i s devised  to grade frequency o f v i s i t o r s a t the h o s p i t a l and o f weekend i n v i t a t i o n s f o r v i s i t s w i t h people o u t s i d e . "Economic F a c t o r s " , i n c l u d i n g employment and e a r n i n g c a p a c i t y , f i n a n c i a l s t a t u s , and degree  of m o b i l i t y which  i s d i r e c t l y r e l a t e d to h i s s t a b i l i t y o f employment, are used to r a t e the p a t i e n t ' s economic l e v e l p r i o r to h o s p i t a l i z a tion.  Employment and earning c a p a c i t y are s u b d i v i d e d i n t o  three grades:  ( l ) M a n a g e r i a l o r the p r o f e s s i o n a l  field  which i n c l u d e s the h i g h e r l e v e l o f employment and e a r n i n g capacity.  (2)  Craftsmen,  c l e r i c a l o r the t e c h n i c a l  field,  which i n c l u d e s those who had e x p e r i e n c e , t r a i n i n g or apprenticeship i n specific s k i l l s .  (3)  The manual l a b o u r e r ,  those who had no t r a i n i n g and were g i v e n very l i t t l e  job r e s -  ponsibility. Table 3 was d e v i s e d from the f i n d i n g s gathered the r a t i n g s c a l e s t o present an o v e r a l l comparison tages.  from  i n percen-  These were r a t e d A, B, C, w i t h A having the h i g h e s t  degree o f p o t e n t i a l adjustment, tential.  and C h a v i n g the lowest po-  P o i n t s were t a l l i e d f o r each case and a percentage  was worked out f o r each group A, B, and C. Using the r a t i n g s c a l e , q u a n t i t a t i v e f i n d i n g s under the t h r e e major areas are presented under t h e i r r e s p e c t i v e headings.  - 35 TABLE 2-a AREAS AID GRADES I.  EXPLANATORY NOTES  PERSONALITY CONSTITUENTS 1. Ego Strength A.  High  B.  Moderate  C.  Low  R e a l i s t i c attitude toward i l l n e s s ; accepts h o s p i t a l i z a t i o n with good attitude; shows great struggle f o r maintenance of mental health upon h o s p i t a l i z a t i o n . Has limited r e a l i s t i c view toward i l l ness; ambivalent f e e l i n g s toward h o s p i t a l i zation; short duration of struggle to maintain mental health p r i o r to admission. L i t t l e or no a b i l i t y to perceive r e a l i ty; defiant to h o s p i t a l i z a t i o n ; l i t t l e or no attempt to regain mental health p r i o r to admission.  2. Concept of Self A.  Strong  B.  Moderate  C.  Weak  3. Motivation A.  High  B.  Moderate  C.  Low  Shows strong desire f o r personal a c h i evements; persistent e f f o r t toward s e l f worth and goals; has v i t a l i t y and c o n f i dence. A moderate desire f o r personal achievements; inconsistent feelings of s e l f worth and goals; f l u c t u a t i n g feelings of v i t a l i t y and confidence. No sense of goal or personal achievement shown; limited f e e l i n g of self-worth and l i t t l e or no e f f o r t toward goals; lacks v i t a l i t y and self-confidence. —  •  •  •  • "  High degree of personal involvement i n treatment; good adjustment on wards; uses p o t e n t i a l f o r s e l f improvement i n f u l l e s t possible way. Moderate degree of personal involvement i n treatment; adjustment on ward seems to fluctuate from day to day; requires encouragement to u t i l i z e own potentials; may see h o s p i t a l as a protective i n s t i t u t i o n . L i t t l e or no degree of s e l f - i n v o l v e ment i n treatment; poor adjustment on wards; l i t t l e or no desire to mobilize own potentials; overt resistance to treatment.  (7  - 36 TABLE  2-b —  AREAS M B II.  GRADES  EXPLANATORY NOTES  SOCIAL FACTORS 4. S o c i a l and R e c r e a t i o n a l Activities  A.  High  B.  Moderate  C.  Low  P e r s i s t e n t h i g h l e v e l o f involvement i n a c t i v i t i e s ; S p o r t s , c u l t u r a l , or c u r r e n t events p e r s o n a l l y pursued, p r i o r to and d u r i n g h o s p i t a l i z a t i o n . I r r e g u l a r p a r t i c i p a t i o n and i n v o l v e ment i n a c t i v i t i e s ; p a r t i c i p a t e s only upon encouragement; l i m i t e d awareness and i n i t i a t i v e toward a c t i v i t i e s . L i t t l e or no a c t i v i t i e s encountered; s o c i a l l y shy; s e l f c o n s c i o u s ; shows no d e s i r e to p a r t i c i p a t e , or involvement in activities.  5. R e l a t i o n s h i p w i t h R e l a t i v e s and F r i e n d s A.  B.  C.  Adequate  Frequent c o n t a c t s w i t h r e l a t i v e s ; a l a r g e number of f r i e n d s and a c q u a i n tances p r i o r to admission; has kept contact with distant r e l a t i v e s . Moderately adequate Irregular contacts with r e l a t i v e s ; f r i e n d s and acquaintances; may have occasional contact with distant relatives. Inadequate Infrequent contact with r e l a t i v e s or f r i e n d s , i f any; l i t t l e or no contact with distant r e l a t i v e s .  6. V i s i t o r s A.  Frequent  B.  Moderate  C.  Limited  Regular v i s i t o r s , once weekly i n h o s p i t a l ; i s asked out on f r e q u e n t weekend i n v i t a t i o n s w i t h r e l a t i v e s or f r i e n d s . V i s i t o r s , spasmodic but on once weekly average; o c c a s i o n a l i n v i t a t i o n s to spend weekends w i t h v i s i t o r s . O c c a s i o n a l v i s i t o r s , or none a t a l l ; i r r e g u l a r or no b r i e f outings with v i s i t o r s .  - 37 TABLE 2-c AREAS AND GRADES III.  EXPLANATORY NOTES  ECONOMIC FACTORS 7. Employment and Earning Capacity A. Managerial, Professional B. Craftsman, Mechanical and C l e r i c a l C. Manual labourers  P r i o r to admission, patient held a responsible p o s i t i o n requiring s p e c i f i c t r a i n i n g f o r the managing of employees, finances and products. A more l i m i t e d r e s p o n s i b i l i t y requiring apprenticeship or vocational t r a i n i n g for s p e c i f i c s k i l l s . • Very l i t t l e r e s p o n s i b i l i t y , r e q u i r i n g no t r a i n i n g at a l l ; duration of employment often i r r e g u l a r .  8. Financial Status A. Self-maintaining  B. Borderline Dependency C. Dependent  P r i o r to admission, held a steady job, had a regular income; possessing recognizable assets of value; able to support dependents. i r r e g u l a r income; personal assets of l i t t l e value; some savings; able to assume some r e s p o n s i b i l i t y f o r dependents. Unemployed; low earning capacity; no steady income; l i t t l e or no personal assets of value; dependent on family, friends or welfare.  9. Degree of Mobility  Chinese Immigrants A.  Low  B.  Moderate  C.  High  Change of residence less than every t h i r d year. Change of residence from one to three years. Change of residence once yearly or more.  Canadian-born Chinese A.  Low  B.  Moderate  C.  High  Change of residence less than every t h i r d year. Change of residence from one to three years. Change of residence once yearly or more.  - 38 -  TABLE 3 * AREAS  RATINGS  1. Personality constituents  EIGHTEEN IMMIGRANT CHINESE PATIEN TS A B C  NINE CANADIAN-BORN CHINESE PATIENTS C A B  (a) Ego strength  0$  59$  41$  11.1$  44.5$  44.4$_  (b) Concept of s e l f  0$  41$  59$  0$  44.5$  55.5$  (c) Motivation  0$  23$  77$  11.1$  33.4$  55.5$  6.2$  81.3$  22.2$  22.3$  55.5$  2. Social factors (a) S o c i a l and recreational activity  12.5$  (b) Relationship with r e l a t i v e s and.friends  0$  31$  69$  11.1$  33.4$  55.5$  (c) V i s i t o r s  0$  0$  100$  11.1$  11.1$  77.8$  6.2$  81.3$  11.1$  33.4$  55.5$^  3. Economic factors (a) Employment and earning capacity  12.5$  (b) Pinancial status  0$  10$  90$  0$  44.5$  55.5$_  (c) Degree of mobility  50$  50$  0$  55.5$  22.2$  22.3$  * Source:  Modification of scale from E. B. M. Damm's Mental I l l n e s s and Migration Stress, U. B. C. Master of Social Work thesis, 1959, p. 48  - 39 -  Personality  Constituents  I n a n a l y z i n g the area o f P e r s o n a l i t y  Constituents  o f the twenty-seven p a t i e n t s , i t was g e n e r a l l y found t h a t both Chinese immigrants and Canadian-born Chinese p a t i e n t s possessed v e r y low ego s t r e n g t h and an a l l around low-grade record.  One o f the v o l u n t a r y  Canadian-born Chinese i n t h i s  study was q u i t e aware o f h i s i l l n e s s and showed a great  strug-  g l e f o r the maintenance o f mental h e a l t h , but most p a t i e n t s fell  i n t o the category o f "moderate" and "low" c a p a c i t y ,  f i n d i n g some d i f f i c u l t y i n a c c e p t i n g  a r e a l i s t i c view toward  mental i l l n e s s and h o s p i t a l i z a t i o n . T h e i r concept o f s e l f or the d e s i r e f o r p e r s o n a l It  achievements f e l l  accordingly.  i s presumed t h a t s i n c e the immigrants had no f a m i l y t o  care f o r them, the p a t i e n t s were found on the s t r e e t s committing bizarre acts.  They were admitted i n a s t a t e o f deso-  l a t i o n and subsequently t h e i r e f f o r t s and d e s i r e s f o r p e r s o n a l achievement or involvement were found to be s e r i o u s l y l a c k i n g and r e q u i r e d much time and e f f o r t t o promote any encouragement.  I t was i n t h i s category t h a t these immigrants  f e l l markedly below t h a t o f t h e i r c o u n t e r p a r t s .  The Cana-  dian-born p a t i e n t s , on the other hand, had t h e i r f a m i l i e s to care f o r them and were admitted at an e a r l i e r stage o f mental i l l n e s s before  they had g r e a t l y degenerated.  I t was  noted t h a t there were more immigrant p a t i e n t s who r e q u i r e d c e r t i f i e d admission than those o f Canadian-born Chinese  - 40 -  patients.  T h i s might i n d i c a t e a l a c k o f knowledge o f P u b l i c  S e r v i c e s , hence the immigrants w i t h h e l d t h e i r admission t o h o s p i t a l u n t i l such a time as i t became a b s o l u t e l y necessary.  I t can almost be surmised t h a t some o f these  immigrants  had a c t u a l l y s u f f e r e d from s t a r v a t i o n a t one p o i n t o r another, p r i o r t o or f o l l o w i n g immigration.  Prolonged  starva-  t i o n i s known to g i v e r i s e t o p s y c h o l o g i c a l symptoms, thus any l e n g t h o f s t a r v a t i o n may v/ell have some p s y c h o l o g i c a l bearing.  The Canadian-born Chinese p a t i e n t s had f a m i l i e s and  r e l a t i v e s t o care f o r them i n t h e i r i n i t i a l  stage o f i l l n e s s  and as the s i t u a t i o n became beyond the c o n t r o l o f the f a m i l y , they suggested, or sent t h e i r r e l a t i v e s t o , mental  clinics.  These p a t i e n t s were kept c l o s e t o the c o n f i n e s o f the home and were t h e r e f o r e l e s s f r e q u e n t l y found behaving i n a b i z a r r e way on the s t r e e t s .  I t i s p o s s i b l y because  and a t t e n t i o n t h a t the Canadian-born  o f t h i s care  Chinese were a b l e t o  show a h i g h e r degree o f m o t i v a t i o n or p e r s o n a l involvement, s i n c e they r e c e i v e d treatment e a r l i e r than the comparative group. The p a t i e n t ' s a t t i t u d e toward h i m s e l f and o t h e r s i s a significant factor.  I t suggests the degree o f d i s t o r -  t i o n he i s e x p e r i e n c i n g about h i m s e l f and o t h e r s . the twenty-seven  cases s t u d i e d here, t h e r e were t e n who  sessed a h i g h degree o f f e e l i n g s o f p e r s e c u t i o n . v a r i e d from:  Out o f pos-  Their ideas  the f e e l i n g t h a t people a t work were s p i t t i n g  - 41 -  on him; the f a m i l y w i t h whom the p a t i e n t was  s t a y i n g could  not be t r u s t e d and t h a t they were l y i n g to him; to such i d e a s t h a t " B i g Joe" was  a f t e r him and was  going to k i l l  him or t h a t the Communists were seeking him out.  I n one  p a r t i c u l a r case, the p a t i e n t f e l t t h a t everyone was about him at work.  These f e e l i n g s may  talking  p o s s i b l y emerge out  of the f a c t t h a t he c o u l d not speak or understand h i s coworker's  language and t h e r e f o r e he soon became s u s p i c i o u s  o f them and became a v i c t i m o f h i s surroundings.  These a t -  t i t u d e s depend l a r g e l y on the judgement and p e r s o n a l i t y o f the i n d i v i d u a l and how hers.  r e a l i s t i c a l l y he sees h i m s e l f and o t -  There i s a n o t i c e a b l y h i g h e r occurrence o f t h i s  tude w i t h the immigrants  than w i t h the Canadian-born  atti-  Chinese.  Another important f a c t o r i s the a t t i t u d e toward new  country.  