by Tam n. Nguyen
image credit: Newcastle University
Introduction
In 2017, the APA Council of Representatives adopted a Multicultural Guidelines (American Psychological Association, 2017). The 10 guidelines put an emphasis on social contexts, interactions with others, the role of language and communication, the role of social and physical environments as well as their associated history, within and across system adaptive interventions, globalization, bio-socio-cultural context, informed research and activities, and finally, a strength-based approach in practicing psychology. The "Pocket guide to cultural health assessment" (D’Avanzo &Geissler, 2008) specifically mentions that there is no better way to learn about a cultural group other than the observation of and the participation in the group’s activities. Those activities include but are not limited to reading literature, interacting with the group members, and participating in important events. Research results also show that by interacting with the people from different ethnic groups, one can be more acceptive to existing ethnic differences (Simmons, Wittig, & Grant, 2010). However, not all people can afford the opportunity to be immersed in the above-mentioned environment.
US, China, Japan and Germany were chosen as these countries possess the world’s largest economies (FocusEconomics, 2018). They drive globalization that speeds up cooperation as well as conflicts. The paper hopes to provide a good start for further cultural engagements with government agencies, businesses and individuals from US, China, Japan and Germany. Cultural diversity awareness is especially important in this new age, when physical barriers are being removed by never-before-seen cyber technologies.
Culture descriptions
This section is based on the “Pocket guide to cultural health assessment” (D’Avanzo & Geissler, 2008) and other cited sources. The descriptions are brief, and readers are encouraged to check out the further details from the pocket guide or in other publications.
The United States (U.S) ranked 3rd on population behind China (1st) and India (2nd). GDP per capita is $59,792. Literacy rates are high (99% for both men and women). The ethnic groups include: Whites (72.4%), Blacks (12.6%), Asians (4.8%), Native Americans (0.9%), Native Hawaiians (0.2%) and other races (6.2%). The largest group of religion is Christianity (73.7%). The life expectancy is 78 years at birth in 2017 with obesity as the main reason for the decreasing. Other reasons include coronary heart disease, lung cancer, strokes and so on. The main culture trait is the “American dream” that entails complete freedom, liberty, equal rights and equal opportunity. The culture is also known for diversity, innovation, violence and racism.
Germany is the most populous country in Europe with 82.6 million people. GDP per capita is $30,400. Literacy rates are high (99% for both men and women). The largest ethnic group is German (91.2%). The largest groups of religion are Protestant (31.8%), Roman Catholic (32.1%) and Muslim (3.6%). German follows the Western model of healthcare with active attitude towards health promotion, and readily available excellent medical care. The most common cause for death is traffic accident. Doctors do not play the central role as medical care and nursing care grow independently from each other, and of equal professionalism. Men and women share equal responsibilities even though women tend to take more family duties. The Germans are usually on time, more tuned in to the present and near future.
Japan ranked 6th on population among Asian countries with 126 million people. GDP per capita is $31,500. Literacy rates are high (99% for both men and women). The largest ethnic group is Japanese (99%). Shinto and Buddhist are the largest group of religion (89%). Japan health problems are well-known, and the causes are shifting more towards lifestyle-related diseases as the Japanese have strong habits of working too hard, smoking, and eating high fat contents. Doctors have highest regards in the society and patients do not usually seek second-opinion. Family plays important role in the care of patients (alongside with nurses). Japanese infant mortality rates are at the lowest among industrialized nations. The Japanese have better grasp of time than others as being on time for work is important to them.
China is the largest country in Asia with a population of 1.37 billion (Wikipedia contributors, 2019) of which 10% is living below the poverty line. GDP per capita is $6,800. Literacy rates are high (95% of men and 87% of women). Major ethnic group is Han Chinese (92%). Common religions are Confucianism, Taoism, Buddhism, Christianity and Islam. For each 1000 Chinese, there are 1.5 doctors and 1 nurse. “Harmony” is the main theme in Chinese culture. Health was related to flows of “chi” (body energy) and should be maintained in order to stay in harmony with others and nature. This is one of the main reasons why some Chinese people still prefer herbal medicines (natural ingredients). However, Western medicines are being used, sometimes in conjunction with herbal medicines which might cause undesired side effects. Among the men, 24% smoke, 21% regularly drink alcohol, and 14% regularly do exercises. Chinese have a family-oriented culture with different roles based on generation, age, birth order, etc. Decisions are usually made by people with higher roles. The concept of time is relaxed with no language difference between past and present tenses. People are encouraged to contain their strong feelings including pains. Traditional diet has high sodium and sugar due to the use of soy sauce and preserved foods.
