Irish Americans: Cultural Implications In
Psychotherapy Treatment
Elizabeth Mathews
Loma Linda University

Table of Content
Introduction…………………………………………………………………………………………………………..……… 3
Background………………………………………………………………………………………………………..…………. 3 Culture.………………..………………………………………………………………………………...…………….3 Historical………………………………………………………………………………………………..………….. 4
Characteristics.………………………………………………………………………………......…………………………. 4 Language. ………………………………………………………………...………………………………………….4 Oppression………………………………………………………………………………………………….……….5 Alcohol…………...…………………………………………………………………………………………..……….5
Depression and Suicide…………………………………………………………………………………………...………6 Northern Ireland………………………………………………………………………………………..……….. 6 Depression and Cultural Impact………………………………………………………………….……….. 7 Suicide and Cultural Change…………………………………………………………………………………8
Family Structure….………………………………………………………………………………………………………. 10 Women/Mothers ……………………………………………………………………………………………….11 Men/Fathers….…………………………………………………………………………………………………..11 Children………….…………………………………………………………………………………………………12
In Therapy……………………………………………………………………………………………………………………12
Conclusion……………………………………………………………………………………………………………………13
References……………………………………………………………………………………………………………………15

There are assumptions and stereotypes surrounding every cultural group in the world; some are true and some are far from accurate. These assumptions and stereotypes provide a lens through which one experiences people they come into contact with. However, most people have established their belief about a certain group based upon media and hearsay. This can fog the lens through which one experiences people and minimize their ability to experience them fully. In the field of behavioral heath, one will inevitably encounter and work closely with people from different cultural backgrounds and the clearer the lens, the better. In order to clean this lens, one must first learn the current truths about a cultural group through asking questions, studying history, and reading current research. The Irish diaspora to the United States was one of the largest in history. In the United States alone, it is estimated that 44 million people claim Irish heritage, one of the largest cultural influences in the country (Gilfoyle, 2004 p. 1). In this paper I will discuss the Irish culture (in Ireland and in the United States), their history and religion, the way in which that impacts the family structure, and the challenges one may face in a therapeutic setting.
Background
The Irish culture is one built on strength and resilience. They are dreamers who are willing to put in the hard work to make those dreams a reality. For hundreds of years the British dominated the country of Ireland. The Irish people experienced great exploitation and much heartbreak in the conflict ridden years that followed. To this day, the country of Northern Ireland remains under British control, continuing the Irish struggle for independence. McGoldrick (2005) describes the Irish people as fierce and rebellious with an immense “courage to survive” (p. 595). They are humorous and charming, yet drawn to tragedy. “Although always joking, they seem to struggle continuously against loneliness, depression, and silence, believing intensely that life will break your heart one day” (McGoldrick, 2005, p. 595). The are known as being fighters, yet also experience a sense of helplessness and take profound responsibility for any wrongs in their life. They struggle with true vulnerability, resulting in a lack of intimacy for a fear of being judged. Many of these attributes align with the religious foundation that has steered the history of Ireland. Catholic versus Protestant is gross oversimplification of the civil unrest in Ireland; however, it does lay a foundation for understanding some of the attributes that Irish people maintain. One can simplify that Catholic values were synonymous with Irish and Protestant values were synonymous with British loyalists. The British put in place a set of Penal Laws that insured that the Irish could not own land, have the right to vote, or attend schooling. The British had complete control over the crops, resulting in extreme Irish poverty. McGoldrick (2005) states that this resulted in the 19th century huge Irish migration to the United States not in search of wealth, but as British exiles (p. 598). In the conflict, religion was tide tightly to freedom and independence. The Irish view church over everything, even family, creating normality in fighting to defend politics and religion. However, “today Catholicism no longer reigns as the core of their national or cultural identity (McCaffery, 2000, p. 17).
