Breaking The Clouds

新闻周刊的专栏作者 Sharon Begley 最近写了一篇文章，批评心理治疗师里太多的人不愿意接受和使用在临床研究中证实过的有效治疗方法，例如 cognitive behavioral therapy (CBT) 和 interpersonal therapy (IPT)，并且批评心理学领域缺乏对科学证据的应有尊重，而且在行医治病的过程中过多依赖自身的经验而不是临床研究证明的有效疗法。

是不是心理学家普遍不讲科学呢？这个没有系统的研究数据（虽然作者提供了一些民意调查的数据）很难下结论。在心理医学内部，各个医生们也有很多差别，有些医生，特别是老一辈的，上学的时候还没有系统地训练过 CBT 和 IPT 这些疗法，很可能依赖经验比较多，不过我也遇到过很多头发灰白的心理学家，对行为和认知行为疗法都运用自如，所以也不能以貌取人。虽然 Begley 称精神科医生受过更多的医学临床训练，对科学数据更加尊重，有一定道理，但也不能保证，精神科医生里也有不那么尊重科学的。

心理学的训练和研究范围非常广大，标准非常参差不齐，所以有很多信口开河效果不好的医生，但也有很多非常厉害，非常棒，并且科学研究成果卓著的心理学家，包括研究神经和基因科学结合心理学的专家。五月份开会时我听过一个讲座，两个UK的心理学家和一个美国的兼修CBT的精神病医生讲怎样用CBT的技巧辅助治疗很严重的精神疾病，包括精神分裂症和严重的OCD，看得我眼花缭乱五体投地，非常 professional，非常能干，效果很好，很多精神科医生根本没这个本事，也没经过这么好的训练。而且，IPT和家庭心理治疗法(family therapy)对青少年躁郁症和厌食/暴食症的疗效也在很多临床研究中证明。

所以看心理医生跟看牙医，看其他科的医生差不多，甚至类似找木匠给你打家具 — 此人的手艺如何才是关键，不能因为他是医生就不加思索地绝对信任。虽然很多心理学家坚持认为他们不用CBT或IPT或其他经过考验的方法也能把病人治好，但是在心理问题方面治好跟治好还有一定的差别，病人觉得比过去强，也许是这个心理学家治疗有方，也许是因为本来无人倾诉，现在有人提供个途径供你每周倾诉一次，让你觉得稍微舒服一点，但其实还没有真正治愈到坚强和可以自愈的地步。

麻烦的是，找医生经常不能看一眼就知道他技术和能力如何，只有谈过几次之后才有点感觉，到时候又很可能担心得罪他而不敢或者不好意思换人。省力的地方则是，因为有临床医学的研究和数据，至少我们知道 CBT, IPT, 家庭疗法，各自对不同的心理疾病和障碍有确凿的疗效，所以第一次看医生的时候，或者看之前，可以询问他是否接受过 CBT, IPT 之类疗法的临床训练。一方面治疗师当然不应该太过拘泥，但是他应该能够在需要的时候使用这些技巧帮助病人彻底地痊愈。

前两天在照镜子的时候，想起朋友说没人能舔到自己的胳膊肘，忽然冒出一个很有趣的念头：没人能看见自己的脸。

照镜子不算哈，那是利用光的反射，间接地看见自己长什么样儿。这是不是一个很奇妙的自然现象？我们能直接地看见别人的脸是什么样的，也能看见自己的手脚和身体，但是却不可能看见自己的脸，或者后脑勺，或者脑子里面。然后不知怎么就联想到 Albert Ellis 和别的心理学家说过不止一次的话：全面地接受别人（包括优点缺点，包括好事和错误）可比全面地接受自己容易多了。我想，这是不是因为准确地认识和了解别人比准确地认识和了解自己容易多了？因为，我们都不能直接看见自己的脸？

神经科学和发展心理学 (developmental psychology) 里面有个很复杂很难的课题：人是怎么长出意识(consciousness)，特别是self-awareness 的，一个人怎么建立起“我”这个概念和自我形象？动物有没有意识和自我的概念？（有些科学家发现一些间接的迹象和证据显示，在某些动物里，这是有可能的，而另一些动物看样子没有。这是题外话了。）特别是婴儿一生下来似乎没有自我概念，他们是怎么逐渐建立self-identity的？这是一个很复杂而微妙的过程，虽然人人都经历过这个过程，但是系统地理解和描述这个过程，现在还没能彻底完成，有很多的机制，我们还弄不清楚。所以，虽然人人都知道“我是谁”，但是“我是谁？”却又是一个自古被不停讨论却没有结论的哲学问题。

