Cross Cultural Psychology of Health and Illness

Health and illness

positive/negative concepts of health and illness are defined differently across cultures.

Cultural influences

causes and habits of health/illness, some cultures personalistic, some mechanistic (West).

Culture

set of implicit/explicit guidelines people adopt as society members (e.g., world view/emotional experience/supernatural). Boundaries are not clear/variations within cultures/changes over time.

Enculturation

passing views onto the next generation.

Tertiary

explicit; visible to the outsider (façade of culture).

Secondary

underlying shared beliefs/rules. Social norms rarely shared with outsider.

Primary

implicit; rules known/obeyed by all. Generally, out of awareness (roots).

Absolutist approach

psychological phenomena are the same across cultures, processes/behaviours vary.

Relativist approach

psychological phenomena only exist in context of culture.

In-between (Absolutist and Relativist)

psychological processes are shaped by experience/humans' biological constraints.

General psychology

universal, sometimes tries to control for culture.

Cultural psychology

cultural variation, psychological consequences of culture. (different meanings in different environments/thoughts shaped by environment/mind and culture are entangled).

Universality

being shared by all people.

Abstract definitions

evidence supports universality.

Concrete definitions

evidence supports variability.

Non-universal (cultural intervention)

cognitive tool not found in all cultures (e.g., abacus).

Existential universal

cognitive tool found in all cultures, same functions, available to some degree in different cultures (e.g., persistence when facing failure).

Functional universal

cognitive tool found in all cultures, same functions, accessible to different degrees in different cultures.

Accessibility universal

cognitive tool found in all cultures, accessible/functional to same degree (e.g., social facilitations).

Cultural dimensions theory

cultures can be distinguished according to five dimensions.

1. Individualism-collectivism - independence of a culture.

2. Uncertainty avoidance - dealing with ambiguity.

3. Power-distance - how hierarchical a culture is.

4. Long/short term orientation - connections with tradition/economic orientation.

Masculinity/femininity - how defined are gender roles.

Theoretical constructions

Hofstede is the dominant system: generalisations (groups vary in homogeneity)/individual differences/layers within culture.

Socio-economic status

e.g., low SES; smoking more likely, high SES; more likely to quit. Low SES; high alcohol consumption, high SES; more balanced diet.

Colour-blind approach

common human nature, ignores cultural differences.

Multicultural approach

recognises group identities are different (especially minorities)/ignoring this leads to negative response.

Error of ethnocentrism

recognise our own ethnocentrism; perceive out own culture as the standard for comparison (judge others negatively by comparing culture).

Selection bias

WEIRD samples (96% all psychology research/70% undergrads; 99% from West unis).

WEIRD outliers

unusual differences appear in; visual perception, fairness, cooperation, special reasoning, categorisation/inferential induction, moral reasoning, self-concept, motivations.

Cross-cultural psychology

aims to better understand implications of cross-cultural variations (helps us interact in a globalising/multicultural society).

Central themes

universality of a specific trait; often looking across groups (levels of universality), influence of a specific trait on thinking/behaviour, often looking within (multiple) groups, studying a culture as a whole rather than individual.

Questionnaire translation

process of forward and backward translation to achieve equilibrium.

Response bias

psychological surveys are influenced by culture, usually surveys done with statements, not scales (combat this; forced answers (nuances lost)/standardisation/reverse scoring items).

Reference group effects

response to questions could depend on the reference group (control this; better to use concrete/objective measures by... providing specific scenarios as questions (quantitative)).

Deprivation effects

people/cultures tend to report value they would like, not what they have (no clear solution; except interpret results with caution).

Experimental methods

culture cannot be manipulated (between groups)/ DV can come from behavioural response/psychological measures/ replication is crucial.

Unpacking culture

identifying underlying variables that create cultural differences; two steps.

1. Show cultural differences in underlying variables.

2. Show underlying variables related to cultural differences.

Cultural specific model

two step model.

1. Participants from each culture create situations where they experience psychological phenomena.

2. Another group assesses full list made in step 1.

Cultural priming

induces cultural ways of thinking not already enculturated by participants cultural group (assumes 1st culture thinking will be present in the 2nd).

