Cultural Tensions in Occupational Therapy Practice: Considerations From a Japanese Vantage Point

Abstract

Culture not only assigns a name to occupation through its language, but it also shapes the form it takes and the meaning with which it is imbued. When an individual chooses an occupation, psychological and physical concerns as well as cultural practices, values, and beliefs come into play. Although occupational therapists are trained to be culturally competent, their grasp of the importance of cultural considerations can be enhanced through detailed accounts of the way in which such concerns affect clinical practice. In this paper, I describe in detail my observations of how differences between American and Japanese culture have created tensions in occupational therapy practice in Japan. Further, largely through a case presentation, I illustrate the necessity for incorporating in-depth cultural considerations as a central part of the occupational therapy process. I argue that the study of culture and the production of culture-specific occupational therapy theories will contribute to best practice. I conclude by demonstrating that universal as well as culture-specific theories are needed to nurture occupational therapy.

Hashi‐ire: Where occupation, chopsticks, and mental health intersect

“…175-176). Similar concerns have been voiced in the literature relating to culture (Bonder, Martin, & Miracle, 2004;Clark, Sato, & Iwama, 2000;Dickie, 2004;Iwama, 2003;Kondo, 2004;Yerxa, 1993). I too raised concerns like these when observing hashi-ire, wondering if these occupations were meaningful and sufficiently individualized.…”

“…Kondo (2004) has also described how, from her perspective, Western assumptions about the value of independence in selfcare occupations seemed "less important for the attainment of future goals than one's history, past experience with meaningful activities, the attitudes, life situations, and experiences of others with whom one interacted" (p. 175). In particular, she perceived independence as constituting "a mismatch in Japanese culture, in which so much decision making is appropriated to the social, familial, and occupational groups to which one belongs and with which one identifies" (pp.…”

“…Today I/we will also work hard." As T. Kondo (2004) wrote, "The attitudes of working hard and enduring hardship have been, and still are, appreciated more than working efficiently or working with pleasure" (p. 181).…”

“…To gaman is to endure pain and discomfort, resulting in what Dorinne Kondo (1990) referred to as "disciplined selves" (p. 76). To endure hard work has been said to be an ordinary experience imbued with virtue for many Japanese (Kondo, 1990;Kondo, 2004). To fully appreciate this process of emotional and physical endurance, however, it is necessary to reframe one' s thinking to see the process of gaman as virtuous rather than a sign of weakness, and it is necessary to see gaman and gambaru as ways of harmony and belonging, rather than slights to self and independence.…”

“…T. Kondo (2004) wrote about "working hard and enduring hardship" (p. 181) as something of virtue, and perhaps essential, to an exploration of occupation in the Japanese context. She used the terms, gambaru and gaman, denoting working hard and enduring, respectively.…”