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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