Lecture notes with Cross-cultural Psychology of Health and Illness at the Leiden University - 2015/2016

Lecture 1: Culture, critical thinking and intelligence

Culture has many definitions. Culture may change a little bit over generations, but there is much stability through the ages (enculturation). An easy definition of culture is “a way to see the world, like a lens you cannot remove during your life” (Helman, 2007).

Hall made a difference between three levels of culture:

• Tertiary level: culture that is visible to outsiders that don’t belong to that culture. For example the clothing, this is the façade of a culture, what you can see.

• Secondary level: the underlying beliefs and rules that are called social norms. Most of the time these social norms aren’t shared with outsiders.

• Primary or deepest level: rules that are known to all, but are implicit. The deepest level of culture is very resistant to change and is generally subconscious. This can be the case if you are in a different culture and act according to your original culture's rules. Also, in some cultures being an older woman and having children is strongly connected and people think it is strange if for example a forty-year old women does not have any children. This an example of the deepest level of culture.

Distinction between traditional versus non-traditional cultures

In traditional cultures social roles are prescribed to the individuals. In non-traditional cultures social roles are achieved by individuals. In traditional cultures it is not your own choice of whom you marry, in non-traditional cultures it is your own choice. In traditional cultures there is a relative and/ or personal distinction between good and bad and the truth is debatable. In non-traditional cultures the distinction between good and bad is very clear and the truth is not debatable. Traditional cultures have very strict social prescriptions, which limit individual choices. Non-traditional cultures do not have very strict social prescriptions.

A psychological approach always implies that behaviour is the result of a person situation interaction. Culture is mixing and moving nowadays. We try to understand other cultures.

Personal construct theory (Kelly)

People behave like little scientist: they observe, analyse and think about what they see. They try to predict the future, because they want to control what is going to happen. They want to increase the amount of nice situations. If people don’t have a good explanation for something, for example death of a beloved one, they get stressed. People use personal constructs (PC) to interpret these events. The personal constructs are influenced by culture. But nobody has exactly the same PC’s. We use categories to come to a quick evaluation of the situation.

PC’s are bipolar (they consist of two categories), for example skinny or fat. Categorizing others divides the world into two categories. We treat people differently according to the out- versus in-group. This could lead to discrimination.

Kelly says that people with comparable PC’s are better partners. We try to adjust our personal constructs to the other person in the beginning of a relationship. Different cultures lead to different personal constructs. Not understanding things that became unpredictable or uncontrollable can lead to isolation. Rigid personal constructs could lead to conflicts.

Cognition, information processing

Cognition refers to consciousness, thinking, interpreting, remembering, believing, anticipating, etc. Information processing transforms information into mental representation. Research about communication of a message shows that a person understanding something doesn’t mean that he/she will remember it. Remembering it doesn’t mean that people will accept it (McGuire).

Stages of information processing, to be discussed in more detail below:

1. Perception

2. Interpretation

3. Acceptance

Perception

For example great (dis)similarities in colour perception across cultures. Blue seems to be the most universally excepted colour. The four basic tastes are sweet, sour, bitter and salty with big cultural differences. There are also big differences in time perspective. In some cultures impatience is rude. Punctuality differs between Holland and Spain, for example. Situations influence the time perception, people who are having fun perceive a minute as shorter. Cultures also differ on what is defined as beautiful and what is ugly.

Interpretation

Attaching personal meaning to what happened. This is based on long term memory and the self-concept. The attribution bias tells us that many of our attributions are biased. The fundamental attribution error states that people have the tendency to explain actions of other people using internal causes and ignoring the situational causes. These biases are influenced by cultural contexts. Every culture defines social categories, for example men versus women. But every culture has a different definition of these social categories. People can move between cultures, that are called subcultures. Immigrants, for example, belong to a subculture (bicultural).

The Barnum effects: we tend to generalise the characteristics to all the members of a cultural group, for example all Italians only think about food and sex.

Context of culture is very important when you interpret it. Other important determinants are: individual, educational, socio-economic and environmental. It is narrow minded to only think that the culture influences the person.

Culture describes values and norms but not how you actually think, feel or act. This is because the context does matter.

Assimilation bias: we see the world through schemes and when we see new information that doesn’t confirm our schemes we use accommodation or assimilation to adapt. Accommodation is modifying our scheme to fit the data, changing our existing beliefs to fit the new information. Assimilation is modifying the data to fit the scheme, which is much easier than accommodation. Children have rudimentary schemes that are extended by accumulating experiences. Accommodation is important because it makes it possible to make subcategories.

