Clinical Psychology Review 22 (2002) 343 – 360
Foundations of psychosocial dynamic personality theory of collective people Marwan Dwairy Haifa University, PO Box 14710, Nazerat Ellit 17000, Haifa, Israel Received 23 February 2001; received in revised form 19 March 2001; accepted 21 March 2001
Abstract The concept of personality emerged as a part of the development of individualism in the western world to understand the quality of the newborn (individual). In premodern society, roles were the elements that constituted the person. Presently, about 80% of the people (Africa, Asia, and South America) in the world still live in a collective, authoritarian system. Personality theories that have been developed in Europe and North America seem to be limited in understanding and predicting the behavior of these people. One major difference between individualistic and collective peoples is their degree of individuation from the family. Western social – political systems enable individuals at the end of their development course to form an independent personality (or self) that is unique and different from others. For westerners, personality structures and processes enable us to predict behavior. Psychopathology is attributed to an intrapsychic disorder within the personality. Typically, psychotherapy aims to restore that order. For people who live in collective social systems, individuation does not take place. Therefore, norms, values, roles, and familial authority directives predict behavior more than personality. Psychopathology among these people has to do with interpersonal disorder within the family. Therefore, psychotherapy should aim to restore that order. This manuscript suggests foundations of a new psychosocial dynamic theory of personality to better fit our understanding of people living in collective societies. D 2001 Elsevier Science Ltd. All rights reserved. Keywords: Collective; Personality; Cross-cultural; Arab; Psychopathology; Psychotherapy
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1. Introduction In premodern society, the individual was not recognized as an independent entity. People behaved in a collective manner, and roles were the elements that constituted the person (Sampson, 1989). In the era of individualism in Europe and North America, the individual emerged as an independent legitimate entity. Psychology is the science that emerged to understand that newborn: the individual. Theories of development came to describe how that newborn develops and theories of personality described the quality of him. All theories of development agree that normal development conveys the child through a process of individuation — from a state of dependency in the first years of life to a state of independence at the end of adolescence. It is said that an individual achieves an independent self, identity, and personality at the end of this process. Freud claimed that normal children develop their identity through a process of identification with the same-sex parent after solving their oedipal conflict successfully and establishing the components (id, ego, superego) of personality (Freud, 1935/1960, 1949). Erikson (1950), on the other hand, identified a trend to achieve autonomy among children in the second year of life (autonomy vs. shame stage), which continues until an identity is crystallized at the end of adolescence (identity vs. role confusion stage). Object relation theory emphasizes the separation–individuation process as fundamental to the developmental process that ends when an independent self is achieved at the end of adolescence (Mahler, Bergman, & Pine, 1975; Segal, 1992). Humanistic approaches claim a free will and an independent self for all people who grow in an unconditional positive regard condition (Rogers, 1961). In essence, psychological development, according to western theories, is the development of an independent personality of the individual (Fig. 1). Personality theories came as an attempt to describe the quality of the individual in individualistic societies. Most of them may be perceived as irrelevant in collective societies where the individual is not recognized as an independent entity. Generally speaking, western personality theories assume the existence of an internal structure of personality that consists of certain constructs and processes capable of explaining and predicting behavior. Disagreement within these theories is restricted to the quality of these constructs and the processes that take place within them (Liebert & Spiegler, 1994; Mischel, 1993). The psychoanalytic theory assumes the existence of id, ego, and superego hypothetical constructs. Conflicts between these constructs are the main processes that take place. Defense mechanisms manipulate psychological contents between the conscious, subconscious, and unconscious mind (Freud, 1935/1960). According to the major streams of psychodynamic theories, unconscious processes not only explain human behavior; they also dictate and motivate it. For object relation theory, separation–individuation and splitting are the major processes that may take place in the personality or self (Mahler et al., 1975). Humanistic theories also emphasize the self and ideal self as major constructs. They assert that defensive unconscious processes take place, especially in an unconditional regard setting, but higher conscious processes are crucial to the understanding of behavior. Self-actualization, however, is the ultimate process that a person strives for (Maslow, 1970; Rogers, 1961). Allport (1961, p. 28), who may represent trait theories, defined personality as ‘‘the dynamic organization
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Fig. 1. Individuation process and personality.
