Borderline Personality Traits in Japan in social transition

Japan in social transition

Japan is in social transition.  We have long been taught that Japan was largely “mono-culture” and “ethnically homogeneous.”  Social constructs such as Japanese, family, marriage, men, women, boys, girls, adults, citizen, students, were easily defined and expected to be largely the same, which in turn was believed to be the foundation of Japan’s strengths, uniqueness and identity as a country.  Changes and diversification of life styles and expansion of life choices, movement toward gender equity, as well as the increase of foreign residents in the past decades, however, forced Japanese to admit that  Japan is no longer so mono-culture as we might want to think. The existence of people who have different value systems and life choices are more and more evident in our daily life. 

 

Clinical Observations

Since January 2016, I have been seeing an average of 15 -20 clients per week in a private practice.  Ninety percent of my clients are not, or would not consider themselves  typical Japanese: foreign workers, foreign students, children born in the international union, Japanese married to foreigners, foreigners married to Japanese, Japanese who spent many years abroad, LGBTQ, Single parents, members of a blended family, people who cannot fit in the work environment, victims of various forms of harrassements and abuses, etc.  Most of them come to see me for depressive or anxious state and would not meet the criteria of borderline personality disorder.  I could see, howeer, many of them were struggling with uncontrollable anger outburst, complicated interpersonal relationships at work or in romantic relationship, chronic emptiness, and very fragile sense of self, which are the hall marks of borderline personality traits.  I wondered what was causing their struggle. 

Psychology of minority, culture and behavior adjustment

 

To bridge the two seemingly unrelated topics of emotional suffering among emerging minority groups in Japan and borderline personality traits, I sought theoretical frameworks that would provide insights.   

Stress-adaptation-growth dynamic

 

A professor of cross cultural communication, Dr. Young Yun Kim (2017) explains how characteristics of both individuals and host community play an important roll in cross cultural adaptation. Dr. Kim proposes that there is a transaction between the two parties just like Linehan (1993)’s biosocial theory.  Individuals openness, resilience and positivity are known to be the adaptation-friendly profile.  On the other hand, the level of host community conformity pressure negatively correlates with the individuals’ adaptation.  These pressures are often very subtle (Kim, 2017).  They will most likely be expressed as confusion at first. As the frustration of the host community increases over time, however, it could be expressed more explicitly as disapproval or stereotyping.  The author specifically points out that countries like Japan that is ethnically homogeneous and geographically isolated are less willing to accept non-conformity. 

In addition, Dr. Kim proposes, they experience a continuous adjustment of “draw back to leap” pattern when individuals are put into a new and unfamiliar enviornment.  It is to say, each stressful event will put individuals in regression stage, but at the same time it generates the energy to leap back.  My assumption was that individuals seek psychotherapy when they are in the "draw back" state, and this state often comes with emotion dysregulation. 

 

Microinvalidation: 

 

In 2007, Dr. Sue and colleagues proposed the existence of racial microagreesion in every day life in the USA. Racial microaggressions are everyday verbal, behavioral, or environmental humiliations that communicate negative racial slights that are often unintentional and unconscious.  The authors call microaggressions as modern and symbolic racism that are pervasive and automatic. Interestingly, Dr. Sue also proposed microinvalidations as a form of microaggressions. Microinvalidations are communications that negate or nullify the psychological thoughts, feelings, or experiential reality of a person of color. 

Just as Linehan (1993) proposed, microinvalidation proposed by Dr. Sue and his colleagues  defines its effect as telling people of color that their reaction to an event is out of proportion, that they are overreacting, and that they are the ones who manipulate the environment to make a non-issue a big issue. In these interactions, the recipient of a microinvalidation is left with the nagging question of whether it really happened, or it is only happening in his head (Spanierman & Heppener, 2004 cited in Sue et al., 2007).

 

To support newly emerging minority individuals in Japan

 

Taken together, the stress-adapt-growth dynamics and the microinvalidations theory seem to suggest that there is an overlap between the development of stress reaction among emerging minority individuals and the development of borderline personality traits (not disorder). Concretely, below are the hypotheses that I use as my rationale to use DBT to work with these individuals. 

  1. Emerging minority groups in Japan find themselves in the process similar to sress-adaptation-growth dynamics defined by Dr. Kim (2017), and they can experience  accute emotional dysregulation during the "draw back" state of the process.  

  2. Japanese society is experiencing “modern and symbolic” discrimination (Sue et al., 2007) towards newly emerging minority group with covert and unconscious, daily microinvalidations conveyed to the emerging minorities. 

  3. Japan’s conformist pressure (Kim, 2017) and microinvalidation (Sue et al., 2007) to the minority groups form social envirotnment similar to invalidating environment described by Linehan (1993) as the contributing factor to the development of high sensitivity to the stimuli, highly intensive reaction to the stimuli, and slow come back to the emotional base.  

  4. Individuals in the emerging minority groups in Japan, therefore, are susceptible to developing moderate borderline personality traits; especially relentless interpersonal conflicts, dissociative cognitive strategy, and self-invalidation. 

  5. DBT is effective to these group because it understands the transaction between the invalidating society and their newly developing identity, and provides concrete skills to navigate the stress-adaptation-growth dynamics.

To support Japanese society to embraces diversity

Japanese society will only diversity from now on.  Japan will be hosting more and more foreign workers and students.  Even among Japanese people, value differences and life choices will become more and more clear.  Japanese society needs to understand the meaning of social and demographic diversification from the majority-minority power relationship and develop clear awareness that there is a power dynamics that favor the majority.  Diversity sounds politically correct, but if taken lightly, both emerging minority groups and existing majority group can fall in a trap of unhappy co-existence without real integration.  My hope is that I use the model above to support Japanese communities to embrace diversity in real sense as the society goes through the transition.  

References 

Kim, Y. (2017). Cross Cultural Adaptation. J. Nussbaum (Ed.), Oxford Research Encyclopedia of Communication. New York, NY: Oxford University Press. DOI: 10.1093/acrefore/9780190228613.013.21

Linehan, M. (1993). Diagnosis and treatment of mental disorders. Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

Sue, D.W.et al. (2007). Racial Microaggressions in Everyday Life Implications for Clinical Practice. American Psychologist 62(4); 271-286. DOI: 10.1037/0003-066X.62.4.271

Takaki, M (2020, March). Dialectical Behavior Therapy – Its relevance for Japan in social transition.  Think Tokyo 2020. Symposium conducted at the meeting of The Asian Conference on Ethics, Religion & Philosophy (ACERP), Tokyo.