The availability bias states that we overestimate the occurrence of events that are easily retrieved from our memory.

The self-fulfilling prophecy states that our expectations influence our behaviour. Association does not mean causation, this is called a false relationship. The belief perseverance effect means that once we have a belief this belief becomes part of our identity.

Prejudice can lead to discrimination.

Acceptance

What we do or don't want to achieve. Goals are age and culture specific. Personal goals are for example losing weight. These are goals that represent what you expect, want, and wish.

Mastery orientation differs between people (Carl Dweck). Because some people give up difficult tasks and others try to reach the goal.

Intelligence and culture

There is a difference between general (G-factor) and specific (S-factor) intelligence. Some cultures promote some kinds or specific factors more than other cultures. Intelligence tests are only valid for a specific population. Intelligence is also highly motivated by motivation. Some people are less or extra motivated, like Chinese or Jewish children (more effort to please the social environment). But every culture has a normal distribution of intelligence.

There is also a difference between IQ and Emotional intelligence (EQ). EQ implies for example ability to recognize and differentiate own emotions.

Health, disease, illness and sickness

Health includes somatic, psychological and social aspects. Disease is a more objective, medical term. Illness is the perception of an individual about disease, so it is psychological. Sickness is having the role of being sick, this is the social perception. But definitions differ per culture. Disease is defined differently in different cultures. For example sickness is also highly correlated with culture, because it is about social roles (and the view of others).

Lecture 2: Research Methods

The goals of psychological research are to describe, explain, predict and change behaviour. You can take different approaches, like quantitative or qualitative approaches. Conceptualization of topics is important for good research. We can see culture as a lens, it is a shared pattern of mental processes. Culture has implicit and explicit parts. People differ to the extent they confirm to their culture.

Hofstede (2001) five dimensions of classifying cultures:

• Individualism versus collectivism: The interdependence of the culture.

• Uncertainty avoidance: Dealing with ambiguity.

• Power distance: What is the hierarchy?

• Long-term versus short-term orientation: This orientation is connected with tradition and the economic orientation.

• Masculinity versus femininity: Difference between male and female values. How big are the differences between male versus female roles?

These dimensions are not absolute, but you can define scales on which you can categorize cultures. Individualism versus collectivism is the most distinguishing dimension, because people from a individualism or collectivism culture differ in cognition, perception and emotion.

It is important to keep in mind the influence of socio-economic status, because it has many cultural implications. SES is also relevant for health, it predicts for example smoking and healthy food intake.

The main determinants of health are:

• Individual lifestyle factors;

• Social and community networks;

• The living and working conditions;

• The general socioeconomic, cultural and environmental conditions.

Empirical aspects

The right contrasts depend on the research question. When you are doing cross-cultural research it is important to be aware of:

• Sampling bias: or the external validity; is this a representative sample?

• Construct validity: does the measurement lead to the question?

• Ecological validity: does the measurement relate to real-life problems?

Group comparisons

When you are comparing groups you can take two different approaches, namely an absolutist or and relativist approach. The absolutist approach does not make a distinction between cultures in the case of psychological phenomena. The relativist approach states that psychological phenomena only exist in the case and context of culture.

When researching relationships you should be careful of spurious correlation, because correlation does not mean causation.

Practical aspects

An important question is: How do you know if you measure the same thing in different groups? The equivalence of measurements tells us how easy it is to apply measures across different cultures. Doing cognitive tests and questionnaires could be more difficult for people from other cultures than it is for the people for who the test is designed for. Extensive piloting and evaluation of measurements is needed to be sure that your tests are good.

Current Research practice

WEIRD is an abbreviation of Western, Educated, Industrialized, Rich and Democratic. Worldwide most of the research (96%) is done using WEIRD participants (Henrich et al., 2010). WEIRD participants responded differently compared with other cultures in for example spatial reasoning, fairness and cooperation (Henrich et al., 2010). But WEIRD participants are our biggest source of information.

Interpretation of data

Assumptions are very important, for example the quality of the measurements influence quality of the data. It is important to be critical, could anything else be the source of a finding that is reported? You need a devil’s advocate to be aware of the confirmation bias.