within the individual of those psychosocial systems that determine his characteristic behavior and thoughts.’’ For him, traits are the ultimate realities of psychological organization. Cognitive theories explain behavior and emotions by means of cognitive processes: encoding, expectancy, evaluation, and so on (Beck & Emery, 1985; Ellis & Grieger, 1985). All western personality theories posit that intrapsychic constructs develop initially from the past experiences of the individual with her/his social environment, but are internalized at a later stage to direct behavior and become almost independent of the environment. Consequently, consistent behavior across situation and time is determined by internal factors rather than current external ones. According to these theories, social factors influence consistent behavior only through representation of internal constructs formulated during the course of development. Hence, past (early) external factors influence behavior more than current ones. Only behaviorism gives a priority to current external factors such as stimuli and reinforcements that determine behavior.
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Markus and Kitayama (1998) claimed that western theories viewed personality as an indigenous, bounded, coherent, stable, autonomous, and free system that may work well in individualistic societies, but which have little relevance in other collective societies. They identified the following ideas that are incorporated in most personality theories: 1. 2. 3. 4. 5.
A person is an autonomous entity defined by a set of attributes, qualities, or processes. Personality determines and causes behavior. Personality explains behavioral differences between persons. Personality is expressed in consistent behavior in terms of situation and time. Personality allows us to understand, predict, and control behavior.
Taking into account that individuation does not take place in most collective/authoritarian societies, norms and familial directives, rather than personality, remain the dominant factors that explain and predict behavior. Consequently, behavior and personality within collective societies could be better explained by external cultural factors (norms, values, roles, and familial authority) than by intrapsychic structures and processes that have not been individuated.
2. Crosscultural approach to personality Theorists within the past few decades have begun to question the universality of western personality theories and have been examining the role culture plays in the development of personality. Recently, the Journal of Cross-Cultural Psychology Research published a special issue (1998, vol. 29, number 1) on ‘‘personality and its measurement in a crosscultural perspective.’’ So far, research on the relationship between culture and personality typically deals with the macrolevel of entire cultural differences or national personality rather than with the microlevel of individual differences and personality. Most studies were: (1) Etic: testing the applicability of western theories in collective societies. (2) Focussing on disposition trait theories of personality to identify culture-specific personality traits. (3) Went in piecemeal way, focussing on single factor or structure of personality such as locus of control, achievement motivation, field-independence, and anxiety (Church & Lonner, 1998). There is an abundance of published material on the comparison between collective and individuated personalities (see Triandis, 1995). Most of this work consider the collective personality as a trait or type rather than an interpersonal dynamic structure that help to understand and predict individual’s behavior. A review of this literature revealed the following characteristics of collective people: 1. The self is not autonomous but is connected to an in-group. It directs its energy towards achieving group rather than personal goals. 2. The behavior of the individual is more situational and contextual rather than dispositional. It is controlled by external, rather than internal, factors that emphasize roles and norms rather than personal attribution of behavior.
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3. Priority is given to interpersonal responsibilities rather than to justice and individual rights. 4. Experience more other-focused emotions (e.g., sympathy and shame) rather than egofocused ones (Dwairy, 1998a; Markus & Kitayama, 1991; Singelis, 1994; Triandis, 1995). These differences in needs, emotions, values, and social behavior actually cover almost the whole space of personality, and as such, should be construed more than a trait of personality to help understand individual differences. This sophistication calls for a dynamic explanation of personality that acknowledges the major roles of family, society, and culture. Hence, we continue to lack a psychosocial dynamic personality theory that defines constructs and processes that explain and predict the behavior of people who possess a collective, unindividuated personality.
