

Specialized to the point of being esoteric
Directly relates to our country’s pathetic
history of treating mentally ill


eg., belief that slaves were less susceptible to mental
disorders (Jarvis, 1842 citing hospitalization rates)
Kraepelin (1904)


Note depression in Algeria and Java
Also noted differences in manifestation of
depression in non-Western cultures, particularly in
the expression of guilt

Ruth Benedict and the cultural relativist viewpoint
Believed that psychopathology is virtually infinite in its
expression between cultures.
 Believed that schizophrenia and bipolar were strictly
Western disorders
 Although she didn’t actually say it, believed that one
culture’s madmen were another culture’s shaman


Eric Berne and the universalist viewpoint
Believed that the major forms of pathology take the same
form across cultures
 Further believed that therapists could be transplanted
across cultures and be equally effective
 Said that a therapist from a foreign culture could
diagnose 25% on sight and another 25% in just a few
minutes of talking


Some syndromes appear universal, others unique—this
hasn’t ended the argument

Some argue that none can be universal because the
manifestations are different across cultures
 Central symptoms (common everywhere)
 Peripheral symptoms (may vary by culture)



Others argue that even the syndromes that appear culture
bound are just manifestations of some universal such as anxiety
There are problems with the viewpoint of Western clinicians
in the study of pathology
Another problem—viewing pathology differently between
cultures

Lambert et al 1992—gave vignettes of internalizing and
externalizing behavior to Jamaicans and Americans—across the
board, Jamaicans saw behavior as more healthy.




Behavior defined by professional community as
any pattern of behavior that leads to a
dysfunctional or maladjusted behavior
Statistical departure from the norms of a society
Defined with respect to the values and
expectations of a society
This last definition can lead to differences in
Autopathology-self-definition of pathology by a culture
 Heteropathology—viewpoint of those outside the culture


Individualism/collectivism
Individualist cultures—experience pathology through the
internalization of distress, guilt, and cognitive symptoms,
chronicity of schizophrenia.
 Collectivist—revolves around relationships
 Individualist—prefer insight oriented therapy
 Collectivist—prefer more expressive, close personal
relationship with therapist


Masculinity/Femininity
Masculine—tend to have catastrophic responses to
failure, such as suicide
 Masculine cultures expect therapist to represent society’s
side, rather than aspirations of client
 Feminine cultures—therapy focuses on empathy,
expressiveness, and creativity


Uncertainty avoidance




Power distance



High UA seems to be linked with anxiety
High UA also linked to view of disorders in a scientific manner
High UA—low value on therapy—too messy
In combination with high UA, low PD is conducive to the dev
of the superego
High PD—high role of therapist as expert, no egalitarian
therapy, no confrontational group stuff
Draguns looked at Japan—opposite of US on IC, PD,
and UA, same on masculine




Should be fairly opposite as patients
Not so different—do evidence guilt
More aggression in psych wards—acceptable place to violate
social norms
American vs Japanese Rorschach—more primitive impulses in
Japan, also more conforming response


About 1% worldwide
WHO study confirmed presence across 9 cultures—Columbia, Nigeria,
US, Britain, Denmark, USSR, Taiwan, and Czechoslovakia








Able to ID using standard instruments in about ¾ of cases
Core syndrome ID’d—restricted range of affect, lack of insight, thinking aloud, poor
rapport, incoherent speech, unrealistic thoughts and delusions
Rate appears fairly constant, but somewhat higher in some areas (western
Ireland, Istria peninsula in Croatia) and lower in others (Hutterites,
Tongas of South Pacific)
More common in men around the world, except in China where it is more
common in women
Outcome is more favorable in developing countries (Columbia, Nigeria,
India) than industrial countries (US, Denmark, others)
Prognosis is inversely related to educational occupational level
More schizophrenia in cities
Catatonic (10% of less dev country cases) and undifferentiated (13% of
less dev cases) are more common in less developed countries. Paranoid
more common in industrialized nations. Paranoid is more specific,
crystallized, and cognitive. Others are more confusional.



