Juris Draguns (The Pennsylvania State University) and Junko Tanaka-Matsumi (Kwansei Gakuin University) study clinical psychology issues from a cross-cultural psychology perspective. Here, they present an evidence-based review of cultural issues in the assessment of psychopathology. They advocate greater attention to cultural values in explaining group differences, and draw the reader’s attention to the potential impact of the diagnostician’s cultural context and of rapid social change.
Gordon Nagayama Hall (University of Oregon) integrates clinical/counselling and ethnic minority psychology perspectives. This paper explores the lack of firm evidence for Empirically Supported Therapies (ESTs) in ethnic minority groups, and the similar lack for specially-designed Culturally Sensitive Therapies (CSTs). The gap between these two goals is attributed to differences in theories and methods in the two research communities, and the lack of dialogue between them.
Laurence Kirmayer (McGill University) is a cultural psychiatrist and director of the Division of Social and Transcultural Psychiatry at McGill University (see section 3). This paper argues that psychotherapies are unique in that they involve explicit talk about the self, which is based on implicit self-concepts, which are shaped by culture. He describes several different culturally-shaped models of the self and discusses their psychological ramifications. These approaches to self are contrasted with the ‘idiocentric’ or individualist model grounding most ‘Western’ assumptions about psychotherapy.
Arthur Kleinman (Harvard University) is a psychiatrist with anthropological training who launched the modern field of cultural psychiatry with this paper. He uses the example of the somatization of depression in Taiwan to illustrate how culture shapes mental health. Moreover, he argues that it is this attention to shaping that should be the hallmark of the new field, rather than a focus on group differences. Over the ensuing decades, several authors have commented on the progress made with this endeavor.
Anna Lau (University of California, Los Angeles), Doris Chang (New School for Social Research), and Sumie Okazaki (New York University) are clinical psychologists who conduct research in East Asian and Asian American cultural settings. This paper reviews the challenges that face researchers attempting to conduct ethnoculturally diverse treatment outcome studies. They begin by considering the limitations of the Randomized Clinical Trial approach, and then propose several alternatives aimed at advancing culturally-focused treatment research.
Sing Lee (Chinese University of Hong Kong) is a psychiatrist with particular research and clinical interests in eating and somatoform disorders. This paper takes the perspective that psychiatric symptoms and syndromes are shaped by cultural context, a process that is evident in the construction of formal diagnostic systems. These systems both reflect and constrain the ways in which psychopathology is experienced, expressed, and communicated to others. The argument is made through a detailed consideration of the revised second edition of the Chinese psychiatric classification system.
Frederick Leong (Michigan State University) is the director of the Consortium for Multicultural Psychology Research, integrating a multicultural perspective with clinical and counselling psychology. In this paper he reviews Kluckhohn and Murray’s integrative approach to anthropology and personality (the universal, the group, and the individual) and then applies these ideas to the therapeutic encounter. He concludes by describing the ways in which a therapeutic relationship can be thought of as a complex adaptive system.
Roland Littlewood (University College, London) is trained as both a psychiatrist and anthropologist and applies ethnographic methods to the study of mental health, with a particular interest in religion. This paper critically examines the progress made in cultural psychiatry since Kleinman’s 1977 paper, in particular the move from labeled cultural categories to fluid cultural contexts.
Steven López (University of Southern California) and Peter Guarnaccia (Rutgers University) are, respectively, a clinical psychologist and a cultural anthropologist who both have a particular interest in Latino mental health. This review emphasizes developments in the field since Kleinman’s Rethinking Psychiatry from 1988, covering theoretical (defining culture, purposes of cultural research, culture in DSM) and empirical (anxiety, schizophrenia, childhood disorders) topics. The paper concludes by considering a few emerging trends for future research in the area.
Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., & Bagby, R. M. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America. Journal of Abnormal Psychology, 117, 300-313.
This study uses multiple clinical assessment approaches – clinical interview, structured interview, and questionnaire – to evaluate symptom differences in Chinese and Euro-Canadian depressed patients. This study outlines a method for cross-group comparisons that point to potential specific explanations. First, item and structural equivalence methods are used to establish that the same symptom measures can be used across contexts and languages. Then, once group differences are established, mediation analysis is used to show how group differences in somatic symptom presentation can be partially explained by a tendency to engage in ‘externally-oriented thinking.’
Stanley Sue and Nolan Zane (both at University of California, Davis) are clinical psychologists with particular interests in Asian American mental health; Dr. Zane directs the Asian American Center on Disparities Research. Here, the authors critique the emphasis on cultural match and specific cultural knowledge, advocating instead for more general principles. They argue that these principles are grounded in good psychotherapy practice regardless of the cultural issues, but are especially important when engaging with clients across a cultural divide.