Those who  f l e d because  the  o f p o l i t i c a l reasons d i d  not appear to have entered Canada w i t h the f e e l i n g o f accept i n g Canadian l i f e but merely t o f i n d a refuge and a s e c u r i t y which some were not a b l e to f i n d . t y t o p l a n ahead adaptation.  The o p p o r t u n i t y and  can c o n s i d e r a b l y f a c i l i t a t e the process o f  I t i s thought t h a t the Chinese immigrants  Canadians w i t h some s c e p t i c i s m because t h e i r f o r e r u n n e r s , as was the immigrant  view  o f the treatment o f  d i s c u s s e d i n Chapter I .  Many o f  p a t i e n t s were found to have only d i s t a n t  t i v e s i n Canada, who the newcomer.  abili-  rela-  d i d v e r y l i t t l e to smooth the path o f  - 42 -  S o c i a l Factors The p r o c e s s of i n t e g r a t i o n f o r the average immigr a n t i s a p a i n f u l one.  To b e g i n w i t h , the p o s i t i o n o f the  immigrant i s t h a t of the "marginal man"  or " s t r a n g e r " .  d i f f i c u l t i e s t o overcome are those o f language and  The  cultural  d i f f e r e n c e s and sometimes h o s t i l e l o c a l a t t i t u d e s .  It is  not s u r p r i s i n g then, t h a t sometimes the immigrant i s d e f e a ted by these v a r i o u s d i f f i c u l t i e s b e f o r e he can h a r d l y g a i n a f o o t i n g and, a c c o r d i n g l y , h i s i n t e g r a t i o n remains lete.  incomp-  I t was found, however, that the Chinese immigrant  p a t i e n t s had l i t t l e  or no p r e p a r a t i o n f o r language or c u l -  t u r a l d i f f e r e n c e s p r i o r t o e n t r y i n t o Canada. P a t i e n t s i n both groups experienced d i f f i c u l t y i n s o c i a l i z i n g and i n i n v o l v i n g themselves i n s p o r t s or c u l t u r a l a c t i v i t i e s p r i o r to admission.  The  Canadian-born  p a t i e n t s , because o f t h e i r c o i n c i d e n c e o f b i r t h , d i d not have a language b a r r i e r as d i d the immigrant Chinese p a t i ents and f o r t h i s reason they were a b l e to p a r t i c i p a t e i n group a c t i v i t y t o an advantage over the immigrant Many o f the immigrant p a t i e n t s were withdrawn  patients.  from  social  a c t i v i t y and had t h e r e f o r e taken to s o l i t a r y r e a d i n g . l a c k of s o c i a l i n t e r a c t i o n was  Their  evidenced by the few v i s i t o r s  they had, d u r i n g t h e i r h o s p i t a l i z a t i o n , but t h i s may  a l s o be  due to c u l t u r a l background, where mental i l l n e s s i s not too w e l l accepted i n the Chinese c u l t u r e and thus t h e i r  - 43 -  a s s o c i a t i o n s were terminated. of c o n t a c t  There was a n o t i c e a b l e  lack  between immigrant and Canadian-born Chinese.  It  was found that most o f the immigrant Chinese were admitted without the accompaniment o f r e l a t i v e s or f r i e n d s i n c o n t r a s t t o the Canadian-born Chinese who, on most were accompanied by a r e l a t i v e who continued from time t o time, although, there  occasions,  to v i s i t  them  seemed t o be the l a c k o f  such i n t e r e s t on the p a r t o f t h e i r f a m i l i e s i n h a v i n g the p a t i e n t s home f o r weekends and h o l i d a y s . Economic  Factors From an economic p o i n t o f view an a n a l y s i s o f case  material reveals that a majority low-grade r e c o r d s  o f the p a t i e n t s h e l d  of employability.  very  Many o f these immig-  r a n t s had worked o n l y as u n s k i l l e d l a b o u r e r s and had had very l i t t l e  education.  s l i g h t l y higher  The Canadian-born Chinese had a  education  unskilled laborers.  but many o f them, t o o , worked as  Only f o u r out o f t h e twenty-seven p a t i -  ents s t u d i e d , had some s p e c i f i c t r a i n i n g .  Most o f these  p a t i e n t s had been working as dishwashers, cooks o r farm hands.  A few operated t h e i r own r e s t a u r a n t  without too much success.  An assessment o f the o v e r a l l  t u r e o f employment o f these p a t i e n t s s t i l l marginal status.  b u s i n e s s but  suggests only a  Many dishwashers and cooks were  employed and t h e farm hands h e l d seasonal  pic-  jobs.  temporarily Consequently,  t h e i r f i n a n c i a l s i t u a t i o n s were a l s o u n c e r t a i n and i n a few  - 44 -  i n s t a n c e s when they had saved some money, they l o s t i t by gambling.  A few o f the p a t i e n t s h e l d p e r s o n a l a s s e t s such  as l i f e  insurance.  There was n o t one case on s o c i a l  assis-  tance.  The r e a s o n may have been t h a t even though the Cana-  dian-born Chinese knew o f such s e r v i c e s , i t was below the d i g n i t y o f the f a m i l y t o accept h e l p from c h a r i t y , a l l y when they had a f a m i l y to care f o r them.  especi-  There i s a  great f a m i l y r e s p e c t w i t h the O r i e n t a l r a c e , and even though they may not appear t o be c l o s e , t h i s f a m i l y r e s p e c t e x i s t s . As f o r t h e immigrants,  they p o s s i b l y d i d n o t know about  such  p u b l i c s e r v i c e and even i f they had known, they may have h e s i t a t e d t o apply f o r such h e l p , s i n c e t h i s would be looked upon as begging. of  I n h i s own country begging i s i n d i c a t i v e  the l o w l i e s t form o f e x i s t e n c e .  A f t e r coming t o the 'land  of P r o s p e r i t y ' t h i s would be i n d i c a t i v e o f f a i l u r e to p r o vide f o r oneself.  Since t h e i r aims were f o r g r e a t e r h e i g h t s  t h i s becomes d i f f i c u l t , i n f a c t , almost i m p o s s i b l e t o a c c e p t . None o f these p a t i e n t s were r e c i p i e n t s o f unemployment i n s u r a n c e .  T h i s may have been because o f the temporary  type jobs they h e l d o r , w i t h the immigrants,  i t may have been  that they were i g n o r a n t o f what they were paying i n t o and p o s s i b l y by the time they took i l l , they were n o t concerned about  such m a t t e r s .  With some, there was v e r y l i t t l e  time  l a p s e between c e s s a t i o n o f employment and admission to hospital.  S e v e r a l o f the Canadian-born  Chinese had l e f t  their  - 45 -  jobs or were unemployed and then g r a d u a l l y began to get i l l but l i v i n g w i t h f a m i l y or r e l a t i v e s , t h e r e seemed to be v e r y l i t t l e concern about c o l l e c t i n g unemployment i n s u r a n c e . I t i s p o s s i b l e t h a t the impact was  of such a 'shameful'  illness  enough f o r the f a m i l y , and such problems as unemployment  b e n e f i t s became a minor d e t a i l i n comparison w i t h the of  the  onset  illness. The average e d u c a t i o n o f the immigrant cases  Grade 7, but w i t h i n t h i s group t h e r e are s e v e r a l who Grade 3 - 5  education.  There was  the group.  The average of the t o t a l e d u c a t i o n was  up by two U n i v e r s i t y students. Canadian-born Chinese f a i r l y high standing. preparedness  was  had  only  one i l l i t e r a t e person i n brought  The average s c h o o l i n g o f  p a t i e n t s was  Grade 9, which i s a l s o a  T h e r e f o r e i n these cases, e d u c a t i o n a l  does not seem to be a major f a c t o r of m a l a d j u s t -  ment but such f a c t o r s as i n t e g r a t i o n appear t o be a g r e a t e r cause f o r maladjustments. Comparison o f the Two  Groups  A g e n e r a l i m p r e s s i o n of both groups r e f l e c t e d submarginal  a  f u n c t i o n i n g i n s o c i e t y w i t h r e g a r d to o c c u p a t i o n ,  f i n a n c i a l a s s e t s and i n t e r p e r s o n a l r e l a t i o n s h i p s . seem t h a t t h e i r o c c u p a t i o n was,  I t would  t o some extent, h i n d e r e d  by  the l a c k o f s p e c i f i c t r a i n i n g and t h e i r f i n a n c i a l a s s e t s s i m i l a r l y f o l l o w e d due who  to the pay  of an u n s k i l l e d l a b o u r e r  i s not always permanently employed.  I n both groups  - 46 -  there was a n o t i c e a b l e l a c k o f i n t e r p e r s o n a l r e l a t i o n s h i p although, w i t h the Canadian-born Chinese, s i n c e t h i s i s t h e i r n a t i v e l a n d , and s i n c e they a r e able to express thems e l v e s to f e l l o w Canadians, showed a s l i g h t l y h i g h e r , a l though not too s i g n i f i c a n t , r a t e o f a s s o c i a t i o n w i t h  others.  T h e i r advantage o f language helped them, e s p e c i a l l y i n r e h a b i l i t a t i o n i n the work shops.  The Canadian-born a l s o had  t h e i r f a m i l i e s , even though t h e i r i n t e r - r e l a t i o n s h i p s outs i d e the f a m i l y were l i m i t e d . P o s s i b l y because o f t h i s l a c k of f a m i l i a l support and  r e l a t i o n s h i p , the i l l n e s s o f the immigrants became acute.  Having no one w i t h whom t o d i s c u s s t h e i r problems may have led in  to t h e i r b i z a r r e a c t i o n s which, i n t u r n , o f t e n r e s u l t e d c e r t i f i e d admissions.  Twelve of the eighteen  immigrants  s t u d i e d here were admitted as c e r t i f i e d p a t i e n t s i n comparison w i t h three out o f nine Canadian-born admitted under c e r tification.  There i s a good i n d i c a t i o n t h a t many o f these  Canadian-born p a t i e n t s , having had f a m i l y a t t e n t i o n and support, d i d not r e s o r t to b i z a r r e a c t i o n s .  A slow and suppor-  t i v e o r i e n t a t i o n t o , and r e a l i z a t i o n o f , t h e i r problems p r o bably h e l p e d the p a t i e n t t o r e c o g n i z e  the t h e r a p e u t i c  value  of h o s p i t a l i z a t i o n , w i t h the r e s u l t t h a t the p a t i e n t agreed to enter h o s p i t a l w i t h l i t t l e The m o t i v a t i o n s are d i f f e r e n t .  or no r e s i s t a n c e .  in life  i n the comparative groups  The immigrants e i t h e r came w i t h the i d e a o f  - 47 -  making money i n order to a t t a i n the North American dards or they f l e d from p o l i t i c a l p r e s s u r e s .  The  stanCanadian-  horn Chinese are concerned w i t h i n t e g r a t i o n hut i n t e g r a t i o n i n v o l v e s many f a c e t s such as overcoming the c o n f l i c t s o f a dual c u l t u r e .  Amongst Canadian-born Chinese, many seemed to  possess f e e l i n g s about domineering p a r e n t s or the l a c k o f acceptance by O c c i d e n t a l Canadians because o f r a c i a l rences.  Dual c u l t u r a l background  a problem.  diffe-  c e r t a i n l y seemed t o p r e s e n t  I f they had been brought up i n China, f o r example,  they would not have f e l t the dominance o f t h e i r p a r e n t s q u i t e so much because t h e i r a s s o c i a t e s would have had s i m i l a r par e n t s and obedience would not be uncommon.  However, i n com-  p a r i n g h i m s e l f w i t h those i n Western c u l t u r e , he would great d i f f e r e n c e s .  notice  Furthermore, p a r e n t s of these c h i l d r e n  would not have been under s t r e s s e s o f adjustment e i t h e r , had they l i v e d i n China.  There i s a constant s t r i v i n g f o r i n t e -  g r a t i o n and acceptance - to become one o f the group.  Both  o f these s t r i v i n g s are i n e f f e c t d i f f e r e n t from each other but each c r e a t e s s t r e s s and s t r a i n .  I t i s no doubt under  such  p r e s s u r e s as these t h a t many have not a d j u s t e d s a t i s f a c t o r i l y . Although, the immigrant i n t r y i n g to o b t a i n the North American standard, he i s not l o o k i n g a t f i r s t as much f o r "acceptance" as f o r " s e l f s a t i s f a c t i o n " . t h e i r g o a l may ferent.  In t h i s respect,  though  be the same, t h e i r m o t i v a t i o n i s somewhat d i f -  - 48 -  A s t r i k i n g comparison Out o f the e i g h t e e n immigrants  o f d i a g n o s i s was noted h e r e . h o s p i t a l i z e d , s i x t e e n were  c l a s s i f i e d as " s c h i z o p h r e n i c , paranoid type", compared w i t h two  out o f n i n e Canadian-born  patients.  The l a t t e r were f r e -  q u e n t l y diagnosed as " d i s s o c i a t i v e r e a c t i o n " and " n e u r o t i c depressive r e a c t i o n " .  In this  study, however, no e v a l u a t i o n  i s made o f these f i n d i n g s although a study o f such diagnost i c f a c t o r s might prove o f i n t e r e s t and v a l u e . I t would seem t h a t many o f the immigrants j e c t e d to p o l i t i c a l i n f l u e n c e such as Communism.  