Universal, but manifestations vary
Although, in some societies as a depressive
syndrome is not recognized at all
WHO 1983
76% of depressed pts reported core symptoms that
included sadness, joylessness, anxiety, tension, lack of
energy, loss of interest, loss of ability to concentrate, and
ideas of insufficiency
 Largely the vegetative symptoms
 40% displayed other symptoms—cultural things
 Guilt is a big part of depression in Judeo-Christian
cultures, but also tied to individualism


China and elsewhere



Combination of symptoms—insomnia, weakness,
headaches, nervousness, irritability
Diagnosis does not exist in Western medicine—
closest thing is undifferentiated somatoform
disorder
Westerners might look at this and think depression


Definition of normal drinking varies widely
Bales (1949) summarized 4 attitudes toward
alcohol
1) Complete abstinence
 2) Ritual attitude
 3) Convivial drinking
 4) Utilitarian attitude



Varies widely
WHO, 2004—Per capita consumption of pure
alcohol in liters










Pakistan
Vietnam
Singapore
China
Brazil
Norway
United States
Spain
France
Ireland
0.2
1.35
2.73
4.45
5.32
5.82
8.51
12.25
13.54
14.45
WHO, 2004
 % Heavy Drinkers
Australia
France
Georgia
Japan
US

Male
6.7
16.6
50.1
22.7
6.4
Female
7.2
7.8
10.6
4.9
5.0


Flushing
Common in Asians—increase capillary blood
flow, increased heart rate, lower bp, # of
subjective complaints

When someone ingests alcohol, alcohol
dehydrogenase (ADH) begins to break it down. This
converts alcohol to acetaldehyde. This is a
poisonous substance that leads to short term illness
or cirrhosis. So aldehyde dehydrogenase (ALDH)
breaks it down further.


US is high, but not that high
WHO Stats (2011)
Males
Females
US
Brazil
Canada
China
Finland
Guatemala
Japan
Lithuania
Zimbabwe
4.5
2.0
5.4
14.8
10.0
1.7
13.2
10.4
5.2
17.7
7.7
17.3
13.0
29.0
5.6
36.2
61.3
10.6





Finland: cold, high alcohol consumption, high
homicide rates
More men than women except in China
High rates when there is social turmoil
Sacrificial or honor suicides (India, Japan)
Truk of Melanesia—between 1960 and 1980, suicide
rate for men 15-24 soared to 200/100,00. Why?



Increase in Western contact, decrease in religious and social
organizations
This breakdown resulted in alienation in young people
According to local model, suicide is an act that expresses anger,
but also solicits support, reconciliation, and nurturance
(Desjarlais et al, 1995)


US—thinner is better
In other cultures, the opposite is true—but
immigrants to the US weigh more the longer
they’ve been here



In one study of Kenyan British and Kenyans in
Asia—KB preferred thinner body types—just like the
British than did KA
Egyptians in Egypt vs Egyptians in Britain—no
anorexia in Egyptian sample, but present in British
sample
Nomadic Moors of Mauritania and Annang of
Nigeria—large is beautiful




Most research in US and Europe
Documents in South Africa, Japan, Hong Kong,
Taiwan, Singapore, India, Iran, China, Korea, etc.
Bulimia may be more culture bound
Presentation may vary by cultures



Lee 199 Hong Kong anorexics—fear of stomach
bloating, not fatness
Khandelwal et al 1995—India—anorexia may be
related to eccentric nutritional ideas or excessive
fasting
Sociocultural factors

Taijin kyofushu—Japan



Young men who are insecure about their social
status
Principal manifestations are extreme selfconsciousness and negative concerns about
appearance and bodily odor
Why does this fit Japan?
 Obsessed with shame
 Obsessed with cleanliness
 Lots of people are on top of each other
 Fear of expressing negative emotions






Extreme fear that genitals are shrinking (penis in men,
breasts in women) and that death will occur when
genitals fully retract
Alternately described as obsessive compulsive
disorder, castration fear, sexual conflict neurosis, acute
panic
Can occur in individuals or in epidemic form
In either case, it is fairly easily treated—not chronic
In either case, patients can cause themselves permanent
physical harm in their attempts to prevent genitals
from retracting
Pts are often less educated and have a strong belief in
supernatural powers

Africa and among black residents of Caribbean
People just quite for hours or days
 Not responsive, but not comatose
 Occurs in response to extreme stress
 Basically snap out of it when they are able to cope
again