3. Sociopolitical climate and personality The individuated personality from the family could not have emerged in Europe and the USA in the past few centuries without concomitant sociopolitical changes (industrialization, capitalism, liberalism, and democracy) taking place. The establishment of a modern state that takes responsibility for all its citizens enables the individual to relinquish her vital interdependence with the family and to rely on a newly established interdependence with the state’s institutions. The role of citizens within this new relationship is to work, obey the law, and serve the security of the state. In return, the citizen’s needs are either provided by the state, or could be attained financially without reliance on the family, clan, or tribe. Only within this sociopolitical context could individuation of personality have taken place. The family, however, remains to be the main provider of the individual’s needs within collective/ authoritarian societies (e.g., Africa, Asia, and Latin America). Hence, where the state is unable to take full responsibility for catering to the needs of its citizens, the individual relies on the family more than the state (e.g., ministries, police, institutions, etc.) to fulfill his/her needs for education, employment, housing, and security. Pursuing individuation within collective societies could bring negative consequences for the individual and family. Hence, efforts to individuate are met with discouragement or punishment in the same manner as breaking the law is punished in individuated societies. Individuation is construed in collective societies as something as destructive as breaching the security of the State in western societies (Dwairy, 1998a). Personality is not only influenced by culture but is thoroughly culturally constituted. Personalities behaving together in concert create the culture. Both are most productively analyzed as a dynamic of mutual constitution (Kitayama, Markus, Matsumoto, & Norasakkunkit, 1997). Individualism and collectivism are two different sociopolitical –cultural systems in which two different personality systems fit in. An individualistic personality is functional within an individualistic society to the same degree that a collectivistic personality is functional in a collective society.
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4. Modifying concept of personality In order to understand and predict the behavior of people who live in collective/authoritarian social systems, we should not detach personality (intrapsychic) factors from social– cultural ones. Rather, the concept of personality should be modified and expanded to encompass a social layer that works in conjunction with internal constructs and processes in order to explain behavior in collective societies. Personality in these societies is a collective construct that describes the interpersonal dynamics between the individual and her family (or in-group). It includes social factors (norms, values, roles, and authority) on the one hand, and intrapsychic factors on the other hand. It should be noted here, however, that intrapsychic factors are typically not independent of external factors in these societies, but are dominated by them.
5. Socialization and development of personality Because of the continuation of socioeconomic interdependence between children and family, full psychological individuation does not take place. Unlike Maslow (1970), in collective societies, the family provides the children’s three basic needs: biological, safety, and belonging, only if self-esteem and self-actualization were relinquished. Instead, the child is asked to rely on social approval for his esteem and work to actualize the will and interest of the family instead of to actualize the self. Disobedience and self-oriented trends are either punished or used as a threat to withhold satisfaction of biological, safety, and belonging needs provided by the family (Dwairy, 1997c, 1998a, 1998b). As a result of the continuous and vital interdependence between the individual and family, only partial individuation takes place during the course of development. The child endorses a collective self (needs, control, and value system) that continues to be dependent and fed by past and current external factors. Only a small portion of the self is differentiated from the family (in-group), and is usually expressed far away from the external observation and control of society. Fig. 1 shows the partial individuation of people in collective societies compared with the individuated and independent personality in an individualistic society. Many researchers have pointed out that adolescence in collective societies is not a tense period of life and not a developmental crisis (Budman, Lipson, & Melies, 1992; Racy, 1970; Timimi, 1995). Changes take place in the role of adolescents according to cultural expectations, and not through a struggle for individuation from the family, and for having independent personality. In a study about Arab youth, majority of them reported that they follow their parents’ direction in all areas of life, such as social behavior, interpersonal relationship, marriage, professional preference, and political attitudes. Furthermore, they reported that they are not suffering from this interdependent relationship and are even satisfied with this way of life (Hatab & Makki, 1978). There is a fundamental difference in the human development between collective and individualistic cultures that leads to fundamental differences in personality structure and dynamic across these cultures.
