Cultural bias in psychology
“To ignore these realities, or to trivialize them, is to contribute to a science while wearing blinders” (Lonner & Malpass, 1994).
A typical psychology text book contains hundreds of terms and theories to help explain human behaviour. Most of these texts appear to suggest that all of these fantastic concepts are universally applicable; we are all basically the same, and that is that. This is a very dangerous assumption to make. It has been estimated that over 90 percent of all psychologists who have ever lived are from the Western world (Lonner & Malpass, 1994). The majority of theories in counselling psychology have evolved primarily from the experiences of White, upper class men, conducting research on White, upper-class clients (Lee & Richardson, 1991). This article shall focus on the cultural biases that are clearly visible in much of the research conducted in psychology, with particular emphasis on the controversy over the resultant definitions and diagnosis of mental illnesses.
Culture can be defined as the “transmitted and created content and patterns of values, ideas and other symbolic-meaningful systems as factors in the shaping of human behaviour and the artefacts produced through behaviour” (Kroeber and Parsons, 1958, p583).
Psychologists and other social scientists have long been interested in the influence of culture on psychopathology, or abnormal behaviours.
We have been provided with the basic components and attributes of what constitutes a mentally healthy and ‘normal’ individual. Self-sufficiency, independence, competitiveness, confidence and an internal locus of control are all characteristics that are required to be deemed ‘mentally stable’ (Pederson, 1987). These are the stereotypical characteristics of [typically American, but can be generalised to those living in a Western Society] White, middle-class men (Ritchie, 1994). Individuals who exhibit connectedness, stability, cooperation and an external locus of control are therefore often seen as less psychologically healthy, even though these characteristics are viewed as positive and virtuous attributes in other cultures (Ritchie, 1994). Do definitions of normality and abnormality vary across cultures, or are there universal standards of normality?
Correct definitions of mental and emotional health are critical in psychology, as they guide counsellors and psychologists in the diagnosis, support and assistance of patients. If the definitions are narrow and biased in favour of particular cultural or social groups, it could lead to wrong diagnoses and unmerited assumptions about the mental health of certain individuals or groups (Richie, 1994). Pederson (1987) was passionate about the problems these assumptions cause, in fact, he claimed that “the consequences of these assumptions are institutionalized racism, ageism, sexism and cultural bias” (p16).
A plethora of research has discovered differences in the levels of mental illnesses present in people from varying ethnic and racial backgrounds For example, Hispanics have been diagnosed with schizophrenia 1.5 times more frequently than Whites, and African Americans are more likely than Whites to be diagnosed with schizophrenia, substance abuse, and/or dementia (DelBello, Lopez-Larson, Soutullo, & Strakowski, 2001). The essential question raised from these results is: are these differences in diagnostic rates due to cultural diversities, or the misdiagnosis from psychologists and counsellors due to their own personal biases? There have been similar concerns raised about cultural biases inherent in IQ testing, with the generalisations that Asian children have, on average, higher IQs than white children, and African children have, on average, lower IQs. Research in this field has indicated that there might be cultural implications inherent in the IQ test themselves, which lead to this perceived difference (Scarr, 1981). It is highly likely that such cultural differences could also manifest themselves in the diagnosed rates of mental illness.
A recent study by Hays, Prosek & McLeod (2010) aspired to explore how culture affects the clinical decision making progress, and cited selecting participants who were “culturally diverse”, with experience in clinical settings. But, of the 41 participants, 28 were White, 10 were African-American, 1 was Hispanic, 1 was multiracial, and 1 identified themselves as ‘other’. This is clearly still a very much Western world based sample. Even studies attempting to understand the influence of culture in clinical diagnoses can be culturally biased, with such a high number of White participants, the results cannot be generalised to every country.
The World Health Organisation (WHO, 1973, 1979, 1981) sponsored the international pilot study of schizophrenia to compare the prevalence of the disorder in 1, 202 patients, in several countries. The investigators were able to identify a set of symptoms that were present across all cultures in the schizophrenic samples, including: lack of insight, auditory and visual hallucinations and delusions of grandeur (Leff, 1977). But, it was found that the course of the illness was easier for patients in developing countries compared to those in highly industrialized countries. Patients in India and Nigeria, for example, recovered at faster rates than those in England, or the United States. These differences were attributed to cultural factors, such as the presence of extended family networks, community support, and the emphasis on returning to work in developing countries.
Cultures may differ in their tolerance for particular symptoms, the Nigerian culture as a whole is more accepting of the presence of voices. In cultures where Shamanism is prevalent, such voices, and indeed visions, are taken as a manifestation of power and of major religious significance, whereas in Western Culture, they would be taken as symptomatic of mental illness (Krippner, 2002). Even in the Western World, there are significant differences as regards how historical instances of “voices” and “a sense of mission” are viewed. Whilst English Professionals in the field might have their doubts about Joan of Arc, such a diagnosis would be very poorly received by French professionals, who have an all together different historical perspective on this individual (Allen, 1975).