Amok—Malaysia, Philippines, Thailand
Combination of excitement, fury and sometimes
homicidal aggression
 Set off by minor personal slights, alcohol consumption,
stress, sleep deprivation
 Mostly in males
 Dramatic, conspicuous, rarely chronic


Zar—North Africa and Middle East
Belief that a person is possessed by spirits
People who are possessed may experience apathy,
withdrawal, loss of appetite
 Often observed shouting, laughing, singing, weeping,
hitting head against the wall
 May be mute or incomprehensible




Beliefs and expectations predispose clinicians to see
psychopathology in a certain way
May overpathologize





Consider behavior as pathological when behavior is really a
manifestation of cultural background
Or when we don’t take time to look past culture
Egeland, Hostetter, Eshleman (1983)—study of Amish pts—
79% of bipolar pts had been previously (incorrectly) diagnosed
as schizophrenic
Febrega et al 1994—African American inpatients were more
likely to be diagnosed as psychotic than whites—although they
were subsequently rated as more improved as well
May also underpathologize

For example—if indiscriminately label behavior (like being
withdrawn) as being cultural

Psychotherapy is widely used in the US, but less so elsewhere in
the world


Very individually focused –so efficacy is not well-established in other,
more collectivist cultures
To make therapy more successful with diverse populations
 Knowledge of diverse cultures and lifestyles
 Skill and comfort in using innovative treatment methods
 Actual experience in working with culturally diverse clients


As a rule, people like to see therapists similar to themselves in
cultural background and gender, but similarity of worldviews and
attitudes to treatment is more important
Psychotherapy outside the US



Find psychotherapy in other parts of the world
Needs to be adapted
Indigenous healing

Encompasses therapeutic beliefs and practices that are rooted in a given
culture


Social perception—process through which we
try to understand other people and ourselves
Social cognition—process through which we
interpret, remember, and use information
about the world and ourselves



Attitudes that reflect a principle, standard, or quality considered
by the individual as desirable and appropriate
Stable and enduring views
Are values similar across cultures?

Schwartz (1997)
 Three basic dimensions (Schwartz et al 2001)
 Conservatism vs autonomy
 Hierarchy vs Egalitarianism
 Mastery vs Harmony
 Schwartz studied 40 countries
 East Asians—high on hierarchy, conservatism and low on egalitarianism and
autonomy
 West European—opposite
 Anglo (including US)—somewhere in the middle

Western and non-Western values—

Weber’s philosophy—
 Western values are work, achievement, striving for efficiency,
consumption of material goods
 Non-Western—respect for tradition, reverence to authority, overall
stability



Heider, 1959—people seek consistency in their
attitudes
A balance is achieved when you and a person
you like agree on something or when you and a
person you dislike disagree on something
Also—overestimate + traits in those we like,
underestimate + traits in those we don’t like



People experience tension when they perceive mismatch
between attitudes and behavior
When we must decide between two or more alternatives, the
final choice may be inconsistent, to some degree with some
of our beliefs or previous actions
To deal with this, we…




Improve our evaluation of the chosen alternative
Lowering our evaluation of the alternative not chosen
Not thinking or talking about the decision that we made
Carr, 1996—cognitive tolerance
Those with interdependent self construal are less likely to expect
beliefs and actions to be consistent
 More situational
 But…actions to reduce dissonance are cross-cultural (Camiller &
Malewska-Peyre, 1997)




The process through which we seek to explain
and identify the causes of the behavior of
others and our own actions
Across cultures, tend to evaluate more
positively the persons and objects we like and
view negatively what we don’t like (even if
objectively they aren’t that bad)
Groups that we see as more similar to
ourselves we like more

The descriptive labels we give ourselves imply
That we have an attribute in us
That our past actions, feelings, thoughts have close connections
with this attribute
 This attribute will affect what we do in the future








All tied to worldview
Different cultures produce different self-concepts and these
self-concepts influence other behavior
Independent vs interdependent construals of the self
Third type of self—the Public Self
The more complex the culture, more likely we are to be
concerned with Independent/Private self and Public self
On the other hand, external threats, competition with
outgroups and a sense of a common fate, increase the
collective self




