When we think of our daily lives we usually think of ourselves and perhaps a small group such as our immediate family for day to day needs. For most of us we think of waking up at a certain time to do school work, our jobs, while thinking of our significant other, our family, and any other plans we can squeeze in due to our busy days. For me during the week is strictly what assignments I have to do that day and work commitments while trying not to skimp too much on my rest. As many of us know, working while attending college is not easy. It is not easy mentally or physically. In our American culture we have this strong mindset of our individual goals and what we need to do to reach them. However, many people in other countries do not have this independent driving force for one’s self to get ahead.
In addition to religion, Eastern and Western cultures have been very different in this aspect. Westerners (example: United States and Canada) put more importance on individual rights and Easterners (Asia, Middle East such as India, Africa, etc.) emphasize social responsibly. Easterners are more inner (self) world dependent by searching inside one’s self and concerned with behavioral ethics. Westerners are more outer world dependent by searching outside one’s self for answers through research for example, and are more concerned with self-dedication to a goal.
These cross cultural differences are known as individualism-collectivism in relation to social anxiety disorders. Vulnerability to social anxiety may be influenced by the range between a culture’s social practice of individualism (personal identities independent of others) and of collectivism (connected to others collectively as a society) (Schneider, Gruman, & Coutts, 2012). Our textbook gives an example of a typical Japanese woman seeing herself as more connected to her community and family, whereas a typical American woman might see herself as more independent and self-sufficient. As a result of a collectivistic culture sharing a common identity with others, these types of societies may experience social anxiety more often (Schneider, Gruman, & Coutts, 2012).
A personal example that rings true of this for me would be my father’s situation. My dad was born in the 50’s in Italy where our ancestors originated and also lived in Lybia – Africa (Muslim region) during part of WWII. He came to America around the age of 9 if I remember correctly. His first language was Italian and he even picked up some Arabic while in Africa. As you can imagine it was very difficult for him to identify with the American culture. Not just because of the language but also certain values that he says seem to be more important in his previous cultures such as strong family connection, loyalty, and emphasis on enjoying life without focusing so much on money or big goals. As for the social anxiety aspect, because of these differences in his experienced cultures, I have noticed that he is very much an introvert. It is uncomfortable for him to meet new people, he doesn’t have many friends, and he doesn’t really like to go out and interact socially very often even with people he does know. He would rather be by himself or with my mom or the family. I think it is almost like a safeguard for him.
Many people that come from collective cultures carry themselves this way in society. I have noticed in different areas where I live of this to be true of people from different countries, not just one in particular. Although I was born and raised here in America, I think some of my father’s mentality has rubbed off on me. I am more of an introvert like he is and my brother is more outgoing and extroverted like my mom is who was born in the United States.
Reference:
Hart, P. Ianni, & D. Ledgerwood. (2012). Applying Social Psychology to Clinical and Counseling Psychology. In F. Schneider, J. Gruman, & L. Coutts (Eds.), Applied Social Psychology: Understanding and Addressing Social and Practical Problems (2nd ed.). Thousand Oaks: SAGE Publications.
Stanley Milgram replicated a study looking into how conformity feeds into normative social influence (Milgram, 1963). For a quick refresher back to Social Psychology 101, normative social influence is when you feel a cohesiveness with the group you are in. This group can be as broad as the country you are born in, or as narrow as the family you are raised. Cultural conformity is one that strongly affects collectivist and individualist cultures.
Collectivist and individualist beliefs are customarily divided up into the east and west. The Individualistic western culture puts importance on individuality and independence. Where an eastern collectivist culture puts their emphasis on interdependence and conformity (Aronson, Wilson & Akert, 2013) These divisions are flexible as in Italy where the the Northern part of the country is considered individualistic and the Southern part remains a traditional collectivist society (Hofstede, n.d.).
The collectivist nature of Southern Italy has, in the past, left a relatively heavy burden on the families of the mentally ill. Italy underwent a major health reform in the late 70’s which eventually closed down mental hospitals replacing them with community services. They followed up with numerous studies to find out how this affected their society as a whole. They measured the burden of the families across the country and found the hospital closures impacted the Southern part of the country significantly greater than the Northern section (Girolamo, Bassi, Neri, Ruggeri, Santone & Picardi, 2007). These studies reflect burden of care issues that Italy has been seeking to resolve over the last few decades. There have been numerous programs established in order to alleviate some of the burden the Southern most part of the country has been experiencing. (Burti & Benson, 1996)
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Resources
Aronson, E., Wilson, T. & Akert, R. (2013). Social psychology (8th ed.). Upper Saddle River, NJ: Prentice Hall.
Burti, L., & Benson, P. (1996). Psychiatric reform in Italy: Developments since 1978. International Journal of Law and Psychiatry, 373-390.
Girolamo, G., Bassi, M., Neri, G., Ruggeri, M., Santone, G., & Picardi, A. (2007). The current state of mental health care in Italy: Problems, perspectives, and lessons to learn. European Archives of Psychiatry and Clinical Neuroscience, 83-91.
THE HOFSTEDE CENTRE. (n.d.). Retrieved February 13, 2015, from http://geert-hofstede.com/italy.html
Social anxiety can manifest for those of us from an individualistic society who find ourselves in a collectivist society. I became acutely aware of my social faux pas after several weeks in rural Senegal. I was working in a health clinic and would routinely bustle through the lobby in the morning and coming back from lunch, nodding and smiling as we North Americans do, but not stopping to greet or engage with anyone. I was on my way to the clinic with work today and I definitely had that “independent and self sufficient” nature you mentioned. Thankfully a kind, older woman explained to me how very rude I appeared to be. She spent time with me in our home and had come to realize I was not intentionally rude, but she made sure I knew that was how I appeared.
At first I develop a terrible anxiety to going into public. I did not want to go to the market and for a few days I took a back route to the clinic and avoided the lobby area where our patients were waiting. Hopefully your father developed a satisfying life with his introversion, I however was not happy hiding from the world. Being a natural extrovert, I gleaned from my Senegalese friends what the cultural expectations were. The entire time I was there it was an effort, a physical challenge even, to slow down and engage meaningfully with the people who came to our clinic. I had to slow my mental processes to not jump right to the health care work we were doing, but in the doing that I became a part of the community I was living in and slowly, as the real me became known to our village, my anxiety about making a social mistake faded.
Knowledge of the cultural variations of social anxiety is critical to clinicians including nurses like myself or health psychologist in order to address health issues effectively and to understand decision-making among collectivist cultures. The individualist culture of the U.S. is reflected in many of the practices of the healthcare system including informed consent and advanced directives (McLaughlin & Braun, 1998). Comparatively, collectivist cultures tend to make healthcare decisions together and with the entire family unit in mind as opposed to only the person seeking care (McLaughlin & Braun, 1998). Additionally, there is considerable cultural variation in approaching death and dying when comparing the individualist culture to the collective culture. McLaughlin and Braun discuss the non-verbal communication that clinicians should be aware of when approaching topics surrounding end of life with collectivist cultures. Overall, I believe cultural nuances are important to consider in order to provide the best care possible. Collectivist cultures need to be treated as a family unit when it comes to diagnoses like heart failure that require significant lifestyle adjustment. Decision making regarding adherence to plans of care and end of life would be dependent on the level of cultural collectivism. Awareness of the ideas of collectivist cultures versus the American norm of individualism are critical to appropriate treatment of all patients.
Reference:
McLaughlin, D. & Braun, K. (1998). Asian and Pacific Islander health care values: considerations for health care decision making. Health Social Work. 23(2): 116-126.