Characteristics
Some defining Irish characteristics have acted as a defense against years of oppression and conflict. Although through migration, marriage, and generations some characteristics have adapted, many of them remain intact and present in the Irish culture from Ireland to the United States. The first of these is their use of language. According to McGoldrick (2005) “The Irish way with words has always been their greatest natural resource, yet, paradoxically, they often are unable to express their inner emotions” (p. 598). Through words, weather spoken, sung, or written, the Irish have passed down their history in a beautiful and poetic way. “For 2,000 years the poet has been the most highly valued member of Irish society, wit its greatest art form, and satire its most penetrating mode of attack” (McGoldrick, 2005, p. 598). Similarly, authors like James Joyce played a significant role in revealing the tragedy the conflict in Ireland entailed. It is important in therapy to remember that their lack of conversation about emotions may not be due to resistance, but rather an internal blocking of emotions (McGoldrick, 2005, p. 598). For many years through the conflict, dealing directly with emotions and feelings would have resulted in further heartbreak, resulting in those being submerged. Similarly, the use of humor is a resource used to deal with pain in the Irish culture. McGoldrick (2005) found that “It offers a primary avenue for expression of forbidden feelings and allows for sharing of misfortune, and its indirectness softens the sting of attack” (p. 599). This humor has been used to both unite and distance in relationships, either to join or to guard against pain. Another characteristic of Irish surrounds their relationship with alcohol. According to McGoldrick, (2005) alcohol is considered “a good man’s weakness” (p. 600). It is rare to find a family in Ireland or Irish Americans who has not been impacted by alcohol abuse. They have used alcohol as a way to alter their current reality. McGoldrick (2005) states that “It dulls the pain, keeps out the cold, cures the fever, eases the grief, enlivens the celebration, allows the Irish all manner of expression, and even cures a hangover” (p. 600). For a country so consumed by conflict and heartache, the use of alcohol became a form of escape. This focus on alcohol made the pub a central location of Irish life. McGoldrick (2005) cautions therapists to thoroughly take into account the history of alcohol use in a family. Because heavy drinking may not be labeled as a problem within a family, it is important to be aware of the use (p. 601). When an Irish person is suffering from a disease such as alcoholism or depression they are unlikely to seek help because due to shame and guilt.
Depression and Suicide in Northern Ireland
“The Irish sense of individual shame and guilt often leads them to assume that their suffering is deserved” (McGoldrick, 2005, p. 601). The Irish tend to minimize whatever pain they may be experiencing both physically and psychologically. Ongoing issues in Northern Ireland have led to increased attention and research about the likelihood of depression and suicidal ideations due to violence and civil unrest. In Northern Ireland there has been a political, religious, and civil conflict prevailing for many years called ‘the Troubles’ (Mahedy, Todaro-Luck, Bunting, Murphy, & Kirby 2012). It has resulted in immense civil unrest and social disturbances, many being traumatic, violent, and impacting community interactions (Mahedy et al., 2012). Mahedy et al. (2012) found that resulting from the ongoing breakdown and segregation of the community there has been a dramatic impact on the psychological wellbeing and mental health of those exposed. This backdrop of civil unrest has resulted in mental health disorders in Northern Ireland, according to Bunting, Murphy, O’Neil, & Ferry (2012), being highly prevalent with 23.1% of the population meeting criteria for a DSM IV depressive 12-month disorder (p. 84). Cutclifee, McKenna, Keeney, Stevenson, & Jordan (2013) found that “Exposure (to violence in their community) was associated with higher levels of depression” (p. 635). Although the daily violence has decreased in recent years, the “social and psychological legacy of ‘the Troubles’ may pass into post-conflict generations” (McAloney, McCrystal, Percy, & McCartan 2009 p. 635). Ongoing civil unrest has aided in shaping the culture of Northern Ireland and has resulted in heightened number of depressive disorders (McAloney et al. 2009). In addition, according to Cutclifee et al. (2013) the rising trends of suicide are “particularly pronounced in Northern Ireland” (p. 466).
