Kenny K Yan, Michael P Accordino, Daniel L Boutin, Keith B Wilson. Journal of Applied Rehabilitation Counseling. Volume 45, Issue 2. Summer 2014.
The Asian population is one of the fastest-growing racial groups in the U.S. with the growth rate of Asians with disabilities steadily increasing. In the context of cultural differences, Asians with disabilities may avoid or refuse some services from rehabilitation agencies because negative family issues may not be shared beyond family members in a traditional aspect of Asians. Traditional Asian parents were educated that family is the central and primary unit and emphasize loyalty within the family (Committee of 100, 2001). Therefore, Asians consider a family member with a disability as a family problem. Because Asians believe that disability is shameful and represents family failure, such issues are hidden from the public and only handled within the families.
Asians are defined as people who are originally from the Eastern Asia, Western Asia, Southeast Asia, or the Indian subcontinent. The most common countries represented are Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam (U.S. Census Bureau, 2003). In this review, two groups of Asians are selected: Chinese (including people from mainland China, Taiwan, and Hong Kong) and South Korean.
History of Asian Immigration in the United States
During the 1800s, most of the Chinese living in the U.S. worked as merchants, domestics, farmers, and grocers in mainland China. The Chinese believed that the Gold Rush could bring them fortune; therefore, they came to the U.S., hoping to return home with wealth. Beginning in 1865, the businessman of Transcontinental Railroad project used the Gold Rush as an attraction to entice many Chinese to work in the railroad industry. The Chinese Exclusion Act of 1882 signed by President Chester A. Arthur prohibited all immigration of Chinese laborers; therefore, Chinese workers became part of an isolated community. As a result, the first generation Chinese immigrants built their own community by promoting small business ownerships in vocational sectors including restaurants, laundry, and merchandise retail (Le, 2009).
In 1965, tire Immigration and Nationality Act opened the door for millions of Asians to immigrate (Le, 2009). Thus, Asians tended to reside in metropolitan areas in the U.S. Due to labor market discrimination, Asian Americans chose to be self-employed and often earned a higher salary than other ethnic groups. In terms of profitability, most Asian Americans hired their relatives as a cheap labor source and many of these relatives had to work very long hours. Because of the language barrier, the Asian family member often did not understand American laws and business regulations and were hired as cheap labor, usually working without benefits, insurance or knowledge of job safety (Le). This review of literature has been divided into the following five sections: (a) Asian demography and re- habilitation, (b) Traditional Chinese views of disabilities, (c) attitudes toward people with disabilities, (d) a South Korean view of disabilities, and (e) changing views of Asians toward individuals with disabilities.
Asian Demography and Rehabilitation
According to the Asian and Pacific Islander American Health Forum (2008), more than 63% of Chinese Americans are foreign-bom, 23% do not speak English fluently, and 72.5% speak a language other than English at home. Since the early 1980s, approximately 850,000 people have annually come to the U.S. from other countries. The estimated foreign-bom population of the U.S. in 2009 was 37.3 million (9.9 million were Asian, 2.4 million are Chinese, 1 million are Korean). According to the U.S. Census (2010), 14.7 million Asians were living in the U.S., with 45.5% located in the West, 21.9% in the South, 11.8% in the Midwest, and 20.9% in the Northeast. Asians represent 4.2% of the civilian non-institutionalized population. The Asian population is one of the fastest growing racial groups in the U.S. from 2000 to 2010; furthermore, the rate of the population continues to increase. Moreover, Asians with disabilities may refuse any kind of services from rehabilitation agencies because of cultural differences from other races.
Rehabilitation services include physical, occupational and speech language therapists, vocational rehabilitation personnel, rehabilitation technology specialists, rehabilitation physicians and nurses, special educators, staff of centers for independent living and community service providers (Johnstone, 2001). A disability can be a challenge regardless of race and ethnicity. Since most Asian countries such as China and Korea have over thousand years of history, they have a strong negative foundation to judge disabilities. For a new Asian immigrant the challenge is often magnified because the Asian culture differs greatly from western culture. In addition to difficulties with languages, housing, and employment, new immigrants tend to experience a language barrier. Consequently, they may have difficulty understanding and accessing rehabilitation services.
