A comparison of the social constructs of emotion in Asian and Western cultures shows that Asians are more prone to experience depression and suicidal behaviors than are Westerners. Studies highlighting the cultural similarities and differences in display rules, the emotion regulation norms, and the physical and emotional expression of depression in these two cultures are cited to support this claim. The Basic Emotion, Component, Appraisal, and Neo-Jamesian theories show that only elements from each provide a complete explanation of why Asians are predisposed to depression because of culture. The Social Constructionist Theory offers a thorough explanation of this phenomenon. The problems and possible remedies facing Asian cultures and the heightened risk of depression among its members are also addressed.
Culture and the Understanding of
the Concept of Depression
Through numerous studies on cultural relativism and cultural categorization of emotion, emotion is shown to be, to a degree, contingent on cultural factors such as display rules, social roles, and culturally determined appraisals. The interpretation of depression eliciting stimuli and situations and expression of depression, in particular, is also influenced by these cultural factors. Furthermore, the social constructionist view of depression makes it possible to compare the concept of depression in Western and Asian cultures. The contrast between the relatively individualistic nature of Western cultures and the collective nature of Asian cultures, and their associated norms for emotion regulation, may offer differing perspectives of depression and therefore help form a cultural observation of depression within the two cultures. The cultural display rules, socially learned performances, and emotion regulation norms that guide the interpretation of and behavioral responses to depression in these cultures reveal that Asians are more prone to depression and suicidal behaviors than are Westerners.
Cultural differences between Western and Asian cultures in individualism-collectivism (I-C), a dimension of cultural variability, show a strong possibility that Asians are predisposed to more negative emotions than are Westerners. Individualistic cultures, most of which are Western, promote individual needs, wishes, desires, and values over group and collective ones (Matsumoto, 1990). Consequently, hierarchical differences in status or power are minimized while equality is emphasized (Matsumoto, 1990). In contrast, collective cultures, many of which are Asian, promote the opposite; they stress the needs of a group, individuals identify themselves as members of a group, and one’s social role is defined by an entrenched system of hierarchical differences and vertical relationships (Matsumoto, 1990). The I-C difference is also related to the social distinction between ingroups and outgroups (Matsumoto, 190). Members of individualistic cultures tend to display more negative emotions to ingroup members and more positive emotions to outgroup members. Conversely, members of collective cultures tend to display more positive emotions to members of ingroups and more negative emotions to those of outgroups (Matsumoto, 1990). These display rules should predispose Asians to more negative emotions, which may result in depression, at least in the social interactions with outgroups.
Power distance, another dimension of cultural variability, which refers to cultural differences in status and power, is positively correlated to cultures that are more individualistic and negatively correlated to those that are more collective. This dimension may already show that Asian cultures foster more opportunities for the occurrence or passive harboring of negative emotions, while Western cultures seem to dissipate many of these potential risks. The importance of equality and the needs of the individual in Western cultures may make it less likely for people to experience depression on a large, societal scale. On the other hand, the vertical relationships encapsulated in collective cultures may make it more likely for people to acknowledge their differences from one another and any perceived inadequacies with those higher in power and status may contribute to the occurrence of depression.
A Japanese-American comparison study by Matsumoto (1990) explored the relationship between I-C and PD cultures and the display rules of the members of those cultures. The study was conducted in two sessions; the first measured display rules through the subjects’ judgment of the appropriateness of displaying emotions in different situations, and the second measured how they judged the intensity of the same emotions. The results of the experiment supported the views that Japanese display rules made it appropriate to show negative emotions to outgroups and lower-status others while American display rules allowed people to express negative emotions more openly in ingroups (Matsumoto, 1990). In addition, Americans rated happiness in public and to outgroups as more appropriate than did Japanese. The Japanese display rules, indicative to some degree of Asian cultural display rules at large, show that in order to foster ingroup harmony and maintain the hierarchical differences in power and status, people find negative emotions to be appropriate when interacting with outgroups and lower-status others but not with ingroups and higher-status others. These display rules may reveal that Asian cultures are less tolerant than Western cultures of negative emotions in ingroups, which discourages them to express and share their negative emotions with their ingroups. A further finding from Matsumoto’s study suggests that although Asians may be more likely to express negative emotions to outgroups, they mask their negative feelings in the presence of others (Matsumoto, 1990). Overall, Asian cultures seem to discourage any expression of negative emotions whether with ingroups, outgroups, or those of different status.
