Attitudes to disability

Disability is typically highly stigmatised in Asian countries with social inclusion uncommon. Disability is felt to bring shame to families because it disrupts Confucian principles in general, and in particular the principle of 'right order' of life. The concern for maintaining harmony in relationships, with nature, within the body, and the principle of reciprocity, also has direct impact on attitudes to disability.

The concept of 'right relationship' is critical to traditional Chinese (and Confucian heritage) culture. In families children are expected to obey and respect their parents (filial piety), elders and older siblings, and to reciprocate the gifts and services given them by their parents, during their lives and into the next life; parents rely on their children to look after them in their old age. Parents in turn are expected to set an example that provides the socialisation for morality in life, to provide a good education and assist their children to become 'proper' citizens. Being 'proper' is central to all social roles and it is believed that by family relationships being in the 'correct order', this ensures that the state will also be in order.

Within this context it is considered that a child with a disability is not able to become a 'right and proper person' and attain full membership in Chinese society. Disability disrupts the harmony in family relationships, in particular the parent-child order and the reciprocal nature of relationship. "Disability in children constitutes socially liminal states; these children and their families are neither legitimately sick nor well, neither alive nor dead within the context of disrupted and disordered lives" (Holroyd, 2003, p. 12). This attitude creates enormous challenges for children and adolescents to develop a healthy sense of self, achieve psychological milestones, and find meaning in their lives or a place in society.

The perceived disturbance of essential (Confucian) societal principles creates shame around disability for many Chinese and other Asian cultures. The whole family feels shame with the biggest burden carried by the head of the family, and blame by the mother, leaving the person with disability with guilt. The disturbance in harmony often results in conflict, and lack of acceptance for the person with disability. The ensuing attitude is evident in the terminology used traditionally, in Chinese - canfei, meaning handicap or useless, or canji meaning handicap and illness (Holroyd, 2003).

Mental health is the disability most strongly stigmatised and can result in people remaining concealed or sent away from the home. Exclusion from society is also in line with cultural values, and can also be understood as a protection and 'supervision' for those who fall outside of the norm. Learning or intellectual impairments are often confused with mental health issues and are equally as stigmatised with people maintaining social distance. Congenital disability, mental health or learning impairments are more likely to be seen to blemish the family heritage or reputation than an acquired or physical impairment, which is better accepted.

On the other hand, the principles of benevolence and compassion through Taoist and Buddhist values can result in considerable communal support and kindness.

Implications for practice

Confucianism, Taoism and Buddhism all contain within their doctrines, the principles of compassion, acceptance and harmony. Practitioners can draw on these to re-frame attitudes and for families to 'save face' by practicing cultural values. These doctrines can also be understood to encourage positive attitudes from those with disability to see challenge as an opportunity for character building (Confucian value) and to repay karmic debts (Buddhist value).

There is a reminder that whilst these values may be embedded in much of East Asian cultural practices and attitudes, not all people subscribe to the doctrines overtly, and many younger people may not relate to them at all. Reference to the doctrines may not always be appropriate; reference to the principles as cultural values may be more meaningful.

Other factors that affect attitude to disability mentioned in Sections I – III also apply here (gender, education levels, urban versus rural living, socio-economic status, generation group, as well as country of origin and levels of acculturation). These influence the degree to which people adhere to traditional values or incorporate contemporary ones.