至少，发展心理学家们知道，一个幼儿发展出self-identity，self-image，以及其他很多性格方面的一个重要因素是它跟母亲（或者主要 caregiver）的互动 (interactions) 与交流，跟环境接触的过程。所以我们对自己的认识，除了内部自动形成的意识，还有从外界输入的很多信号，特别是来自父母的信号，融合在一起形成自我意识。这个过程完全是清醒的意识之下的

心理治疗经常花很大一部分时间和精力分析自己的思想和行为的规律，我觉得，就是因为我们每个人都看不见自己的脸，绝大多数人其实对自己相当不了解。这并不是说绝大多数人都需要心理分析自己，如果平时思路、行为、感情十分通畅自然，没有别扭和障碍，没有自我伤害或者跟自己过不去的现象，那么一切都好好地运行，不那么了解自己也没关系，或者因为潜意识中的自我形象和self-identity跟真实自我非常吻合，非常smooth，很少遇到矛盾和冲突的现象。那么就不需要分析，听其自然。只有在自我形象跟客观的“我”以及自己的其他感情心理需要产生巨大的矛盾和冲突的时候，才需要回头理顺这些东西。要搞清楚“我为什么是这样的”之前，还得搞清楚“我到底是什么样的”，所以，“我是谁”不仅是个哲学问题，也是一个心理学问题。

管理学上有一种叫做360度的工作评价方法，让好几个人评估一个管理人员的表现，上级、下属、平级同事、顾客，都参与评价这个人，以达到全面的结论。我没看见过这方面的心理研究或者试验，所以对下面这个问题没有答案：有多少人的自我形象认识跟“客观”的形象—别人（包括亲近的人）对他的形象认识—是一致甚至类似的呢？稍微观察一下就可以发现，自我形象跟他人的印象，常有很大差别。一般我们都相信，我们自己最了解自己，别人最容易误解，但其实并非如此。极少人会主动去问别人：你觉得我是个什么样的人？但是如果你试验收集一下别人对你的看法，多半会吓一跳，别人对你的看法，跟你对自己的看法，很可能差别很大，甚至互相矛盾。有时候，自我认识是错得最厉害的，但别人的认识很可能也是片面或者离谱的。

只要稍微注意一下，我们都认识 self-image 很不准确的人，很多人的自我认识跟别人对他们的了解和看法完全南辕北辙 — 当然，别人的评价往往是片面的，或者戴了他们自己的有色眼镜，或者有利益冲突或性格不合而不公平不客观。但是，有时候连熟悉和亲近的亲朋好友的对某个人评价都跟他自身的认识背道而驰，还有看别人比看自己眼光准得多的例子，这就是颇有趣和奇怪的现象了。原因之一是，分析自己其实并不容易，需要多次练习才能熟练，自审并不是每个人都愿意或者能够做到的，了解而不能接受自己，又是很可怕的事。很多人下意识地维持一个不那么真实的自我形象，其实是因为无法接受真实客观的自己，无法接受自己的真实“弱点”或者“缺陷”。但是如果能够一边自审一边用宽容地态度看待自己，接受一切弱点和缺陷和不完美的地方，能带来放下包袱大松一口气的作用，并且治好一种慢性的毛病：因为对自己的期望不切实际而长期失望，对自己长期不满。所以了解自己必须和接受自己结合起来，否则就可能弊大于利了。

C. Huntsinger from Northern Illinois University and P. Jose from Victoria University of Wellington also published their study “Relations Among Parental Acceptance and Control and Children’s Social Adjustment in Chinese American and European American Families” in the issue of Journal of Family Psychology 2009, Vol. 23, No. 3. The authors studied parental acceptance, control, and “Chiao Shun” (or, Jiao-Xun, the Chinese word for training) in 35 immigrant Chinese American families as well as 38 European American families (parents were mostly born in the States). Data were collected from children from preschool to 4^th grade.

They found that within the couples, fathers and mothers in Chinese American family group rated similar levels of acceptance and control; but they did not in European American family group. Parental acceptance and control showed to influence children’s social development. Parents who are warm and accepting has been associated with positive adjustment, while parents who are overly controlling and punitive as well as those who show affection but low levels of controlling are related to maladjustment among children and adolescents in the USA.

Findings from this study concluded that for Chinese American fathers and mothers as well as European American mothers, higher acceptance and greater control were linked to their children’s more positive psychosocial adjustment, while for European fathers, acceptance and control did not predict children’s outcome four years later. Among the limitations to this study are relatively small sample size and over-representation of well-educated individuals in both Chinese American immigrants and European American study groups.