Emotion regulation norms for Asian and Western cultures also demonstrate a greater likelihood for depression among Asians than among Westerners. Since emotion regulation refers to the ability to manage and modify one’s emotional reactions in order to achieve a desirable outcome, it reflects the different ways that culture tries to achieve social order (Matsumoto, Yoo, & Nakagawa, 2005). Two aspects of emotion regulation, reappraisal-the way individuals appraise an emotion-eliciting situation to change its impact on the emotion-and suppression-the inhibition of emotional expressive behavior-can be used to compare Asian and Western cultures. Individualistic cultures are associated with more reappraisal and less suppression because these cultures value emotions and free expression more than collective cultures, which are associated with less reappraisal and more suppression in order to maintain ingroup cohesion and harmony (Matsumoto et al., 2005). Studies have linked emotion regulation to different types of adjustment. Individuals high in reappraisal and low in suppression experienced more positive and less negative emotions, were more open in sharing their emotions with others, had better social support, were less depressed, and reported higher self-esteem, optimism, and life satisfaction; in essence, reappraisal has been associated with positive outcomes and suppression with negative emotions (Matsumoto et al., 2005). These conclusions can also be applied to individuals from Asian and Western cultures at large-Asians may feel more negative emotions, have less social support, and be more depressed than Westerners.
Although suppression has been associated with negative consequences on the individual level, a study by Matsumoto et al. (2005) shows that it may have positive consequences on the social level. Suppression may play an important cultural function in organizing and maintaining cultural systems and groups. Thus, the social order is preserved at the expense of the emotional well-being of the individual. Part of their study, which held data about country-level emotion regulation, reveals that emotion regulation is positively correlated with both positive and negative indices of adjustment (Matsumoto et al., 2005). In other words, while individualism may promote high levels of both positive and negative adjustment because it values free, uninhibited emotional expression, collectivism may promote only either positive or negative adjustment. Despite the fact that suppression in collective cultures may lead to greater social harmony and a high level of positive adjustment, individuals may still experience negative consequences. Therefore, while Asian countries and cultures may report a relatively positive adjustment for society in general, individuals themselves may report negative adjustment. This phenomenon may very well show that Asians who suffer from depression are stifled by cultural emotion regulation norms from receiving psychological or emotional help and support.
The Social Constructionist Theory has helped define the social constructs of Asian cultures that make Asians more prone not only to negative emotions but also to social anxiety, a precursor to depression. Cultural display rules, social roles, and emotion regulation norms have effectively contributed to the predisposition of Asians to be more passive, non-assertive, and anxious in interpersonal situations than Westerners (Okazaki, Liu, & Minn, 2002). The results from a study that examined differences between Asian American and White American on a trait measure of social anxiety and self-reports of anxiety-related emotions during a 3-min social performance task indicated that Asian Americans reported more anxiety than White Americans (Okazaki et al., 2002). Their data also revealed that some differences among Asian Americans of various ethnicities in their levels of social anxiety are related to their levels of acculturation. If there are indeed significant differences among Asian Americans depending on their level of acculturation to American culture, they would be due to whether Asian Americans still prescribe to Asian social constructs of emotion. Although Asian Americans reported more social anxiety, they did not behave in an observably different manner than White Americans during the anxiety-provoking social task (Okazaki et al., 2002). In light of the emotion regulation norms that guide behavioral responses, both Asian Americans and Asians may be less willing to express any type of strong emotions, positive or negative, in front of people. This observation may support the view that Asians are exposed to social rules that increase the likelihood for anxiety, and subsequently depression, because those same rules prevent them sharing their emotional burdens with others.