Physiological approach

The physiological approach is a new direction in cultural psychology. Genetics and epigenetics are the core of nature and nurture interactions. We will focus on the factors that affect biological and psychological processes. These could shape beliefs and norms that are shared by a group of individuals.

Sasaki et al. created a framework that combined gene and culture interaction and related this framework to illness and health.

Genetics

Chromosomes contain DNA, which contain genes. Genes encode for proteins. 1% of the genes vary across people, this leads to individual variation. Differences can be caused by mutations or polymorphisms. External variables can influence the way a gene expresses. Epigenetics are the environmental factors that influence the activation of genes, but these factors do not influence the DNA sequence, just the working of the genes (if the gene is switched ‘off’ or ‘on’). So you need to understand that a gene can be up- or down-regulated by chemical tags. Methylation silences genes, it is a chemical process. Epigenetic tags can be the result of certain lifestyle choices, for example smoking or drinking alcohol. Some epigenetic tags are heritable.

Gene x Environment interactions

This interaction compares the person x situation theory. Some predispositions only develop in the case of a certain situation or circumstances, like stress or loneliness.

Certain social factors could influence the neurotransmitter and hormone levels, which could lead to change in gene expression.

Coevolution is the influence of evolutionary processes on the cultural norms a society has and on the genetic variants. The gene culture interaction is the interaction between genes and a culture. It explains the genetic variability that exists between individuals and how this manifests in the context of the culture.

It is important to take culture into account when you are identifying health risks.

Lecture 3: Cognition

Basic principles of sensation

We experience different things from different senses. Sensation leads to perception, which is the conscious experience of what we perceive. Perceptual organisation makes it easier for us to structure the incoming information. Cognitive functions are for example memory and attention. Cognition is different from perception. People from different cultures differ in their perceptual and cognitive processes.

Senses versus perception

We have a lot of senses through which we get information. Perception is the conscious experience of the information that we get.

Through experience we can learn patterns, this influences our sensation and perception. Previous exposure influences processing of new information. Predictability also influences processing of information and how much attention we pay to an object.

Statistical learning

Through experience we learn what is frequent, what goes together and what is important. We make a distinction between common and special or between normal and different. If a stimulus has salient aspects we will process this faster.

Top-down modulation is attention that is internally driven. Our cognitive processes interact with our senses. Bottom-up modulation is attention that is externally driven. Prior experience can influence our perception.

Sound and the auditory environment

Growing up in a different culture leads to exposure to a different auditory environment. When listening to music, Western people make more categories than people from other cultures. So a 12-tone scale can be divided in three categories which each have four tones. If you grew up with the use of categories you will yourself develop and use these categories. But if you did not grow up with it, you did not develop these categories. Because there is a big difference between rhythms people from different cultures differ in the degree to which they can find the beat in a song.

Developing structure in perception

Hannon and Trehub (2005) conducted a study about how well adults could indicate if there was a violation in the rhythm. You see a very clear difference in where someone grew up and to which auditory environment he or she was exposed to. Difference in rhythm process takes some time, it has to develop.

Language also provides an auditory environment. Dutch and English languages score very different from other languages in an language index. NPVI makes it possible to compare languages.

Music composers adjust the rhythm of their instrumental songs to their mother language. There is for example a big difference between French and English instrumental music.

People group on a different way, depending on how they hear a rhythm. You can for example focus on loud-soft or on soft-loud. The grouping process is different for Japanese or English speakers. For the amplitude English people are divided, but the Japanese are not. For the duration this effect is the reversed, Japanese are distributed but the English people are not.

Conclusions

What someone perceives is dependent on bottom-up and top-down processes. The basic sensory mechanisms are the same for everyone, but the perceptual processing of the same stimuli is different for people from different cultures. The perceptual environment or context that someone grew up in shapes perception and cognition. Speech rhythm is related to for example the rhythm in (instrumental) music.

Part II of the college is about the article from Nisbett and Masuda. The article focused in the difference between Western and East-Asian people. The idea is that the differences in cultures are based on the difference in focus on independence or interdependence.

Reasoning

The causal attribution is the interpretation of an event, why do you think someone did what he or she did? The biggest difference in attribution between East versus West is talking about intrinsic or extrinsic forces.

Dialectic is coming to a conclusion by extensively talking about a subject and see different sides of a problem. Logic is more based on applying a rule. So people who are logical focused make a difference between what is right and what is wrong. People who are focused dialectically want to seek the middle way. Categorisation is also different between East and West. People differ in if they focus on relationships or not.