Culture differences and similarities
The paper "Large-scale psychological differences within China explained by rice versus wheat agriculture" (Talhelm et al, 2014) provides some insights into cultural differences between Eastern and Western culture. The paper proposed a Rice theory, explaining why some regions have interdependent culture while others have independent culture. The paper compared the efforts in growing wheat and growing rice. Since it is much harder to grow rice, the paper believes regions that grow rice will have interdependent culture while wheat growing regions will have more independent culture. Through collected statistics on GDP, divorce rate, inventions, implicit individualism, and rice per capita in conjunction with surveying 1019 Han-Chinese participants in 28 provinces, the paper made a strong case for their Rice theory within China. However, the paper did not prove that similar results will be achieved in other parts of Asia and the world. Therefore, while the proof in China case is strong, it is not enough to really back up the Rice theory.
In another study, Miyamoto found that the surrounding environment may influence the way the people think (Miyamoto, Nisbett, Masuda, 2006). There were two rounds that both involve carefully selected scenery pictures of schools, hotels and post offices. Round 1’s results indicated that Japanese sceneries are more complex while objects in American sceneries stand out more due to less complex backgrounds. Round 2’s results indicated that both American and Japanese participants, once primed with Japanese sceneries, paid more attentions to contextual information when examining other pictures. Such interesting results give us a little more insight into the cultural differences as of why Asians are usually better with context-dependent cognitive process while Americans are more accurate in absolute tasks. This study implies the same results with Germany which is similar to US and China which is similar to Japan.
Regarding health care, while spending the most money, the US is ranked the worst among 11 top developed countries (Khazan, 2017). Germany, despite being proactive and having one of the best healthcare systems, is not at the top of the chart. One of the reasons is the inequality between the rich and the poor. We should note that these top 4 countries also have large populations which make the contrast between the rich and the poor more obvious. Another reason is the cuisine culture. The Chinese use a lot of fat and oil in their cooking. Both Japanese and Chinese love to add spices, man-made food chemicals including high level of sodium, msg in their food products. The Americans do eat less sodium but consume much higher level of sugar. Each of these countries follow a different healthcare model. Germany follows the EU model which treats healthcare like a social service. The US treats healthcare as an industry. Japan and China put heavier healthcare duties on the families.
Considering the long-time presence of the US in Germany, it is safe to assume that the Germans and the Americans are able to understand each other culturally. Japanese culture is quite popular in the West with the West’s acceptance of Sushi, Japanese made cars and electronics. There are many similarities between Japanese culture and Chinese culture such as similar character typefaces, understandings and practice of traditional medicine, education styles, etc. Most problems for cultural understanding lie between Chinese and the West (US, Germany) with the West describing the Chinese as demonic and untrustworthy (Meijun & Zhihe, 2015). Sadly, there are some truths to the stereotype with some Chinese company violate trademark laws, execute economic espionage, violate copyright laws, and so on. Most of the cultural differences can be traced back to differences in core beliefs.
Beliefs and attitudes
The core of Chinese culture is “Yi-ching” which can be dated back to 1000 BC. It is basically a philosophical platform (the “ching”) for everything and is deep-rooted in the concept of changes (the “Yi”). It is commonly known to the West by the symbol of swirling black and white pieces, hugging but not blending into each other. There is a tiny piece of white in the black and vice versa. Briefly, black and white (“good” and “bad”) are both needed for a complete harmony which is the ultimate goal. For example, a large size company may steal a technology from another company in another country. Such crime should be punished but since the punishment may cause more disturbance to the economy (the existing harmony), the government may overlook such crime. In reverse, the government is also willing to commit high crimes in order to restore the balance (Lusher, 2017) and some citizens may be fine with it.
Japan was influenced greatly by neo-Confucianism originating from China (Every Culture, n.d.). The country put a strong emphasis on the hierarchy of everything (society, family, etc). It is known that the Samurais can execute anyone below his class if proper respect of class was not shown to him (III & Smith, 1981). We still see the reflections of this neo-Confucianism today via the strong etiquette practices that most Japanese perform. Etiquette is also a big thing in China, but people view it from the spiritual angle when the Japanese view it as an essential part of their everyday lives. It is possible that with the arrival of Communism and the Revolution, the working class back then did break free from all chains including the etiquette practices that were enforced by the once higher classes.
