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Culture and Social Psychology
Social psychologists increasingly have appreciated the influence of culture on psychological functioning (Fiske et al., 1998; Kim and Berry, 1993; Moghaddam et al., 1993; Matsumoto, 2001). Consistent with this trend, Fiske and colleagues (1998) have pro-posed a mutual constitution of psychological and cultural life. Specifically, these investigators suggest that culture influences psychological functioning which in turn can change cultural ex-pressions. They further argue that although the human tendency to form cultures sprang from evolutionary processes, culture, in turn, has exerted an influence on the subsequent course of evolution.
Myriad definitions of culture have been proposed by social scientists across a range of disciplines. Culture can be defined as a collective organization of behaviors, ideas, attitudes, values, beliefs and customs shared by a group of people, and socially transmitted across generations through language and/or other modes of communication. As this definition suggests, cultural processes are of core importance to individual psychological functioning, as they influence the cognitive, affective and behav-ioral aspects of a range of personal and social activities. Factors that influence the manner in which cultural patterns are mani-fested in interpersonal relationships include gender, ethnicity, race, socioeconomic status, educational background, neighbor-hood and geographic region of residence, country of origin, transmigration patterns, religious and political affiliations, and stage in the life-cycle.
Social psychological researchers have emphasized the importance of distinguishing culture-specific from universal
psychological findings (Triandis, 1997). This is illustrated by the conceptual distinction between emics (findings that differ across cultures and suggest culture-specific psychological principles) and etics (findings that apply across cultures and suggest universal psychological principles) (Matsumoto, 1994). Given cultural in-fluences on psychological phenomena, a cross-cultural approach is presumed to be essential for the articulation of universal prin-ciples (Moghaddam et al., 1993). Theorists and researchers who take a cultural perspective have argued persuasively that many findings from social psychological research in the USA reflect specific cultural dynamics and are not necessarily universally ap-plicable (Moghaddam et al., 1993; Triandis, 1997). Culture influ-ences the understanding of self, social cognition, relationships and group behavior (Table 17.12).
Culture affects definitions and causal explanations of health and illness, as well as the nature and quality of help-seeking behavior (Kazarian and Evans, 2001; MacLachlan, 1997). Given that one’s ethnomedical system influences one’s involvement in the health care system as either patient or health professional, it is essential to inquire about the patient’s “explanatory models” of health and illness and to be cognizant of the match between the doctor’s and patient’s world view vis-à-vis illness and its treatment (Kleinman, 1988). Further, it behoves health providers and patients to acknowledge that medicine as practiced in hospitals forms a subculture consisting of specific values, beliefs, and practices (i.e., the culture of medicine). In this regard, interactions between patients and health care providers can be viewed as cross-cultural communications, with all participants working to comprehend one another’s world views.
Recent work emphasizing the understanding of psychological functioning from a cultural perspective has led mental health practitioners to recognize culture as central to the conceptualization, assessment, and treatment of clinically significant emotional and behavioral problems (Gopaul-McNicol and Armour-Thomas, 2002; Kleinman, 1988; Tseng 2001; Tseng and Streltzer, 2001). A cultural perspective has important implications for defining and conceptualizing normal and abnormal behavior, with some arguing that dichotomizing behavior as either normal or abnormal reflects historically Western scientific cultural constructions (Foulks, 1991). A cultural perspective is also important for developing and implementing culturally sensitive interventions. There is considerable evidence to suggest that culture influences many of the psychological and social variables typically associated with psychological development, including child-rearing practices and customs, constellation and structure of family life, communication and emotional expression, social support networks, frequency and quality of life stress, the ways in which difficulties are defined and managed, and values regarding help-seeking behavior for emotional distress (Foulks, 1991). As cultural differences across these domains vary, manifestations of psychological and personality dysfunction also will differ (Foulks, 1991). This particularly isapplicable to disorders that are thought to derive more from social and environmental influences than from biological factors.
Implicit in Western models of psychiatric nosology are a number of culture-bound assumptions regarding mental health and psychiatric disorder. Examples of North American culture-bound biases articulated by Lewis-Fernandez and Kleinman (1994) include: 1) an emphasis on individuality and autonomy (egocentric view of self) as opposed to a more interdependent emphasis (sociocentric view of self); 2) a view that psychopatho-logical conditions have either an organic or a psychological etiol-ogy but not both simultaneously (mind–body dualism versus a more integrated somatopsychological view); and 3) an assump-tion that cultural effects on psychological functioning are epiphe-nomena underneath which can be found a universally knowable biological reality. The tendency to organize one’s understanding of behavior according to these biases must be monitored care-fully in work with patients. Further, clinicians and researchers need to contextualize behavior and experience, and use relevant cultural norms to understand behavioral difficulties and their adaptive value (Lewis-Fernandez and Kleinman, 1994).
The importance of cultural considerations in psychiat-ric diagnosis has increasingly been recognized (Mezzich et al., 1996). Cross-cultural social scientists have investigated psychiat-ric epidemiology in different cultures, with particular attention to schizophrenia spectrum disorders and mood disorders. This work primarily has been conducted using an etic approach. Although there is considerable evidence that supports the universality of schizophrenia, cross-cultural differences in symptom expression and course have been reported (Kulhara and Chakrabarti, 2001). An additional area of work that approaches diagnostic classifica-tion from an emic perspective is that of culture-bound syndromes or folk diagnostic categories, defined as “… certain recurrent, lo-cality-specific patterns of aberrant behavior and experience that appear to fall outside conventional Western psychiatric diagnos-tic categories” (Simons and Hugnes, 1993, p. 75). These disorders reflect symptom patterns that are linked to the cultural context within which they are embedded. Examples of culture-bound syndromes in Western societies include anorexia nervosa and the type A behavior pattern (Simons and Hugnes, 1993).
In addition to influencing assessment and diagnosis, cul-tural variables should be taken into account in psychotherapeutic endeavors. In this regard, cultural considerations are important in understanding the conditions under which mental health treat-ment may be sought, the type of approaches that would be most effective, the clinical stance of the therapist within the treatment setting, and the nature of the therapeutic relationship. Effective psychotherapy requires sensitivity to differences that may affect the therapist’s and the patient’s perspective on the problem, treat-ment method, and therapeutic process and objectives. Thus, it is important for therapists to be cognizant of the patient’s cultur-ally defined values and belief systems, definitions of normality and psychopathology, problem-solving styles, communication patterns, interpersonal customs and family role behaviors. This cultural perspective is essential when working with adults (Tseng and Streltzer, 2001), children (Canino and Spurlock, 1994; Vargas and Koss-Chioino, 1992) and families (McGoldrick et al., 1996).
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