In the issue of Jan/Feb 2002 of journal Child Development, researchers (A.J. Fuligni, et al) from Center for Culture and Health, UCLA published article, “The Impact of Family Obligation on the Daily Activities and Psychological Well-Being of Chinese American Adolescents.” The authors studied 140 adolescents (ave. age 14.6 years old, 74 girls and 64 boys) of Chinese immigrant families in the U.S. using a daily diary method that includes an initial measure of attitude towards daily family obligation and several checklists of their daily activities and psychological well-being for a period of two weeks. The authors found that subjects show a greater inclination to balance family obligations with their academic demands than their social life with peers on a daily basis. The extent of involvement in family obligations was not associated with psychological distress. Not surprisingly, girls were asked to sacrifice more for family obligations than boys; however, analysis of gender differences in psychological well-being is not shown in the article. The authors did report that oldest and only children tend to show more distress than their younger siblings.

Also in the issue of Journal of Family Psychology 2009, Vol. 23, Number 3, R. Chao et al from University of California published research article, “Interpretations of Parental Control by Asian Immigrant and European American Youth”. The authors studied adolescents’ affective interpretations of parents’ control, that is, feelings of anger toward control, and how their interpretations moderate the relationship between control and adolescents’ behavioral adjustment. A total of 1085 immigrant youth of Chinese, Korean, and Filipino descent, and also European American youth from high school in the greater Los Angeles area were included in the study. Parental behavioral control was measured with the Firm Control/Lax Control scale of the Children’s Report on Parent Behavior Inventory. Parental psychological control was measured with Barber’s revised scale of psychological control from the Child-Rearing Practices Behavioral Inventory. Affective interpretations of anger toward parental control were measured by asking adolescents how angry they would feel toward parental control. Adolescents’ behavioral adjustment was measured using the internalizing and externalizing scales from the Youth Self-Report of the Child Behavioral Checklist.

Not surprisingly, there were differences between European American and Asian immigrant youth in the effects of both behavioral control and psychological control. The immigrant youth from Chinese and Korean families demonstrated less anger toward parental control (both behavioral and psychological control) than European American youth. The authors attribute such differences to cultural differences and Confucian influences on Chinese and Koreans. The authors also report that among European Americans, as adolescents’ feelings of anger increased, the beneficial consequences of behavioral control decreased, whereas the negative effects of psychological control on behavior problems decreased. These were not observed in Asian immigrants.

In the issue of Journal of Family Psychology 2009, Vol. 23, No. 3, S.Y. Kim et al from University of Texas at Austin published article, “Parent-Child Acculturation, Parenting, and Adolescent Depressive Symptoms in Chinese Immigrant Families.” Adolescent either US born or foreign born in households with at least foreign-born one parent were recruited from seven middle schools in Northern California. In a pool of 444 Chinese American families, the authors used a sample of 388 father-adolescent dyads with foreign-born fathers, and 399 mother-adolescent dyads with foreign-born mothers. Most of the participants originally came from Hong Kong or southern provinces of China. Fewer than 10 families came from Taiwan. Each parent and the child received a packet of bilingual questionnaires (in English and Chinese) measuring acculturation, parenting quality, and adolescent depressive symptoms. The authors found that a high discrepancy in father-adolescent acculturation levels relates significantly to more adolescent depressive symptoms. Furthermore, a high level of discrepancy in American orientation / adaptation between fathers and adolescents is associated with unsupportive parenting practices that is in turn linked to more adolescent depressive symptoms. These findings are reportedly sustained after controlling of the influence of parents’ socioeconomic status.

The Chinese have a long history in the United States. Earlier Chinese immigrants mostly contributed to building railroads of this country and making delicious Dim Sum. Over the years, more and more Chinese immigrants have made significant contributions to the intellectual and other aspects of the society. Since hundreds and thousands of those highly educated mainland students and scholars immigrated after late 1970s and 1980s, with their hard work and achievements, not only the population of Chinese has been greatly increased but the overall socioeconomic level of Chinese has been significantly elevated as well. Still, awareness of mental health in the community is yet to improve. Despite enormous research on mental health in generally, both biologically and psychologically, specific works on Chinese/Asian population here are only just a few. Here I provide some summaries of research related to Chinese/Asian American mental health. For more detailed information, please read the original journal papers. (Two students in the community, E. Tsai and W. Hsu, have provided substantial help and I appreciate their dedication to this important community work.)