Attention

Western people focus more on the object. East-Asian people focus on relationships between the figure and the field, so they also consider the contextual information. Field dependence is the extent to which you can distinguish field from the salient object. Asian people have a preference for the field and are more sensitive for changes in the periphery, they are less focused on the main subject. This influences also for example art. Asian people focus more on the context and less on one main subject.

Priorities within a culture, language affordances and economical history influence all these differences between Western and East-Asian people.

Some differences lead to more differences, after a while you are not sure the difference that you are measuring is caused by for example the attention.

American-Asian people tend to be more on the side of the Asian group, but they respond in an intermediate fashion. In this case American-Asian people grew up in the same environment as the Western people, so what is the cause of this difference?

Summary

You can measure differences between cultures in perception and cognition in the lab. People from Western or East-Asian countries differ in reasoning and perception. They differ in application of roles, focus on the object or the context and the focus on relationships. Differences between these cultures are related to environment, cultural importance and language. Individuals that are exposed to multiple cultures response different, for example American-Asian people.

Lecture 4: Emotion, Migration, Stress & Motivation

Changes in the nervous system are caused by emotions. These changes lead to changes in for example breathing and muscle contraction, this prepares us for actions. This way emotions are defined as labelled activation.

Happiness, surprise, sadness, fear, disgust and anger are the six basic, universal emotions. But what comes first? Do people over the world see the situation as the same? Research about this topic gave different explanations. For example James Lange stated that the situation leads to a physical experience and this experience leads to the emotion. Cannon and Brard (1927) stated that the physical experience and the emotion appear at the same time.

Positive emotions

Influencing positive emotions would be nice, because life satisfaction and quality of life is higher when experiencing positive emotions. Happiness promotes a lot of other actions, for example being more cooperative, which leads to more work satisfaction. But the relationship between happiness and satisfaction is reciprocal. In general it is the case that people who have a higher income are more happy, but there are some exceptions (for example people from Latin America). Gender, age and ethnicity don’t influence happiness. People who live in countries that lack personal freedom and have difficult human right situations are less happy. Being happy looks like a personality trait, because people who are happy stay happy.

Becoming more happy

Spending time with friends and family and being supportive for others will increase happiness. It is important to look for meaning in the work that you are doing. Staying fit, be optimistic, staying realistic is also important. Making time for yourself and organize your life is also important to become happy.

Emotion as an evaluation

Every country has norms about how you can express your emotions, but emotions are universal. The culture determines if expressing an emotion is acceptable. Emotions can also be seen as an evaluation, because you can determine them as pleasant versus unpleasant, expected or unexpected etc.

Our bodies response in a similar way to different emotions, in the bodily responses there is no difference between for example Americans and people from Japan.

There are cultural differences in what is considered as important. In collectivistic cultures the social environment and family is more important, in individualistic cultures situations that influence self-esteem, material success and achievements are considered as important.

Conclusion

The physiological process or arousal is universal, this is the initiation of emotion. But the interpretation and how the emotion is expressed is different for people from different cultures.

Stress and Health

Stressors, which can be major and daily, influence health. Interpretation of symptoms influences the use of health care. The way the illness is perceived and how people cope with it is important for the development of the illness. Behaving influences health, morbidity and mortality. The connection between health care workers and patients is also important.

There are different explanation that lead from the stressor to illness, like environmental, psychological and biological models.

Lazarus stress model

The primary appraisal of an event determines if the situation is perceived as threatening or not. The secondary appraisal determines if negative or positive stress is experienced, it tells you if you can deal with the situation. Prolonged stressors can really add to a worse health situation. Coping with stress is partly determined by culture. The consequences of stress can be on psychological, physical or social level.

Migrants and stressors

Stressors are for example the cause of the migration, the migration itself, the consequences of the migration and other problems that immigrants face when adapting to the new culture. All this factors could lead to anxiety, injustice, sadness or anger. The appraisal of the situation is dependent of the duration, predictability and controllability of the situation. The interpretation of the stressor is very important for the primary and secondary appraisal. Most non-Western immigrants use avoidance and an emotion-focused way of coping with the problems. On the long-term this way of coping is not effective, it is more effective to use a more Western, problem-focused way of coping.

