Shanghai Part II. Disruptive Behavior from a Cultural Point of View

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We used the parent consultation model in videotaped cases and with two real families from Shanghai. 

Josh and I adapted the PCM in a new way to explore more carefully the cultural factors involved in caregivers’ concerns – what matters to them – about their children’s problems.  Josh had suggested that we consider including questions designed to bring forth the particular and sometimes hidden meanings that parents give to their child’s troubles. These questions, drawn from the work of the Harvard Medical Anthropologist, Arthur Kleinman – http://www.fas.harvard.edu/~anthro/social_faculty_pages/social_pages_kleinman… – were:

What do you call the problem?

What do you think has caused the problem?

Why do you think the sickness started when it did?

What do you think the sickness does and how does it work?

How severe is the sickness?  Will it have a short or long course?

What kind of treatment do you think the patient should receive? 

What are the most important results you hope she receives from the treatment?

What are the chief problems the illness has caused?

What do you fear most of the illness?

We did not ask the parents all these questions, but we asked them questions during the course of the interview that reflected the issues identified as important by Kleinman’s list. For example, in one moving case from the clinic, the mother revealed that her daughter’s diagnosis of autism meant to her that she should not have another child (because of her belief that autism was inherited), and that her daughter was destined to have a tragic future. Understanding the caregivers’ concerns at a deeper level reveals hidden fears and cultural differences that are important in planning the next step.

In another case, the mother described telling morality tales to her son with a disruptive behavior problem so that he would grow up to be a decent and moral man. This was particularly important for us to take into consideration in our discussions with her, since we believed that the boy’s developmental disorder played a significant role in his behavior problems, and so helping his parents see him as a good boy who had trouble controlling himself, instead of a disobedient boy who chose to do other than he was told, was an important part of the intervention. 

 

 

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