This culturally embedded formula for Asians to experience more social anxiety than Westerners is reinforced by culturally relevant risk factors for suicidal behaviors among Asian American youths. Asian American youths are at greater risk for suicide than majority group youths (i.e. White Americans and African Americans) because they experience risk factors that every youth experiences such as antisocial behaviors, substance abuse, and lack of familial stability, and those related to acculturation to the majority culture such as discrimination, alienation, and identity confusion (Lau, Jernewall, Zane, & Myers, 2002). Asian American youths who fail to acculturate properly and develop an adaptive ethnic identity are prone to maladjustment, which entails life dissatisfaction, low self-esteem, pessimism, and depression. It is primarily the parents of Asian American youths that confound their efforts to acculturate and thus contribute to stress and frustration (Lau et al., 2002). Acculturation stress and intergenerational acculturation conflicts have been identified as factors that influence suicidal behaviors among Asian youths in Great Britain (Lau et al., 2002). A struggle between Western cultural norms and Asian cultural values can be seen in the parent-child conflicts of Asian American youths.
A medical record abstraction at a mental health outpatient clinic identified correlates of suicidal behaviors in a sample of 285 Asian American youths (Lau et al., 2002). The records pointed out that adolescents were at the greatest risk for suicidal behaviors and were more prone to depression than were younger children. Consequently, depression was a strong predictor of suicidality as well (Lau et al., 2002). The data showed that youths who were less acculturated and experienced high parent-child conflict were at significantly greater risk than youths who were more acculturated and had lower conflict. Interestingly, youths who were diagnosed as suicidal displayed a higher number of internalizing symptoms and fewer externalizing symptoms (Lau et al., 2002). Perhaps the cultural sanctions against expression of negative emotions and the Asian cultural tendency to portray mental disorders as shameful and the tendency to downplay such disorders as temporary emotional states that do not require treatment, medical or otherwise, contribute to the prevalence of suicidal behavior among Asian American youths (Lau et al., 2002).
Asian Americans as a whole, including both youths and adults, have had their mental health needs neglected by United States federal mental health policies (Nagayama Hall, & Yee, 2012). This neglect is perpetuated in part by the three myths about Asian Americans: they are a small group; they are a successful group and do not have any financial or cultural problems; and they do not experience mental health disparities (Nagayama Hall, & Yee, 2012). Although many, especially White Americans and the government, see Asian Americans as the model minority, they are not by any means exempt from problems surrounding their social and cultural position in the United States. The first myth is debunked by data from the U.S. Bureau of the Census showing that Asian Americans are proportionally the fastest growing ethnic group in the U.S. The second myth can be disproven by the sheer fact that not all Asian Americans receive the same education and opportunities to advance in society. Some groups have less education, greater unemployment, and higher poverty than others (Nagayama Hall, & Yee, 2012). Moreover, even Asian Americans who are successful by educational, employment, and income standards encounter problems associated with their ethnicity. The stress of acculturation contributes to the occurrence of mental health disorders such as depression and anxiety disorders. Their overall success in integrating with American culture belies the reality that many experience mental health disparities due to clashing cultural values and display rules; as a result, this conflict and the neglect of their mental health needs predispose them to an increased risk of depressive symptoms and behaviors and (Nagayama Hall, & Yee, 2012).
A specific look into the avoidance of mental therapy in South Korea further strengthens the argument that Asian cultures foster societies in which Asians are more likely to experience depression and less likely to seek help for it. Academic and corporate pressures contribute to an alarming rate of stress and suicide among South Koreans (Kim, Won, Liu, Liu, & Kitanishi, 1997). Many Koreans, however, largely resisted Western psychotherapy for their growing anxieties, depression, and stress. The Buddhist and Confucian values that dictate much of South Korean society emphasize stoicism and modesty while subordinating individual problems and concerns to the good of society. In line with these ethics is preservation of “face”, or dignity for the family (Kim et al., 1997). If they do seek help, Koreans are compromising the dignity of their families by indirectly stating that they need mental therapy because their families are at fault. Koreans decide not to seek professional psychotherapy or counseling because the culture considers open expression of emotional problems as taboo. Thus, many Koreans forgo mental help and cope with their problems on their own (Kim et al., 1997). However, the suicide rate has doubled in Korea between 1999 and 2009 and it may continue to grow if Koreans do not seek therapy or some form of counseling to cope with depression and stress (Kim et al., 1997). The problem of depression in Korea is mirrored in other East Asian cultures perhaps because they all share the same cultural prohibition of expressing negative emotions to both ingroups and outgroups and the view that depression is not a serious mental health problem.