Traditional Chinese Views
The most influential philosophical and religious beliefs affecting the Chinese are Confucianism and Taoism. The focus of Confucian society is on keeping relationships stable, which affects social harmony and order. Social harmony is important for the expression of ones’ opinions and values. When people of Chinese descent begin their families, they base its foundation on the five cardinal relations in harmonious interdependence, which include aspects of: (a) sovereignty and subject, (b) father and son, (c) elder and younger brother, (d) husband and wife, and, (e) friend and friend (Jenni, 1999). Thus, Chinese have a strong family structure in which elderly males hold the family authority. Senior family members are superior to junior generations and newly married couples are expected to live with the family of the groom. Elderly family members want the family to stay together in order to maintain future existence (Lau, 1996).
Taoism is based on the two principles of following natural laws and the Way (or Tao) as well as being humanistic (i.e. kind, polite, considerate) by following human laws. The belief of Taoism is duality of all things in the universe (i.e. Yin and Yang), the dialectic of change and the importance of balance. Harmonious interactions exist between Confucianism and Taoism, as both are part of ancient and contemporary China. The philosophies provide the plank for social order and responsibility. The idea of disability is seen to be disharmony, therefore, hardly tolerable among the Chinese (Jenni, 1999).
The Effects of Stereotypes and Superstitions
Because of this strong need to maintain the family structure, people with disabilities often face particular challenges (Lau & Kwok, 2000). In the Chinese culture, most people with disabilities experience discrimination and are treated with prejudice. People with a disability have been judged based solely on the outside appearance and attitudinal stereotypes are passed on from generation to generation. People with disabilities are often seen as outcasts of society and having little worth as citizens in the Chinese culture. In many Asian countries, people with disabilities are still regarded as incapable to be educated and functioning members of society. Therefore, people with disabilities are often forgotten and fall through the cracks (Jenni, 1999). Even in the U.S., people with disabilities in the Chinese culture are discriminated against and treated as second-class citizens.
Traditional views often rely on superstitions that disability is a form of punishment, promoting the idea that having a disability may be considered a tragic experience. Therefore, parents may hide a child with a physical disability because the traditional Chinese may be judgmental to physical disabilities. Traditional Chinese who have strong religious beliefs might also generalize negative judgments to the whole family because they believe that the disability was caused by family members who have committed bad deeds in the past or present (Mente, 2000). Therefore, as a result of this rationale, the family is deemed to have a negative fate as well as shame (Choi & Choi, 2002). The perceptions that traditional Chinese hold about disabilities come from superstitions within the culture (Hur & Hur, 1999). Furthermore, traditional Chinese culture dictates that females are assumed to be less intelligent than males. Chinese American females with a disability are often unsure of how they will be treated by the American culture since their own culture has often demeaned them (Choi & Choi).
Chinese parents who have children with visible disabilities tend to want their children to be the best even though they may struggle to compete. Sometimes, children with disabilities may be sheltered by their parents. For instance, at certain functions where many first generation Chinese Americans get together, parents would try to hide in order to “protect” their children, because parents of children with disabilities fear that the elders would not understand or accept someone who has disability.
High expectations are often placed on Asian children who are able-bodied. Young adults feel constant pressure from their Chinese families to be more successful than their peers academically. In contrast, American parents may give more freedom to their children to choose in order to develop the child’s potential in different areas. Chinese parents rarely consider that it can be damaging to their child when they send messages that failure is not an option (Lau, 1996). Chinese children may feel pressure to consistently “be the best” in order to prevent disappointing their parents. Children have gone as far as making important life decisions, such as their work and life plans in order to satisfy their parents. Asian children also may pursue the dreams of parents, and not their own. Consequently, the constant tensions and the pursuit of goals that are not their own may lead to burnout and eventually academic or vocational failure in children (Lau, 1996).