were sub-  The Cana-  dian-born are s u b j e c t e d to d i s c r i m i n a t i o n but t h i s i s a s i t u a t i o n which they have been born i n t o and t h e r e f o r e i t i s not a sudden encounter rants.  f o r them as Communism was f o r the immig-  The Chinese immigrants,  a f t e r shedding Communism, a r e  a g a i n exposed t o p r e s s u r e s o f d i s c r i m i n a t i o n which they a r e not p e r s o n a l l y experienced to combat when they meet w i t h i t . A n a l y s i s o f the twenty-seven  cases suggested  that  these p a r t i c u l a r areas, p e r s o n a l i t y , s o c i a l and economic f a c t o r s , would be the most s i g n i f i c a n t t o e x p l o r e .  However,  upon a c t u a l a p p l i c a t i o n , these areas presented some d i f f i c u l t i e s , p a r t i c i i l a r l y those areas which i n c l u d e d e a r l y l i f e t o r y and h i s t o r y p r i o r to e n t r y i n t o Canada.  his-  They c o u l d n o t  be adequately r a t e d because o f l a c k o f i n f o r m a t i o n i n the hosp i t a l records.  - 49 Summary As shown i n t h i s Canadian-born  study, the m a j o r i t y o f both  Chinese and Chinese immigrants f e l l  n a n t l y i n t o the average to low r a t i n g grades.  predomi-  T h i s was p a r -  t i c u l a r l y n o t i c e d i n P e r s o n a l i t y c o n s t i t u e n t s and S o c i a l f a c t o r s f o r the immigrants and P e r s o n a l i t y and Economic areas f o r t h e Canadian-born.  T h i s may i n d i c a t e a slow ad-  justment toward i n t e g r a t i o n i n the second g e n e r a t i o n .  The  immigrants who were admitted possessed extremely h i g h f e e l i n g s o f p e r s e c u t i o n by Communists and people i n g e n e r a l . Many o f the immigrants were found d i r t y , unshaven, r i s h e d and b a r e l y c l o t h e d , and wandering  around  undernou-  aimlessly.  Por these reasons they were r a t e d w i t h a h i g h e r percentage i n the C category o f P e r s o n a l i t y c o n s t i t u e n t s .  On the other  hand, the Canadian-born were a b l e t o make a h i g h e r r a t i n g i n the " p e r s o n a l i t y " a r e a n o t h a v i n g reached a p o i n t o f complete d e s o l a t i o n , t h i s was g r e a t l y dependent  on " S o c i a l F a c t o r s "  such as care by r e l a t i v e s who admitted these p a t i e n t s a t an e a r l i e r phase o f development  i n their illness.  Both  showed t h a t they had f a i l e d to e s t a b l i s h any l a s t i n g  groups friend-  ship w i t h people p r i o r t o admission. The d i s c r i m i n a t i o n i n Canada f o r Canadian-born  Chi-  nese does not seem t o p r e s e n t as profound an e f f e c t as d i d Communism on the Immigrant Chinese p a t i e n t s .  The Canadian-  born Chinese were born t o t h i s circumstance and thus the  - 50 -  impact was not as g r e a t as f o r those who  encountered abrupt  p o l i t i c a l changes a f t e r t h e i r f o r m a t i v e y e a r s .  The r e s e n t -  ment of f o r e i g n p o l i t i c s i n t o one's n a t i v e l a n d would he g r e a t e r and would t h e r e f o r e e x i s t the u n d e r l y i n g r e b e l l i o u s a t t i t u d e w i t h most p a t r i o t s . the Canadian-born  As f a r as d i s c r i m i n a t i o n w i t h  Chinese i s concerned, the f i r s t g e n e r a t i o n  Chinese Canadians more or l e s s accept t h e i r s t a y i n Canada as a p r i v i l e g e from the p i o n e e r i n g European  s t o c k and  their  f e e l i n g o f resentment i s o f a s l i g h t l y d i f f e r e n t n a t u r e . There i s some sense o f g r a t i t u d e . As i t has been found here o f Chinese p a t i e n t s , Miss Damm i n h e r t h e s i s s i m i l a r l y found t h a t the German immigrant p a t i e n t s and Canadian p a t i e n t s had an average to low r a t i n g grade i n P e r s o n a l i t y , Economic and S o c i a l f a c t o r s . I n both of these s t u d i e s the p a t i e n t s f e l l predominantly i n the o c c u p a t i o n a l o r economic f i e l d s .  Many were u n t r a i n e d  f o r s p e c i f i c o c c u p a t i o n s which c l a s s i f i e d them as u n s k i l l e d l a b o u r e r s , a l t h o u g h they had an average e d u c a t i o n of Grade  7-9. Both German and Chinese immigrants had  signifi-  c a n t l y h i g h f e e l i n g s o f p e r s e c u t i o n . The Germans f e a r e d p e r s e c u t i o n by the Jews, and the Chinese by Communists. ever, i n a d d i t i o n to t h i s , the Chinese encountered d i s c r i m i n a t i o n i n Canada.  How-  racial  T h e i r r a c i a l f e a t u r e s were more  o u t s t a n d i n g , making i n t e g r a t i o n d i f f i c u l t because they could  - 51 -  on no o c c a s i o n "be taken f o r the p r e v a l e n t European s t o c k hut t h i s was p o s s i b l e f o r the German immigrants. c o u l d a l s o l e a r n the language  They  q u i c k e r than the Chinese,  whose w r i t i n g o r speech had no s i m i l a r i t i e s .  To b e t t e r  understand the comparative groups and t h e i r problems, three t y p i c a l case examples can now be examined.  CHAPTER I I I SOME REPRESENTATIVE  CASES  The two Chinese immigrant  p a t i e n t s admitted t o hos-  p i t a l hy c e r t i f i c a t i o n and one Canadian-born  Chinese p a t i e n t  v o l u n t a r i l y admitted, whose cases a r e presented here, a r e r e p r e s e n t a t i v e o f each o f the groups of i l l u s t r a t i v e  cases was taken because  number o f immigrant Canadian-born  studied.  A r a t i o n o f 2:1  there was a doubled  p a t i e n t s s t u d i e d i n comparison w i t h the  Chinese p a t i e n t s .  These cases a r e c i t e d i n  order t o g i v e f u r t h e r i n s i g h t i n t o some o f the i n d i v i d u a l problems o f the Chinese: adjustment  t h e i r l i m i t a t i o n i n occupations,  t o another c u l t u r e , and to i n c r e a s e  of these c u l t u r a l handicaps.  The i l l u s t r a t i o n s a l s o h e l p t o  give some i d e a o f t h e i r f a m i l y l i f e , family l i f e  o f the immigrants.  understanding  e s p e c i a l l y the d i s t u r b e d  A deeper i n s i g h t i n t o the  i n d i v i d u a l personality constituent i s also noticed i n this case a n a l y s i s .  Through the use o f case i l l u s t r a t i o n s , the  s t a t i s t i c s o f Chapter I I become people w i t h Case 1, Chinese immigrant Kim,  problems.  p a t i e n t , Kim  a twenty-two year o l d c e r t i f i e d p a t i e n t was  admitted to the Crease C l i n i c o f P s y c h o l o g i c a l M e d i c i n e ,  - 53 -  Essondale, B. C , In June, 1958„  from Yancouver, after a  r e l a t i v e found him i n Winnipeg, wandering aimlessly, poorly clothed, and unshaven. to Crease  He does not know why he was admitted  Clinic. The patient i s a quiet, seelusive person who was  horn i n Sun Way, China, and began attending school following the Japanese occupation.  He started school at the age of  thirteen, and l e f t at the age of eighteen.  He worked on the  family's farm u n t i l he l e f t f o r Canada i n 1955. After coming to Canada, he worked f o r h i s uncle during the day and was enr o l l e d i n a night school course i n English three hours a week. He continued these combined a c t i v i t i e s intermittently f o r three years. As he d i s l i k e d working i n his uncle's t a i l o r i n g shop, he took jobs as a dishwasher aurants.  Initially,  or cook i n various r e s t -  the patient was employed i n a cafe i n  Vancouver but i n the early part of 1957, he purchased a restaurant here, s e l l i n g the business i n July of the same year, because business had become increasingly poor.  He then de-  cided to leave Vancouver f o r Winnipeg, t r a v e l l i n g f i r s t to Powell River, Chilliwack and Hope, working as a cook.  He  The names of patients and a few other pertinent data have been changed to preserve the i d e n t i t y of patients but not as f a r as to a l t e r the i n t e r p r e t a t i o n of the case.  - 54 -  became i n v o l v e d i n gambling In  need of money, he then took a job a t Swan l a k e , a g a i n as  a cook. who  and l o s t two hundred d o l l a r s .  A p p a r e n t l y he came i n t o c o n f l i c t w i t h the foreman,  complained  f l i c t s Kim he was  o f h i s poor cooking.  Because of these  con-  l e f t h i s job and continued on t o Winnipeg, where  found wandering the s t r e e t s by r e l a t i v e s who  wired  back to Kim's uncle and l a t e r made arrangements f o r h i s r e t u r n t o Vancouver. He was his  r e t u r n e d to Vancouver but s i n c e t h a t time  behaviour has been b i z a r r e and he has appeared  and confused,  restless  sometimes being found k n e e l i n g i n the downtown  s t r e e t s , p r a y i n g and t a l k i n g to imaginary people. m i s s i o n to h o s p i t a l , h i s c o n t a c t w i t h r e a l i t y tenuous.  Upon ad-  seemed v e r y  Most of the time he would s t a r e i n t o space and  seemed to be h e a r i n g v o i c e s . t o l d him t h a t she was  He  he  s a i d t h a t P r i n c e s s Margaret  going to p r o t e c t him  from  everybody.  Kim's l a c k o f c o n t a c t w i t h r e a l i t y i s shown by h i s inappropriate grin. acute  He was  diagnosed  as " s c h i z o p h r e n i c r e a c t i o n -  undifferentiated". Kim improved w i t h treatment  and h i s confidence  d e s i r e f o r p e r s o n a l achievement r e t u r n e d s l o w l y .  and  He became  i n t e r e s t e d i n t h e r a p e u t i c a c t i v i t i e s and became p e r s o n a l l y i n v o l v e d i n them.  As the time f o r h i s d i s c h a r g e drew near,  patient himself f e l t had  t h a t unemployment and h i s poor  a great d e a l t o do w i t h h i s present d i s t u r b a n c e .  the  adjustment He  felt  - 55 -  that h a v i n g t o l i v e i n an environment which i s completely d i f f e r e n t from h i s n a t i v e anxiety  land had induced a great d e a l o f  and h i s former responses were inadequate t o cope  w i t h the s t r e s s e s . The  uncle describes  the p a t i e n t as always having  been q u i e t , withdrawn, s e c r e t i v e and concerned about making money.  A c c o r d i n g t o the uncle,  the p a t i e n t had v e r y few  f r i e n d s i n China or i n Yancouver. time, he began r e a d i n g be  found i n work.  disturbed.  Being alone most o f the  and h i s only  s a t i s f a c t i o n seemed t o  When he was unemployed, he seemed v e r y  He took no i n t e r e s t i n r e c r e a t i o n a l a c t i v i t i e s .  Family H i s t o r y The  only family h i s t o r y obtainable  i s a brief  statement which the p a t i e n t h i m s e l f has g i v e n and a l s o t h a t which the p a t i e n t ' s uncle has c o n t r i b u t e d .  The p a t i e n t  said  t h a t h i s f a t h e r , aged f i f t y - s i x , i s an extremely domineering man, v e r y tempermental and g i v e n  to v a r i o u s  d r i n k i n g , gambling, and opium smoking.  v i c e s such as  The f a t h e r o f t e n beats  h i s wife and was p a r t i c u l a r l y hard t o get a l o n g w i t h when drunk o r when he had l o s t at gambling.  The mother, on the  other hand, i s an easy-going person and i s a f f e c t i o n a t e t o ward her c h i l d r e n . The  H i s mother i s f i f t y - f o u r y e a r s o f age.  f a m i l y c o n s i s t s o f f o u r s i b l i n g s , the p a t i e n t b e i n g the  third oldest. to be good.  The r e l a t i o n s h i p s between s i b l i n g s are s a i d Apart from h i s a c t u a l parents, Kim has d e c l a r e d  - 56 -  that he has other parents who  are l i v i n g i n Hew  Westminster.  Apparently the patient purchased papers i n order' to enter Canada. The uncle f e l t that t h i s boy has always wanted to be very independent and therefore was unwilling to accept any help.  The uncle f e l t that the boy was unnecessarily  over-confident• Personality Constituents In assessing t h i s case, there i s evidence that there has been some d i f f i c u l t y i n the relationship between the patient and h i s father.  This childhood experience  may  well have become one of the causal factors i n his present illness.  "Persons with so-called c o n s t i t u t i o n a l suscepti-  b i l i t y to schizophrenia, according to Freudian concepts  are  l i k e l y to be affected severely by adverse experiences i n childhood."  