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A dangerous threat that can result from ignoring cases of depression and when individuals neglect or are incapable of seeking mental aid is a rising suicide rate. China, India, and Japan accounted for more than 40% of all world suicides in 2006 (Beautrais, 2006). Surprisingly then, although many Asian cultures believe that suicide is a source of personal and family shame, much of the world’s reported suicides occur in Asian countries. Problems of underreporting cases of suicides and suicide attempts such as inaccuracy of reports, prohibitions against the collection of suicide data, and the stigmatization of suicide make it difficult to assess the true numbers of suicides that occur in Asian countries. Nevertheless, limitations aside, there is still an alarming number of suicides that take place in Asian countries every year. As in Western countries, mental illness is strongly correlated with suicide in Asian countries (Beautrais, 2006). Indeed, many of the life stresses that cause depression-poverty and marital, family, and relationships problems-are equally shared by Asian and Western countries. However, some cultural, historical, and contextual features of suicidal behavior in Asia may show that life stresses may more often lead to suicide than in the West (Beautrais, 2006). The struggles of young rural families involving early marriage, low social status, and lack of personal autonomy; economic stresses for Asian businessmen who are pressured to work long hours and drink away their stress; and academic stresses for adolescents in Japan and Korea who compete for admission to prestigious schools may invariably lead to suicide. Not only do the societal conditions in which Asians live may engender more cases of depression and suicide, but also the social constructs of emotion particular to Asian cultures.
While the Social Constructionist Theory argues that social roles, emotion regulation norms, and cultural display rules explain why Asians may be more prone to depression than Westerners, appraisal theories help highlight the role of appraisal as interpretations of emotion-eliciting situations in this phenomenon. Appraisal, which is involved in reappraisal in emotion regulation, is defined as the evaluation of an event. Appraisal, therefore, plays a significant role in emotion regulation because it allows an individual to interpret a situation as positive or negative, thereby influencing the emotion felt. Whereas in Asian cultures, appraisal is framed by values that promote embeddedness, power distance, and hierarchy, in Western cultures, appraisal is perceived through values that promote individualism, egalitarianism, and affective autonomy (Matsumoto et al., 2005). Asian cultures assess appraisal through the collective mind, or through the socially desirable outcomes of ingroup harmony and maintenance of power distance. Therefore, Asians may tend to appraise situations as positive or negative depending on the goals of their societies. However, because Asians may appraise emotional situations under the context of social values, they may run the risk of both diminishing positive emotions and exaggerating the negative emotions for the individual. For example, if an Asian youth receives a relatively poor grade based on his parent’s standards, he may ignore the fact that although he did not please his parents, he scored the highest out of his class. Nonetheless, the youth appraises the situation negatively because he places the needs of the group (his family) ahead of his individual needs and concerns. In contrast, a Western youth may appraise the situation differently, seeing his performance as satisfactory and thereby feeling happier and less stressed. Appraisal theories are thus contingent on the social goals and values pertaining to culture.