Attitudes Toward People with Disabilities in the Chinese Culture
Cultural differences between Chinese and Americans affect how each forms attitudes toward people with disabilities (Chan, Lam, Wong, Leung, & Fang, 1988; Chan, Lee, Yuen, & Chan, 2002; Tsang, Chan, & Chan, 2004; Wang, Chan, Thomas, Larson, & Lin, 1997; Wang, Thomas, Chan, & Cheing, 2003). Chan et al., (2002) examined Chinese high school and college students and found that they have less positive attitudes toward either mental or physical disabilities than American students. Students in Hong Kong and Taiwan reported more negative attitudes toward people with physical disabilities than toward people with developmental disabilities. On the other hand, the U.S. government enforces the Americans with Disability Act, which offers support to and prevents discrimination against students with disabilities (Blackseth, 2011), thus U.S. students tend to be more positive toward individuals with special needs in comparison to Chinese students.
Chan et al. (2002), using the Attitudes Toward Disabled Person Scale (ATDP, 2002), surveyed first year college students in Chinese and American universities; the results showed that, on average, American students scored 10 points (0.5 standard deviation) more positive than Chinese students. Wang et al. (2003) analyzed the attitudes of American and Taiwanese college students toward people with disabilities. Wang et al. found that both groups most often preferred females with milder disabilities at a younger age and with higher education. Furthermore, most American students tended to be more accepting of people with developmental disabilities, and Taiwanese students tended to be more accepting of people with physical disabilities.
Chinese attitudes toward people with disabilities have been changing because of education offered in academia. However, not all college majors have a positive effect on attitudes toward disability. Chan et al. (2002) compared undergraduate occupational therapy and business students in Hong Kong, and found that first year students in both majors had similar attitudes toward disabilities. By the end of the first year, occupational therapy students showed more positive attitudes than business students toward individuals with disabilities.
A South Korean View of Disabilities
Traditional South Korean culture values harmony with order, contrasting with American mainstream culture that stresses individualism (Hur & Hur, 1999). South Koreans value harmony within family, community, and society. They are influenced by Confucianism and strong ties to family. In addition, South Koreans value education, hard work, and possess high ambition to excel. Traditional South Korean values include filial piety, respect for elders, benevolence, loyalty, trust cooperation, reciprocity, and humility. While there may be some similarities between the American and South Korean cultures, it is clear that South Koreans may value community and harmony within the family more than a non-Asian family in the U.S.
Demographically, South Korean Americans represent 1.1 million of the U.S. population (U.S. Census Bureau, 2003). South Korean Americans adaptive to American mainstream culture (Kim-Rupnow, 2001). One of these differences is the American emphasis on individualism. Since South Koreans emphasize harmony with order, they tend to be influenced by the opinions of family members or others within the community when making decisions. If South Korean Americans make decisions based on their own preferences without considering others, South Korean Americans could be labeled “selfish.” Many South Koreans consider themselves as extensions of their families and often regard the welfare of family members based on gender and age. Exchanging roles and sharing power are not encouraged because of strong beliefs that order and harmony exist when South Koreans have clear distinctions between the roles and duties of men and women. This traditional legacy often results in the husband leading and the wife following. Children are ranked by age with younger children required to respect their older siblings (Breen, 2004).
South Koreans believe supernatural influences cause disabilities (Hur & Hur, 1999) and tend to feel helpless, depressed, or blame themselves or their ancestors when they discover a disability in themselves or their family. South Koreans tend to seek little help and leave everything to fate. The person with a disability is often cared for by parents, who usually expect their child to “outgrow” such conditions. People who have had a scientific education believe that disabling conditions may be overcome with appropriate medical intervention and actively search for medicine, therapy, or surgery from health professionals (Kim-Rupnow, 2001). The modern views of South Koreans are that lifelong disability is a revenge for a past wrong doing of the person with the disability or the of the family. Many South Koreans with disabilities and their families suffer from shame, helplessness, denial, withdrawal, and depression. Some people view acquired disability as the result of bad luck or misfortune (National Center for the Dissemination of Disability Research, 1999).
Changing Views of Asians Toward Individuals with Disabilities
Western countries have influenced Asians in areas such as housing and clothing. The family structure is becoming modernized and most young people move out after they get married and live in small family units with only three to four family members (Nagayama Hall & Okazaki, 2002). In the modem Asian families, males and females both work and pursue careers. Females and males tend to receive more equal respect than in the traditional Asian community. As Asian countries are developing, people have greater opportunities to get a higher education.