Kim had d i f f i c u l t y i n r e l a t i n g with peers which  could also be i n d i c a t i v e of poor family r e l a t i o n s h i p , although, i t i s stated that Kim got along well with h i s brother and s i s t e r s .  Kim was found to have r e l a t i v e l y high ego  strength p r i o r to admission but at admission he was l y unaware of r e a l i t y .  complete-  Although h i s s i t u a t i o n improved con-  siderably, he was given a "B" grading due to h i s complete  Ratanakom, Prasop, "Schizophrenia i n Thailand," Summer 1959, The International Journal of Social Psychiatry, Vol. V, no. 1, p. 47. 1  - 57 -  d e s o l a t i o n at time o f admission.  H i s concept  of s e l f  proved s i m i l a r l y and h i s sense of g o a l and p e r s o n a l ment were shown by h i s involvement  achieve-  i n workshop a c t i v i t i e s .  I t would seem t h a t Kim was Canada.  im-  admitted  illegally  into  T h i s f a c t c o u l d have c r e a t e d a d d i t i o n a l s t r e s s and  a n x i e t y f o r him. Social Factors I n view of the p a s t , h i s l o n g standing  difficul-  t i e s i n s o c i a l adjustment and p o s s i b l e c o n f l i c t with author i t y f i g u r e s may tween Kim  w e l l be rooted i n the poor r e l a t i o n s h i p  and h i s f a t h e r . As f a r as s o c i a l a c t i v i t i e s were concerned,  was  be-  withdrawn and  s e c r e t i v e and  ning r e l a t i o n s h i p s with others.  found  Kim  d i f f i c u l t y i n maintai-  He was  not i n v o l v e d i n so-  c i a l or r e c r e a t i o n a l a c t i v i t i e s p r i o r to h i s a r r i v a l i n Canada, and d i d not develop  any i n t e r e s t in. r e c r e a t i o n a l a c t i -  v i t i e s while i n h o s p i t a l , although he became engrossed workshop a c t i v i t y .  He had no f r i e n d s , only an uncle  whom he l i v e d a f t e r coming to Canada. °his u n c l e who  saw  Kim  on o c c a s i o n .  with  H i s only v i s i t o r  He was  u n c l e but p r i o r to d i s c h a r g e there was  in  was  discharged to h i s  no mention of weekend  o u t i n g s to h i s u n c l e ' s home. Economic F a c t o r s While a t r a n s i t i o n from a r u r a l to an urban s e t t i n g i n i t s e l f produced a g r e a t d e a l o f s t r e s s and  strain,  this  - 58 -  boy bad t o contend w i t h an adjustment c u l t u r a l environment. inadequate  t o an e n t i r e l y new  O l d responses would prove  completely  i n d e a l i n g w i t h c u r r e n t s i t u a t i o n a l problems.  Through s t u d y i n g h i s background i t would appear t h a t t h e p a t i e n t had brought  w i t h him v e r y few r e s o u r c e s which would  a s s i s t him i n h i s adjustment  t o the new environment.  He  l a c k e d e d u c a t i o n and v o c a t i o n a l t r a i n i n g and a c c o r d i n g t o a v a i l a b l e evidence, knowledge o f the language. he worked as a cook and dishwasher, time w i t h each j o b .  Consequently,  remaining o n l y a s h o r t  H i s m o b i l i t y r a t e was comparatively  h i g h , as he continued h i s search f o r employment. Moreover, the f a i l u r e o f h i s most r e c e n t e n t e r p r i s e , t o g e t h e r w i t h h i s l o s s o f $200 i n gambling  and a pe-  r i o d o f unemployment might w e l l have been p r e c i p i t a t i n g tors i n h i s present i l l n e s s . he was unable  fac-  A q u i e t , withdrawn young man,  t o c o n f i d e h i s hopelessness  t o h i s uncle -  h i s immediate f a m i l y i n Canada - and thus an o u t l e t f o r h i s devastated f e e l i n g s were not' r e l e a s e d but accumulated  within  him w i t h r e s u l t a n t p r e s s u r e s which he was n o t able to w i t h stand. I n view o f h i s improvement and d e s i r e to r e t u r n home, Kim was d i s c h a r g e d t o h i s u n c l e .  There was S o c i a l  V/ork c o n t a c t w i t h t h i s p a t i e n t d u r i n g h o s p i t a l i z a t i o n .  How-  ever, there was some language d i f f i c u l t y between p a t i e n t and worker.  F o r t u n a t e l y , the worker was a b l e t o secure a second  - 59 -  generation  Chinese i n t e r p r e t e r f o r a short w h i l e which  h e l p e d i n o b t a i n i n g the recorded  information.  The Canadian-  born Chinese i n t e r p r e t e r had some l i m i t a t i o n s i n t r a n s l a t i n g the Chinese language and consequently the r e c o r d i n g i s not as f u l l as i t might have been. Case 2, Chinese immigrant p a t i e n t , Lim lim  was a c e r t i f i e d p a t i e n t admitted t o Crease  C l i n i c i n J u l y , 1953 from Vancouver. everyone and was extremely withdrawn. age,  he was born i n H o i p i n g ,  a grade 10 e d u c a t i o n 17.  via  little  San P r a n c i s c o ,  Now twenty years o f  Kwong Tung, China and r e c e i v e d  i n China, completing i t a t the age o f  There i s no r e c o r d  He speaks very  He was s u s p i c i o u s o f  o f h i s adolescent  English.  behaviour on f i l e .  When he a r r i v e d i n Canada  he was met a t the t r a i n by Mr. Horn, a  c l o s e f r i e n d o f Lim's f a t h e r .  Lim's f a t h e r came over from  Vancouver I s l a n d t o v i s i t h i s son f o r a few days. the boy s a i d very  little,  Although  the f a t h e r d i d not n o t i c e  anything  unusual about him and made arrangements f o r him t o remain w i t h Mr. Horn u n t i l he found employment i n Vancouver.  Within  a few days, however, Lim's f a t h e r r e c e i v e d a l e t t e r from Mr. Horn s t a t i n g t h a t the boy was not w e l l and that he was a c t i n g very  strangely.  He would n o t t a l k and was morose.  Mr. Horn  a l s o s t a t e d t h a t Lim d i d not t r u s t the Horn f a m i l y , t h a t he had  i d e a s t h a t the f a m i l y were a l l l y i n g to him, and as a r e -  s u l t , d i d n o t co-operate w i t h them.  He claimed  t h a t they  - 60 -  might he p u t t i n g p o i s o n i n h i s f o o d . at  He  s l e p t very  n i g h t s and would o f t e n have nightmares.  heard  shouting, "Please l e t me  little  He would  be  out, I am going to be  killed.  I don't want t o d i e , I want t o l i v e . " lim him and  f e l t t h a t people upset him by t a l k i n g about  f o l l o w i n g h i s every move.  everyone was  He was  convinced t h a t  s a y i n g untrue t h i n g s about him.  s i o n , as he was  On one  l o o k i n g out of the window, he saw  Works Department d i g g i n g a h o l e i n the r o a d .  occa-  the P u b l i c  He f i r m l y  l i e v e d t h a t they were d i g g i n g a h o l e i n which to bury  be-  him  alive. During h o s p i t a l i z a t i o n l i m improved g r e a t l y but he had d i f f i c u l t y i n a d j u s t i n g to h o s p i t a l l i f e and i n r e a l i z i n g that he was  ill.  He d i d not s o c i a l i z e v e r y w e l l on the ward  n o r d i d he show any enthusiasm  for recreational  activity,  a l t h o u g h he became q u i t e i n t e r e s t e d i n the workshop and med  to take d e l i g h t i n h i s achievements,  l i m was  as " s c h i z o p h r e n i c r e a c t i o n , paranoid type". charged  see-  diagnosed  He was  dis-  i n f u l l to h i s f a t h e r on Vancouver I s l a n d .  Family H i s t o r y The p a t i e n t ' s f a t h e r , many y e a r s ago, w h i l s t on a visit  t o China, married the woman who  i s now  l i m ' s mother.  The f a t h e r l e f t h i s w i f e i n China and r e t u r n e d t o Canada, soon a f t e r which she bore l i m .  The mother was  able t o p r o -  v i d e adequately f o r h e r s e l f and Lim, but Lim was  known to  - 61 -  be a t h r i f t y person. good mental health.  Both parents' families have always had The patient's father i s now  76 years  of age, and i s one of s i x partners i n a greenhouse operation. Personality  Constituents  Examination of the h o s p i t a l records indicates that lim  possessed a low capacity of ego strength and had  culty i n accepting h i s i l l n e s s .  diffi-  S i m i l a r l y , his concept of  s e l f and motivation were moderate to low upon admission but improved greatly during h o s p i t a l i z a t i o n and he became quite involved personally i n therapeutic treatment. No doubt, Lim l e f t China f e e l i n g that he could find security with h i s father.  Possibly having been deprived  of a father figure during h i s early l i f e , Lim's of meeting h i s father were great.  expectations  To have been more or l e s s  rejected by him when f i r s t a r r i v i n g here had no doubt a damaging e f f e c t on Lim's outlook.  "Psychological i d e n t i t y r e f e r s  to a self-concept, expressed i n the s t r i v i n g s , goals, expectations, and values of a person or group of persons. swers the question  'Who  am I?' or 'Who  are we?'  ...  I t anThe  psychological i d e n t i t y of an i n d i v i d u a l or of a family p a i r  1 or group i s i t s psychic center of gravity."  "Psychological  i d e n t i t y and s t a b i l i t y of behaviour must be considered  to-  gether ... S t a b i l i t y of behaviour i s I t s e l f the end product Ackerman, N. W., The Psychodynamics of Family L i f e , Basic Books Inc., New York, 1959, p. 82.  -  62  -  of complex interdependent processes",  such as the c o n t r o l  of c o n f l i c t , c a p a c i t y to change, l e a r n , f i l l  new l i f e  roles  and  achieve f u r t h e r development.  The l a c k o f a f a t h e r image  and  good f a m i l y i d e n t i t y may w e l l have i n f l u e n c e d l i m ' s c a -  p a c i t y f o r e s t a b l i s h i n g h i s i d e n t i t y and s t a b i l i t y i n l i f e . Lim's d i f f i c u l t y i n communicating, and h i s  with-  drawn s t a t e might have been brought on by the disappointment of h i s b r i e f meeting w i t h h i s f a t h e r or he may have been warned by h i s mother t o say very l i t t l e  about h i s l i f e i n  China, l e s t i t a f f e c t h e r p o s i t i o n i n Communist She may have f e a r e d q u e s t i o n i n g  territory.  about h e r son's disappearance  out o f the country. Social  Factors The  f a m i l y arrangement appears t o be q u i t e unusual,  but p o s s i b l y n o t so, to many Chinese f a m i l i e s .  Assuming t h a t  t h i s was the f i r s t time the f a t h e r had met h i s son and h e i r , the f a t h e r showed very It  little  i n t e r e s t i n h i s son's  welfare.  would seem t h a t Lim's f a t h e r might have taken him to Van-  couver I s l a n d to f i n d a job t h e r e .  H i s f a t h e r showed no i n -  t e r e s t i n t a k i n g Lim home to the I s l a n d but l e f t him w i t h his  own f r i e n d s who were s t r a n g e r s  t o Lim. I t was shown  that h i s h i g h degree o f f e e l i n g s o f p e r s e c u t i o n hindered h i s  Ackerman, op. c i t . , p. 84.  - 63 -  s o c i a l i z a t i o n and acceptance  of o t h e r s .  Hot b e i n g a b l e to  r e l a t e to o t h e r s w e l l , he became s u s p i c i o u s of them u n t i l t h i s was m a g n i f i e d to such a degree t h a t he delusions.  Lim's e a r l i e r a d o l e s c e n t experiences were not  r e c o r d e d on f i l e . to  experienced  h i s present  They may  have c o n t r i b u t e d a great d e a l  behaviour.  Economic F a c t o r s Lim had not found employment i n Canada and there i s no r e c o r d o f p r e v i o u s jobs p r i o r to h i s e n t r y i n t o Canada, nor o f h i s t r a i n i n g i n any s p e c i f i c f i e l d  of work.  He  showed an a l l round low-grade r a t i n g except f o r m o b i l i t y r a t e which was  f e l t t h a t h i s only change of r e s i d e n c e  from China t o Canada.  At the time of admission, Lim  was was  c o n s i d e r e d "dependent". Case 3, Canadian-born  Chinese p a t i e n t ,  Tim, a Canadian-born voluntary patient.  Chinese, was  admitted as a  He had been a t t e n d i n g a p h y s i c i a n f o r  some time p r i o r to h i s admission t o Crease Tim completed from 5 - 10 p.m.  Tim  Clinic.  Grade XI w h i l e he worked as a w a i t e r  A f t e r completing Grade XI, he l e f t  school  to  work on a farm f o r two years f o l l o w i n g which he worked  at  construction jobs.  When he worked on the farms,  worked f o r l o n g hours and low pay, Chinese  he  o f t e n boarding w i t h the  farmers. For the p a s t y e a r Tim had been h e a r i n g v o i c e s ;  - 64 -  they were mostly heard a t n i g h t and were mostly i n Chinese although sometimes they were i n English..  However, these  v o i c e s stopped a few days a f t e r admission. matic d e l u s i o n s .  