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6. Personality dynamics Understanding an individual’s personality helps understand and predict the behavior of a collective person only partially, because much of her behavior is explained by norms and social expectations. Therefore, to understand a collective person, we need both external sociocultural factors and the individual’s personality. Markus and Kitayama (1998, p. 69) defined a person in collective societies as ‘‘connected, fluid, flexible, committed being who is bound to others.’’ They proposed four principles to explain the interdependence view of human nature: (a) a person is an interdependent entity; (b) behavior is a consequence of being responsive to the others with whom one is interdependent; (c) individual behavior varies situationally and temporally; and (d) the study of personality leads to an understanding of the relational and interpersonal nature of behavior (Markus & Kitayama, 1998). In the case of the collective personality, the main drama takes place between the individual’s needs on the one hand, and the external social authority on the other hand, for the purpose of monitoring her behavior to ensure that it conforms to expected social norms and values. This is the main conflict rather than a conflict between id and superego, or self and ideal self. The main source of anxiety is external (punishment or shame) rather than internal (guilt), while the main source of happiness is external (social approval) rather than internal (self-actualization). Social coping skills, rather than psychological defense mechanisms, are needed to avoid punishment or shame. Central to these mechanisms are identification, respect, obedience, and adherence to the social authority, while unacceptable trends may be expressed not in view of the social authority. In the Arab society (as an example of collective societies), four social coping skills are needed to balance the conflict between the individual and society (Dwairy, 1998a). 6.1. Mosayara Mosayara is to get along with others’ attitudes, wishes, and expectations by concealing one’s real feelings, thoughts, and attitudes (Griefat & Katriel, 1989; Sharabi, 1975). It is more than being ‘‘diplomatic’’; it is a positive value and a lifestyle in which leads one to accommodate the expectations of others. In a collective/authoritarian society, mosayara is a reasonable social means to avoid confrontation and maintain good relationship and support. In many Asian cultures, obedience is considered an extremely positive social value. People in such societies avoid saying ‘‘no’’ because it is considered rude rather than assertive. In contrast to what may be expected by western people, mosayara does not cause any discomfort. On the contrary, it is the comfortable way to communicate without threatening the social approval and support that is vital for the people. 6.2. Istighaba Istighaba is the other side of the coin. Feelings, needs, and attitudes that are not expressed due to mosayara are expressed in the absence (ghiab) of others. Socially unacceptable verbal and nonverbal (e.g., deeds) actions are expressed away from the ‘‘eye of society’’ or in
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solitude, to avoid isolation or punishment. This method serves to discharge and ventilate forbidden wishes without losing vital social approval and support, or violating social rules. While mosayara is highly appreciated, istighaba is not. People usually deny using istighaba and tend to reframe it or cover it in different language such as, ‘‘I did not tell him what I really think because I did not want to insult him’’ or ‘‘I did not tell my father what I really want to do because I did not want him to worry.’’ 6.3. Fahlawia Fahlawia is another method to fit in and get your needs met (El-Athem, 1969). It is a combination of mosayara, istighaba, projection of responsibility onto others or external factors, humor to ease stress and avoid confrontation, cleverness, verbal exaggeration of one’s achievement by denying one’s shortcomings, and indirect methods of managing one’s life without challenging the social system. Bribery, which is common among collective societies, is one aspect of fahlawia that enables people to survive within social injustice without confronting the system. 6.4. Identification with the oppressor Oppression is inevitable in authoritarian/collective societies. Freiri (1970/1995, 1992/ 1994) described a social mechanism in Brazil that helps victims of oppression coexist with the oppressor by providing them with an illusion of power in order to give meaning to the oppression. Consequently, oppressed people in many Asian and African societies, especially women, identify with and justify the oppressing norms and values from which they suffer on the one hand, and endorse the same oppressing attitudes on the other hand. Variation of these four social defense mechanisms are found in all authoritarian/collective societies under different names. These mechanisms enable the individual to survive and the social system to maintain the status quo. Just as defense mechanisms distort reality and deceive the consciousness, social coping mechanisms deceive the others. An individual distorts expression of unacceptable content in both cases.
