On Being Hospitable: Yankee Doodling, Pith Helmets, and Pathology

The archetype of Western imposition of sameness is Constantine, who in the year 312 CE had a vision in which he was to place a cross on the shield of his soldiers. Upon victory, he then baptized his captives under the sign of the cross as Christians. One truth, one civilization, one voice in the human soul served as the scalpel to excise the Jews, the Donatist heretics, and sundry enemies. This Constantinianism1 refuses to recognize differences and homogenizes peoples. It is what Emmanuel Levinas calls the eternal return of the same,2 and what Christians might call inhospitality.

In the past, pith-helmeted Western missionaries, with the blessing of colonial governments, criss-crossed continents preaching a universal gospel of Christian salvation and, unwittingly, a gospel of Western culture. Today, new missionaries have arisen. In their right hand they carry the Diagnostic and Statistical Manual of psychological disorders and in their left hand a compendium of Western clinical theories. The Cartesian ego of Western psychology has been a major commodity exported in the past century. Like missionaries of old, psychologists donned their own pith helmets and spread the gospel of a timeless and universal psyche. They have diagnosed pathology in a Western setting and then “discovered” the same nosology cross-culturally. In reality, our psychology was, and still is, a product of Euro-American ideologies.

Three experiences in the past decades have changed the way I think about the relationship of hospitality to healing and the role of American mental health approaches in international contexts. I fear we have encouraged “Yankee doodling,” disparaged mother tongues, and universalized “secularese.” None are hospitable to non-Western indigenous cultures. All can undermine healing in the name of Christ.

Mexico City

In the early 1980s I led a student delegation to Mexico for a semester. I had a day free in Mexico City and decided to spend it at the national university of Mexico. I was awed by its imposing architecture, its size (200,000 students at the time), and advanced psychology department (with 300 faculty I was told). I wandered into the bookstore as was my wont. Unbeknownst to me, it was not permitted for customers to browse the shelves, but the staff for some reason (a bearded, foreign, visiting professor?) ushered me into the stacks. There were only four long rows of shelves with books for sale. One half of one whole row was devoted to psychology texts—an eighth of the space available for student texts. I was puzzled. Why such interest in psychology? I began examining the textbooks. There were some texts in English I had read in graduate school. Most of the books used in the university were translations of American textbooks. Some introductory texts were written by Mexicans, but they reviewed primarily research with individuals who lived in the United States. There were very few books written by Mexican authors on research studies with Mexican participants. A small number of authors attempted to develop an indigenous psychology. I immediately bought a copy of each. I could not but conclude that American psychology would shape the consciousness and worldview of Mexicans.

Nairobi, Kenya

Dr. Gladys Mwiti is a graduate of Fuller’s School of Psychology and now a Kenyan psychologist. We were commissioned to write a book on African indigenous Christian counseling.3 Mwiti had provided counseling for pastors in Rwanda after the genocide, and later in the aftermath of the bombing of the American embassy in 1998, she coordinated counseling for the traumatized. Soon after her arrival we dreamed of writing a book for therapists in Africa. It was a profound experience to support and collaborate with an African Christian psychologist as she articulated what she intuited clinically, below layers of Western psychologies. I served as amanuensis.

The book was accompanied by a DVD to illustrate many of the themes. Our clinical approach was constructed on an African three-legged stool: African Christian traditions, African indigenous resources, and Western research and practices—in that order of importance.4 Several days after the beginning of a workshop in Kenya, a therapist asked me, her eyes brimming with tears, “You mean that, truly, we can use our own proverbs in therapy? We have only learned Rogerian and Freudian models of counseling and our own African tradition was looked down upon.” I found this deeply troubling.

Nanjing, China

Wang Xuefu had already completed his PhD in Chinese literature, but when we met him he had just returned after studying pastoral counseling at an American seminary. He was teaching at the time at the Nanjing Union Theological seminary, China’s largest and only graduate seminary. We asked him what he had learned in the United States that he found helpful in his counseling in China. He remained silent, reluctant to answer. When we asked what was most helpful, he responded immediately, Carl Jung. The latter understood spirituality and culture, he told us. Xuefu built on his knowledge of Chinese literature generally and on LuXun in particular, China’s first modern poet/novelist. From LuXun he learned the importance of facing the future, Zhi-mian. Xuefu, who spent a year at Fuller as a visiting scholar, is one of the few indigenous therapists I have met in China, but there are others.