He had many so-  On one o c c a s i o n he worried  "because he  thought h i s u r i n e was sometimes r e d and a t other times green. He c o n s t a n t l y w o r r i e d  about h i s eyes, t h i n k i n g they were r e d .  He has f r e q u e n t l y asked h i s mother i f h i s tongue was p u r p l e and  she has t o l d him t h a t he was j u s t imagining He was p l e a s a n t  and c o - o p e r a t i v e  these t h i n g s .  on the ward and  was i n t e r e s t e d i n v a r i o u s r e c r e a t i o n a l a c t i v i t i e s .  He has  planned to l i v e a t the Y.M.C.A. a f t e r h i s d i s c h a r g e .  He  r e a l i z e d t h a t h i s ''nerves" were b o t h e r i n g him p r i o r t o h i s admission and now he r e l a t e s t h a t those v o i c e s t a l k e d about h i s childhood  days, some o f which were p l e a s a n t  and some o f  which were n o t . I t i s s t a t e d i n Tim's f i l e  t h a t he l o o k s much  younger than h i s s t a t e d age and a c t s i n q u i t e a c h i l d i s h , immature f a s h i o n . Family  History Tim was born and educated i n Canada and comes from  a family of f i v e children.  His father returned  to China  w i t h two o f h i s o l d e r b r o t h e r s b u t was unable to come back to Canada because o f the i n t e r v e n t i o n o f World War I I . f a t h e r d i e d about s i x months a f t e r a r r i v i n g i n China and the two c h i l d r e n were brought up by r e l a t i v e s  there.  The  - 65  Very l i t t l e  -  i s known o f the p a r e n t - c h i l d  s h i p but i t i s thought t h a t the mother was ward her c h i l d r e n as she  relation-  affectionate to-  sent f o r them a f t e r the war  was  over.  On r e c e i v i n g the news of her husband's death, the mother r e married.  Prom t h i s marriage the mother had  A few y e a r s a f t e r Tim had band a l s o d i e d and w e l l w i t h the However, he  Tim  two  daughters.  l e f t home, the mother's second hus-  returned  home, but d i d not get  e l d e s t s t e p s i s t e r who  was  along  sixteen years o l d .  got along very w e l l w i t h the twelve year o l d  stepsister.  He  found t h a t h i s mother nagged him  about  little  t h i n g s such as keeping h i s room t i d y , which soon reached a p o i n t o f annoyance w i t h Personality  Constituents  Tim It  Tim.  showed a moderate degree o f p e r s o n a l i t y  would seem that Tim had  s i n c e he  some p e r c e p t i o n  of h i s i l l n e s s ,  sought m e d i c a l a t t e n t i o n ; t h i s a l s o shows some s t r u g -  g l e to m a i n t a i n mental h e a l t h p r i o r to admission. p o i n t of d i s c h a r g e He  he r e a l i z e d t h a t he had  a l s o knew t h a t he  But he  the  been m e n t a l l y i l l .  His  sense of g o a l and h i s  s i r e f o r p e r s o n a l achievement were f a i r l y h i g h . ted h i m s e l f  At  c o u l d not r e t u r n home because of h i s poor  r e l a t i o n s h i p w i t h h i s mother.  ter.  strength.  Tim  de-  suppor-  through s c h o o l , working i n the evenings as a wail a c k e d the p e r s p e c t i v e  t r a i n i n g f o r f u t u r e employment. involvement i n treatment was  very  to o b t a i n any  His motivation  or  good as shown by  specific personal his  - 66 -  c o - o p e r a t i o n on the ward. Social  Factors There i s no evidence  of s o c i a l or r e c r e a t i o n a l  involvement p r i o r t o admission  mentioned i n the r e c o r d s ,  hut i t can he assumed from h i s r e c r e a t i o n a l and s o c i a l  inte-  r e s t s w h i l e i n h o s p i t a l t h a t he had been moderately a c t i v e i n these f i e l d s p r i o r t o h o s p i t a l i z a t i o n .  He appeared t o  have a moderately adequate c o n t a c t w i t h the f a m i l y , he  although  could n o t get along w i t h one o f h i s s t e p s i s t e r s and found  h i s mother o v e r l y p a r t i c u l a r .  Nevertheless,  having  lived  w i t h h i s f a m i l y would have g i v e n him some sense o f s e c u r i t y and  of belonging.  There i s no mention o f h i s r e l a t i o n s h i p  w i t h f r i e n d s n o r i s there any mention o f the c o n t i n u a t i o n o f any  f r i e n d s h i p through the frequency  of v i s i t o r s received.  Economic F a c t o r s Tim possessed  a low o c c u p a t i o n a l s t a t u s , working  as a farm hand and c o n s t r u c t i o n worker. t r a i n i n g and t h e r e f o r e h i s e d u c a t i o n  He l a c k e d  specific  could n o t be u t i l i z e d '  to a maximum toward b e t t e r employment.  H i s employment was  somewhat i r r e g u l a r but he had n o t t r a v e l l e d any s i g n i f i c a n t d i s t a n c e i n s e a r c h f o r employment which c a t e g o r i z e d him i n "A"  standing f o r h i s m o b i l i t y r a t e .  Comparative Summary These three cases are r e p r e s e n t a t i v e o f the twentyseven cases  studied.  Out of the twenty-seven p a t i e n t s there  - 67 -  were only seven cases w i t h s o c i a l worker c o n t a c t . s i m i l a r i t i e s between Immigrant and Canadian-born  The  dis-  Chinese  p a t i e n t s from the s t a n d p o i n t o f e d u c a t i o n r e v e a l s that the Canadian-born Chinese p a t i e n t s have a h i g h e r e d u c a t i o n a l l e v e l than t h e i r immigrant  brothers.  However, they had not  u t i l i z e d t h e i r e d u c a t i o n f o r any s p e c i f i c t r a i n i n g and were t h e r e f o r e employed i n s i m i l a r occupations as the dishwashing, farming or as cooks. t h a t s p e c i a l i z e d t r a i n i n g was m i n a t i o n i n job a p p l i c a t i o n s .  immigrants:  There i s some p o s s i b i l i t y  discouraged because The immigrant  of d i s c r i -  Chinese p a t i e n t s  were found to possess g r e a t e r f e e l i n g s o f p e r s e c u t i o n than the Canadian-born  Chinese and t h i s may  p o l i t i c a l i n f l u e n c e s from China.  have some b e a r i n g on  S e v e r a l o f the  Canadian-  born Chinese p a t i e n t s , h a v i n g gone to China f o r a l e n g t h y p e r i o d o f t h e i r c h i l d h o o d , and h a v i n g r e t u r n e d to Canada, show an i n c r e a s e d m o b i l i t y r a t e i n comparison w i t h the immigrant Chinese p a t i e n t s who rate.  have moved o n l y once - t o immig-  Three out of n i n e Canadian-born p a t i e n t s had been  taken to China f o r a s i g n i f i c a n t p e r i o d i n t h e i r c h i l d h o o d years which may  have produced a s i g n i f i c a n t problem i n c u l -  tural conflict.  Other Canadian-born  Chinese were found t o  have had d i s r u p t i v e c h i l d h o o d experiences such as l i v i n g i n orphanages  or being l e f t t o r e l a t i v e s because  o f the e a r l y  death o f p a r e n t s . Even w i t h the l i m i t e d amount of m a t e r i a l a v a i l a b l e  - 68 -  from the r e c o r d s , the case h i s t o r i e s  o f Kim, Lim and Tim  have served t o p o i n t up some of the s i g n i f i c a n t f a c t o r s i n t h e i r mental i l l n e s s which were t a b u l a t e d f o r the t o t a l group i n Chapter I I .  With such m a t e r i a l s e t f o r t h , i t i s  now p o s s i b l e t o re-examine I w i t h a view t o r e a c h i n g  the hypotheses c i t e d i n Chapter some d e f i n i t e  conclusions  mental i l l n e s s amongst the Chinese i n t h i s  about  community.  CHAPTER IV POLICY AND TREATMENT IMPLICATIONS  The g e n e r a l p u b l i c views most European as b e i n g l i k e  themselves,  immigrants  e s p e c i a l l y when the immigrants  have a c q u i r e d some knowledge o f the E n g l i s h language and show no c o n s p i c u o u s l y v a r i a n t customs or h a b i t s . migrants, however, may possess p h y s i c a l r a c i a l t i c s which make them conspicuous.  Other im-  characteris-  Por these people,  r a t i o n may take l o n g e r i n comparison  w i t h the other  integgroups.  " I t i s l e s s easy f o r the I t a l i a n s or the P o l e s t o l e a r n the E n g l i s h language  and to adopt American customs g e n e r a l l y ,  than i t i s f o r the Germans o r the Scandinavians, and the obs t a c l e s t h a t l i e i n the way o f the Chinese and the Japanese are s t i l l g r e a t e r . " tendency  Often, democracy i s j e o p a r d i z e d by the  o f c i t i z e n s t o r e a c t n e g a t i v e l y t o immigrant  and t o prevent them from any great s u c c e s s .  groups  At a l l l e v e l s  of l i v i n g t h e r e e x i s t s to some extent a " s t a t u s " o r p r e s t i g e w i t h i n the group. b o u r i n g group,  I t would appear t h a t the e s t a b l i s h e d l a -  i n t r y i n g to maintain a higher status or l e v e l  of employment than the immigrant upon the immigrants  and to discourage r a t h e r than encourage  Smith, W. C , Americans i n P r o c e s s , Edwards Bros., Ann A r b o r , Michigan, 1937, p. x. 1  Inc.,  workers i s i n c l i n e d t o l o o k  - 70 -  the newcomers to improve themselves. The  f o l l o w i n g are f i n d i n g s which support the hypo-  theses set f o r t h i n an e a r l i e r Language D i f f i c u l t i e s The  and  Chapter.  Maladjustment  h y p o t h e s i s that "Language d i f f i c u l t i e s  create  maladjustment" w i l l he f u r t h e r supported here through quantitative  findings.  In studying  r a n t p a t i e n t s , there was persecution. and  these eighteen  Chinese immig-  a great frequency of f e e l i n g s of  Most o f these p a t i e n t s d i d not  speak E n g l i s h  they became s u s p i c i o u s of t h e i r co-workers i n t h e i r  sual conversations.  S e v e r a l o f the immigrant p a t i e n t s  drew from co-workers as a r e s u l t of the were being show any  t a l k e d about.  The  Canadian-born group d i d not such as  those shown by the immigrants but i t i s b e l i e v e d t h a t  was  i n pursuing  The  language b a r r i e r and  t i o n i s b e l i e v e d to c o n t r i b u t e cases.  their  a v o c a t i o n or a p r o f e s s i o n  g r e a t l y a f f e c t e d by d i s c r i m i n a t i o n i n the f i e l d  ployment.  with-  s u s p i c i o n t h a t they  d i r e c t r e s u l t o f f e e l i n g s of p e r s e c u t i o n ,  l a c k of m o t i v a t i o n  ca-  of  em-  the l a c k o f communica-  to maladjustments i n many  Many of the immigrant p a t i e n t s were found t a l k i n g to  themselves or to v i s i o n s which they saw.  Could t h i s be  that,  i n want o f companionship, they v i s u a l i z e d these f i g u r e s or were found t a l k i n g to themselves?  V/ith the d i f f i c u l t y  of  the language, job o p p o r t u n i t i e s were narrowed f o r these immigrants.  Most of the Chinese immigrant p a t i e n t s s t u d i e d here  - 71 -  were employed as w a i t e r s or farmers and were grouped t o g e t her  , thus p r e v e n t i n g  t h e i r i n t e r m i n g l i n g with the Canadians  and h i n d e r i n g i n t e g r a t i o n .  Those who d i d speak some E n g l i s h  spoke a broken E n g l i s h which was d i f f i c u l t f o r the p r o f e s s i o n a l s t a f f i n h o s p i t a l t o understand, hence was not h e l p ful  i n a s s e s s i n g t h e i r problems. D i f f i c u l t i e s i n l e a r n i n g the E n g l i s h language a l s o  accentuated  s o c i a l i s o l a t i o n p r i o r to h o s p i t a l i z a t i o n .  It  was found t h a t these p a t i e n t s l a c k e d s o c i a l a c t i v i t y and t o all  evidence,  found s o c i a l i z i n g d i f f i c u l t .  They showed no  i n t e r e s t i n s p o r t s , c u r r e n t a f f a i r s o r c l u b s , p r i o r t o admission.  Only 12.5$ o f the immigrant p a t i e n t s showed any  s i g n o f i n t e r e s t i n s o c i a l o r r e c r e a t i o n a l a c t i v i t y and 81.3$ o f which f e l l  i n t o a low category.  A slightly  higher  percentage o f 22.2$ was shown by the Canadian-born p a t i e n t s in  t h e i r i n t e r e s t toward s o c i a l i z a t i o n .  themselves, having  Many l i v e d by  only a few acquaintances.  p e r s o n a l c o n t a c t p r i o r t o admission  This lack of  was r e f l e c t e d i n the  number o f v i s i t o r s d u r i n g h o s p i t a l i z a t i o n . The  d e s i r e t o l e a r n a new language w i l l a l s o de-  pend, t o a g r e a t extent, upon the i n d i v i d u a l person and h i s a s p i r a t i o n s and m o t i v a t i o n s  in life.  Of the e i g h t e e n  Chi-  nese immigrant p a t i e n t s , t h r e e showed a strong d e s i r e to l e a r n the language by t a k i n g i t up i n n i g h t s c h o o l It  courses.  