One size does not fit all

Recently, I traveled to Asia. Whenever I do this, I become even  more acutely aware of the cultural phenomena and how it may impact our perceptions and reactions in daily life. As a benign example, I attempted to buy some clothings during my travel. Unfortunately, I could not purchase many, as the sizes there did not fit me at all. This is quite an interesting encounter on many levels. First, being Asian, I assumed that somehow the sizes in Asia would fit me better than the sizes in USA. The sizes in USA tend to run too long or too loose for me, as the body proportions do not fit well. However, it turned out that, althought the length fitted, the width did not in Asia. Sizes there tended to run small. Not only did they run small in the particular country I visited, they also tend to run in only one size. For them, one size fits all. Unfortunately, it did not fit me. In the end, I bought some fabric to sew my own clothes with, which it turned out to be not unusual to do so in that country.

I brought up this example because it examplifies the assumptions we make through culture and its norms. In both USA and the country I visited, there were the cultural norms. In USA, there are nurmerical sizes from 0 to 14 (and more) or descriptive sizes of small to large (and more) that have standardized parameters. In the other country, there is only one size, and it was standardized to what the parameters are for most women in that country. I came to realize, and to qualify the standards in the country I visited, the parameter norms are for a specific demographic of women, namely the adolescent and young pre-motherhood women. Other women would have to make do with what I ended up doing, tailor-making their own attire. There is another option, which I did use, which was to purchase at shops that catered to tourists or foreigners, mainly to Caucasian travelers, as they tend to run a few sizes larger.

When we talk about norms, we leave out the exceptions or the “abnormal”. This leads me to wonder about what truly is “abnormal”. This question arises everytime when I meet with a client. Is this normal, or is this abnormal? Is this developmentally appropriate or is this medically symptomatic? The answer is not often clear. It is not clear because I see the person in a cultural context. What are his or her cultural norms, and where is he or she in the spectrum? There are more questions. In whose culture is the comparison being made? Is the person culturally congruent with how he or she identifies and how he or she expects to act? These are questions I ask myself and my client repeatedly as each new norm is named.

Nothing is more tricky than when conducting mental health assessments and utilizing therapeutic techniques. Many of the assessment,  and treatment research have not been very culturally-sensitive. In fact, many of the theories conceptualized have not been culturally-sensitive as well. If you would like more detailed analysis of them, please feel free to contact me through the contact form on the “About me” page on this blog. However, in consideration of brevity, I would not go into how these research have not been culturally competent.

The unfortunate part of all this is that we are using a “one size fits all” approach with these tools. It would be akin to my experience with purchasing clothings in USA and during my recent travel. Even with the variance in sizes in USA, they are still made in standard parameters that do not fit all within these dimensions. The size may be close enough but it would not fit well. There are some diagnostic and therapeutic tools out there that attempt to address the variance with set parameters but yet, this does not mean it fits perfectly.

Often, individual stories and challenges vary along with their differing contexts. It is not only social isolation or lack of supportive systems that make the person feel alone in their difficulties. It is because they are alone in the way each of their stories unfold. However, it does not mean what they experience can not be shared with or understood and empathized by others. The feelings experienced are universal. All human beings do share some basic make up as homo sapiens. It also certainly does not mean that the person is alone in their struggles to heal. There can always be room for another person to be supportive and helpful as there are plenty of persons out there who care about their coworker, neighbor, friend, family, or loved one, or those who simply have an altruistic calling.

Returning to the cultural aspects of the discussion, I wonder about the recent craze for “evidence-based” practices and “scientific” diagnostic tools. I believe there is a need for reliable and valid practices and tools, and that well researched tools can be most effective and ethical ways to help. However, the consumer, which also includes the therapist using these tools, have to be conscious of the fact that these labels are often tested on culturally limited research subjects. Most importantly, even with any attempts to have more representative research subjects, the very method of research is sanctioned by a certain cultural parameter of logic. Most psychological research is done in the vacuum of the contexts that many people who suffer mental health issues come with. Logically, this is to  identify whether the topic under study is truly a factor in the relationships of the outcomes. If there are other factors, it would be difficult to make this inference. However, this is the very vaccum that disregards not only the cultural reality of the persons, but also the interrelatedness and non-linear nature of socio-psychological problems. This becomes a challenge when ideas tested in vacuum gets applied to complicated real life situations.

With all this academic like talk of research, what does this mean? It just means, as consumers of research, we have to be our own tailors. Use the fabric given and use your own parameters so you can wear it well. Or you can even purchase the suits, but make sure to mend them so they fit well. This is very much more so with diagnoses. There are many schools of psychological thought, and many more therapeutic techniques to use, that they at least have some variance to accommodate diversity. They are in the mode of “USA sizes of clothing”. However, the diagnostic measures happen to be only in the “One Size Fits All” mode, and this is where “proceed with caution” placards should be posted in all directions.

As an endnote, I want to reiterate that I do think we have to be objective and scientific in the field of psychology and psychotherapy. This is how we, as therapist, can be most ethical and effective, by making sure how we think and what we use as tools are truly valid and reliable for our clients. But I also believe there is another framework for science, and I will discuss this in my next blog article. Stay tuned.


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