Depression and Cultural Impact
Bunting et al. (2012) found in a study of mental health disorders in Northern Ireland that 19% of the population showed signs of mental health disorders, 11.5% of the population were on prescribed medication for mood disorders, and of those the most prevalent disorder was major depressive disorder at 7.9% (p. 84). Traumatic events throughout ones life can directly result in long-lasting repercussions on a person’s psychological wellbeing (McAloney et al. 2009). McAloney et al. (2009) found that there are “higher levels of depressive symptoms among adolescents with greater exposure to community violence” (p. 635). Findings show that 77% of young people in Belfast, Northern Irelands capital city, have in fact experienced some sort of community violence in their lifetime and 64% have experienced at least one violent event in the last 12 months (McAloney et al. 2009 p. 640). Most people in the world, including those in the United States, are indeed exposed to violence and the stress created by that throughout their life. Some trauma is almost always inevitable. However, the degree of that violence is what has changed the culture of Northern Ireland. McAloney et al. (2009) states that a normative outlook toward violence based on it being an “integral part of daily life over the decades of ‘the Troubles’” has created a “relaxed” justification of sectarian violence (p. 644).
According to Mahedy et al. (2012), financial difficulties or Socio-Economic Standing (SES) is one of the trends leading to distress in community members. Their (Mahedy et al. 2012) findings show that 43% of youth coming from low SES reported greater emotional distress. The country of Northern Ireland continues to be primarily segregated by sectarian unrest. Schools are put into two categories, Catholic or State maintained (McAloney et al. 2009). Those attending Catholic maintained schools tend to be Catholic and those attending State schools tend to be Protestant. McAloney et al. (2009) findings show low SES, based on participants receiving free school meals, has been found to be more prevalent in Catholic maintained schools. Simultaneously, the exposure to violence is specifically high in those attending Catholic maintained schools. Mahedy et al. (2012) found that high exposure to violence and financial insecurity are stresses that are linked to the higher number of depressive symptoms in youth in Northern Ireland than in other regions of the UK.
Suicide and Cultural Changes
According to O’Neill et al. (2014) , 90% of people who die from suicide also have a mental disorder (p. 1). As stated above, Northern Ireland shows very high rates of mental disorders, specifically depressive disorders. Many of these mental disorders are linked to the violence and turmoil created by ‘the Troubles’. There are many sources of trauma (rape, death, disease), not all relating to the conflict. However, O’Neil et al. (2014) found that the related trauma to the conflict is 39% of the total trauma in Northern Ireland (p. 1). In addition, O’Neil et al. (2014) found that self-harm demonstrated in the population of Northern Ireland as a coping strategy links directly to the magnitude of conflict related trauma. One being directly involved in ‘troubles’ event like “an explosion, or riot, being a victim of violence or having a relative, friend or someone known to them killed or injured” (O’Neil et al. 2009 p. 4) significantly increases the change of self-harm or likelihood of suicidal ideations. O’Neil et al. (2014) found that the ideation of suicide in those with mood disorders is 30.2% stating “this is not surprising given the associations between conflict related trauma and DSM mental disorders in Northern Ireland” (p. 3).
The conflict is becoming considerably less violent due to a treaty signed between opposing sides. However, this conflict has been prevalent for hundreds of year and spanning many generations. The cease-fire currently in place has significantly decreased daily violence, but the impact on living generations remains large. Even with the decrease of violence, Cutclifee et al. (2013) findings show that there is continuous increase in suicide in the men of Northern Ireland between the ages of 18-35 years of age. According to Cutclifee et al. (2013) the participants in the study of suicide ideations in men “talked variously about their sense of discontent, upset, frustration, even anger at what they perceived to be their relative lack of ‘worth’ or ‘success’ in life.” (p. 470). This lack of purpose could be linked directly to the slow but important changing of this conflict from physical to political. Current generations are dealing with the transition, both romanticizing and condemning past behavior. Terrorist acts are still seen as acts of heroism displayed in murals, newspapers, and history books. McAloney et al. (2009) found “that the passing down of information about specific acts of violence has been common among families and communities to justify the continuation of sectarian violence” (p. 644).