Migrant’s Biological Health

Migrant have different genetic predispositions and might have been in different circumstances that brought them in health compromising situations. For example being in touch with malaria or dietary habits.

Migrant’s social support

In the beginning of immigration immigrants lack social support. They don’t receive less emotional support than native people but they expect more, so the perceived support is less.

Benefits of immigration are for example freedom, better education and safety from prosecution or physical danger.

Health risks of migration are for example that the migration itself can be traumatic (in the case of refugees), loss of identity, increase the risk of illness (like cardiovascular disease) and Westernization, like new health risks. The consequences of immigration influence mental health, like being unemployed, housing conditions, discrimination and racism. Known mental health problems are suicide, drug and alcohol use, depression and domestic violence.

Berry made a distinction between marginalization, assimilation, separation and integration. Integration leads to the least problems. See slide 7 for the table.

Symptoms of acculturative stress are for example sadness, insomnia, feeling isolated or lonely and homesick.

There are six ways of explaining why problems occur in immigrants.

• Multi-migration: difference between living in a village or city and other differences between the history and the present situation, like religion and the climate. Not just the country changes, a lot of other factors also change.

• Push-Pull: the pull part is defined as voluntary and the push part as involuntary. Pull immigrants sometimes have to deal with disappointment or feelings of guilt. The push immigrant might experience grieving and make their home country nicer than it really was.

• Selection-stress: some people immigrate because of mental problems. Immigration is associated with age, class and culture conflict.

• Host-migrant attitude: is the new country welcoming or not? Countries differ in the way they treat migrants.

• Psychosocial transitions: if the personal life space is endangered the migrants is much more likely to be traumatised by the migration.

• Cultural bereavement: missing what you had to leave behind. This grieving can last for many years and can influence development of drug or alcohol abuse and depression.

Migrating as a whole family, learning a new language, having education and intellectual skills are examples of protective factors in migrants. Migrants have preventive strategies that work well for some and not so well for others. Examples are using the media to keep in touch with the home country, buying a property there, recreation in micro-cultural worlds and exaggeration of the original culture.

Motivation

Motivation is defined as the internal drive that initiates the goal-directed behaviour that is individual. Many theories try to explain motivation, like the drive theory that states that motivation is caused by a physiological or psychological deprivation that leads to a need. The sociobiological approach just focusses on (social) instincts. Arousal theories state that people always are looking for an optimal level of arousal. The psychoanalytic approach states that the ego plays an important role in motivation. Sociological approach determines that social factors are important. Cognitive theories state that having control determines motivation. Humanistic theories state that for example self-worth determines motivation. The influence of the environment on the motivation is different for collectivistic or individualistic cultures.

Maslow developed a hierarchy of needs, which exists of: physiological, safety, love or belonging, esteem and self-actualization.

Lecture 5: Stress and immigration

People have certain prejudices about immigrants. Immigrants are for example often seen as separated, according to the Dutch people.

Older theories on migration

• The immigration Stress Hypothesis states that immigration is very stressful and can cause behavioural and psychological problems in adolescent immigrants.

• The assimilation/ melting pot hypothesis states that all immigrants in the end assimilate.

Acculturation goes on two axes, namely the cultural maintenance and the adaptation to the host society. There are four acculturation strategies: separation, integration, marginalization and assimilation. Marginalization is the case if an immigrant does not really have an identity.

Research concluded that bidimensional models are more valid than the more unidimensional models. Integration is found to be the best for well-being of the immigrant. Integration is also more preferred by immigrant adolescents. See the slides for the acculturation strategies and their percentages. Immigrant children prefer separation in the personal context and integration in public context, for example the school setting. It is important to consider which questions you should ask to measure integration, separation and assimilation. For example: Is marriage a good example of integration?

Discussion

Assimilation is not necessary for good well-being of the immigrant. Just a few immigrants choose only for assimilation, most prefer integration.

Immigrants paradox

Immigrants have a bigger chance of living in a small house and have poorer access to medical care etc. Having a low SES is related to worse school results, lower intelligence, behavioural problems, smoking, obesity and a poorer health. The immigrant stress hypothesis states that the development of immigrants is poor because they have many problems. The immigrant paradox states that immigrants are less likely to have problems on behavioural, psychological and health area, but they have a lower SES.

Assimilation and the paradox

The first generation of immigrants children performed well, there was a decline in the second generation. This is strange because we expected the second generation to be better assimilated.