Most often when I travel in China, my audience is eager to learn of Western secular psychology. There are exceptions. Fuller together with the John Templeton Foundation recently held a three-day academic conference on Chinese and Western approaches to psychology of religion in Qufu, the home town of Confucius. We attracted some 400 students who stayed the duration of the scholarly conference. In a country that has historically been virulently secular, it came as a surprise to us and to local officials that the students continued to come to the conference for the next two days.

global reflection bannerSchool of Psychology Students Reflect on Time Abroad in China

Adam Ghali
I was asked to prepare a presentation on conflict resolution for Christian counselor and pastoral care training seminars. The task seemed daunting; however, I found preparing the talk to be a formative process. I learned about conflict resolution in China, in the West, and around the world. It took me some time to identify culture as the angle that I would take in my presentation. To develop the lecture, I read about Chinese history and philosophy, and learned about how these might relate to conflict resolution in China. During the presentation, a number of things stood out. I gave participants a chance to tell their own conflict stories, and to share the stories that contained life lessons about conflict that they told their children. They readily participated, and seemed to thrive. I was struck by how much the group appreciated the research that I had done about their culture. Through my work, I was able to validate their culture and bring to the foreground something that had been only minimally visible to them. . . .

Read more of Ghali’s reflections, as well as reflections from Annie Matthew and Lisa Findlay »

On Being Inhospitable

It is inhospitable to fail to recognize the alterity of the other, to assume the other is the same as myself. If human nature is universally the same, we can export our psychology without qualification to Latin America, Africa, or China. I argue this can create problems for the receiving culture. Of course, whether they choose to adopt Western psychology as their own is a decision they will need to make, lest emphasizing indigeneity becomes a new form of colonialism.

In a recent New York Times article “The Americanization of Mental Illness,”5 Ethan Watters proposes that we have exported our clinical nosology such that PTSD, anorexia, and depression are now household words in Sri Lanka, Hong Kong, and Japan. In his book, Crazy Like Us, Watters6 argues that mental illnesses are not discrete illnesses like cancer with a natural history, but instead are different the world over, shaped by the ethos of particular times and places.

However, it is exactly this diversity of forms of mental illness internationally that is in the process of being homogenized into Western categories. After all, we have assumed that we are the same biologically and that a scientific psychology uncovers a syndrome, which, of course, is universal. Watters states: “There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western ‘symptom repertoire’ as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures.”7 For example, Sing Lee, a psychiatrist at the Chinese University of Hong Kong, studied a rare form of anorexia in the 1990s in which, unlike American anorexics, the patients complained of having bloated stomachs but did not intentionally diet or express a fear of getting fat. However, in November 1994, when a young girl collapsed and died on a Hong Kong street, reporters used American diagnostic criteria for anorexia because a weight loss book was found in the woman’s school bag.

The incident changed the meaning of anorexia, but, more importantly, it may also have changed the expression of the illness itself. Lee’s clientele of anorexics changed into the American standard. By the late 1990s, Lee reported that between 3 and 10 percent of young women exhibited fear of becoming fat as the dominant reason for not eating. Granted it is more than the availability of a label that “creates” an illness in a culture as capitalist as Hong Kong. I agree with Derek Summerfield of the Institute of Psychiatry in London when he says:

Western mental-health discourse introduces core components of Western culture, including a theory of human nature, a definition of personhood, a sense of time and memory and a source of moral authority. None of this is universal. . . . The problem is the overall thrust that comes from being at the heart of the one globalizing culture. It is as if one version of human nature is being presented as definitive, and one set of ideas about pain and suffering. . . . There is no one definitive psychology.8

If Western psychology reflects Western ideals, then it should come as no surprise that Western psychology will assist, for better or for worse, in the process of socializing emerging nations into modernity. I have seen non-Western mental health workers evangelized by classic Freudians, by devotees of the family therapist Virginia Satir, and by acolytes of cognitive behaviorism—all purveying the truth of a universal human nature. In many non-Western countries, the discipline of psychology appears to be practiced almost exclusively in the Euro-American tradition. While Western theologians have become much more sensitive to the socio-cultural context of their theologizing, not so for psychologists it appears.

Failure to appreciate the cultural particularity of our work as we export it tends to encourage third-world psychologists to imitate American models of psychological research. Indian psychologist A. K. Mohanty has referred to the replication of Western psychology by Indian psychologists as “Yankee Doodling.”9

On Being Hospitable

So what would it mean to be hospitable as an international psychologist? I turn to the progenitor of the three Abrahamic faiths for a prototypic model of hospitality. For Abraham, hospitality is offered to strangers, to the other (Gen 18:2–8), while he himself is a wanderer: “By faith Abraham obeyed when he was called to go out to the place which he would afterwards receive as an inheritance. And he went out, not knowing where he was going. By faith he sojourned in the land of promise as in a foreign country” (Heb 11:8–9). Graham Ward comments:

