Towards a Cultural-Clinical Psychology

The cultural shaping of alexithymia: values and externally oriented thinking in a Chinese clinical sample

OBJECTIVE

Alexithymia is a multi-faceted personality construct characterized by difficulties in identifying and describing emotional states. Originally based on observations of American psychosomatic patients, the construct is now studied in a variety of cultural contexts. However, few studies have critically examined alexithymia from a cultural perspective. Dere et al. [1] recently found support for the hypothesis that one alexithymia component - externally oriented thinking (EOT) - is linked to cultural values, among Euro-Canadian and Chinese-Canadian students. The current study examines this association in a Chinese clinical sample.

METHODS

Outpatients presenting at three hospital-based psychology clinics in Hunan province, China (N=268) completed a structured clinical interview and self-report measures of alexithymia and cultural values. All participants endorsed clinically significant levels of depressed mood, anhedonia, and/or fatigue.

RESULTS

As expected, EOT was negatively predicted by Modernization and Euro-American values. Two other alexithymia components, difficulty identifying feelings and difficulty describing feelings, were unrelated to cultural values.

CONCLUSION

These findings suggest that cultural variations in the importance placed on emotional experience must be taken into account in cross-cultural alexithymia research. Such studies should also consider separately the specific components of alexithymia; failure to do so can lead to overestimation of alexithymia in groups where scores are driven by culturally-promoted EOT.

Depression in China: integrating developmental psychopathology and cultural-clinical psychology

With a starting point in John Abela's groundbreaking developmental psychopathology research on adolescent depression in China, we aimed to review the state of the literature on Chinese depression across the lifespan. We began with Dr. Abela's published studies relevant to depression in China and our own research with adults before turning to the reference lists of these articles to find additional sources. Then we conducted literature searches using PsycINFO and PubMed to find other relevant studies published between April 2001 and April 2011 . There are two distinct literatures on depression in China. Developmental psychopathology research has emphasized adolescent samples and cognitive models of causation; cultural-clinical psychology and cultural psychiatry research have emphasized adult samples and the meanings associated with emotions, symptoms, and syndromes. Both approaches to the study of depression in China have yielded important findings but have also highlighted issues that could be better addressed by incorporating the other approach. Beyond depression in China, the psychological study of culture and mental health more generally would benefit from greater exchange between developmental psychopathology and cultural-clinical psychology.

Depression in cultural context: "Chinese somatization," revisited

We have presented a view of culture and mental health that builds on work in cultural psychiatry, anthropology, and cultural psychology, and applied it to research on culture and depression. In particular, we have returned to the well-known topic of Chinese somatization. A culture–mind–brain approach to these questions helps us think about them in a way that points toward new research. We have applied this approach to thinking about a single set of questions, relevant to a single (DSM-based) diagnosis, in a single cultural group. The potential, however, is to rethink how we conceptualize mental health in ways consistent with cultural psychiatry’s general perspective over the past several decades, while incorporating rather than rejecting the many recent advances in brain and behavior sciences. In so doing, we gain a more expanded and nuanced view of the global landscape of mental health, accompanied by a more expanded and nuanced view of individual patients.

Anxiety symptom presentations in Han Chinese and Euro-Canadian outpatients: is distress always somatized in China?

BACKGROUND

Cultural variations in the relative emphasis on somatic versus psychological symptoms of distress are a common topic in cultural psychopathology. The most well-known example involves people of Chinese heritage, who are found to emphasize somatic symptoms in presenting depression as compared with people of Western European heritage. It remains unknown whether a similar cultural difference is found for anxiety disorders.

METHODS

Euro-Canadian (n=79) and Han Chinese (n=154) psychiatric outpatients with clinically significant concerns about both depression and anxiety were selected from a larger dataset based on their responses to a structured interview. They also completed two self-report questionnaires assessing somatization of depression and anxiety.

RESULTS

As expected, Chinese participants reported a greater tendency to emphasize somatic symptoms of depression, as compared to the Euro-Canadians. Contrary to expectations, the tendency to emphasize somatic symptoms of anxiety was higher among the Euro-Canadians as compared to the Chinese participants.

LIMITATIONS

Characteristics of our participants limit the generalizability of our findings. The current study is preliminary and requires replication.

CONCLUSIONS

Despite the exploratory nature of this study, the results suggest that the popular notion of 'Chinese somatization' should not be over-generalized. Our findings also imply that there may be important differences in the cultural understanding of depression and anxiety in both Chinese and 'Western' contexts. Future studies should seek to unpack potential cultural explanations for why Euro-Canadian outpatients may emphasize somatic symptoms in the presentation of anxiety to a greater degree than Chinese outpatients.