Mixed methods

best solution; use this to replicate findings while disproving alternative accounts (makes compelling evidence).

Interpretation bias

includes...

1. Belief preservation effects - holding onto views when faced with conflicting evidence.

2. Self-fulfilling prophesy - expectations lead to the thought that you see confirmatory evidence.

3. Availability bias - overestimation of frequency of occurrence of salient events.

4. Representiveness bias - faulty categorisation based on inaccurate features.

5. Fundamental attribution errors - overestimating internal causes of behaviour (e.g., influence of personality) and understanding situational context.

Challenges to research

language barriers/ limitations of practical settings/ types and prevalence of disorders differ/ health communications differ/ timely and costly.

Emotions and culture

Darwin; emotions/emotional experiences are universal; six basic emotions are recognised across cultures (happy/sad/surprise/fear/disgust/anger).

Emotions and facial expressions

e.g., pride; strong universally, involves the whole body (head back, erect posture, slight smile, arms akimbo).

Perspectives on emotions

James-Lange/Two factor theories of emotions (universality v cultural variability).

James-Lange theory

focuses on physiology; predicts emotions should be universal due to physiology/physiological similarities of humans.

Two-factor theory

focuses on interpretation; predicts emotions vary across culture due to differences in cultural experience (may lead to different interpretations of physiological responses).

Display rules

dictate intensity/ appropriateness of expression (norms)/ ritualised displays; culturally idiosyncratic, facial expressions not recognised universally.

1. Some cultures encourage intense emotions (Kaluli; New Guinea).

2. Some condemn public displays of anger (Utuk Eskimos) v encourage (some Arabs).

3. Some prefer emotional smoothness (Balinese, Japan, collectivist cultures).

4. Brain scans show greater response of emotions from one's own culture.

Emotional experience

e.g., study on physiological response to anger-provoking event (Anderson + Linden). Both groups initially equally angry, Chinese Canadian blood pressure returns to normal faster than Euro Canadians. Suggest CC more comfortable with anger suppression.

Facial feedback hypothesis

we use facial expressions to infer emotional states; also using a facial expression can make us feel that way (facial expressions can impact our emotions). Implies cultural diversity in emotions.

Life satisfaction and happiness

affected by; wealth, human rights, equality, life satisfaction definition (concept of happiness).

1. Individualistic countries - number of positive emotions.

2. Collectivist countries - how much respect is given for living up to norms.

Happiness and subjective wellbeing

happiness is central in West (historical; 18th century 'the Enlightenment' world becomes more rational/predictable). Before, happiness seen as good luck, cultures seeing happiness as good luck are less happy.

Culture and happiness

cultures vary in terms of importance placed on happiness; EC prefer fun/useless game, AA prefer dull/useful game... similar findings for made up university courses.

Personal theories about life satisfaction

in retrospective studies; EAs report having more balanced emotional states, US report being happier than they actually were. EAs believe in more balanced emotions, US believe you should feel happy generally.

Motivation

any condition that initiates/activates/maintains goal-directed behaviour (DRIVE).

Prevention orientation

one tries to avoid negative outcomes. (e.g., study example; studying because you don't want to miss opportunities/ acculturation example; trying not to lose the values of you're home country).

Promotion orientation

one strives to secure positive outcomes. (e.g., study example; studying because you want to find a job you'll enjoy/ acculturation example; trying to learn the language to maintain a sense of belonging).

Self-enhancement

motivation to view oneself positively (more pronounced in West/WEIRD samples with independent view of self).

Face

social value given by others, if one fails to fulfil one's social obligations/expectations.

1. Higher in collectivist cultures; fitting in societal norms to gain face.

2. (e.g., more brand items make you more important; gain face/increased social value).

Face is easier to lose than gain.

Different motivations

cultures more concerned with face; more prevention orientation. Rather than focusing on feeling good, collectivist societies focus on people feeling good about them. Face is associated with self-improvement vs self-enhancement (correct weaknesses instead of focus on strengths).

Maslow's hierarchy of needs

Self-actualisation

Esteem

Love and belonging

Safety needs

Physiological needs

Incremental theory

(internal locus of control); Primary strategies, choices are made because it is good for the person (e.g., choosing a study because you like it); more common in West.