God blesses Abraham in his radical dispossession. But there is a deeper paradox that issues from this passage—being a foreigner and a wanderer, does not prevent Abraham from also being a host. In fact, it is being a stranger himself that makes him welcome other strangers extravagantly. And welcome them not as Lord and patriarch, but as servant, as one who has been looked upon favourably by those who are tired and hungry, thirsty and homeless. It is the recognition of their common situation that enables one to act as host and the other to act as guest. Both submit to a situation. To be a guest is to place oneself into the hands of another, in humility.10

It is not surprising that Abraham becomes a symbol of community, as in Rublev’s icon of the holy Trinity. Abraham’s welcoming of the three travelers in the Genesis account typifies the virtue of hospitality. “Do not neglect to show hospitality to strangers, for by doing that some have entertained angels without knowing it” (Heb 13:2). In 2 Kings 4, Elisha is shown hospitality by a Shunammite family, and he raises their son from death. Within all of these stories from the Hebrew Bible is the underlying ethical assumption that Israelites are required to show hospitality.11

So the question that emerges for me is, how can I as an international psychologist be hospitable? We have much to learn from international psychologists instead of assimilating them into our frame of reference, our psychology. What can we learn? Much. Non-Western psychologies that move toward indigeneity are more open to a wide range of epistemologies in contrast to our love affair with science. They are often more sensitive to social obligation, communal ritual, and ancient wisdom. While the West is beginning to reconsider the beneficent role of religion in healing, the more indigenous psychologists I meet internationally assume religion is integral to healing.

Here are two examples: In Israel, Yoram Bilu and colleagues worked with a traumatized, conservative seminary student by interpreting his dreams (consistent with his folk tradition), reading him psalms, and helping him reintegrate into his community.12 In Chengdu, China, the program director of the mental health unit at the Huaxi hospital does not support individual psychotherapy for traumatized victims of the earthquake but focuses on rebuilding the community destroyed by the earthquake and honoring local spiritual traditions.13

Perhaps we have something to learn about how to care for persons with schizophrenia. It is generally accepted that schizophrenics fare better over time in non-Western worlds than in industrialized Europe and the United States, societies that know that schizophrenia arises from chemical imbalances and brain abnormalities.14 Schizophrenics outside the United States and Europe have up to two-thirds lower relapse rates. Those regions of the world with the most resources have the poorest outcomes, the most troubled and socially marginalized schizophrenics! In countries like India, Nigeria, and Colombia, schizophrenics had longer periods of remission and higher levels of social functioning. Forty percent of schizophrenics in industrialized nations were judged severely impaired while only 24 percent in the poorer countries. Why?

Anthropologist Juli McGruder from the University of Puget Sound spent years in Zanzibar studying three families with a schizophrenic member.15 Thinking in the populace is still predominantly animist. Spirit possession beliefs are prevalent to explain social deviation. McGruder found that these beliefs were hardly stigmatizing but in fact prescribed a variety of socially accepted interventions. Their care for the schizophrenic member kept the ill person bound to the family and kinship group. The troubling spirits were not cast out as in some Christian circles. As one caregiver of a schizophrenic commented: “We all have ‘creatures in our heads.’”16 McGruder adds regarding the spirits: “Rather they are coaxed with food and goods, feted with song and dance. They are placated, settled, reduced in malfeasance.”17 McGruder observed family members “use saffron paste to write phrases from the Koran on the rims of drinking bowls so the ill person could literally imbibe the holy words.”18 Or the Koran would be read over water before bathing.

The caregivers were hospitable in regard to the illness. The spirits were allowed to come and go. The spirit-possession beliefs allowed the person with schizophrenia a cleaner bill of health when the illness went into remission than a view that assumes schizophrenia is a state. In the home of a schizophrenic, McGruder was amazed at the tolerance shown by the family to the troubled daughter. The ill member was incorporated into the daily tasks of running a household. Moreover, since the illness was seen as the work of outside forces, it was understood that schizophrenia was an affliction for the sufferer but not an identity. This is hospitality for the mentally troubled person. This is a profoundly religious and communal response to schizophrenia.

In contrast, higher relapse rates in Western societies seem to be correlated to what is high expressed emotion (EE), i.e., criticism, hostility, and emotional over-involvement in the patient’s life. Watters (2009) reports that in one study, 67 percent of white American families with a schizophrenic family member were rated as “high EE,” among British families, 48 percent were high EE; among Mexican families the figure was 41 percent, and for Indian families 23 percent. In the West, high EE is not necessarily lack of empathy but may be a result of the belief that individuals are the shapers of their own destinies and should be able to change by force of will.