In an early study of New York psychiatric cases, Opler and Singer (1959) found that Irish- American schizophrenic patients were more likely to experience paranoid delusions than Italian- American patients. The authors cited possible cultural differences in parenting and upbringing in order to account for the difference. Another possibility, which is not often discussed, might be genetic differences in the actual structure of the brain. There is increasing evidence that many forms of mental illness stem from subtle “mis-wiring” in the brain, it is quite plausible that there could actual be a genetic bias behind this (Phelan, 2002: in relation to schizophrenia). The prevalence of sickle cell anaemia amongst the African population, whilst very rare in the white population, has long been accepted. Indeed, there is a theory that genetic tolerance towards malaria (which isn’t prevalent in the Western World due to the mosquito disease vector not being present) has, as a side effect, increased the likelihood of sickle cell anaemia (Aidoo et al, 2002). Further research could well uncover similar predispositions towards certain types of mental illness in genetically different populations.
There are universal aspects of the symptoms and presentation for at least some of the major psychopathologies, such as schizophrenia. At the same time, however, many psychopathologies are thought to be heavily influenced by culture, especially in terms of the specific behavioural and contextual manifestations of the abnormal behaviour, and the perceived effect of the behaviour on the everyday lives of the individuals (Matsumoto & Juang, 2004).
Classification systems need to contain both etic and emic elements in order to display a rounded view of the symptoms and disorders in question. Where to draw the lines, and how to measure psychological traits and characteristics within this fluid and ever changing system, is the challenge that faces the area of psychology today. Although the field has made vast improvements in this area in the past few years, future research will need to elaborate further on these issues so that the classification and measurement can be made more precise, meaningful and relevant. Inclusion of more diverse populations in pluralistic countries such as England, the United States, and now more recently Ireland, is also needed in this area of research. If this can be done, proper understanding, assessment and diagnosis of mental disorders will in turn develop effective preventions and treatments that will improve and enhance people’s lives, all over the world.
Works Cited
Aidoo, M., Terlouw, D., Kolczak, M., McElroy, P., ter Kuile, F., Nahlen, B., Lal, A., & Udhayakumar, V. (2002). Protective effects of the sickle cell gene against malaria morbidity and mortality. The Lancet, 359, 9319, 1311-1312.
Allen, C. (1975). The schizophrenia of Joan of Arc. History of Medicine, vol. 6.
DelBello, M, P, Lopez-Larson, M, P, SoutuUo, C, A,, & Strakowski, S, M, (2001), Effects of race on psychiatric diagnosis of hospitalized adolescents: A retrospective chart review. Journal of Child and Adolescent Psychopharmacology, 11, 95-103
Hays, D. G., Prosek, E. A., & McLeod, A. L. (2010). A Mixed Methodological Analysis of the Role of Culture in the Clinical Decision-Making Process. Journal of Counselling, 88, 114-121
Kroeber, A. L., & Parsons, T. (1958). The concepts of culture and of social system. American Sociological Review, 23, 582-583.
Lee, C. L., & Richardson, B. L. (Eds.). (1991). Multicultural issues in counselling: New approaches to diversity. Alexandria, VA: American Association for Counselling and Development.
Leff, J. (1977). International variations in the diagnosis of psychiatric illness. British journal of psychiatry, 131, 329-338.
Matsumoto, D., and Juang, L. (2004). Culture and Psychology, 3rd Edition. USA: Thomson and Wadsworth.
Opler, M. K., & Singer, J. L. (1959). Ethnic differences in behaviour and psychopathology. International journal of social psychiatry, 2, 11-23.
Pederson, P. (1987). Ten frequent assumptions. Cultural bias in counselling. Journal of Multicultural Counselling and Development, 15, 16-24.
Phelan, J. (2002). Genetic bases of mental illness – a cure for stigma? Trends in Neurosciences, 25, 8, 430-431.
Ritchie, M. H. (1994). Cultural and Gender Biases in Definitions of Mental and Emotional Health and Illness. Counsellor Education & Supervision, 33, 4.
Controversies in Psychology 
What is interesting is the fact that other cultures can accept hearing voices and experiencing hallucinations and do not seem to automatically look to therapists and drug therapy as a way to “cope”. Future research could investigate what it is within the culture that allows this lack of fear and emphasis on deficits and look at a way of bringing some of their attitudes and beliefs to our culture.
I think cultural bias sheds interesting light on some of the problems with the objectivity of psychology. Why do the things I find repugnant seem perfectly acceptable in other cultures?! I think that this is where cultural bias crosses over into social constructionism. As ‘scientists’ we should make every effort to be objective (even though objectivity or universalisability may not exist). Acknowledging that there is cultural bias in psychology is certainly a step in the right direction. We certainly understand the western, male, middle-class white male, but what about what it actually means to be human? Psychology can attempt to address these problems, but as Niamh said in the previous comment, it is difficult when we are dealing with real problems and real human conditions (condition as in human state, not prescribed illness!) when we have a template of a specific cultural identity to measure all of humanity.
I liked the way in which you applied cultural biases to the diagnosis of mental illnesses. In your discussion about schizophrenia you made the point that sufferers from developing countries recover faster than those from industrialised countries, with this being due to greater family networks and community support. I would like to further develop this point.