Americans generate more abstract personality
trait descriptions, “I am sociable” than Asians
“I am usually sociable with my close friends”
(Bond & Tak-Sing, 1983)
When groups who are interdependent have
context supplied for them, they are more
abstract—“Describe yourself in school”
These self-construals serve as a cognitive
template for interpreting the actions of others
Those with independent selves assume that
others will have stable personalities as well

We have a powerful motive to have a + view of
self



As young as 4, Am kids believe that they’re better
than average
False uniqueness effect—stronger for males
Markus & Kitayama, 1991—compared US and
Japanese—Japanese were much more likely to
have lower estimates of abilityAmericans
said that 30% would do better than them,
Japanese said 50%



Cultural identity—membership in a distinct
culture
Thus, multicultural people should have more
than one cultural identity
Cultural reaffirmation effect


Semin and Rubini (1990)
Southern Italy (collectivist)
Your sister is a cow.
 I wish a cancer on you and all your relatives.
 You are queer and so is your father.


Northern Italy (individualist)
You’re stupid
 You’re a cretin
 Swear words relating to sex/sexual nouns
 Swear words referring to religious figures


For maximum effect, know the type of culture in
which you are issuing the insult



Categorical assumptions that all numbers of a given
group have a particular trait
Can be + or Can be generally true or completely false


Can be about one’s own group—autostereotypes



Sociotype—stereotype based on some facts
Or other groups—heterostereotypes
We tend to spin stereotypes
Functions of stereotypes


A form of cognitive schema
Help individuals maintain + self-esteem from group
memberships
 Key dimension in all stereotypes of characters is
 “Beneficence dimension”—honest, kind, loyal, trustworthy
 Second dimension “Competence”—intelligent, successful, wealthy,
educated


Origin of stereotypes
Rothbart & Taylor (1992)
Usually perceived as natural categories
 Inborn—even in adoptive parents
 Can hold strong stereotypes even though never met
people from a particular group
 Katz & Braly, 1933—had students identify adjectives
they thought represented different groups
 Study has been repeated since 1933—people are now
more willing to assign stereotypes
 But the content has remained remarkable similar


Contact influences the clarity and valence of
stereotypes





Ethnocentrism and stereotypes are natural, inevitable
Prejudice isn’t
Discrimination—unfair treatment based on group
membership
Institutionalized discrimination
Highly prejudiced people




Less well-internalized personal standards about avoiding
discriminatory behavior
Less guilt and shame about not acting in accord with these
already weak standards
Less ambivalence about their feelings about outgroup
membership
High hierarchy places with societally sanctioned
prejudice encourage such behavior





The most widely replicated study is Asch’s 1951 study of
conformity
Presented with several unequal lines and one standard
comparison line
Confederates made false but consistent judgments
About 1/3 of subjects gave wrong answer
Been replicated cc, but rates vary a bit






Bantus—51%
Germany, Japan—20% (outgroup as confederates in Japan)
In Japan, 34% even showed anticonformity
Collectivism doesn’t necessarily mean increased conformity
Less pressure for conformity in hunting/gathering cultures
Anticipation of negative sanctions

Groupthink



Individuals in social groups show tendencies to
adhere to their shared views so strongly that they
ignore information inconsistent with those views
Want to maintain cohesiveness, so people downplay
risks/misgivings
Group polarization—


Tendency of group members to shift, as a result of
group discussions, to more extreme positions
Risky shift

Milgram (1974)—very controversial—















65% of Am subjects accepted orders to give very strong electric shocks
Despite ethical outcry, has been cc in 8 countries
65%
USA Male
65%
USA female
85%
USA students
85%
Italy students
85%
Germany male
40%
Austral. Male students
16%
Austral female students
50%
UK male students
62%
Jordanian students
90%
Spain students
80%
Austria-general
92%
Netherlands—general
Lessons




Substantial #s will comply and carry out orders, even if harmful
All but Jordan are industrialized
Seems to be related to power distance
Ingroup/outgroup distinction is important










The norms of a culture about helping
Moral obligations about helping
Self-definitions that the individual is the kind of person who helps
The affect attached to helping
The utility of helping
The perceived difficulties of helping
The costs of helping
Self-efficacy about helping
Once you help, rewards or punishment increase or decrease future
helping
CC