was noted t h a t these were the younger immigrants.  Those  - 72 -  over t w e n t y - f i v e y e a r s o f age seemed to l a c k t h i s d e s i r e or were concerned only w i t h p r e s e n t employment and making a living.  The study r e v e a l s , then, t h a t language  can r e s u l t i n inadequate communication  difficulties  which, i n t u r n , con-  t r i b u t e s t o poor mental h e a l t h . Mental I l l n e s s and l e v e l o f E d u c a t i o n and Occupation In  support o f the h y p o t h e s i s t h a t "Prevalence o f  mental i l l n e s s amongst the Chinese immigrant  i s r e l a t e d more  s i g n i f i c a n t l y to h i s l e v e l o f e d u c a t i o n and o c c u p a t i o n than to  t h a t of the n a t i v e - h o r n people", the study showed t h a t the  l e v e l of e d u c a t i o n was  not as s i g n i f i c a n t a f a c t o r f o r malad-  justment as the c o r r e l a t i o n w i t h the l e v e l o f o c c u p a t i o n . Both immigrant  and Canadian-born  Chinese had obtained a f a i r  e d u c a t i o n a v e r a g i n g Grade 8 but because cific  o f the l a c k o f spe-  t r a i n i n g both groups f e l l i n t o the l a b o u r i n g c a t e g o r y .  Of immigrant p a t i e n t s 1 1 . 1 $  and o f Canadian-born  patients  1 2 . 5 $ showed a f a i r l y h i g h e a r n i n g c a p a c i t y but the m a j o r i t y in  both groups f e l l i n t o a low c a t e g o r y .  of  the immigrant  As h i g h as  81.3$  p a t i e n t s were i n c l u d e d i n the v e r y low e a r -  n i n g c a p a c i t y group.  I t would almost seem t h a t the  born Chinese p a t i e n t s l a c k e d i n i t i a t i v e  to pursue  Canadian-  vocational  t r a i n i n g to b e t t e r themselves i n the o c c u p a t i o n a l f i e l d . There appeared  to be no h i n d r a n c e s , such as d i s r u p t i n g s c h o o l  attendance to become the breadwinner  f o r the f a m i l y .  a concern o n l y f o r t h e i r own b e n e f i t the  V/ith  Canadian-born  - 73 -  Chinese p a t i e n t s seemed to l a c k plans o r i n s i g h t f o r t h e i r future.  I n China, most o f the s k i l l e d  are o b t a i n e d through a p p r e n t i c e s h i p . t i o n w i t h a few o f the immigrant  o r s e m i - s k i l l e d jobs There i s some  sugges-  p a t i e n t s that apprentice-  ship i n t h e i r former country was not considered necessary as they possessed  some erroneous i d e a s t h a t t h e i r f a t h e r s were  w e l l e s t a b l i s h e d i n a b u s i n e s s i n Canada.  T h i s was substan-  t i a t e d by the f a c t t h a t t h e i r f a t h e r s sent them money r e g u l a r l y , an amount the f a m i l y i n China were able to l i v e on i n comfort.  These immigrant  p a t i e n t s were not found t o have  taken up any v o c a t i o n a l t r a i n i n g a f t e r f i n d i n g t h a t the c h o i c e of employment was l i m i t e d f o r those without t r a i n i n g ,  lan-  guage' d i f f i c u l t i e s may have h i n d e r e d t h e i r p u r s u i t o f vocat i o n a l t r a i n i n g and a c c o r d i n g l y , they became employed as w a i t e r s or farm hands.  T h e i r c h o i c e o f employment i s unique  i n the r e s p e c t t h a t they i n v a r i a b l y chose occupations such as w a i t e r s , cooks or farm hands.  The reason may have been  that they d e s i r e d t o group together f o r companionship and moral support or i t may have been the precedence immigrants  s e t by the  when they were barred from other o c c u p a t i o n s . O c c u p a t i o n a l s t a t u s g i v e s an i n d i v i d u a l a sense o f  s e c u r i t y and s t a b i l i t y .  F i f t e e n o f the eighteen Chinese  p a t i e n t s i n t h i s study were employed i n u n s k i l l e d l a b o u r i n g jobs, some o f which were seasonal and temporary;  t h e i r em-  ployment c o u l d n o t have g i v e n them any great s e c u r i t y  - 74 -  e s p e c i a l l y where wages were much lower than those o f the average Canadian l a b o u r e r because o f the type of employment and t h e i r dependency ment.  upon t h e i r own countrymen  f o r employ-  T h e i r l i v i n g c o n d i t i o n s must be d e p r e s s i n g as w e l l .  The l a b o u r i n g jobs which these p a t i e n t s h e l d gave them no sense o f s t a t u s i n l i f e .  I t was noted t h a t not one i n the  l a b o u r i n g c l a s s possessed a s u p e r i o r p o s i t i o n w i t h i n h i s o c c u p a t i o n a l group.  These are s u b s t a n t i a t i n g f a c t s which  uphold the f i n d i n g s t h a t those who  have f a i l e d to a d j u s t  were o f low-grade p o t e n t i a l , and s t r o n g l y suggest a c o r r e l a t i o n between mental i l l n e s s and the l e v e l of e d u c a t i o n and occupation. M i g r a t i n g People and E m o t i o n a l D i s t u r b a n c e The h y p o t h e s i s t h a t " M i g r a t i n g people are more s u s c e p t i b l e t o emotional d i s t u r b a n c e " was found to be q u i t e t r u e i n t h i s s m a l l study o f Chinese immigrants when compared w i t h Canadian-born Chinese.  T h i s may  immigrant group s t u d i e s but there was  not be t r u e i n o t h e r a f a r greater  fre-  quency o f mental i l l n e s s amongst the immigrant Chinese than A s t a t i s t i c a l survey  in  t h e i r Canadian-born c o u n t e r p a r t s .  of  the number o f Canadian-born Chinese and Chinese immigrants  i n B r i t i s h Columbia was not o b t a i n e d , but there i s some l i k e l i h o o d t h a t the immigrants are fewer i n number, which would only i n c r e a s e t h e i r r a t e o f mental i l l n e s s .  Many of these  immigrants l a c k e d the b e n e f i t o f f a m i l y l i f e  activities  and  - 75 -  f a m i l y p s y c h o l o g i c a l support. themselves, racial  They were l e f t t o fend f o r  i n a d j u s t i n g t o a new c u l t u r e where t h e i r  c h a r a c t e r i s t i c s a r e a g r e a t o b s t a c l e to i n t e g r a t i o n  and a s s i m i l a t i o n .  A l l these f a c t o r s p r e s e n t a major s t r e s s  f a c t o r f o r the Chinese immigrant  and the study r e v e a l s some  r e l a t i o n s h i p between mental d i s t u r b a n c e and m i g r a t i o n f o r this Oriental  group.  C u l t u r a l Background and Emotional D i s t u r b a n c e s The h y p o t h e s i s , "Emotional d i s t u r b a n c e s are assoc i a t e d w i t h extreme d i f f e r e n c e s i n c u l t u r a l background" i s explored i n the f i n d i n g s o f t h i s study. immigrant  S i x o f the eighteen  p a t i e n t s were found t o have been i n Canada f o r as  l o n g as n i n e t o e i g h t y e a r s p r i o r t o admission, o t h e r s were w i t h i n a p e r i o d o f t h r e e to two y e a r s . lized,  Y e t , when h o s p i t a -  they c o u l d not speak enough E n g l i s h to express them-  s e l v e s which showed how d i f f i c u l t immigrants  i t was f o r the Chinese  t o l e a r n t o use the E n g l i s h language  limited conversation.  These immigrant  even f o r a  p a t i e n t s showed t h a t  they c o u l d n o t a d j u s t w i t h i n t h i s p e r i o d o f time and proved to  be f a i l u r e s i n the new c o u n t r y .  This d i f f i c u l t  process  of  i n t e g r a t i o n , o f course, has a t t r i b u t a b l e f a c t o r s such as  those mentioned i n the d i s c u s s i o n o f s o c i a l i z a t i o n and the tendency  toward  group s o l i d a r i t y .  Being q u i t e d i f f e r e n t ,  t h e i r customs and h a b i t s p o s s i b l y h i n d e r e d these people mixing w i t h the Canadians  from  because a t times t h e i r ways and  - 76 -  h a b i t s were laughable to the Canadians.  Their d i s t i n c t i v e  r a c i a l f e a t u r e s arouse p r e j u d i c e amongst the dominant o r Canadian groups who a r e i n c l i n e d t o t h i n k o f and t r e a t them as a group r a t h e r than as i n d i v i d u a l s .  The r a c i a l  charac-  t e r i s t i c s being conspicuous, and the Chinese b e i n g aware o f t h i s f a c t , they p o s s i b l y h e s i t a t e d t o mix s o c i a l l y w i t h Canadians, f e e l i n g t h a t they would not be w e l l r e c e i v e d . P e r s o n a l i t y f a c t o r s o f ego s t r e n g t h a l s o g r e a t l y determine  emotional s t a b i l i t y .  Both immigrant  and Canadian-  born Chinese p a t i e n t s presented a low-grade p i c t u r e o f p e r s o n a l i t y c o n s t i t u e n t s and showed l i t t l e or  strong desire f o r challenge.  personal incentive  Of the immigrant  Chinese  p a t i e n t s , n o t one showed a h i g h ego s t r e n g t h i n which case they were r a t e d 0$ i n the l i g h t o f c r i t e r i a s e t out i n the rating scale. ego  The Canadian-born  p a t i e n t s showed a h i g h e r  s t r e n g t h w i t h 11.5$, but the m a j o r i t y o f the cases  i n t o the B and C r a t i n g s .  fell  Much o f emotional s t a b i l i t y i s  deep r o o t e d i n the s e c u r i t y o f f a m i l y l i f e . that seven out o f the e i g h t e e n immigrant  I t was found  patients studied  had been l i v i n g w i t h o n l y one parent, the mother i n China, w h i l e the f a t h e r was away working i n Canada. to  some extent, accounted  w i t h concomitant or  social  T h i s may have,  f o r a l i m i t e d masculine  identity  l a c k o f a c a p a c i t y t o engage i n c o m p e t i t i v e ,  activities.  - 77 -  Dual C u l t u r e and Mental  Stability  The h y p o t h e s i s that "Dual c u l t u r e s o f extreme d i f f e r e n c e s a f f e c t mental s t a b i l i t y " was more a p p l i c a b l e to the Canadian-born  Chinese p a t i e n t s who  dominance by t h e i r p a r e n t s .  r e f l e c t e d an over  T h i s i s perhaps the c a r r y o v e r  of the Chinese c u l t u r e o f u p b r i n g i n g , w i t h r e s p e c t shown to parents and e l d e r s .  The parents c l i n g to the e a s t e r n c u l -  t u r e o f u p b r i n g i n g but as the c h i l d r e n come i n c o n t a c t w i t h the dominant or Canadian group, they become aware o f the f r e e r r e l a t i o n s h i p between t h e i r a s s o c i a t e s and t h e i r par e n t s and a l s o a g r e a t e r sense o f independence parents.  from  their  T h i s promotes a r e b e l l i o u s a t t i t u d e w i t h i n the  Canadian-born  Chinese a g a i n s t h i s p a r e n t s as a means of r e -  t a l i a t i o n a g a i n s t the p a r e n t ' s demands. l i v e on the f r i n g e s o f Chinatown  The Canadians  who  are u s u a l l y f a m i l i e s i n  the lower income and s o c i a l stratum, w i t h both parents poss i b l y working and, a c c o r d i n g l y , g r e a t e r independence pected o f the c h i l d r e n .  I t i s the c h i l d r e n i n t h i s  t i o n t h a t the Canadian-born  i s exsitua-  Chinese compare w i t h themselves,  and w i t h whom they e s t a b l i s h a sense of i d e n t i t y .  This  w e l l be an i n f l u e n t i a l f a c t o r i n the l i m i t e d l i f e  goals  these Chinese set f o r themselves.  Such an adjustment  may  to  such extreme d i f f e r e n c e s o f c u l t u r e can present a great ment a l s t r e s s on the minds o f youth. cultures.  They are t o r n between two  Because they have been brought up i n one  culture,  - 78 -  they become awkward i n t h e i r attempts t o a d j u s t to another with resultant The  stress. s i g n i f i c a n t d i f f e r e n c e s i n c u l t u r e are u s u a l l y  n o t i c e d i n the "teen" y e a r s which i s a s t r e s s f u l age i n i t s e l f without the presence o f c u l t u r a l c o n f l i c t s .  This i s  u s u a l l y the phase i n l i f e when a c h i l d begins t o break away from the p r o t e c t i o n o f h i s parents and experiences some sense o f independence. of language.  One major c u l t u r a l c o n f l i c t i s t h a t  As the Canadian-born  Chinese p r o g r e s s i n  s c h o o l , they f i n d that the Chinese language i s inadequate to express themselves and as a r e s u l t ,  they b e g i n t o d i s -  continue the use o f the Chinese language a t home, e x p r e s s i n g themselves i n E n g l i s h t o t h e i r p a r e n t s w i t h a f e e l i n g o f defiance, tinged with g u i l t .  T h i s a l i e n a t e s the parents  from t h e i r c h i l d r e n and adds another dimension t o the many parent-youth c o n f l i c t s which are p a r t o f the growth p r o c e s s , "language the  seems t o be one o f the g r e a t e s t b a r r i e r s between  parent and the c h i l d ; one cannot express h i m s e l f f u l l y  i n E n g l i s h and the other cannot  ... i n Chinese.  