Core cultural values based on Confucian ideals are important to note in order to effectively provide care to Vietnamese older adults. Confucian ideals emphasize filial piety, loyalty, social harmony and hierarchical order. Unlike American culture, Vietnamese culture values interdependence of an individual within the family and the group (Timberlake & Cook, 1984; Jamieson, 1993; Shon & Ja, 1982) to promote harmony and order. There is less emphasis on individuality and more on social unity.
Each family member adheres to a specific hierarchical role. For example, a son or daughter is expected to show utmost respect and love to his or her older adults as well as demonstrate his or her filial piety unquestionably. This is a key reason why nursing home or other institutional placement may be viewed negatively by the Vietnamese community. Institutionalized care is thought to be particularly offensive to Vietnamese older adults who may expect to be cared for in their old age in a home setting by their family. However, with the widening of the generational gap between Vietnamese older adult immigrants and younger U.S. born Vietnamese, there is conflict on how to care for their older adults while still maintaining filial piety towards their older adults.
Traditional beliefs in Vietnamese culture regarding shame and guilt are also important to understanding how Vietnamese older adults report symptoms. Since the Vietnamese culture is oriented towards the family and the group, the individual is thought to represents the family as a whole. Thus, if an individual loses respect or status in the community, the whole family “loses face” too. The individual and the whole family feel shame and guilt because of the decline in social status. This concept of “loss of face” may be why some Vietnamese older adults and their families are reluctant to report distressing symptoms (Tran et al, 2006). They are vulnerable to the stigma of chronic and severe mental illness and so their fear of losing face and embarrassing the family can be stigmatizing for Vietnamese older adults.
Another important belief and practice in Vietnamese culture is Eastern medicine or oriental medicine (Thuốc Đong Y), which incorporates traditional Chinese and Vietnamese medicine (Thai, 2003). Western medicine views the body and mind as dual components whereas Eastern medicine views the body and mind as unified components. Thus the mind can affect the body and vice versa. In Eastern medicine, emphasis is also placed on balance of the yin and the yang, or the hot and the cold. This balance refers to the internal structures of the body. To stay healthy, one must maintain this balance by controlling inner mental and physical states. For example, self control of emotions, thoughts, behavior, diet and food and medication intake are all important in maintaining health and balance. Excess eating or worrying can lead to an imbalance of excess “heat,” thus resulting in mental and physical illness.
Traditional Vietnamese older adults also hold complex spiritual and religious views. Folk religion, Confucianism, Buddhism, Taoism and Catholicism are all important traditions of Vietnamese culture. (Ho Tai, 1985) It is not uncommon for Vietnamese older adults to draw upon several traditions. For example, a Vietnamese-Catholic may also practice Buddhist concepts such as ancestor worship, fate, perseverance and enduring suffering. Another complex religious belief is spiritual possession, which stems from folk religion, ancestor worship and Taoism. For instance, in a documented case by Yeo and colleagues (2001), a Vietnamese man believed that his demented wife was “possessed” by spirits and only the extraction of these spirits would heal her.