In one community hundreds of young men went to prison which had a profound effect on family life and on the community, which also sustained a high number of conflict-related deaths and injuries, resulting in parental depression and often alcoholism. It has been suggested that, in seeing their parents self-medicate with tranquilizers children have inherited the trauma of their parents (McAlister 2009)
A continuous cycle of mental disorders and “normalizing” of such violence continues to impact generations (McAloney et al. 2009). Lack of worth, specifically in men 18-35, may be linked directly to “misconception of what it was to be a ‘real man’ in Northern Ireland” (Cutclifee et al. 2013 p. 470). According to Cutclifee et al. (2013) testimonials men of Northern Ireland do not seek out help about depressive symptoms or suicidal ideation but “solve their problems on their own, and do not show their feelings” (p. 470), as demonstrated in the above quotation. Cultural changes in violence no longer being as readily accepted as a form of expression of ones political or religious beliefs, although good, seems to be impacting current generations outlook on themselves and may be impacting the their social, emotional, and psychological health.
Civil unrest and social disturbances have shaped the culture of Northern Ireland for hundreds of years. Effects of this on the community and on the personal level are evident as risk factors for psychological distress (Mahedy et al. 2012). The amount of and normalization of violent acts in this country have put youth at a risk of a higher level of depressive disorders (McAloney et al. 2009). Since the cease-fire violent acts, especially public ones have decreased. However, it is still impacting three quarters of adolescents in Northern Ireland and the level of the prevalence of such violence depends on which side of the conflict you belong to (McAloney et al. 2009). This directly correlates with school and social segregation, in addition to SES (Mahedy et al. 2012). The increasing trend of suicide in Northern Ireland correlates with the amount of ‘conflict’ trauma one experiences (O’Neil et al. 2014). Although the physical violence has decreased in this generation, the lasting effects of families condoning retaliation to violent acts with violence remains multigenerational (McAloney et al. 2009) and shows to be the source of depressive symptoms and suicidal thoughts in men ages 18-35 (Cutclifee et al. 2013). The culture of Northern Ireland, previously based on civil violence, is changing, but is still in the midst of much civil unrest. Depressive disorders and patterns of suicide in this country are an insight into the cultural impact generations of violence and trauma can have on a civilization and how it continues to impact mental disorders in the community (O’Neil et al. 2014).
Family Structure
Gender roles in Ireland tend to differ from other European countries. Traditionally, women have held an extremely important and powerful role in the family system. McGoldrick (2005) found that specifically unique to Irish culture is the ability for women to be respected and maintain a role in society without being married. “There has long been a respected role for the unmarried ‘Auntie Mame,’ the feisty, independent, funny, and important contributor to family well-being” (p. 601). Women tend to be independent; shown through the fact that during the emigration to the United States, more women than men migrated (McGoldrick, 2005, p. 601). Women also tend to be seen as the family authority figure, seemingly linked to the male avoidance and need to be taken care of. While mothers are thought of as being “morally superior” to men, they are also expected to be “silent and strong while still being obedient “ (McGoldrick, 2005, p. 602). While men typically turned to drinking, women were expected to hold the family together. The relationship between mother and son tend to be the strongest and most lasting in the Irish family (McGoldrick, 2005, p. 602). Sons tend to be low functioning outside of the family, and only move on when married and able to be taken care of by a wife. It is important to not blame a mother for her family’s tribulations because they take on enough responsibility and blame already. Traditionally, fathers in Irish families tend to be distant and absent (McGoldrick, 2005, p. 602). In Ireland, due to the constant civil conflict, men spent much of their time involved in the community outside of the home which solidified their role outside of the family. This also increased their role in pubs, leaving the wife to handle the familial struggles. However, in the United States, men were given more opportunity for success. McGoldrick (2005) refers to their opportunities as the 3 P’s Police, Pubs, and Politics, where they quickly excelled into lawyers, FBI agents, and business owners (p. 602). This provided Irish men the ability to be more present and involved in their family if they so desired. In relationships, men tend to deal with issues through avoidance of their partner. They are seen as being humorous and often the life of the party, while “his wife and children feared his underlying anger and found him hard to get close to” (McGoldrick, 2005, p. 602). Relationally, Irish men and women tend to be emotionally distant and apt to avoid intimacy. Due to over 900 years of oppression in Irish history, men had a diminished sense of power; resulting in a matriarchal system. Because of their admiration for their mother, Irish children tend to keep themselves in line (McGoldrick, 2005, p. 603). Irish homes tend to be strict and well disciplined; yet can include harshness if alcohol is involved. Again, alcohol use is something to be highly assessed for in therapy. Irish families do not depend on their extended family for emotional support, however they are very clannish and will choose family bonds over most (McGoldrick, 2005, p. 605). Because of their lack of emotional openness with loved ones, resentment can often build up that keeps a family separated (McGoldrick, 2005, p. 604). Families also tend to not burden their extended family with problems, this coupled with an immense respect for personal boundaries and privacy, may lead to emotional distance. However, a strong sense of familial loyalty always remains.