One of the major differences between industrialised and non-industrialised countries surrounds the individualism-collectivism continuum. Industrialised societies, particularly western ones, are largely individualistic, whereas non-industrialised ones are collectivistic. Many of the fundamental symptoms of schizophrenia revolve around communicating with others. Such communication with others is harder in an individualistic culture where automatic belonging and support no longer exists. The traditional family base has fallen apart due to increased divorce and conflict. In some instances, this serves to other further the illness rather than help the sufferer recover. Furthermore, individualistic cultures often promote competition which can result in alienation, whereas collectivistic cultures offer greater stability and co-operation which support schizophrenics (Gross, 2007).
So as you said, community support and family networks are important aspects for non-industrialised countries in helping schizophrenics recover, but it is important to note that this is based on the knowledge that a collectivistic culture offers more support than an individualistic one.
An insightful blog raising some pertinent issues, in particular that of classification. The vast majority of psychological theories and constructs are created by and for Western society. Classification of mental illness is no different. The main diagnostic tool used by clinicians (DSM) utilises Western constructs and ideologies and therefore ignores the majority of humankind. Using the DSM to diagnose mental illness in a Pygmy from the Congo is like putting a cats head on a dogs body. They just do not sit well together. Quite apart from the inherent difficulties with the DSM and classification in and of Western societies is the blatant disregard for cultural diversity. Consequently a complete overhaul of the DSM is now necessary.
I think that cross-cultural studies are the way to go with the future of cultural psychological studies with the emphasis on creating an understanding on the variations among cultures and rectifying the issue of cultural bias in psychology by carrying out multiple investigative studies into experiments and theory’s which have been outlined in the past. It is difficult to not be biased and favour one’s own culture but psychologists need to look at the bigger picture and be psychologists. It has also to be recognised that throughout time also culture changes. People’s ways and traditions change in time. For instance in Turkey which is an accession country is waiting to enter into the European Union, traditions and andocentric biases which has long been a part of Turkey are now changing, new legislation and changing views are existent. People are changing as the world around us changes. We adapt and evolve with our surrounding environments.
It is perfectly fine to favour one’s own culture and to report on what is beneficial for them but I would say that the issue here (regarding an assumption of universality) is within the issue. I believe that the United States’ has hegemony over what constitutes ‘Western’ Psychological research and practice as perceived by the level of publications from that country compared to others. While this article has showed up very effectively, some ways in which cross- cultural psychology has challenged the dominant ‘Eurocentric’ i.e. white middle-class basis of psychology (Katz, 1985)- giving insight into the contextualising and indigenising of psychological research; I would go far to say that psychology will still have pretensions of being morally, politically, and ethically neutral so long as the United States remains its promotional base.
I agree with you Alan, if the United States remains the focal point of psychological research and investigations, there is no chance that findings can be properly generalised across different countries. It is not just America, however. From a cultural and sociological approach the Western world is defined as including all cultures that are directly derived from European cultures, i.e. Europe, North and South America, Israel, Australia and New Zealand (Thompson, William; Joseph Hickey, 2005). Together these countries constitute Western society. Already we have removed any possibility of individuality and cultural differences, although we know that there are large differences in cultural practices. It’s not just America- yes alot of research is generated there and accepted as universal, but the same can be said by reseach conducted in any of the major ‘Western’ countries.
I am aware that other countries constitute the western world and do indeed conduct said psychological research. My point, however, was that America (ostensibly) has a controlling influence in what psychological research is being documented (given their economic status, power, privilege) and that other Western countries themselves make their generalisations and outcomes dependent on what is convenient to American samples – so as to get it published there. Cross-cultural psychology practices provide a much richer channel for scientifically appropriate research and are definitely providing a challenge to that way that psychological data is reviewed. My argument was based on the concept of Americanisation in world society.
I am very wary of your suggestion that there may be sufficient genetic differences between irish and italian americans which may account for differing rates of diagnosis for schizophrenia. Culture (and particularly nationality) have not had sufficient time nor isolation to affect a genetic difference between these groups, if it may at all. It is much more likely that differing social factors have influenced this result since they may be largely similar within these groups yet sufficiently different between them. This points to one possible argument in favour of a “one sample to rule them all” approach within the presentation of research. That research which looks beyond socially constructed behaviour to the underlying mechanisms inherent within all humans should find little difference in results across cultures. This is the really interesting results in psychology for me, those that are true for all of us. Let us distinguish between sociology and psychology by the criteria of universality (or as near as dammit) and focus on what it means to be human not just those superficial aspects of being human here, there or then.
In response to Lisa’s comment, I am also very interested in the idea of discovering what it is that makes us human, removing cultural, social and those damn pesky individual differences (although they are what make us who we are, but they are a hindrance for a social scientist) , but I honestly think that we will never get an answer to that question. In some ways maybe that’s a good thing, we’d have nothing to think about then if we found the answer to the ultimate question of life, the universe and everything! Referring to the findings from Opler & Singer (1959), I must point out that I did not suggest sufficient genetic differences; the authors put cultural differences in upbringing forward as a possible explanation for the differing symptoms. The section on genetic differences is supposed to be separate to the Opler et al study, I’m sorry for the bad formatting there!!!