Study in the Netherlands

The SES of the Dutch children was much higher than the SES of the first and second generation immigrants. We found some replication of the immigrant paradox: for example first generation reported fewest psychological problems. We found some decline in the second generation. Immigrants with a low SES performed as well or sometimes better than national contemporaries in terms of adaptation. We saw smaller effects in the USA and Canada than in the Netherlands.

Changing eating patterns influences risk on certain diseases for people from Asia who moved to the United States. Also more acculturation in the western countries is associated with a higher blood pressure.

Explanations for first generation immigrants doing well

• Optimism: Immigrants saw the bad situation in their home country. They know that they are having a better life in the new country. They come full of optimism, but they lose their optimism during time.

• Cultural maintenance: Certain practices or food preferences change and influence health.

• Othering

• Measurement Invariance/ statistical artefact

Statistical artefact

Researchers tend to publish things that confirm their hypotheses. The articles that survive are the articles that confirm something, this is called the survivorship bias. Most effect sizes of the immigrant paradox are small. There is also contradicting evidence and some degree of replication. So we need a meta-analysis.

Measurement invariance

Are we really measuring the same thing across cultures?

Family obligations

Looking after your family and not arguing with your family is for some cultures more important. Family obligations are important for non-Western countries. If you are helping the family you are not on the streets and can’t have problems. But too many obligations are also not good, because they can be detrimental. Immigrants who reported higher family obligations also reported higher self-esteem.

Unique factors are related to well-being of the immigrant. Collectivistic children do not want to embarrass their family, so they avoid vandalism, expulsion and alcohol- and drug use. Too much family obligations are not a good thing, because they can keep the attention from school. Acculturation conflict is for example if parents of immigrant children want their children to do more chores, they think the chores they have to do are too less.

Discrimination and othering

Discrimination negatively influences (mental) health and it causes for example high blood pressure, heart problems, depression and somatization. Discrimination is very hard to study because it can be very hard to detect because nowadays a lot of discrimination is subtle. Incidents of discrimination will not always be remembered or people attribute the incidents not to discrimination. A lot of immigrants ever experience incidents of discrimination. But second generation immigrants are mostly more affected by these incidents than the first generation immigrants, this partly explains the decline over generations.

Segmented assimilation means that the effects of acculturation depend on the context of a situation. On this way assimilation may have positive effects in an affluent situation, but most of the immigrants do not arrive in an affluent situation. The adverse effects that come from immigration can be caused by living in the lower segment of society and in combination with the feeling of being discriminated.

Lecture 6: Culture, Body-image, lifestyle and health

Social perception

Social perception is the process by which we are trying to understand other people around us and ourselves. Social perception is influenced by experience. Social cognition is the process through which we interpret information, remember information and use it. Social cognition is depended on situations.

Values are stronger than attitudes and are relatively stable. People who grew up in the same environment share more values than people that did not grew up in the same environment.

Hofstede made four distinctions between culture

1. Individualism and collectivism

2. Power Distance

3. Masculinity and femininity

4. Uncertainty avoidance

People from different countries differ on this four distinctions. Western and non-Western values differ. Western values miss harmony & cooperation and they lack social satisfaction.

Cognitive balance is when there is consistency between attitudes of two or more people. We overestimate the positive traits in groups that we like and underestimate the positive traits in groups we don’t like.

Cognitive dissonance is a mismatch in yourself. It can be a mismatch between your attitude and behaviour, for example if you want to be healthy but just ate a cake. You can avoid this psychological tension if you increase your evaluation of the choice you made, for example you didn’t go to the gym because you really enjoyed the movie you saw.

People make social attributions based on for example having a scar or someone’s accent. Accent influences evaluation of competence, the social status and personality traits. People with scars are seen as less sociable, as less attractive and as more dishonest.

The self-centred bias means that people avoid responsibility for failure and take the credit for personal success.

People are unconscious about the fact that they view situations with their own culture frame. People tend to forget the actual situation and remember just their attribution of the situation.

Cross cultural communication barriers

For example language, non-verbal communication and stereotypes are barriers. We attribute meaning to a situation by observation, evaluation and interpretation.

We categorize everything we hear and see and make stereotypes. Stereotypes cause errors but sometimes they can be helpful, in for example detecting a disease. An national character is the most traits that is common in people from one nation. National characteristics can be due to specific events (like war), a history of oppression and wealth and poverty.