Irish Americans In Therapy
McGoldrick (2005) found that Irish Americans tend to think of therapy like they would confession, “in which you tell your sins and seek forgiveness” (p. 608). It is because of this that they will most likely take a one down position to the therapist, seeking authority advice instead of asserting their own opinion. “Their basic belief is that problems are a private matter between themselves and God” (McGoldrick, 2005, p. 608). It is because of this belief that they tend to feel embarrassed expressing their feelings, preferring to deal with it alone. Letting family members know about a problem they are having tends to be the most embarrassing and thus the most difficult for Irish Americans. Although they are not likely to report a problem, they are very likely to acknowledge that there is an issue and willing to work on it. However, McGoldrick (2005) found that “given their traditionally low expectations for happiness in this life, they may also not expect that much change is possible” (p. 608). In therapy, focusing on the problem presented by the client, for example Bowen therapy, tends to be the most impactful because it is the least invasive and threatening (McGoldrick, 2005, p. 608). This is a way to maintain the clients privacy while still addressing familial issues. Requiring a large family therapy session may result in high anxiety and drama that may not be beneficially. Because they look to therapists as an authority figure, therapy that has a specific plan and a “right and wrong way clearly spelled out” will likely be the most successful, as opposed to vague and open-ended (McGoldrick, 2005, p. 609). Humor is also an aspect of therapy that may be beneficial when dealing with Irish Americans, providing focus on positive feelings and hope. In therapy, therapists may need to focus on the unsaid instead of the said, reading between the lines, to figure out what is really bothering the client. This can be frustrating but therapy with Irish Americans can be gratifying as well. Even with their discomfort with therapy, they tend to be willing to work and follow through with their goals. Instead of dealing with family interactions directly in therapy, because of their sense of privacy and fear of being disloyal, it may be more valuable to give the client tasks to do at home to deal with their communication problems (McGoldrick, 2005, p. 610). McGoldrick (2005) found that Bowen therapy may be the most valuable “because of its emphasis on working out relationships in private, and on personal responsibility for change” (p. 611).
Conclusion
The Irish people are extremely multifaceted. They have endured extreme amounts of heartbreak and have continued to overcome. Because of the legacy of conflict in Ireland, and continuing in Northern Ireland, there are heighted levels of depression, specifically in males. However, they are becoming more prone to seeking out help and desire change surrounding the expectancy of violence turmoil. They are strong and resilient people who are capable of therapeutic change, although not comfortable moving beyond the clients perception of the problem. Forcing therapy and familial change is not a good idea, based on their historical background of repression and shame, “it is better to reinforce the changes that the family members do make and to let them return for therapy later at their own initiative” (McGoldrick, 2005, p. 612). Focusing on their strengths and personal resources may be the best approach. McGoldrick (2005) found that “their deep sense of personal responsibility is, in fact, their greatest personal resource in therapy” (p. 612). Understanding this innate responsibility and embarrassment of problems will help therapists to direct therapy in a beneficial way for Irish and Irish Americans.

References
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