Component theories further elaborate how components that lead to depression occur more often in Asian cultures than in Western cultures. In addition to appraisal, subjective feeling, action readiness, expression, and instrumental behavior are all emotion components that help construct an emotion. Through Ortony and Turner’s conclusion that emotion components are dissociable elements and the results of the study by Okazaki et al., (2002), we can see that depression is caused by various components that by their own may not be indicative of the emotion. Asian cultures define these components in relation to social order and harmony, once again subordinating the needs and desires of the individual to those of society. Naturally, appraisals and behaviors that reflect restraint and inhibition of expressing negative emotions are more prevalent and readily used in Asian cultures. However, even if one were to experience components of depression, the full manifestation of the emotion may not occur because depression and other mental health disorders are looked down upon in Asian cultures (Beautrais, 2006). The individual would likely associate an experience of depression, despite having all the components that form depression, with a general negative emotion that can be overcome by sheer willpower or other non-professional therapy; in addition, the individual can choose to ignore one or several components of depression to deny that they are depressed. Unfortunately, component theories, like appraisal theories, do not offer a full explanation of why Asians may be predisposed to depression because they do not ensure the full manifestation of depression.
The Basic Emotions Theory may support the universality of depression, but does not explain why or how Asians are more prone to experiencing it. The study on social-anxiety for Asian Americans and White Americans by Okazaki et al., (2002) showed that facial expression is not a primary or even reliable indicator of emotion. Likewise, another study exhibiting display rules in Japanese and American subjects showed that while the Japanese felt the same emotions as the Americans, they did not show negative emotions to strangers (Matsumoto, 1990). Facial expressions of emotion are but one part of socially defined components that generate an emotion. Depression is interpreted differently by Asian cultures than it is by Western cultures due to differing social values and roles (Beautrais, 2006). Moreover, the expression of depression is inevitably different for Asian cultures and Western cultures because of cultural display rules. In short, the Basic Emotions Theory merely states that depression exists, but not to what degree individuals in different cultures experience it.
There is a link between the Neo-Jamesian Psychophysiological Perspective and a study by Arnault & Kim (2008) that shows that Japanese and Korean women had higher somatic distress and depression than American women. The results of the study showed that there were certain somatic distress symptoms unique to depression among the Asian women: gastric and abdominal upset, weakness, dizziness, aches and pains, and palpitations (Arnault & Kim, 2008). Through a comparison with American women, Japanese and Korean women were found to experience culturally-specific somatic symptoms. This finding supports the psychophysiological perspective that each emotion has its own pattern or signature of bodily changes. Therefore, according to this perspective, depression should also have its own unique signature of bodily changes. Although the study may support the claim that emotions are equivalent to physiological changes or can be purely defined by them, it also showed that the somatic symptoms felt by the women were culturally-specific. American women would not be able to experience the same symptoms as the Asian women did, and they would probably not label their symptoms collectively as depression. Furthermore, the Japanese and Korean women used an “idiom of distress” used to describe their symptoms that highlighted the importance of cultural values and beliefs.
The Social Constructionist Theory is, therefore, the best theory illustrating how Asians are more prone to depression and suicidal behaviors than are Westerners. It encompasses elements from the Appraisal theory, Component theory, Basic Emotions theory, and Neo-Jamesian Psychophysiological Perspective. Emotion components that form the emotion of depression are all influenced by the social norms of a particular culture. Asian cultures, which value embeddedness, power distance, and hierarchy, evaluate emotion components and somatic symptoms according to these cultural orientations. On the other hand, Western cultures evaluate emotion components and physiological symptoms according to individualism, egalitarianism, and affective autonomy. The culturally specific evaluations of Asian cultures increase the likelihood of people experiencing depression than in Western cultures. The downplay of negative emotions may also reveal that in Asian cultures, negative emotions are relatively hypo-cognized concepts, emotion concepts that are not so thoroughly mapped out in a culture’s emotion lexicon. Nonetheless, the expression of negative emotions is confounded and inhibited by a cultural reluctance to acknowledge that people have mental health problems. Socially learned performances, syndromes, and language all contribute to create a high disposition for depression in Asian cultures.