Body image

The human body is not just a physical organism. The image is influenced by culture, this influences beliefs about:

• Ideal size, shape and clothing. They can tell us something about age, gender, social rank, occupation and role, membership of certain groups and about the social function. Bodily symmetry is a predictor of healthy attributes, like the immune system. Beliefs about size, shape and clothing influence for example dieting. In Africa the ideal woman is overweight, this is a big difference with for example Europe. Westernization also has bad influences, like girls from South-Africa who want to look like Western girls. SES and being an immigrant influences obesity. The percentage of obesity in the Netherlands differs between ethnic groups. More women than men are overweight.

• Boundaries of the body between countries. Boundaries between bodies can be very different between countries. For example Mediterranean people allow less social distance than people from other countries.

• Inner structure of the body.

• Balance and imbalance. Health is seen as the body that is in balance. Hippocrates made a distinction between four liquids for example. The hot and cold theory is similar, it is related to temperature and energy which can be hot or cold. Certain illnesses are seen as hot, this can be caused by sun, fire or hot foods. The head that enters the body can cause headaches.

• Disability. Cultures differ on what they see as disability. Impairment is seen as bodily and a disability as seen as social constructed.

Culture, Diet and Nutrition

Surinamese, Turkish and Moroccan women eat more in terms of the guidelines for a healthy diet than Dutch women. They eat less fat and more carbohydrates. But their vitamin and mineral intake are lower. The cholesterol levels of Turkish and Moroccan women are lower than in the Dutch women. But they also have lower HDL cholesterol levels, which results in unfavourable outcomes.

Cultures differ in what they think is edible or not. Snacks are inventions by Western societies. It is important to see what is seen as food and what not in different cultures or countries. Cultures differ in the extend they do fasting, mixing milk and meat, eating meat. Like a distinction between hot and cold and yin and yang food. Asians make a distinction between hot and cold food. Special foods are for example because of a ritual of as social food. In most countries social classes differ in what they eat. When we have people coming over food is less simple.

Culture and food deprivation

Deprivation can be caused by poverty, no resources, natural disasters, wars and the international political economy etc. People with low SES are less healthy. People with a higher educational level have a higher life expectancy and life longer without feeling sick or having complaints. In the Netherlands the difference between high and low educational level in perceived health is approximately twenty years. Relatively less immigrant groups than Dutch youth meet the physical activity norm. Differences in ethnicity in meeting the physical activity norm. For example 65% of the Dutch women meet the norm, which is much higher than women from other countries who live in the Netherlands.

Models of alcoholism:

• Moral of religious models;

• Medical models;

• Psychological models;

• Socio-Cultural models;

• Small group and family models.

Use of alcohol in the Netherlands

Turkish and Moroccans drink less than the Dutch people. But there is a significant increase in alcohol use in the younger people (Turkish and Moroccan), but it is still less than the Dutch youths.

Migrants have more drug problems than Dutch youths.

The abortion rate under non-Dutch women is 3-12 times higher. 60% of the abortions in the Netherlands are non-Dutch. STD are also more prevalent under non-Dutch youths.

There are also differences in the perinatal mortality in the Netherlands. The mortality is much higher in minority groups. It could be a knowledge factor because the non-Western woman made inadequate use of the provided prenatal care.

Health care use and experience

Nielsen (2010) did a systematic review and found that immigrants have a lower self-perceived health in Europe. Kunst (2008) found that immigrants visit doctors 30% higher and often for the same problem. Also physiotherapy and the prescribed drug use are higher. Just 15% of the Dutch people think they have a bad health, this is much less than people from other ethnicities. So immigrants perceive their health as much worse.

Lifestyle

Lifestyle is a psychological perspective. Lifestyles are learned and are hard to change. They are part of our identity and will be defended. They are supported by culture and groups. They are an habitual way of coping with problems and restore satisfaction and wellbeing.

Changing people’s health behaviour is hard and underlying mechanisms should be taken into account. Factors like stress and social control are very important. Also symptom and cognitive control are important. The behaviour change is more realistic if you pay attention to these underlying mechanisms.

Health promotion

Certain strategies are more appropriate for cultures:

• Using Peripheral;

• Evidential;

• Linguistic;

• Constituent-involving;

• Socio-cultural or deep structure.