7. Personality structure Clinicians who work with clients in collective societies find it difficult to distinguish the needs, attitudes, and values of the individual from those of others. Furthermore, they found difficulties to distinguish the individual’s needs (id) from her judgment (ego), and from her values and attitudes (superego) (Dwairy, 1998a). All are one structure. Thoughts and values are confused within the needs of collective people. Thinking in collective cultures, is more a function of values and control rather than reasoning. In Arabic, for example, mind is called aq’l, which is derived from aq’l (control). Wisdom reflects an understanding of one’s ancestral cultural heritage rather than her intellectual power (Dwairy, 1997c). Social values are indistinguishable from needs to such individuals. For them, values are needs and, under
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given circumstances, they would be willing to sacrifice their lives (id) for their religious or ideological values. Needs (id) and ideals (superego), self and ideal self, and real and false selves are indistinguishable from each other. Instead, two main and distinct components of the collective personality structure could be identified to account for the variability in individual behavior. These are the social layer and the private layer. 7.1. Social layer This is the component that conducts social behavior. It is undifferentiated from authoritarian/collective rules, norms, and values of the social environment, and utilizes mosayara, fahlawia, and identification with the oppressor to achieve social support and accomplish goals. Unlike ego, self, and superego, this layer of personality is not an independent one. It is still conducted directly by external factors. It is socially dependent and activated in the presence of social control and directs the individual’s behavior accordingly. This layer is the portion of personality that should be shown and maintains social approval and support for individuals. It directs individuals on how to communicate with others on the basis of scarifying personal needs for the family, undermining personal opinions to preserve the social structure, and following norms and values. 7.2. Private layer This component is activated in private settings, or within small groups distant from social controllers in order to discharge forbidden sexual, selfish, and aggressive needs, and ventilate unacceptable attitudes through istighaba and fahlawia (Fig. 2). It is the only way to express unaccepted personal needs or attitudes without threatening the social approval and support, which are vital for people in collective/authoritarian society. Unlike the social layer, which is typically reactive, the private layer tends to be impulsive. It is the component that is associated with inner personal world. Society typically denies the existence of the private layer and the behavior emanating from it. It could be considered the social collective subconscious where forbidden drives are suppressed or repressed. These two personality components accomplish jointly, and in conjunction with the aforementioned social defense mechanisms, what seems to be an impossible task — the expression of forbidden drives without provoking the authoritarian/collective social system. This structure of personality reflects on the concept of unconscious. To understand this, we need to transform our individualistic perspective to a collective one in which the main ‘‘drama’’ takes place within the collective unit rather than within the person. The private layer, in collective personality, contains contents that are rejected or punished by the society. It is takes place consciously by the individual and away from the consciousness of the society. Therefore, the private layer is the subconscious of the society, while the social layer is the consciousness that insists to deny, on the social level, the existence of the private activity. The private layer is recognized typically on the private level away from social threat.
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Fig. 2. Collective personality (up) vs. individuated personality (down).
7.2.1. Example 1: hiding violent behavior In a research concerning socialization of children in Arabic families, parents were asked to tell how they deal with their children’s problems. The vast majority of them told the interviewer that they would explain or verbally direct their children. When they were asked, ‘‘what you will do if your explanations do not work?,’’ 89% of the parents disclosed their ‘‘hidden agenda,’’ telling the interviewer that they will use any means, including physical punishment, to control their children (Dwairy, 1997c, 1998a). These are ‘‘two faces’’ of the same parents: in the first stage, they wanted to meet the expectations of the ‘‘educated’’ interviewer; in the second stage, they were obliged to disclose their private way to deal with problems.
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7.2.2. Example 2: hiding sexual behavior Although sexual abuse and incest are common among Arabs like in western societies, Arabs still deny the existence of these phenomena and reject research findings that show that about 20% of Arab children are victims of sexual abuse (Dwairy, 1997c, 1998a). These acts are performed typically by the private layers of people’s personalities, while the social ones deny it. 7.2.3. Example 3: hiding attitudes When Arabs discuss social or political issues, typically, they tend to agree with the dominant attitude in the conversation. This is part of mosayara and of the effort to show respect. People who have different attitudes tend to hide it to maintain social closeness. These different attitudes could be easily disclosed in a private meeting (istighaba), or in another social meeting with people who adopt similar attitudes. Unlike individualistic personality components that are autonomous, collective personality components are contextual and socially dependent. The two layers of personality explains the differences in the social vs. private behavior much better than the self, ideal self, true self, id, ego, and superego. In addition, the social coping mechanisms that are utilized by these two layers explains that difference much better than intrapsychic defense mechanisms.