The views of disability are also changing. For example, older generation mothers tended to lack knowledge about physical examinations; most of them went without, even during pregnancy. However, young mothers are willing to have a physical examination before and during pregnancy. The physical check-up is a good way to decrease the chance of having a child with a disability (Hong Kong Government, 2006). In Hong Kong, the government delivers more supportive services. For example, more Hong Kong special education schools have opened and teachers are trained to teach children with disabilities. The Hong Kong government offers financial support by providing a stable place for people with disabilities to work (Hong Kong Paralympic Committee, 2006). These services provide job-related training and counseling and at least 6 months of post-placement service to help the individual with disability to settle in employment. The Department of Health in Hong Kong also provides antenatal service to pregnant women. Through the antenatal shared-care program to monitor the whole pregnancy and delivery process, the parents are notified of any defects of the embryo such as Down Syndrome; therefore, parents have chance to “prevent” having a child with disability (Hong Kong Department of Health, 2013). Lastly, modem society no longer seems to view that disability is physical and mental “punishment” for past wrong doing; however, there are remnants of this belief, especially from those in older generations.
Similar to all racial groups, there is variation within and between Asian cultures. For the purposes of this study, the researchers have explored the perspectives of disability and human development for two specific ethnic groups within the “Asian” community: Chinese and South Korean. South Koreans seem to have a stronger sense of self-esteem than the Chinese (Lau & Kwok, 1997). Disability issues still need to be addressed because people with disabilities from culturally diverse backgrounds experience twice the amount of discrimination than experienced by individuals who are able bodied (Tan et al., 1999). As people from across the globe become educated about disability and disability-related issues, traditional ideas should be gradually replaced by more respectful and supportive perceptions.
The major issue blocking Asian access to rehabilitation service stems from the traditional view of disabilities. Most Asians are living in developing counties where economic problems have blocked people from getting higher education. As a result, the environment does not encourage or often permit people to gain new information. Therefore, the knowledge of the people is passed mouth-to-mouth to the next generation. In addition, the structure of family shifts power to the elderly. Family members tend to place the greatest trust in what has been passed on to them from their elders, who may have not had educational opportunities. Still, people from older generations may believe that negative views of disability, which were passed down through generations, continue to be valid.
Education is a crucial tool to change views of Asians especially concerning people with disabilities. According to a survey from a Hong Kong researcher (Chan et al., 2002), college majors, as well as courses that view disability more favorably could affect attitudes of undergraduate students. Furthermore, the college environment has been more conducive to positive treatment of disability. Overall, higher education can help change the traditional views of students (Chan et al, 2002).
Education is also one of the best interventions for changing traditional discriminatory views and superstitions toward disability (Schauer, 2003). The planning committee for 2008 Paralympic games successfully scheduled events that were held in China after the Olympic Games (Hong Kong Paralympic Committee 2006) and were a good worldwide example of the opportunity to change educational systems. Such an occurrence would not have been likely in a previous generation. Knowledge dissemination will continually be needed to change traditional views toward Asians with disabilities in the next generation.
Unfortunately, cultural distrust of the dominant culture may block Asian access to rehabilitation in the U.S. This trend is especially true for new Asian immigrants since most of them may have the traditional beliefs toward people with disabilities. Interpersonally, Asians may tend to avoid sharing problems considered abnormal to others. They may also try to hide mental or physical disabilities and avoid seeking help from professionals. Therefore, such problems may become increasingly worse due to denial and camouflage.
Rehabilitation Counseling Application
When a rehabilitation counselor is working with clients from an Asian communities, he/she needs to incorporate culture and the clients’ worldview into rehabilitation planning. Since most of Asian clients expect solutions from their counselors, during the counseling process, the counselor should educate Asian clients and explore the best way to deal with the issues together. The counselor should also encourage family involvement throughout the counseling process because of the traditional Asian family structure. The key to success when working with Asian clients is to understand Asians’ belief system as well as their cultural background. As a result, some degree of preparation is required before the initial intake. With preparation and an open mind, rehabilitation counselors will be able to work more effectively with Asian clients with disabilities and promote more favorable outcomes.