I have learned that hospitality with international, or culturally different clients, is what I am called to do. All new clients come to me as strangers and, as we converse, I hope that a bond will emerge as we recognize mutual differentness. I strive to acknowledge the gifts of their cultures and to inquire what it looks like to flourish therein before addressing psychological issues. I invite, and bless, the whole client who enters therapy, a safe place where the local dialect of faith can be spoken. I listen for the meaning of the client’s story rather than isolated symptoms. In other words, I learn the client’s mother tongue.

To expect the other to learn my therapeutic language so that we can communicate in therapy is inhospitable. Hospitality requires being a polyglot, affirming the good that is apparent in the client’s life and tradition, building on the client’s tradition, narrative, practices, and rituals, and making as few assumptions as possible so as to let dialogue emerge. Hospitality means I am a host, not a pharmaceutical salesperson. I give only what the guest needs. But I cannot give what I do not have. Therapy is not hospitality when it is reduced to a fee for the service of removing a symptom. This is an instrumentalized version of hospitality. Hospitality to persons of other faiths in therapy requires learning—and honoring—that which is sacred to them.

1. See James Carroll, Constantine’s Sword: The Church and the Jews; A History (Boston: Houghton Mifflin, 2001).
2.1Emmanuel Levinas, Collected Philosophical Papers, trans. Alphonso Lingis (Dordrecht, Netherlands: M. Nijhoff, 1987).
3. We are grateful to Mr. Ron VanderPol, a member of the Fuller Theological Seminary Board of Trustees, who first envisioned such a project and then provided funding.
4. Gladys Mwiti and Alvin Dueck, Christian Counseling: An African Indigenous Perspective (Pasadena, CA: Fuller Seminary Press, 2006). The book is available free of charge to those interested: http://documents.fuller.edu/cio/africa_counseling/index.asp.
5. Ethan Watters, “The Americanization of Mental Illness,” New York Times Magazine, January 10, 2010, MM40, http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html.
6. Ethan Watters, Crazy Like Us: The Globalization of the American Psyche (New York: The Free Press, 2009).
7. Ibid., 2.
8. Quoted in ibid., 9.
8. “Yankee Doodle went to town / A-Riding on a pony; / He stuck a feather in his cap, / And called it macaroni.” Dudel comes from the Low German and means “foolishness.” Macaroni was a fashionable wig in pre-revolutionary America. The implication of the verse was probably that the Yankees were so unsophisticated that they thought simply sticking a feather in a cap would make them the height of fashion. Mohanty thought Indian psychologists were simply being fashionable by imitating Western scientific psychology: A. K. Mohanty, “Beyond the Horizon of Indian Psychology: The Yankee Doodler,” in Psychology in Indian Context, ed. F. M. Sahoo (Agra: National Psychological Corporation, 1988).
10. G. Ward, “Hospitality and Justice toward ‘Strangers’: A Theological Reflection,” paper presented at the symposium “Migration in Europe: What Are the Ethical Guidelines for Political Practice?” Katholische Akademie, Berlin, November 2003, p. 3; http://www.katholische-akademieberlin.de/Veranstaltungen/2003112729/Ward_pdf.pdf.
11. Zwi R. J. Werblowsky, “Hospitality,” in The Oxford Dictionary of the Jewish Religion, ed. Zwi R. J. Werblowsky and Geoffrey Wigoder (Oxford/New York: Oxford University Press, 1999), 339.
12. Yoram Bilu, Eliezer Witztum, and Onno Van der Hart, “Paradise Regained: ‘Miraculous Healing’ in an Israeli Psychiatric Clinic,” Culture, Medicine & Psychiatry 14 (1990): 105–27.
13. Y. Yuan and Y. Yang, “The Cultural Basis and Feasibility of the Post-quake ‘Bare-foot Psychotherapist,’” Schweitzer Archiv für Neuorologie und Psychiatrie 161, no. 8 (2010): 316–18.
14. T. J. Craig, C. Siegel, K. Hopper, S. Lin, and N. Sartorius, “Outcome in Schizophrenia and Related Disorders Compared between Developing and Developed Countries: A Recursive Partitioning Re-analysis of the WHO DOSMD Data,” British Journal of Psychiatry 170 (1997): 229–33; K. Hopper, G. Harrison, A. Janca, and N. Sartorius, eds., Recovery from Schizophrenia: An International Perspective; A Report from the WHO Collaborative Project, the International Study of Schizophrenia (Oxford: Oxford University Press, 2007).
15. J. McGruder, “Madness in Zanzibar: ‘Schizophrenia’ in Three Families in the ‘Developing’ World,” PhD dissertation, University of Washington, 1999.
16. Watters, Crazy Like Us, 157.
17. Ibid., 158.
18. Ibid.

This article was published in Theology, News & Notes, Fall 2011, “Where In the World Are We? Reflections on Fuller’s Expanding Global Reach.”