8. Consistency and individual differences The behavior of the individual is not consistent across situations in collective societies (Dwairy, 1998a; Markus & Kitayama, 1998). A huge discrepancy exists between public and private behavior among children, parents, teachers, and social and political leaders. Individual differences are minor in social settings. People communicate, express emotions, and function according to social rules. Public behavior is predictable by social roles, norms, and values in the collective personality, whereas it is predicted by intrapsychic personality constructs in the individualistic personality. In private settings, behavior is almost unpredictable and is occasionally in contradiction with social behavior. Incest, infidelity, sexual abuse, and violent means of socialization are a few examples of private behaviors that are not uncommon within collective societies but which are not acknowledged. Individual differences within collective societies are related to two major factors. 1. Level of individuation that determines the proportion between the social and private layers. The majority of people adopt more collective identity and less individualistic ones, while few others are more individualized and identify less or adhere less to the social norms. Among those who are more collective, there are some who are succeeded to give and take in a balanced way, and those who give and scarify themselves without gaining social approval and support. These are the people who are suffering and depressed.
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2. Social status, roles, gender, age, and profession. Regardless of the level of individuation, social leaders, parents, males, elders, and professionals behave differently than common people, offspring, females, youngsters, and nonprofessionals, respectively. These two factors are more central in understanding individual differences than intrapsychic factors such as ego strength, intelligence, or temperament. Based on these two factors, most of the variance of individual’s behavior are explained.
9. Personality assessment Based on the suggested conceptualization of personality, the conventional battery of tests should be reconsidered. Level of individuation (or level of psychological interdependence) is the main variable that should be evaluated. This evaluation should tell us the proportion between the social and private layer of personality and the contexts in which each layer is activated, the coping social skills used, and the efficacy of them. If the client is not individuated from the family, evaluating the social layer is crucial to the understanding and prediction of the individual’s social behavior. Conventional batteries of psychological tests do not meet this need because they focus on evaluating intrapsychic constructs and processes. Instead, there is a need for new instruments and techniques that could assess relevant constructs (e.g., norms, values, roles, social authority, coping skills, and social defense mechanisms), and to understand the individual within her familial and social contexts. The Person-in-Culture Interview (Berg-Cross & Chinen, 1995), for example, could be used to enable us to understand the relationship and interdependence between the client and her family. Another innovative technique is to ask the client to bring an object from her environment to a session and talk about it (Dwairy, 1999b, 2001). This technique is based on the interdependence between the individual and her physical environment in collective societies. Objects in the environment of the individual are charged with memories and emotions. Therefore, projective techniques on real objects or family pictures are much more meaningful than Rorschach, TAT, or other conventional projective techniques. Given that the behavior of collective people differs substantially from social to private contexts, new assessment tools should be developed to evaluate this change across situations on the one hand, and assess the dynamics between the social and private layers that explain and predict these changes on the other hand.
10. Psychopathology Psychopathology, according to Western personality theories, is an intrapsychic disorder that causes suffering (e.g., anxiety, depression, and somatic complains), impairment of individual functioning, and sometimes, detachment from reality (DSM IV, American Psychiatric Association, 1994). This perspective is based on the reductionistic distinction between individual and family, mind and body, and imagination and reality. Most collective
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cultures adopt a holistic perspective that do not put clear cut between individual and family, mind and body, imagination and reality. Therefore, their distressed took place in all of these aspects of life. Among them, it is difficult to find individual psychological problems without significant familial body manifestation (Dwairy, 1997b). On the other hand, it is too difficult to put a clear cut between reality and imagination because they have different concepts of reality, making it difficult for professionals to identify pathology that is related to delusions and hallucinations (Al-Issa, 1995). In collective societies, however, a person suffers when the individual – family (or individual– in-group) relationship is disturbed. Feelings of anxiety or depression with debilitating somatic complaints may develop as a result of this disturbed relationship (Dwairy, 1998b). Reality for these individuals is not necessarily an ‘‘objective’’ one, but could be represented in dreams and visions acquired through meditation. Hence, detachment from objective reality is not necessarily pathological and, in some cases, could be appreciated or found helpful (e.g., trances in traditional healing) (Dwairy, 1997b). We should look for psychosocial disturbances