Entity theory

(external locus of control); Secondary control strategies, choices are made as they are good for face (e.g., I choose a study because its good for study); more common in non-West.

Acculturation stress

mental/emotional challenges of adapting to a new culture.

Stressors in migration

planning/insecurity/travel. Consequences; prejudices/discrimination/unemployment.

Acculturation problems

experience of loss (old life) and conflict (discrepancy in norms).

Reasons for migration

(causes; international student/war/love/poverty/prosecution). Push and pull factors.

Cultural distance

how close is the language to mother tongue/ more similar heritage, less acculturation stress.

Cultural fit

degree that personality is similar to dominant cultural values in host culture. (e.g., people who are in extraversion fit extraverted cultures/ people with more independent self-concepts suffer less stress in acculturating to the US).

Acculturation strategies

two issues with implications for outcome of acculturation;

1. Attitudes towards host culture - does individual participate in wider society/seeking to fit in?

2. Attitudes towards heritage culture - does individual try to preserve heritage/traditions; leads to distinct strategies affecting acculturation experience.

Impact of migration on self-concept

for bilinguals; multicultural experiences impact self-concept on two ways; blending/frame-switching.

Blending

peoples self-concepts reflect a hybrid of their two cultural worlds. (Evidence suggests; mostly people appear intermediate on many assessments compared to monocultural people from different cultures).

Frame-switching

maintaining multiple self-concepts, switching between them depending on context. (People don't lose heritage culture self once that have mastered their host culture self; e.g., language/rules at school vs home).

Attractive

e.g., padunag women (Thailand)/ American women/ Mursi women (Ethiopia); different beauty standards.

Universally attractive

evolutionary roots; commonalities across cultures;

1. Clear completion.

2. Bilateral symmetry.

3. Average features (face).

4. Overall, healthy looking.

Clear complexion

skin signals health most, cosmetics companies capitalise on this. People have strong aversive reactions to skin conditions. (e.g., two Nigerian girls with lamellat ichthyosis, hidden to protect others in the family, marriage to someone with family skin disorder is strongly discouraged).

Bilateral symmetry

marker of health; when organisms develop under ideal conditions left and right will be symmetrical. Genetic mutations/pathogens/stressors in the womb can lead to asymmetrical development.

Average features

more attractive than deviating from the average;

1. Average features, less likely to contain genetic abnormalities/ more symmetrical.

2. We process stimulus closer to a prototype more easily. Easy processing gives a positive feeling that gets interpreted as attraction.

Body weight

1951 anthropologists/psychologists concluded heavier women = more attractive/ today, thin women are ideal (West, e.g., models). Rich countries; thinner tend to be richer.

Western Africa; fat seen as a compliment, not poor/malnourished.

Non-western immigrant groups adopt deviant western body images; bulimia/taking laxatives.

Body image and media

norms and how we should look is strongly influenced by media. Often portrays unattainable ideals. Major influence on feelings of inferiority/ugliness/abnormal.

Leads to; use of cosmetics/skin whitening/tooth whitening - can cause anaemia/cancer.

Propinquity effect

people are more likely to become friends with those whom they frequently interact. Based on mere exposure effect; the more we are exposed to a stimulus the more we are attracted to it. Culturally universal mechanism.

Similarity

similarity-attrition effect; people are attracted to others if they share many similarities. Particularly strong in cultures with high relational mobility individualistic greater than collectivistic).

Mechanisms of attraction

Japan doesn't seem to matter that much; usually true in collectivist countries. Overtime there are more interatrial couples; we now interact with people of different cultures.

Cultural biological variations

two explanations/mechanisms;

1. Innate biological differences = result of selection pressures over generations.

2. Acquired biological differences = cultural effects on one's biology in one lifetime, independent of genes.

Innate biological variations

humans evolve due to selective pressures in their environment; different environments = different selective pressures, different populations evolve different traits (e.g., skin colour).

Skin colour

strongly correlated with UVR reaching different parts of the globe.