All cultures are more likely to help an in-group member
In Reciprocity—mutual exchange
Situation is key
Large cities are more likely to help
Good mood more likely to help
Self-definition—collectivist cultures more likely to report a moral
obligation to help friends whether need is extreme or minor






Some cultures the ingroup is very narrow (in Italy in 50s
was family) and no other collectives are important
Link between individual and each collective can vary
Cultures differ on which collectives are most important
Also based on common fate
Age, gender, social class—also form ingroup
Individualist
More ingroups
Not as attached to any single ingroup
Survival of society and of individual depends more on successful
and effective individuals than groups
 Fewer distinctions between in and outgroups




Collectivist




Fewer ingroups
Very attached to ingroups
Groups for survival
Strong distinctions between in and outgroups


Personality—a set of relatively enduring
behavioral and cognitive characteristics, traits, or
predispositions
CC approaches to the study of personality
Is personality universal?
 If there are universal aspects, where did they come from?

 1) Bio innate and evolutionarily adaptive factors that create
genetic predispositions to certain types of traits
 2) Possibility of culture-constant learning principles and
processes

What types of traits would you expect to see in other
cultures?

Latin America


Sub-Saharan Africa



Tolerance of dissonance
Detachment
Japan—Doi, 1973


Cognitive tolerance
India



Guerrero (1985)—a culture may be characterized in terms of a series of ‘historio
socio-cultural premises’ (HSCPs)
Amae—indulgent dependencekey of relationships—
China—Confucian values of filial piety and industriousness, value the
giving of face and the protecting of face
Philippines—




Pakikisama—going along with the majority
Kapwa-fellow being—shared identity
Hiya-sense of shame
Bahala-na—stoical resignation

Eysenck and Eysenck—believe that there are 2 or 3
genetically influenced dimensions




Introversion/extraversion
Emotional stability
Eysenck Personality Questionnaire (EPQ) has been used in at
least 35 countries
Most researchers agree with these dimensions, but
think that they don’t tell the whole story of personality






5 factors developed by factor analysis of personality traits
Extraversion
Emotional stability
Openness to experience
Agreeableness
Conscientiousness



Factor analysis of other languages’ personality
words yields similar dimensions
Eysenck’s work found extraversion and emotional
stability in German, Dutch, Japanese, Chinese,
Filipino samples
FFM model has been validated in
Dutch, Chinese, Italian, Hungarian, German, Russian,
South African, Australian, Finnish, Polish, Portuguese,
Israeli, Korean, and Japanese samples---seems to be
universal
 Why?
 Evolutionary approach


This does not minimize cultural and individual
variability

US—medical model—disease results from a
specific, identifiable cause originating in the body






SES is consistently related to health outcomes
Social isolation also a big influence on health
Interaction of biology and culture



Influences views of psychopathology
Health is a lack of disease
More recently, hardiness has come to include the absence
of disease, but also the presence of + health states
Malaria
Environmental problems and poverty
Medical decision-making

Over 80% of deaths from CVD occur in lower
and middle-income countries



CVD accounts for 30% of all global deaths
Other studies find that collectivist cultures had
higher rates of death from parasites and infectious
diseases
Issues in wealthier countries


Certainly diet-related—US—high cholesterol
Ni-hon-san study compared Men
 Japanese in Japan—lowed CHD
 Japanese in Hawaii
 Japanese in California—highest CHD

WHO (2011)
More risk factors: smoking, alcohol
 Fewer prevention efforts and early detection
 Less access to effective and equitable health care
 Contributes to poverty
 At macro-economic level, heart disease, stroke and
diabetes are estimated to reduce GDP between 1 and
5% in low- and middle-income countries






Spirituality—more broadly defined than religion
Largely ignored in psych
Meditation and prayer are associated with lower
blood pressure and pulse, lower metabolism
People who regularly attend religious services live
longer
CC

Many cultures embrace traditional beliefs and folk
theories as causes for illness and mental illness—spiritual
forces, spiritual healing—cure is prayer