rather than intrapsychic pathology in collective cultures. Disintegrity that threatens the vital interdependence between the individual and her family (or ingroup) is the main feature of psychosocial pathology in collective cultures. Dysfunctions in the social and private layers and failure or misuse of the social defense mechanisms are the main features of abnormality. For example, imbalance between the level of mosayara and the level of social approval and support, or disclosure of istighaba that threatens the social approval and support, may cause psychosomatosocial distress. Given the essential structural differences between individualistic and collective personalities, the clinical picture of various aspects of psychopathology differs and has been shown to be culturally related. Syndromes of schizophrenia, depression, anxiety, and many other disorders are different in collective societies (Dwairy, 1998b; Okasha, 1999; World Health Organization, 1992). These disorders are related primarily with psychosocial and familial distresses such as oppression, divorce, or lose, and typically involve psychological, as well as somatic, complaints. The common type of schizophrenia, for instance, among Arabs and other collective societies is reactive acute schizophrenia precipitated by social or familial stress situation. Okasha, Seif El Dawla, Khalil, and Saad (1993) reported that in 74% of the acute psychotic cases in Egypt, a stressor preceded the onset and correlated positively with favorable outcome at a 1-year follow up. During this same follow-up period, 64% of the cases had full remission. Surprisingly, the social and clinical outcome of the cases had no correlation with family history of psychiatric illness (Okasha et al., 1993). These results agree with other studies that have shown similar features among other collective cultures: acute psychosis that is mostly precipitated by stress, has an acute abrupt onset and, in the majority of cases, shows a rapid recovery and maintenance of well-being after 1-year follow-up (Chaleby, 1988; Cooper, Jablensky, & Sartorius, 1990). Symptoms presenting with this psychosis are rather polymorphic, including schizophrenic (e.g., delusions and hallucinations), affective (e.g., depression and delayed sleep), and neurotic symptoms (e.g., worry and excitement). Depression also has different symptomatology among collective people. While depression is considered in the west as a mood disorder characterized by sadness and anhedonia, many reports from collective societies describe depression with more somatic complains and less
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mood changes (Al-Issa, 1989; Baasher, 1962). Bazzoui (1970) reported 65.5% of depressed cases in Iraq as having physical symptoms, and only 34% as having mood changes. Guilt feeling and worthlessness were almost absent. Fear of breaking the rules or shaming themselves and their families were much more dominant than guilt. Suicidal thoughts and attempts were rare. Interestingly, about one quarter of the depressed cases exhibited a desire to run away from their homes into the wilderness. Clinical picture of schizophrenia, depression, and many other disorders, as well as the prevalence of these disorders, are substantially different among collective societies. These differences in symptomatology and prevalence stem from the basic cultural differences. Bazzoui (1970) claims that the development of personal responsibility and superego, as well as the ability to feel guilt, must exist before a person may experience depressive feelings of worthlessness; otherwise, depression may be manifested by physical symptoms. As compared to westerners, collective culture is holistic: individual and family, as well as mind and body, are inseparable. Therefore, external stresses are the important ones that cause shame, rather than guilt, and almost every psychological distress overshadowed by physical manifestations (Dwairy, 1998a).
11. Psychotherapy Although the objective of western psychotherapists is to restore intrapsychic balance and harmony, therapists working with clients who adopt collective personality should work towards restoring psychosocial integrity between the individual and his family. Intervention should focus on and address individual– family relationships and conflicts rather than intrapsychic ones. Insight therapy that provokes unconscious (typically forbidden) contents misses the central problem and could create or increase individual–family conflicts that the client will be unable to face (Dwairy, 1997a; Dwairy & Van Sickle, 1996). Many core western therapeutic techniques face cultural barriers in collective societies. Addressing emotions, disclosing family problems outside the family, discussing intimate and sexual issues, analyzing transference, and exposing clients to ambiguous situations such as projective techniques or nondirective therapy are all difficult to do and may give a contraproduct (Dwairy, 1998a, 1999a). Egalitarian family therapy that challenges authority and conventional roles within the traditional family system was found to be unsuccessful and led to the termination of the treatment. Family intervention should be based on understanding the cultural background of the client (Abu Baker, 1999). Joining progressive elements within the family to achieve within it a change that enhances the position of the client within the family is central to psychotherapy in collective environments (Dwairy, 1997a, 1998a, 1999a). Progressive aspects could be found between and within family members, including authoritarian and, perhaps, oppressive figures such as the father, husband, or grandfather. Typically, these figures believe they work for the benefit of the client. Therapist should understand their world view and help them consider new ways to handle the conflicts with the client. This therapeutic mission is similar to helping the client handle intrapsychic conflicts (e.g.,
