Cultural Competence

APA President Marcia Goin’s timely article in the December 5 issue, “Striving for Cultural Sensitivity and Competence,” induces me to add some of my thoughts, especially on the question of East v. West. The concept of fundamental differences between East and West can be a productive framework, but today it is often used in confusing and confused manner, mixing political, geographical, and cultural meaning. For our purpose, it will be prudent to remain in the cultural, especially psychological, domain.

The idea of “individual”—separate, independent, and in an adversarial relation to all others—is a more symbolic culmination of the Western cultural matrix including theological, philosophical, and psychological elements. From this follows a therapeutic ideal of a “strong ego.” In Eastern tradition a person is not a separate being but a relational one. This leads to a developmental ideal of “egolessness”—to use an often-misunderstood word. The one cannot explain the other because they (East, West) are based on contrasting premises of life and world.

In this scheme, East is what is not West, and West is not what is East. A common Western image of East tends to be a projection of what is suppressed in Western culture and psyche, and vice versa. One topical illustration of the historical Western one-sidedness is a moralistic fervor surrounding “political correctness” today. The effort to correct the past one-sidedness often goes too far in the opposite direction. In other words, “one-sidedness” is a deeply embedded and structural problem in society and psyche. To learn of East is a way toward Western self-understanding, and to know West better is for East to become more wholesome.

What does the above have to do with our clinical practice? Little, because we are all so burdened. As Dr. Goin observes, it is simply impossible to keep up with incredibly accumulating technical knowledge. However, usefulness of technical knowledge may be less in how much data one has but rather in how one uses the data. This is like saying that how one says something is more important than what one says. It is better to understand how one is conditioned and embedded in his/her own culture and pattern of thought than to try to understand the other—including those from other cultures.