Organizational culture—dynamic system of rules
that are shared among members of an organization
Organizational climate—shared perception of the
way things are around here
Organizational structure
Complexity—degree to which organizations foster
differentiation of tasks and activities
 Formalization—degree to which organizations provide
structure and rules
 Centralization—degree to which orgs concentrate their
operations and decision-making capability in a limited #
of units or people


Hofstede’s dimensions—thought corporate
climate would be the same because it was the
same company
116,000 questionnaires
 160 items



Japan—work is more central to a person’s life
India—devalues workphysical labor belongs
to untouchables in the caste system


Exemption from physical labor is a sign of nobility
Way to spiritual maturity is meditation, not work


Not only work, but also organizational culture
and climate affect stress
Does a fit between individual and cultural
values affect job sat and stress?
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Yes and no
Individuals engage in a “temporary culture”—
culture separate from rest of their lives
But, individuals are happier if their values match
their supervisors
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Selection and assessment
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In Western theories—must have procedures to assess
skills and personalities to figure out who should be
hired. Similar procedures to assess whether people
are performing jobs well
Variations in Europe
Huo & von Gilnow (1995)—Interviews are
rarely used for selection in China and Taiwan
 Similar views in studies in Japan and Korea
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Collectivist cultures—open and critical
feedback can destroy group harmony or cause
loss of face
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Appraiser more likely to be a benevolent provider of
instructions about what to do in the future
Appraisal likely to focus on group—HK and
China—over 90% thought ability to function in a
group should be part of appraisal
Individualist cultures—appraiser is more of a
coach helping to define work goals and
progress OR as an overt and direct critic of
poor previous progress
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Productivity
Social loafing—individual productivity declines in larger groups
in US
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Leadership
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2 factors cause this
 Lack of efficiency
 Lower effort in groups due to decrease in responsibility
But—Studies have identified social striving in Japan and China
Individualist—position in a work team is bounded by choices
Collectivist—less reason to have a clearly delineated role b/c identity is
not defined by what they do individually
When is leadership needed?
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Individualist—leader is one who provides task or relationship-oriented
guidance that is lacking
Collectivist—always have a leader, usually based on seniority or power
distance
 But relationship with leader varies

Values in the US
Time—efficiency
 Individual control—control your own destiny
 Specialization
 Pragmatism
 Democracy
 Equal opportunity
 Independence—authority is resisted
 Competition
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Symptoms
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Excessive hand-washing and concern for sanitation
Fear of physical contact with others
Absentmindedness
Development of mild psychosomatic disorders
Insomnia
Fatigue
Feelings of helplessness
Fits of anger
Excessive fear of being cheated, robbed, injured
Overreaction to minor physical symptoms
Strong feelings of homesickness
Greater cultural distance—increased culture shock
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Most of our behavior is controlled by habits but habits
don’t work in new culturesense of a loss of control
Discrepancies in expectations amplify lack of selfefficacy and loss of control
Factors predicting culture shock
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Loss of control
Discrepant expectations
Lack of social support
Insufficient social skills
Cultural dissimilarity
Insufficient cultural knowledge
Unsatisfactory social contacts
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Only tourists who avoid real contact with the
local culture avoid adjustment
1) Sense of optimism, very + feelings—often
being welcomed by associates
2) Feel less in control. Difficulties of language,
schools for kids, housing etc set in. People tend
to associate with co-nationals
3) Rock bottom. Either go home or start to cope
4) If stay, acquire new skills
5) Adjust as well as at home
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Learning the local language
Tend to either assimilate or contrast
Personality matters
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Conceptual complexity
Tendency to use broad categories
Fascist tendencies
Empathy
Sociability
Critical acceptance of stereotypes
Interest in the host culture
Task orientation
High self-esteem is correlated with + feelings toward outgroup
Sense of humor
Patience
Willingness to communicate without being afraid of making language
mistakes
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Someplace that looks the same but is different
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Positive transfer—when what you learn in one
setting works in another
Negative transfer—what you’ve learned in one
setting causes you difficulties in another
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Regulate emotions
Use critical thinking skills
Culture is a psych construct
 There are individual differences
 We have cultural filters
 Conflicts may be cultural (not personal)
 Be patient, presume good intent
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Welcome to PSY 381 Psychology of Culture