1. Light skin = sufficient UVR synthesises vitamin D.

2. Dark skin = prevents over-absorption of UVR, prevent folic acid breakdown (risk of anaemia/cancer).

3. Exception = nuit (Greenland), diet rich in fish/sea mammal blubber high in vitamin D, darker skin.

Culture-gene coevolution

as culture evolves, it places new selection pressures on the genome, genome also evolves in response to these pressures. (e.g., cow domestication allows us to process milk/ farming in Africa, resistance to malaria).

Visual acuity

the moken (sea nomads in southeast Asia), children swim underwater to retrieve seafood; they have 2x visual acuity of European children (not genetic, with training Euro children could do this too).

Obesity

adults, nearly 3x between 1975-2016; 39% overweight, 13% obese.

Children/adolescence 5-19y/o; 4-18%. More people obese than overweight in most regions (except sub-Saharan Africa and Asia).

Greater reliance on fast food/ less need to exercise.

French paradox

potion sizes (eat what's given to them)/attitude towards food (French savour it).

Height

economic wealth of a country has close ties with the height of its people. More wealth = healthier diet, especially during growth spurts. Fluctuations of countries height coincide with societal changes at the time impacting on diet (Europeans tend to be taller).

Life expectancy

median ages vary significantly across the globe; Morocco 53.1y/o, Netherlands 42.6 y/o, Syria 24.3 y/o, Niger 15.4 y/o. influenced by many factors;

1. Socio-economic development (e.g., poverty).

2. Birth rates.

3. Disease.

4. Ongoing conflict.

Biological variations

our bodies are influenced by culture;

1. Geographical influence on selection (innate differences in e.g., skin colour).

2. Gene-culture coevolution (innate differences in e.g., lactose persistent/malaria resistant).

3. Current culture, including wealth (acquired differences in e.g., visual acuity/obesity/height/age).

Concept of health

West = health is often conceptualised in a biomedical model; health is seen in absence of disease.

Disease = seen as ongoing from specific/identifiable cause within/arriving from outside the body.

Other cultures see health as an imbalance between;

Negative (yin) and positive (yang) forces in Chinese medicine, or elemental ingredients (buhtas) and waste products from food (vayu, pitta and kaph) in Indian Ayurvdic medicine.

Also, alternative view, disease is due to supernatural causes.

Body functions

difference within western medicine; French see body as 'terrain', emphasises a sense of balance (French doctors prescribe spa visits/tonics/vitamins/less emphasis on daily bathing; diet and germs can strengthen terrain).

US see body as a 'machine', threatened by external forces; US doctors more likely to prescribe anti-biotics/surgery more than elsewhere.

Views not mutually exclusive

views on health are shaped by culture, influencing health/healthcare usage. Distinctions seem clear-cut, but people can simultaneously hold views grounded in different traditions. Patients might seek traditional healthcare for one type of complaint/seek biomedical care for another/ or both together.

Culture specific conditions

e.g., Chirindi (Zimbabwe), woman and her husband cold.

Menopause

hot flushes/vaginal dryness/trouble sleeping/ mood changes (Western specific condition/diagnosis does not exist in Asian cultures). Women who see menopause as a health condition rather than aging rate it more negatively.

Pain experience

African Americans consistently show lower pain tolerance/higher pain ratings/lower pain thresholds than non-Hispanic whites. Maybe influenced by; genetic differences/endogenous pain control mechanisms/attitudes towards pain/language issues - expression of pain/perceived discrimination/pain coping strategies/life experiences.

Opioid crisis

increased use of strong pain killers; increase prescription 2.8% in 2010 - 14.2% in 2017.

USA - 130 deaths a day/2.1 million with opioid use disorder.

Possible reasons;

1. Changing views on pain (not wanting to accept pain as a part of life.

2. Pharma-companies, downplaying risks/aggressive marketing.

3. Misperception of addictiveness.

4. Hospital quality judged based on pain score.

Wait and see approach

patients wait and see before calling doctor/doctors reluctant to prescribe or refer to specialists/GP is a gatekeeper. (e.g., Greece, call straight away and receive treatment/ US more available over counter).

Placebo effect

e.g., uclear disease; improvement rates upon placebo usage; Brazil 7%, Denmark + Netherlands 22%, Germany 59% (unclear what explains differences).

Also, placebo effects for lowering blood pressure, lowest in Germany of 32 countries; so cultural differences can be specific to different conditions.