Cultural Aspects of Psychotherapy
Authors: E.D. Wittkower, H. Warms
Journal: Psychotherapy and Psychosomatics (1974)

This paper deals with the relevance of cultural factors to the application of psychotherapy. It is divided into two parts: cultural psychotherapy and crosscultural psychotherapy. Cultural psychotherapy. Despite certain universal features, marked differences as regards intensity, quality and depth, exist in the forms of psychotherapy practised. Preferences in their choice crossculturally depend on differences in etiological views and on cultural and ideological differences. In many non-industrialized areas of the world, the belief prevails that mental illness is due to supernatural and preternatural forces, e.g. to angry deities, witchcraft or sorcery. In those countries shamans, priests and witchdoctors, in the accepted view, are much better qualified to deal with mental illness than scientifically trained doctors. The procedures which these healers adopt are partly of a physical and partly of a psychological nature. Factors of potential psychotherapeutic value inherent in their procedures include: naming of the supposed supernatural agent, suggestion reinforced by the high prestige of the native healers, projection of internal badness on the scapegoat or any other sacrificial animal, displacement of attack by killing an animal in lieu of a person, and penance by sacrifice. Because in many developing countries reliance on group approval predominates over superego pressure, therapeutic procedures are usually carried out in groups. The psychotherapeutic effect of cult ceremonies has been documented. Owing to the emphasis on individualism, rational thinking, scientific idolatry and tolerance of dissent, psychoanalysis found a fertile ground in the United States. It was rejected in authoritarian countries, such as Soviet Russia and Japan. Russian 'pathogenic psychotherapy', and German 'autogenic training' ignore the unconscious, are ego directed and have a drill quality. In accordance with Marxist theory, work therapy figures prominently among psychotherapeutic measures in the Soviet Union. It is conceivable that the yoga component in autogenic training and the mysticism in Jung's analytic psychology and in existential psychotherapy appeal to the mystic leanings of Germans. In accordance with the teaching of Zen Buddhism, Morita therapy practised in Japan aims at acceptance of mental suffering rather than at restoration of mental health. Crosscultural psychotherapy. Application of Western psychotherapeutic procedures to non-Western societies gives rise to difficulties. Divergent views expressed on this matter are: (a) that psychotherapeutic methods are universally applicable; (b) that understanding of each individual must be based on assessment of his specific experiences, and (c) that identical nationality and cultural background facilitate the psychotherapeutic process. If mother tongue of patient and psychotherapist differ, finer nuances presented in the patient's material may be missed by the psychotherapist, misunderstandings may occur and the newly acquired language may be used by the patient for defensive purposes. Difficulties mount still further if the world view of the psychotherapist grossly diverges from that of the patient. Suspicion and distrust of the white intruder in this case may be rife. Consequently, workers in the field dispute the possibility of applying Western type of psychotherapy to non-Western uneducated persons. For a long time, in developing countries, the services of traditional healers in the treatment of the mentally ill will be indispensable. As the world view of the indigenous population undergoes a change towards Westernization, the following interim steps have been suggested: (a) to acquire skills and techniques to overcome the suspicion and distrust of the Western or Western trained psychiatrist; (b) to establish collaboration between psychiatrists and traditional healers; (c) to adapt Western methods to the cultural climate in which they operate; (d) to offer a rationale for the application of folk healing procedures and to integrate them into Western methods, and (e) to hand over increasingly the care of the mentally ill in developing countries to foreign-trained indigenous psychiatrists.