While Asian and Western cultures seem to be the primary culture groups in the world, we can observe similar cultures such as that of the Utku if we focus on the more fundamental I-C dimension of cultural variability. The Utku society shares more values and traits with collective Asian cultures than with individualistic Western cultures. The Utku value ingroup harmony over individual needs and desires, which have the potential to disrupt society. Parents show affection to their children up until a certain age around 3 and 4 years old, in order to assimilate them into the larger social context of society (Briggs, 1970). Adults expect children to eventually abandon their childish, selfish ways and adopt a communal mindset of equal distribution of food and goods. In order to maintain their social harmony, the Utku try not to exhibit anger, which would be detrimental to the carefully monitored society by causing conflict and breaking relationship ties.
In their efforts to avoid anger, they have effectively made it a hypo-cognized concept, indirectly doing away with one of the precursors to depression. Because none of the Utku claim to be angry and no one can observe any signs of anger, the Utku may not even experience depression. By eliminating not only anger but also negative emotions in general, the Utku may only perceive positive emotions. Unlike other collective cultures like Asian cultures, the Utku have a relatively limited and simple emotion vocabulary and thus may not even consider depression to be an emotion concept, much less experience it. While studies on cultural display rules and emotion regulation norms suggest that individuals in collective cultures are more prone to negative emotions, this does not seem to be the case for individuals in Utku society. The only possible instances where depression may have occurred, in Raigili and Saarak’s sullen moods when their mother no longer carries them, do not guarantee that the children felt depression (Briggs, 1970). Even if they felt sadness, it would have been construed and interpreted through social values; they experience emotions through the context of their society. In essence, the Utku reveal one exception to the commonly held view that individuals in collective cultures are more prone to depression.
The comparison of Asian and Western cultures and their disposition for depression brings up a problem of the immutability of culture. If Asians are truly more prone to depression because of culture, then how do we rectify this problem, if there even is a solution save the complete upheaval of deeply entrenched social norms and values? Even with the evidence citing that Asians experience more depression and are at greater risk of suicidal behaviors than are Westerners in America and in their native countries, the global rates of suicide in Asia seem to increase every year. The medical findings can be a starting point to influence government health, economic, and educational policies to change or perhaps sway cultural values. While the thought of completely or irreversibly altering a culture’s values and beliefs is not only near impossible but controversial, government and public awareness of depression and suicide may help decline the rampant number of suicides that occur in Asia. There is an important distinction to be made between countries and cultures-countries may comprise of one or several cultures, and conversely, a culture is not indicative of any country’s beliefs or values (Matsumoto et al., 2005). Changes in other dimensions like international politics have translated into changes in public sentiment and even cultural values. There is a great possibility for governments of collective cultures to perhaps assuage the dangers of emotion suppression and allow for more open and free expression of emotion. They can also try to establish medical and mental health institutions that allow people to meet with psychiatrists privately to prevent the patient from any associated familial or individual shame for having depression.
The medical records of Asian American outpatient youths and U.S. mental health policies that neglect the special needs of Asian Americans can help direct attention to the increased likelihood among Asian Americans to feel depression. The transcultural study by Kim et al., (1997) showed that even Asian students have developed coping methods to deal with stressful events. Health reforms that pair Asian patients with those of same ethnicities may alleviate any barriers to full expression of emotion and provide a chance to better diagnose and remedy depressive symptoms among low acculturated Asian Americans or immigrants. An observation that American psychiatry should be more sensitive to the relationship between the mind/emotions and the body would also help assess and treat Asian patients who experience depression and stress (Arnault & Kim, 2008). Programs to help Asian immigrants to become acculturated with American or Western culture may dissipate any tension between Asian values and Western values. Understanding of emotion concepts across Asian and Western cultures could also be more easily facilitated through these acculturation programs. These civil policies and other measures may make it easier for Asian Americans to adopt American or Western culture while at the same time not relinquishing their native Asian cultures. This process of integration would ensure that they do not lose their cultural identities but rather focus on the values and emotion constructs that promote emotional well-being and health.
Although Western cultures seems to be a better culture in terms of emotional expression and general individual well-being, it is far from perfect and may even be worse than Asian cultures in maintaining social order. Cultures all share the desire for social order (Matsumoto et al., 2005). Western cultures seem to promote this relatively well by empha