Lecture 7: Mental health and culture

People from different countries can see a case in a different way and give a child a different diagnosis. Behaviour that is seen as normal in one country, is sometimes not seen as normal in another country.

What is (ab)normal behaviour

There are big differences between situations in what behaviour is seen as normal and what not. Abnormal behaviour is based on for example frequency. For an illustration of perceptions of social behaviour see the slides. They make a distinction between control and uncontrolled and as normal and abnormal. This model is fluid and can change over time. Alcohol is an example, in one culture it can be seen as normal, in others as symptoms of a psychological disorder.

The DSM-V is used to classify psychological disorders in Western countries. It categorises mental diseases which based on Western values. Therapy in the West is very individualistic, just solving the problem with the help of the therapist (mostly family or friends are not involved in the therapy).

There are not very big differences between ways of curing a depression, so alternative ways can also be effective.

Idioms of stress are names given to symptoms of feeling sick. These are culturally defined ways of talking about a disease.

The relativist view states that the cultural set of principles influence the norms and emotional responses.
The universalist view states that there is not a differences between cultures.

People in the Western world think that you can cure a disease by using a scientific method. Non-Western people can explain a disease in terms of personalistic causes.

A shaman is like a medium and can master if someone is possessed. Cultural healing can work because of the expectations the patients have of the situation (it works like a placebo-effect). The aim of the healer is to resolve conflict that cause the illness, restore the cohesion in the group and integrate the patient back into the normal society. A healer is very different from for example a psychiatrist in the Western world.

Culture-bound syndromes are foreign disorders that do not fit into the DSM-V. For example in West-Africa the disease Brain tiredness occurs in students that did too much thinking and which brain is tired.

In general more females are diagnosed with an anxiety disorder in the Netherlands.

In Korea and Japan it looks like people have a persistent fear of being offensive to other people, but not everyone has a social phobia. The environment someone lives in determines which fears are experienced.

Post-traumatic Stress Disorder seems to be universal, because people tend to response in the same way after experiencing a traumatic event, like a war. The symptoms are generally the same across cultures.

In Western cultures people focus on being happy, optimistic and feeling joy so they focus more on depression. Other cultures focus on jealousy etc., so do not focus on depression. In the Western world a depression is seen as a chemical imbalance in the brain and is treated on a more biological way. There is a big difference in what is seen as a depression between cultures, like in Latino cultures it is seen as having headaches and in Middle Eastern countries as having problems of the heart.

In China is a taboo on mental illness, so a depression is explained in a somatic way.

Medical professionals in Japan avoid giving a young woman the diagnosis ‘depression’, because that could mean that they cannot find a husband. In some countries professionals are trained to explain a situation in terms of the situation of a patient and not because of an illness.

In the Netherlands woman are more diagnosed with depression than man.

Schizophrenia and DSM

The symptoms of schizophrenia can be divided into positive, negative, cognitive and affective symptoms, according to Western cultures. In most parts of the world it is more common in men, but in China this effect is reversed. Research shows that psychiatrists who do not have the same ethnic background as their patients overdiagnose these patients.

Suicide

In for example India and China is much more suicide than in for example Australia and the VS. In general suicide is higher in higher developed countries. Suicide is very high in Japan and is seen as something that is honourable. Suicide rates are higher for Surinamese and other migrants than native Dutch people. Young Turkish and Moroccan Dutch people have a lower risk than native Dutch people.

Cultural sensitivity is important to keep in mind, because some DSM-V symptoms are considered as normal in other countries.

Societies can have a high versus low tolerance threshold. High tolerant means accepting diversity of behaviours and low tolerance means intolerant against specific behaviours.

There are cultural and national differences in for example selling wine to students. Smoking is more prevalent in low- and middle income countries (and this is still growing). In general more men than women smoke.

Malnutrition can lead to developmental problems in infants and adolescents. Eating disorders are spreading to non-Western countries, like South-Africa (because they mimic the Western habits).

People higher in spirituality have more positive health outcomes because of more inner resources and adaptive coping.

In 2002-2007 Moroccan and Turkish Dutch people in the Netherlands visited a GP two times more frequent because of mental health problems. Young people still underuse the mental health care. Drop-out rates of mental health care rates seem higher among ethnic minorities. Factors like language fluency play a role. Frequently there is no good match between a Western therapist without experience with other cultures.  

Source

These lecture notes are based on the subject Cross-Cultural Psychology from the year 2015-2016