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psychodynamic approaches) through compromise between the id and superego. In working with collective families, the compromise is rather between client and family that aim to achieve new familial order that brings relief from tension and symptoms, without threatening the family unity. Therapy should be directed towards finding a new order within the cultural system rather than threatening it. Therapists should learn how clients and their families conceptualize their lives and problems, and help them find a new familial order rather than to impose an individualistic point of view. Therapists should detect and utilize subtle contradictions within the value system of the client. For instance, disclosing the contradiction between anxiety or defensive compulsive behavior and the belief in almighty God (savior of people) is critical to alleviate anxiety. For many clients, religion is the best therapy. It is tantamount to cultural therapy for collective people. Based on the experience of clinician in collective societies, four recommendations could be suggested (Dwairy, 1998a): 1. Systemic eclecticism: To employ various theoretical approaches in a flexible way to serve the individual’s adaptation to her family and society. 2. Short-term, directive, and goal-oriented: Collective clients are seeking typically concrete advise or directives. Insight and explorative therapy is not the treatment of choice. 3. Culture-centered therapy: Neglecting the cultural correlates of a collective client is synonymous with rejecting a major part of his personality and being. Therefore, therapy should address culture as well as interpersonal aspects of life. 4. Outreach treatment: Clinic-based therapy is to actually invite the client to a formal western oriented encounter, which has shown itself to be alienating to collective clients. Outreach encounter, especially at the beginning of the therapeutic relationship, is recommended. Based on the fact that collective people have a different concept of reality which appreciates imagination and vision, and based on their trend to describe problems in metaphoric language, it is suggested that the utilization of imagination, metaphors, meditation, yoga, and mind–body techniques is congruent with holistic collective cultures (Dwairy, 1997b). Furthermore, Al-Krenawi (1999) has found using cultural rituals may be helpful and fits the cultural background of collective people.
12. Conclusions Differences between people in collective and individualistic societies are substantial and extend to differences in traits. They are different in development, personality, psychoevaluation, psychopathology, and psychotherapy. The dynamics that predicts behavior among people in collective societies differs from that in individualistic ones, thus, challenging the universality of individualistic personality theories. There is a need for the development of a
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psychosocial dynamic theory of personality that defines appropriate constructs and processes to better predict the behavior of collective people. People in collective/authoritarian societies have collective personalities that encompass major cultural factors that determine their social behavior. There are no distinct internal constructs (e.g., ego or self, and superego or ideal self) in collective personality that are differentiated from the family. The main components that are distinctive in a collective personality are social and private layers. The social layer includes social norms, values, roles, and authority, in addition to endorsing social coping skills (e.g., mosayara and fahlawia, identification with the oppressor). The private layer allows the person to ventilate and fulfill forbidden drives and attitudes (through istighaba) away from social control. These are the main personality constructs and processes that explain and predict behavior among collective people. It is proposed that new assessment objectives should be determined and adopted. The first step in the assessment process should be to assess the level of individuation of the person. New instruments should be developed to evaluate concordance between social and private layers, and evaluate the social defense mechanisms used. Given that the activity of these layers is contextual, there is a need to evaluate when and how each layer is activated, and to evaluate the efficacy of the social coping skills. Psychopathology should be interpreted as a person–family rather than an intrapsychic disorder, and the clinical symptomatology observed does not necessarily coincide with what is presented in DSM IV. Psychotherapy whose objective is to achieve a new intrapsychic order or self-actualization could escalate person–family conflict in which the client is ultimately the losing party. Treatment should address the main conflict (person–family) through family intervention that looks for new compromise and avoids challenging the authority of the family or threatening its structure. Mapping the family to identify and recruit its constructive members to effect change is a crucial process in therapy. It is also useful to detect and utilize contradictions within the client’s value system. Furthermore, employing imagination, metaphors, rituals, and mind–body techniques in therapy fit these clients who have a different concept of reality, and who describe their problems in metaphoric language. Unless psychologists in collective societies develop more indigenous personality theory that cater to the nature and needs of collective individuals, they will remain hostage to western personality theories whose efficacy have been shown to be questionable when applied in their societies.
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