EDP 816 Module 7 Culture, Health and Well-Being Example

Headaches, Harmony and a Good Life: Culture, Distress and Well-Being

Student Name

Doctor of Education Program, Aspen University

EDP 816: Cultural Perspectives in Psychology

Instructor Name

Month Day, Year

Headaches, Harmony and a Good Life: Culture, Distress and Well-Being

Physicians at Grace's clinic noticed a pattern. Some patients who later met criteria for depression first came in describing headaches, fatigue, poor sleep and aches, and did not mention sadness unless asked directly. Some were frustrated when referred to Grace, the psychologist, saying they had come for their bodies, not their minds. No real patients are described. This paper examines the research on culture, distress and well-being.

Somatic and Psychological Expression

Ryder et al. (2008) compared outpatients with depression in Changsha, China, and Toronto, Canada. Chinese patients reported more somatic symptoms, such as fatigue, sleep problems and bodily discomfort, while Euro-Canadian patients reported more psychological symptoms, such as sadness, guilt and low self-worth. The difference was partly explained by externally oriented thinking, a tendency to focus on outward events and bodily experience rather than inner feelings, which was more common in the Chinese sample. Both groups had depression; they experienced and described it differently. The authors argued that neither presentation is the true one and that Western emphasis on psychological symptoms is itself culturally shaped.

What Good Feelings Mean

Kitayama et al. (2000) studied Japanese and American college students' daily emotional experiences. They distinguished socially engaging emotions, such as friendly feelings and closeness, from socially disengaging emotions, such as pride and feeling superior. In the United States, general good feelings were more closely associated with disengaging positive emotions; in Japan, with engaging positive emotions. Feeling good, in other words, was tied to feeling independent in one context and connected in the other.

What Predicts Well-Being

Diener et al. (2003) reviewed research on personality, culture and subjective well-being. Personality traits such as extraversion and neuroticism predicted well-being across cultures, but the strength of other predictors varied. Self-esteem, for example, was more strongly related to life satisfaction in individualist nations than in collectivist ones, where relationships and social norms played a larger role. Cultures also differed in how much people valued and reported positive feelings.

Applying the Research to Intake

The research suggests that patients presenting with somatic complaints may be experiencing depression in a culturally typical way, not hiding it or lacking insight. The clinic will add a brief depression screen when somatic complaints persist without clear medical cause, and physicians will introduce referrals to Grace in terms that respect patients' experience, such as "stress can affect sleep and energy, and Grace helps people with that," rather than implying the problem is "in their head."

Treatment Goals

Treatment goals will be set in patients' own terms. For a patient whose well-being centers on family harmony, a goal of restoring relationships may matter more than raising self-esteem. Grace will ask, "What would things look like if you were doing well?" and build goals from the answer.

Within-Group Variation

Many European American patients present depression somatically, and many Chinese American patients describe sadness readily. Ryder and colleagues' findings describe group tendencies, and the clinic's practices apply to everyone.

Patients' Own Explanations

Patients bring their own explanations of illness, and these shape whether they accept a diagnosis. A patient who attributes fatigue and poor sleep to overwork and family strain may reject the word "depression" but accept help with stress and sleep. Others explain distress in spiritual terms or as a family matter rather than an individual one. Ryder et al. (2008) argued that the way distress is expressed is tied to how a culture understands the person, and those understandings also shape what help seems appropriate. Grace will ask patients what they think is causing their symptoms and what they think would help, and will frame treatment in terms that fit those explanations where possible, for example presenting therapy as a way to manage stress and restore sleep.

Introducing a Referral

The way a referral is introduced affects whether the patient comes. Physicians will introduce Grace as part of the clinic's team for people under strain, describe what she does in practical terms and, where possible, introduce her in person during the visit. A warm handoff of this kind reduces the sense that the patient is being sent away because the physician thinks the problem is not real.

Well-Being as a Treatment Outcome

If well-being differs in kind across cultures, so should the outcomes the clinic tracks. A measure that counts only positive feelings such as pride or excitement may miss improvement for a patient whose good days are marked by harmony at home. Kitayama et al. (2000) found that engaging emotions were tied to good feelings in Japan, which suggests including items about closeness and getting along with others in outcome tracking.

Checking the New Screening Step

The clinic will track how many patients with persistent somatic complaints are screened, how many screen positive and how many of those accept and benefit from care. Grace will also review a sample of positive screens to check that the step is not labeling patients whose symptoms have medical causes. Diener et al. (2003) cautioned that measures of well-being and distress carry cultural assumptions, so the review will include patients' views of whether the screening felt appropriate.

A Note on Language

Some languages spoken by the clinic's patients have rich vocabularies for bodily states linked to emotion, such as feelings located in the chest or stomach, which English renders awkwardly. Interpreters may translate these as physical symptoms only. Clinicians will ask interpreters to convey the patient's own words where possible, so that the emotional meaning carried by bodily terms is not lost.

Conclusion

Ryder and colleagues showed that depression is expressed in culturally shaped ways, Kitayama and colleagues showed that good feelings differ in kind across cultures and Diener and colleagues showed that predictors of well-being vary. For the clinic, screening that recognizes somatic expression and goals that reflect patients' own definitions of well-being bring care closer to how patients live.

References

Diener, E., Oishi, S., & Lucas, R. E. (2003). Personality, culture, and subjective well-being: Emotional and cognitive evaluations of life. Annual Review of Psychology, 54, 403-425. https://doi.org/10.1146/annurev.psych.54.101601.145056

Kitayama, S., Markus, H. R., & Kurokawa, M. (2000). Culture, emotion, and well-being: Good feelings in Japan and the United States. Cognition and Emotion, 14(1), 93-124. https://doi.org/10.1080/026999300379003

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(2), 300-313. https://doi.org/10.1037/0021-843X.117.2.300