Much i s  l e f t u n s a i d , and n e i t h e r can f u l l y a p p r e c i a t e the h a b i t s and a t t i t u d e s o f the o t h e r ,.."  1  The a s s o c i a t i o n s i n youth, o f Canadian-born nese w i t h the o c c i d e n t a l Canadians does not f r e q u e n t l y  Chiremain  Chen, E., Master t h e s i s , Maj or mental and emot i o n a l c o n f l i c t s c o n f r o n t i n g the American-born Chinese o f second and t h i r d g e n e r a t i o n ^ U n i v e r s i t y o f Michigan, 1945, pp. 20 - 21.  - 79 -  through, adulthood.  There i s an apparent waning o f a s s o c i -  a t i o n i n adulthood when c u l t u r a l d i f f e r e n c e s are m a n i f e s t e d to a g r e a t e r degree.  Each are drawn to t h e i r own  thus l i m i t i n g the number o f a s s o c i a t e s .  groups  Those who  failed  to make adjustments possessed a low c a p a c i t y of s o c i a l f u n c t i o n i n g as i t was, t h e i r own r a c i a l  without the l i m i t i n g o f a s s o c i a t i o n t o  group.  T h i s d i s c o n t i n u e d r e l a t i o n s h i p w i t h Canadians i s to a g r e a t extent due to the c r i t i c i s m o f the Chinese group. I f the Canadian-born Chinese are found not to be too c l o s e l y a f f i l i a t e d w i t h the Chinese community, the Canadian-born a r e c o n s i d e r e d t o be r e j e c t i n g t h e i r r a c i a l group and are subsequently c h a s t i s e d by the group q u i t e s e v e r e l y .  On the other  hand, the Canadian-born Chinese f e e l t h a t complete  loyalty  to t h e i r own  their  group may  l e a d to c r i t i c i s m r e g a r d i n g  p l a c e as a Canadian c i t i z e n and t h a t they would be  criti-  c i z e d by Canadians f o r not s u p p o r t i n g l o c a l groups.  The  v a c i l l a t i o n i n f e e l i n g s between two c u l t u r a l h e r i t a g e s of v e r y d i f f e r e n t k i n d s b r i n g about d i f f i c u l t i e s i n adjustment i n the new c o u n t r y . Another major p a r e n t - c h i l d c o n f l i c t i s the expect a t i o n of c h i l d r e n of t h e i r parents.  The  Canadian-born  Chinese c h i l d r e n see the companionship and a c t i v i t i e s w i t h t h e i r p a r e n t s which are enjoyed by Canadian c h i l d r e n . Chinese p a r e n t s are u s u a l l y occupied w i t h e a r n i n g a  The  - 80 -  l i v e l i h o o d , such as o p e r a t i n g shops, and t h e r e f o r e f i n d or  no time t o spend w i t h t h e i r c h i l d r e n .  little  The p a r e n t s expect  t h e i r c h i l d r e n to h e l p them i n the shops hut as o p p o r t u n i t y a r i s e s , the c h i l d r e n t r y t o r e f r a i n from h e l p i n g and pursue an independent  course.  "Parents rebuke them f o r not h e l p i n g  w i t h the o p e r a t i o n o f the f a m i l y b u s i n e s s and the ensuing f r i c t i o n a l i e n a t e s p a r e n t s from t h e i r c h i l d r e n and v i c e versa." Communication Problems If  the Chinese immigrant  and Canadian-born  Chinese  experience d i f f i c u l t y i n communication i n the normal course of  t h e i r l i v e s , t h i s d i f f i c u l t y i s accentuated f o r the men-  t a l l y i l l Chinese admitted t o c l i n i c o r h o s p i t a l .  There i s  a great i n d i c a t i o n t h a t the use o f an i n t e r p r e t e r would be of  v a l u a b l e a s s i s t a n c e to both the p a t i e n t and the p r o f e s -  s i o n a l d i s c i p l i n e s concerned w i t h h i s r e c o v e r y ,  language i s  e s p e c i a l l y important i n p r o f e s s i o n s , where s e r v i c e s are dependent upon the mutual understanding o f the problem i n p r o v i s i o n of S o c i a l S e r v i c e s .  such as  I n t r y i n g to achieve a f u l l  understanding o f a person, not o n l y i s language  an important  f a c t o r but so a l s o i s the u n d e r s t a n d i n g o f f e e l i n g tones and attitudes. employing  America,  Although t h i s i s d i f f i c u l t  t o capture even when  an i n t e r p r e t e r s i n c e the p a t i e n t - w o r k e r r e l a t i o n s h i p  Lee, R. H., The Chinese i n the U n i t e d S t a t e s o f Hong Kong U n i v e r s i t y P r e s s , I960, p. 130.  - 81 -  is  somewhat l o s t through the use  theless, i t i s preferable w i l l otherwise e x i s t .  1  to the  The  sense those f e e l i n g s and  o f a "middleman ', n e v e r l i m i t e d communication which  worker can a t l e a s t be a l e r t e d  attitudes  a c t i v e l y p a r t i c i p a t e i n the  even though he does not  conversation..  C u l t u r e s as w i d e l y d i f f e r e n t as the North American c u l t u r e s make working w i t h the  Chinese  and  Chinese doubly  d i f f i c u l t when compared w i t h those c u l t u r e s where there some s i m i l a r i t i e s i n background.  another f o r "your mother".  are  I n China, f o r example,  there i s a word f o r "mother" which r e f e r s to "my  mother"  T h i s d i f f e r e n c e i s of great  serious  errors  Poor usage of words can  t h i s , t h a t the  in  create  c a u s i n g misunderstanding of f e e l i n g s  patient-worker r e l a t i o n s h i p .  and im-  portance i n communication as there i s a tone of r e s p e c t e x p r e s s i n g "your mother".  to  and  I t i s f o r s i t u a t i o n s such as  c h o i c e of i n t e r p r e t e r i s important but  too, w i l l depend l a r g e l y on the  a v a i l a b i l i t y of  this  interpreters.  In employing an i n t e r p r e t e r , i t i s a l s o important to know the  i n t e r p r e t e r ' s f e e l i n g toward and  situation.  T h e r e f o r e a few  worker to a s s e s s how ation.  Por  example, the  l o y a l t y to the p r e t e r may  the  pertinent  understanding of q u e s t i o n s may  the  help  i n t e r p r e t e r w i l l r e a c t to the Chinese p l a c e a g r e a t v a l u e  employer and  i f such i s the  case, the  s l a n t h i s i n t e r p r e t a t i o n so as not  h i s employer which undoubtedly r e s u l t s i n  the  situ-  on inter-  to embarrass  misinterpretation.  - 82 -  The  worker must b u i l d a good r e l a t i o n s h i p w i t h h i s  ter  so t h a t he  can t r u s t the i n t e r p r e t e r and  Then, no matter how  c r i t i c a l the  interpre-  vice  s i t u a t i o n may  versa.  become, the  i n t e r p r e t e r can f e e l f r e e t o g i v e a d i r e c t t r a n s l a t i o n . The  Interpreter  as a P a r t of the  It i s felt they should be interviewing a t i o n and  Treatment Team  t h a t where i n t e r p r e t e r s are  employed,  g i v e n some t r a i n i n g or some knowledge of  process so that they can understand the  problems i n v o l v e d .  setting.  There are  s i t u a t i o n s where o n l y s t r a i g h t i n t e r p r e t a t i o n i s such as i n f a c t g a t h e r i n g . where p a t i e n t s terpreter  are  apt  Por  be i n c l u d e d  those  required,  to be more s e n s i t i v e , a t r a i n e d i n -  t r a i n e d i n t e r p r e t e r would be  settings.  a  However, i n a mental h o s p i t a l  can b r i n g about b e t t e r r e s u l t s .  ages s k i l l f u l l y and  situ-  T h i s would almost e n t a i l  full-time interpreter i n a large  the  one  who  i n a d d i t i o n , has  such i n v o l v e d  can  An  adequately  speak both l a n g u -  some i n s i g h t i n t o case  work, the i n t e r p r e t e r  as a member of the  treatment team and  should not  merely as a mouthpiece. The  i n t e r p r e t e r i n such a case should be  on an equal l e v e l , w i t h the whole team working as a s i o n a l group.  The  accepted profes-  worker becomes, to a l a r g e extent, depen-  dent upon the i n t e r p r e t e r f o r any  h e l p t h a t he might wish to  g i v e the p a t i e n t .  the  I f i n any  f e e l i n f e r i o r within  the  way,  i n t e r p r e t e r i s made to  treatment team, he  can  exert  - 83 -  misleading i n t e r p r e t a t i o n by withholding information or by using other devices. services and  I f the i n t e r p r e t e r discontinues h i s  should the patient-worker relationship take on -  an abrupt change, the worker may  f i n d himself quite help-  less. However, an interpreter can be used to an advantage i f the interpreter-worker relationship i s on a positive level.  The interpreter, too, i s dependent upon the worker  and i f the interpreter has been adequately oriented, he  may  even r e f l e c t the mannerism and tone of speech of the worker i n speaking to the patients.  The interpreter-patient  tionship plays an important r o l e i n determining the  relapatient's  acceptance of the worker and i n showing acceptance of the patient.  In orienting the interpreter, the worker must be  aware of the professional r e l a t i o n s h i p and must avoid therapeutic  any  i n c l i n a t i o n s toward the interpreter.  There i s , without a doubt, no greater advantage than a s o c i a l worker of the p a r t i c u l a r national background with the s k i l l of his own  language as well as that of English  to be employed i n a setting such as t h i s , where the language manifests i t s e l f as the greatest b a r r i e r i n communication. I t i s my  opinion that extensive work with families and com-  munities i n such situations can be a great f a c t o r i n rehabil i t a t i n g these patients to t h e i r families and  communities.  - 84 -  S p e c i a l Problems o f R e h a b i l i t a t i o n P r i o r t o discharge  of a p a t i e n t , i t may  sable to l o o k i n t o the f a m i l y s i t u a t i o n and w e l l the f a m i l y has the f a m i l y and how  adjusted  be  advi-  f i n d out  to the m e n t a l l y  how  i l l member o f  they f e e l about h i s r e t u r n home.  This  i s p a r t i c u l a r l y important w i t h the Chinese f a m i l y where mental i l l n e s s i s not w e l l accepted and b r i n g i n g shame upon the whole household. more p a i n s t a k i n g  e f f o r t may  i n t e r p r e t e r to h e l p more a c c e p t i n g  i s regarded  as  In such cases,  be r e q u i r e d o f the worker  and  the f a m i l y to be more understanding  o f the p a t i e n t , and  i n c r e a s i n g confidence  a l s o to h e l p him  a  and  gain  i n a d j u s t i n g to h i s surroundings.  Many of these c u l t u r a l p r e j u d i c e s are o l d h a b i t s and ways t r a n s p l a n t e d have continued confines  of the  to be perpetuated by those who  l i v e i n close  s m a l l community l a c k i n g i n t e g r a t i o n and  exchange of i d e a s .  These people are unaware o f the  a t t i t u d e s i n China and haviour  by the e a r l y Chinese immigrants, which  I t i s enlightening  groups as these t h a t make the worker's task doubly Where i n t e g r a t i o n has  be-  such difficult.  been l a c k i n g , there i s a l i k e l i h o o d  that the language b a r r i e r would present a l s o p o s s i b l e t h a t the O c c i d e n t a l may ted by the Chinese f a m i l y when he sonal f a m i l y problems.  current  they do not wish to change t h e i r  to f i t changing t i m e s .  the  a problem and i t i s  not be too w e l l accep-  shows concern about p e r -  T h i s i s a s i t u a t i o n i n which an  - 85 -  i n t e r p r e t e r may be o f great a s s i s t a n c e i n breaking  the b a r -  r i e r and i n t r o d u c i n g the work o f the s o c i a l worker. Tentative  Recommendations I t can be suggested that p r o v i s i o n s should be made  f o r a b e t t e r informed p u b l i c , e s p e c i a l l y the immigrant nese.  I t may a l s o be recommended t h a t there  contact  Chi-  exist a closer  between them and t h e i r Canadian-born b r o t h e r s so  that the immigrants may have a b e t t e r knowledge o f p u b l i c services. but  These s e r v i c e s the Canadians may take f o r granted,  f o r one who comes from a land where s i m i l a r s e r v i c e s may  not e x i s t , he might have i n s u f f i c i e n t knowledge about such s e r v i c e s as mental h e a l t h s e r v i c e s t o even i n q u i r e about them.  Use o f p u b l i c s e r v i c e s may a l s o have been avoided be-  cause o f past e x p e r i e n c e s where the American "Congress passed a g e n e r a l immigration law e x c l u d i n g  ' u n d e s i r a b l e s ' and  persons l i k e l y t o become a p u b l i c charge."  