Revealing difficulties of people with roots outside Japan subjected to unfair treatment

We live with people of diverse identities and social backgrounds. They are of different ages and genders, some have foreign roots, and others have various physical or mental abilities. While it would be ideal if we all could understand each other and cooperate, the reality is that it does not work that way. People of specific identities and backgrounds are stereotyped, devalued, and marginalized; in other words, they are relegated to the margins of society. Since every person has more than one identity, they may have multiple reasons to feel oppressed, such as being elderly, a sexual minority, and a foreigner at the same time. Can a person really remain healthy when placed in such a difficult position? Hanako Suzuki, Associate Professor specializing in counseling psychology at the College of Comprehensive Psychology at Ritsumeikan University, has been researching people who tend to get marginalized due to their social background, through questionnaires and interviews to find out the kind of difficulties they face and how these difficulties affect their mental health.

"We are currently working on two main themes: first, the mental health of people with roots outside Japan currently living in the country," introduces Suzuki. "They are often subjected to unfair, if not discriminatory, treatment, such as being treated less courteously than others or not being entrusted with more responsible tasks. However, there are relatively few scientific reports on these issues in Japan compared to other countries." For example, in the U.S., people are discriminated against their skin color, and mental health studies have been conducted on them. In Japan, there are many people who are considered minority in the society, such as Zainichi Korean and LGBTQ folks. And those who do not have visible differences, for instance in their skin color, are not always likely to be treated fairly in Japan. Their difficulties may simply be overlooked, and in that case, society must be made aware of them.

To ascertain the reality of people with diverse backgrounds, Suzuki first conducted a questionnaire survey of approximately 40 people, including university personnel and those introduced by international associations, who have foreign roots and are distinguishable by their skin color and other characteristics. In addition to whether they had experienced any unfair treatment, they were asked to report their gender and ethnic identity, as well as a self-evaluation of their own mental health, so that a composite consideration could be made not only using their ethnicity but also through an assessment of multiple identities. According to Suzuki, the survey is still being compiled, but some respondents indicated that they were treated unfairly 'more than once a week.' And those who answered 'several times a month or more' accounted for more than 25% of the total respondents.

Suzuki explains that such research on the mental health of people of various identities, including those with indigenous backgrounds, has been ongoing in the U.S., Australia, and New Zealand. In particular, one of the problems to be addressed in New Zealand has been that the Māori people could not easily access higher education due to sociohistorical factors, which resulted in perpetuation of poverty. In Japan, however, the research has just begun, and Suzuki underlines the importance of taking sociocultural context into consideration while conducting and interpreting psychological research. One reason for this is that people of specific identities—for example, Black Americans in the U.S. and Zainichi Koreans in Japan—have settled in the respective countries from very different backgrounds. Also, the sociohistorical structure of the two countries is very different. This makes it difficult to apply prior research in other countries directly to Japan.

Suzuki points out another reason. Many Japanese believe in a so-called 'myth' that they are a mono-ethnic, monolingual, and mono-cultural people. "When I tell others that my research targets people with multicultural backgrounds, they assume that I am doing research on international students or dismiss it as niche research. Even if they acknowledge its necessity, it is only because the number of residents with international backgrounds in Japan is increasing, and there has not been much research on them. However, regarding it as an example of the differences in identity and backgrounds between counselors and clients, I think that this topic can be applied to a wide range of subjects," says Suzuki.

Secrets of supporting people with visual impairment to live positive

The second theme that Suzuki is currently working on is the mental health of people with disabilities, especially those with visual impairment and low vision. People with low vision are not totally blind but have visual impairment that cannot be corrected by eyeglasses or surgeries, which interferes with their daily lives. Suzuki was invited to join a team of ophthalmologists and medical staff, who provide medical treatment and care, to conduct research on the well-being of such people. To her surprise, little research has been published on the mental health of individuals with low vision. According to the Japan Ophthalmologists Association, as of 2009, 1.64 million people in Japan are visually impaired, of which 1.45 million have low vision, and the number is expected to increase further in its aging society.

Few people can easily accept their visual impairment, especially when they are told that they may go blind in the future, as most of us hugely rely on vision in our daily lives. It is perceived that there is little that doctors can do after making a diagnosis, and patient care still lacks a standardized process and relies on the experience of frontline staff. They report that some people still manage to enjoy their daily lives in a cheerful and energetical manner. "How can they manage to stay positive despite their potentially despairing difficulties?" questions Suzuki.

The team plans to interview people who use low-vision care facilities and ask them to rate their satisfaction with life from the time of diagnosis to the present. They will be asked to give a low score for a point of their life when they were highly dissatisfied and a high score when they were satisfied, and to recall what they went through during times for which their scores are particularly low or high. And what influenced their ways of life and thinking then: personality, family, work, or other factors?

However, the team faced difficulties in defining inclusion criteria of well-being for people with visual impairment to participate in this study. "When people have disabilities, many of them might answer 'no' to a question which simply asks them if their well-being is high. When conducting this kind of survey in the West, we may tell the subject to imagine an 11-point ladder from 0 to 10 and ask them to point out the rung of the ladder they were standing on at each milestone in their life. However, as people in East Asia tend to value the balance between the good and the bad, the ladder metaphor may not be appropriate to make an evaluation of well-being," explains Suzuki. Therefore, the team decided to have the participants evaluate whether they were 'doing what they had hoped to do.' This is a quantifiable but relative evaluation. For a person who previously had difficulty getting out of the house, for example, 'being able to get out' would be equivalent to doing what they had wanted to do. For those who are still in the process of facing their impairment, it may be too tough to imagine what they would like to do at the moment. Although this research is still in its planning stage and awaiting to be approved by the Committee on Research Ethics at the University, it is expected to reveal not only when a participant felt a sense of accomplishment but also when they felt like they could not do what they wanted to do and the dissatisfaction they experienced at that time. The results will be added to a body of scientific literature to create a manual for medical staff that describes when and what kind of support should be provided to increase recipients' satisfaction level.

Incorporating cultural and social contexts into psychology framework

In working on mental health research of people with diverse backgrounds, Suzuki says that she cannot help but be aware of the importance of the context in which psychological studies are carried out—; for instance, non-Western psychology may be quite different from Western-derived psychology. Simply translating English terms such as well-being, diversity, and inclusion to Japanese may fail to convey the meaning of these terms in the Japanese social context and cultural mindset. This awareness has led her to conduct a summer school not only with Japanese students but also with graduate students from overseas to understand how to translate psychological terms considering their cultural meanings. In addition, as an executive board member of the Japanese Psychological Association, she called for creating 'Guidelines for Respecting Diversity in Psychology' for members to be aware of and consider diversity in psychological research, education, and clinical practice in Japan. The first edition was released in March 2023 after public comment in the Association.

Although it is not easy for people with power to change their behaviors and mindsets and to share their privileges, it is indispensable for resolving many international and social problems of our time, especially when we know that people of specific identities are marginalized in society, or when we know that accepted standards and definitions in science tend to be determined by specific countries. Suzuki asserts, "We need to think of social structures that affect people who are often marginalized. Also, we need to be mindful of the framework of psychology that has developed mainly in the West, examine the ways in which it is appropriate to different cultures and sense of values, and reintegrate it, taking care not to destroy their uniqueness." Only then can psychology truly contribute to mutual understanding among various people across the world.