Mental Health Beliefs and Help Seeking Behaviors of Korean American Parents of Adult Children with Schizophrenia

Journal of Multicultural Nursing & Health, Summer 2005 by Donnelly, PaJa Lee

This cross-cultural qualitative study explored the mental health beliefs and help-seeking attitudes of ten Korean American parents of children with schizophrenia. In-depth audio-taped interviews were conducted in Korean. The data were transcribed, interpreted and translated into English. A culturally congruent method of data analysis was developed to illuminate the essential meanings expressed in Korean metaphors, imagery, and idioms. The three themes are: 1. Help seeking: Moving from traditional to Western, 2. Dancing with the rhythms of mental illness, and 3. Family shame and stigma. The study strongly indicated the need for culturally appropriate community-based treatment programs with family education. It raised awareness that cultural conceptions of mental health determined their help-seeking. This study can serve as a foundation for contemporary nurses to develop culturally relevant programs to achieve treatment goals.

KEY WORDS: Caregiving; Help-seeking; Korean Americans; Mental Health; Beliefs; and Schizophrenia.

The purpose of this study was to investigate mental health beliefs of Korean American parental caregivers (KAPC) of adult children with schizophrenia (ACWS) and the resulting impact on their help seeking behaviors. The trend of immigration to the United States has both markedly intensified and enriched this nation's cultural diversity. It also has heightened the critical need for nurses to possess a deep understanding of clients' beliefs and cultural convictions. Immigrants bring with them established value systems, attitudes, and health practices, which arise from cultural and religious tenets. Health care professionals' grasp of these cultural factors can significantly influence treatment expectations, levels of compliance, and resulting treatment outcomes.

Koreans represent a large number of immigrants entering the United States (Kim, 1995). Prior to the Immigration Act of 1965, only 7000 Korean Americans (KA) lived in the United States. But by 1993 the KA population soared to over two million (Korean Overseas Information Services [KOIS], 1993). As of January 2003, New York State claimed approximately 230,000 KA residents (Communication with New York Korean Consulate, January, 2003).

One important area of need for Korean Americans is mental health care. However, Korean Americans have demonstrated difficulty utilizing the American mental health system. A major obstacle for Korean Americans is lack of mastery of the English language, which deters them from using community resources, mental health programs and referrals (Do, 1988; Kim, 1995). Additionally, KA families experience strong feelings of family shame and social stigma associated with mental disorder based on the Korean cultural meaning of schizophrenia. In the traditional Korean society mental disorder was known as a crazy or divine disease which was treated by folk healers or Shamans (Barcus, 1982; Nah, 1990). Therefore, KAs' beliefs regarding schizophrenia have a profound impact on the family and the outcomes of client care. By understanding KA parental caregivers' ingrained cultural beliefs about mental disorder and help seeking behaviors, health care professionals may better facilitate KA psychiatric clients' treatment and rehabilitation process. Therefore, the culture of KA parents with ACWS must be understood in order to comprehend their help seeking behaviors and mental health beliefs.

BACKGROUND

Korean Culture

Culture is the way of life of a people which provides a cognitive map of unwritten rules for living (Eliason, 1993; Leininger & McFarland, 2002; Spradly, 1979). As Herberg (1995) stated, the definition of health and illness are culturally determined in any society, and are conditioned by cultural belief systems.

Korea, characterized as the "land of morning calm," has a 5,000-year history. Koreans value harmony between people, human society, and nature. Maintaining a balanced emotional state is believed to be a prerequisite to health (Do, 1988). Although outside influences, such as Western Christianity have greatly affected the modern Korean American's view, deeply ingrained traditional beliefs and values are grounded in Buddhism, Taoism, and Confucianism (KOIS, 1993, Osgood, 1961). The Chinese philosophy of Taoism, the way of life, permeated Koreans' life with spiritual qualities of patience, contentment, and harmony. The teachings of Buddhism are also reflected in the lives of Koreans. They learn to endure hardships through self-discipline, which provides the strength to overcome difficulty and pain in life.

As the principal force in Korean cultural history, Confucianism, religion without God, has played a most significant role in shaping the Korean view of life. In this philosophical view, the family is regarded as the most important social system. Confucianism espouses filial piety that dominates Korean family structure and function, and places a high priority on the education of children. Confucian principles remain the basis for determining rules of conduct in political, intellectual, and ethical matters (KOIS, 1993; Lee & Lee, 1990). Without an understanding of Confucian concepts, it is difficult to comprehend Korean Americans' way of life. Those Koreans who have adopted Christianity share with Confucianism principles that foster family oriented values (Nah, 1990). These influences have shaped the ways of thinking and coping with realities among Korean American families with mental illness.