T h i s A c t was  passed i n 1882 but i t i s p o s s i b l e t h a t remnants o f such t a l k still  exist.  I n r e h a b i l i t a t i n g the Chinese p a t i e n t s , f i n a n -  c i a l a s s e t s a r e c a r e f u l l y looked  i n t o so t h a t he may make a  b e t t e r adjustment, without f i n a n c i a l  worries.  I n the l i g h t o f t h i s study, i t i s the w r i t e r ' s o p i n i o n t h a t many o f the Chinese immigrant p a t i e n t s were subjected  t o a separated  family l i f e ,  1 Lee, op. c i t . , p. 12.  that o f the f a t h e r i n  - 86 -  Canada, that of the mother and  f a m i l y i n China.  amendment of the Immigration P o l i c y i n 1947,  After  the  many of these  f a m i l i e s were r e u n i t e d w i t h much disappointment f o r the wives and  children.  c e i v i n g p e r i o d i c hut  The  wives had  been accustomed to r e -  l a r g e sums of money from t h e i r husbands  i n Canada, thus a n t i c i p a t i n g great e x p e c t a t i o n s bands upon a r r i v a l here.  of t h e i r hus-  However, upon seeing them f o r the  f i r s t time i n t h e i r work h a b i t s , the  f a m i l i e s were g r e a t l y  d e f l a t e d , h a v i n g remembered t h e i r f a t h e r on v i s i t s to China dressed  i n f i n e c l o t h e s , w i t h ready cash, and w i t h p l e n t y  o f l e i s u r e time,  low,  i n Canada, the wives "complained  t e r l y t h a t , when asked, the husbands gave them a few  bit-  dol-  l a r s , i n s i s t i n g the wives had no need f o r more s i n c e they p a i d the b i l l s and r e n t , and There was  provided  a l l the f a m i l y needed.  a r e v e r s a l of r o l e s , from the wives*'point  view, w h i l e the husbands f i n a l l y assumed t h e i r  of  rightful  1  ones."  T h i s i s b e l i e v e d a p p l i c a b l e to the Canadian Chinese  immigrant wives.  T h i s bone of c o n t e n t i o n i n i t i a t e d many  disagreements i n the household.  With the r e m i t t a n c e of l a r g e  sums of money i n China, the c h i l d r e n of the f a m i l y were to p r i v a t e schools and upon a r r i v a l , they r e f u s e d to t h e i r fathers i n menial occupational  opportunities.  join All  these f a c t o r s c r e a t e d disharmony i n the f a m i l i e s which l » e e  op.  c i t . , p.  209.  sent  can  - 87 -  have a b e a r i n g on t h e i r mental h e a l t h .  The Immigration  P o l i c y i s r e s p o n s i b l e , t o some extent, f o r the c r e a t i o n o f such a s i t u a t i o n . In c o n c l u s i o n , p r e v e n t a t i v e measures f o r mental h e a l t h r e q u i r e a g r e a t e r e f f o r t toward i n t e g r a t i o n .  This  i s the only f i r m s o l u t i o n f o r b e t t e r mental h e a l t h .  Integ-  r a t i o n i s a two-way p r o c e s s .  I t i s a l s o up to the Canadians  to show a g r e a t e r acceptance of the Chinese.  The second  g e n e r a t i o n Canadian-born Chinese a r e paving the way f o r g r e a t e r acceptance by improving  their educational  standards  and moving i n t o the p r o f e s s i o n a l f i e l d s , which s e t s the C h i nese on an equal l e v e l w i t h the Canadians and h e l p s toward winning r e c o g n i t i o n on the same b a s i s . Recommendations f o r F u r t h e r  Studies  T h i s study has been p r i m a r i l y a ground-breaking, pilot  one, t o u c h i n g on only a few a s p e c t s o f the problems o f  the Chinese i n our community.  I n a l i m i t e d way, i t has r e -  v e a l e d some o f the problems i n v o l v e d i n immigration,  i n adap-  t a t i o n t o a new c u l t u r e , and i n the r e l a t i o n s h i p between ensuing c o n f l i c t s and mental i l l n e s s .  I t was n o t designed t o  i n c l u d e any major f i n d i n g s r e g a r d i n g the treatment  services  o f f e r e d to h o s p i t a l i z e d Chinese people, who are s u f f e r i n g from a v a r i e t y o f mental i l l n e s s e s .  N e v e r t h e l e s s , i t i s con-  s i d e r e d a p p r o p r i a t e t o o f f e r some recommendations f o r s t u d i e s which might be attempted by others i n t e r e s t e d i n the problems  - 88 -  of the Chinese - both immigrant and Canadian born. Por example, the study of a comparative group of Chinese p a t i ents and Canadian Occidental patients might reveal d i f f e rent kinds of problems and point up measures which might ease the i n t e g r a t i o n of immigrants into a new culture. Secondly, a study of the Chinese community i n r e l a t i o n to l i v i n g conditions which may or may not be contributing f a c tors to mental i l l n e s s and the attitude of the community t o ward mental i l l n e s s might provide s i g n i f i c a n t data.  Finally,  a study of the effects of i l l e g a l entry upon the mental health of the Chinese might a l e r t us, not only to greater knowledge of mental i l l n e s s , but provide us with some enlightenment about our present immigration p o l i c i e s insofar as this group of immigrants are concerned. The whole purpose and intent of the study has been to shed some l i g h t on a problem which has been broadly stated i n t h i s wayj ... acculturation, assimilation, and integration form a two-way process. A great many Chinese want a firmer place i n the American society. The Americans must help, too, by thinking of them as fellow c i t i z e n s and be less concerned with t h e i r ancestry. Only thus can true integration be achieved and made e f f e c tive i n America, ostensibly the most democratic society i n existence. Although much remains to be done to achieve the i d e a l , many steps have been taken to improve race r e l a t i o n s . But more should be and can be done by a l l Americans co-operat i n g f o r the perfection of the democratic ideal.' Lee, E. H., The Chinese i n the United States of America, Hong Kong University Press, I960, p. 430.  - 89 -  APPENDIX "A" A working sheet f o r the g a t h e r i n g o f i n f o r m a t i o n from c l i n i c a l f i l e s a t Crease C l i n i c o f P s y c h o l o g i c a l Medicine and P r o v i n c i a l Mental H o s p i t a l .  A l l p a t i e n t s ; s i n g l e , male, between the ages of twenty t o f o r t y - f i v e years o f age, admitted and d i s c h a r g e d between March, 1950 and March, I960, f i r s t admission t o a mental i n s t i t u t e , Chinese Immigrant or Canadian-born Chinese. GENERAL INFORMATION Age  a t admission  Month and y e a r o f admission Canadian-born  Chinese  o r Chinese Immigrant  Religion Discharge d i a g n o s i s S o c i a l work c o n t a c t s p r i o r t o admission S o c i a l work c o n t a c t s d u r i n g h o s p i t a l i z a t i o n SOCIAL AND OCCUPATIONAL INFORMATION E d u c a t i o n , grade Occupation  v o c a t i o n a l t r a i n i n g i f any  Length o f p r e s e n t employment  l e n g t h o f other  employment i f any F i n a n c i a l s t a t u s , income, s a v i n g s , or v a l u a b l e a s s e t s L i v i n g q u a r t e r s , boarding or l i v i n g w i t h f a m i l y or alone ... M o b i l i t y , job and housing Social activities,  f r i e n d s , hobbies or c l u b s  Social contacts, v i s i t o r s  - 90 -  APPENDIX "A"  (continued).  PERSONAL INFORMATION A.  Subjective  ( p a t i e n t ' s view)  Reason f o r admission S e l f awareness on admission  and d i s c h a r g e  A t t i t u d e toward i l l n e s s A t t i t u d e toward d i s c h a r g e A t t i t u d e toward other s S p e c i f i c future plans B. !  Objective  ( c l i n i c a l view)  Physical condition Appearance Personality S o c i a l prognosis,  a c t i v i t i e s on ward  Acceptance o f h e l p PAST HISTORY. Some i n f o r m a t i o n o f past h i s t o r i e s were o b t a i n a b l e relatives or family.  through  I n many cases p a t i e n t s were unable t o  g i v e much i n f o r m a t i o n about themselves and t h e r e f o r e v e r y l i t t l e i s known about the motives o f immigrants. FAMILY HISTORY Socio-economic background .'. Family,  size, relationship  Developmental h i s t o r y  - 91 -  APPENDIX "A"  (continued)  IMMIGRATION M o t i v a t i o n f o r immigration Beforehand knowledge  o f new country  Alone or accompanied Post m i g r a t i o n i m p r e s s i o n  BIBLIOGRAPHY'  Books Ackerman, 1. W., The Psychodynamics of Family L i f e , Basic Books Inc., New York, 1959. "~ Gorbett, D. C., Canada"s Immigration Policy, University of Toronto Press, 1957. Davie, M. R., World Immigration, The MacMillan Company, New York, 1949. Eaton, J . , &":Weil, R., Culture & Mental Disorders, Glencoe, Free Press, 1954. Eisenstadt, S. N., The Absorption of Immigrants, The Free Press, Glencoe, I l l i n o i s , 1959. Hamilton, G., Theory and Practice of Social Case Work, Columbia University Press, New York, 1954. Hollingshead, A. B., & Redlich, F. C., Social Class and Mental I l l n e s s , John Wiley & Sons, Inc., New York, Kluckhohn, C., & Murray, H. A., Personality i n Nature, Society, and Culture, A. A. Knopf, New York, 1956. Lazarsfeld, P. F., & Rosenberg, M., The Language of Soc i a l Research, Free Press, Publishers, Glencoe, I l l i n o i s , 1955. Lee, R. H i , The Chinese i n the United States of America, Hong Kong University Press, I960. ' Lin,  Yutang, My Country and My People, The John Day Co., New York, 1939. —  Mead, M., C u l t u r a l Patterns and Technical Change, American Library, New York, 1957. Opler, M. K., Culture and Mental Health, The MacMillan Company, New York, 1959. Rose, A. M., Mental Health and Mental Disorder, W. W. Norton & Co., Inc., New York, 1955.  - 93 -  Books (continued) S e l l t i z , C , Johoda, M., Deutch, M., Cook* S. W., Research Methods i n Social Relations. Henry Holt & Co., Hew York, 1951T — Smith, W. C , Americans i n Process, Edwards Bros., Inc. Ann Arbor, Michigan, 1937. Strong, E. K., The Second-Generation Japanese Problem,. Stanford University Press, C a l i f o r n i a , 1934. Taft, D. R., & Bobbins, R., International Migrations,, The Ronald Press Co., Few York, 1955. Van Kooten, T.C., Living i n a Hew Country, Guardian Publishing Co., Hamilton, Ontario, 1959. Wilensky, H. L., &':lebeaux, C. N., I n d u s t r i a l Society and Social Welfare, Russell Sage Foundation, New  York, 1958.  Young, C. H., The Japanese Canadians, The University of Toronto Press, Toronto, 1938. Young,P. V., S c i e n t i f i c S o c i a l Surveys and Research, Third Ed., Prentice H a l l , Inc., Englewood C l i f f s , . Hew Jersey, 1956.  • A r t i c l e s , Reports & Other Studies Bustamante, J . A., "Cultural Factors i n some Schizophrenic Patterns", The International Journal of Social Psychiatry, The Avenue Publishing Co.,. Vol. V, no. 1, Summer 1959.. Chen, E., Major Mental and Emotional C o n f l i c t s Confronting the American-born Chinese of Second and Third Generation, Master thesis, University of Michigan.. 1945. Damm, E. B. M., Mental I l l n e s s and Migration Stress, Master of S o c i a l Work thesis, University of B r i t i s h Columbia, 1959.  - 94 A r t i c l e s , Reports & Other Studies  (continued)  Fantl, B., " C u l t u r a l Factors i n Family Diagnosis of a Chinese Family", The International Journal of Social Psychiatry, Summer 1959, The Avenue Publishing Co., V o l . V, no. 1. Hughes, K. M., "Resistance i n Relatives of the Hospital i z e d Mentally 111", Smith College Studies i n Social Work, Oct., 1956, V o l . XXIX, No. I . " l a Barre, W., "Some Observations on Character Structure i n the Orient, I I . The Chinese, Part Two," Psychiatry, Nov., 1946, V o l . 9. Leighten, A. H., "Psychiatric Disorder & S o c i a l Environment", Psychiatry, Nov., 1955, V o l . XVIII. l i n , T. Y., "Study of Incidence of Mental Disorder i n Chinese & Other Culture", Psychiatry, 1953, V o l . XVI. r  Mezey, A. G., "Psychiatric Aspects of Human Migrations", The International Journal of Social Psychiatry, Spring I960, The Avenue Publishing Co., V o l . V, No. 4. ;  N a r o l l , R., "A Tentative Index of Culture-Stress", The International Journal of S o c i a l Psychiatry, Autumn 1959, The Avenue Publishing Co., V o l . V, No. 2. Opler, M., "Considerations i n the Cross-Cultural Study of Mental Disorders", The International Journal of S o c i a l Psychiatry, Winter 1959, The Avenue Publishing Co., V o l . V, No. 3.. Ratanakom, P., "Schizophrenia i n Thailand", International Journal of S o c i a l Psychiatry, Summer 1959, The Avenue Publishing Co., V o l . V, No. 1. Regensburg, J . , "Implication f o r the Practice of S o c i a l Casework", S o c i a l Casework, January I960, V o l . XII, No. 1.  

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