Germany shares the Japanese desire for orderliness, especially in business (Zimmermann, 2018). Changes to business plans are usually not welcomed. Work-place conversations rarely involve humors and employees are evaluated based on competencies which often times do not include interpersonal-communication skill. Located at the center of Europe, German culture has been very well-developed and influential. For example, Germany is the birth place of many great classical music composers and many influential philosophers. Karl Marx invented Communism and it reshaped the world in an unimaginable way. All those profound achievements have been made possible by Germany’s robust education system with the belief that education should not be a commercial product. People all around the world can always come to Germany and enjoy German education for free (Study EU, n.d.).
The US education is completely different from the German’s and is being treated as an industry. US student-loan delinquencies now hit a record of $166 billion and climbing (Bloomberg, n.d.). US government spend $9000 on each graduate student (Shepard, 2018). Besides tuitions and federal money, universities will also be able to receive various grants and donations from the US military, the national foundations, and wealthy individuals. With financial power, universities are able to attract top faculties to run the most difficult research projects. While high-impact innovation rate is much higher than other countries, the commercialization of such innovations is slower than China where the number of potential users is much greater. US beliefs and core values are documented in the Constitution and the Amendments. The nation values freedom and it brings a competitive edge to everything. Because of that reason, people from around the world would like to come to the US to receive its unique education environment.
Psychological issues
This paper believes in the connection between happiness and mental health. The happier the people, the less chance they will have psychological issues. Therefore, to understand the differences in the countries’ psychological issues is to understand the key differences in their conceptualizations of happiness. The differences can be summarized and categorized into: 1. Self-transcendence vs Self-enhancement; 2. Eudemonism vs Hedonism; 3. Harmony vs Mastery; 4. Contentment vs Satisfaction; 5. Valuing vs Avoiding suffering; 6. Relevance vs Relative irrelevance (Joshanloo, 2014).
Western cultures tie happiness to the individuals and focus on self-enhancement with measurements such as self-determination, deliverance from convention, resistance to enculturation, etc. Eastern cultures, on the other hand, believe that strong individual pursuits of happiness may cause imbalance to the society as a whole. Influential Eastern religion such as Buddhism explains sufferings as the results of being so self-centered. For example, a man can be rich and not happy because he keeps comparing himself to other richer men. Eastern cultures focus more on self-transcendence with “wisdom” as the most important measure. This leads us to the topic of Eudemonism vs Hedonism. Hedonism is defined as the pursuit of pleasures and is measured by the presence of positive emotions and self-satisfactions. It is consistent with the core values of Western cultures, especially the definition of the “American Dream”. In sharp contrast, Buddhism and Islam look down on Western eudemonistic beliefs and consider it to be the cause of unhappiness, sin, and destruction of the society.
Eastern cultures believe in humans being a small, integral part of the whole universe reflecting through the concepts of “the will of the universe”, “reincarnation”, “natural energy flows”, etc. The West, however, believes in the mastery and controls of the environments (nature, social interactions, family, jobs) which in turn lead to higher level of autonomy and independence. Such belief forms the core of the West’s “Life-satisfaction” which is the fundamental component of evaluating mental well-being. The East associate life-satisfaction with contentment where failures should be viewed as parts of a natural whole and be accepted as necessary components of life. Consequently, this leads to differences between East and West in defining sufferings.
Socio-political discrimination barriers
Let us start by having a look at racial bias towards Latinos in the USA as described in "Understanding bias toward Latinos: Discrimination, dimensions of difference, and experience of exclusion" (Dovido et al, 2010). There were four empirical studies. Study 1 measured bias against Latinos in convenient store settings with the action of buying $10 gift certificates with personal checks. Convenient store cashiers asked Latinos to pay more than $10 for the gift certificate 9% of the time and white Americans 2% of the time. When paying by personal checks, cashiers asked Latinos for ID 12% more than they did with white Americans. Study 2 examined two cultural dimensions of "civic" and "ethnic". Results suggested that white Americans judge other groups with different levels of moral intensity depending on the "distance" from such groups per mentioned dimensions. Study 3 and 4 focused more on the effect of social identity cue.
There are limitations some of which were acknowledged by the paper such as the fact that there are many Mexicans living illegally in the US, serving as legitimate reason for checking Latinos ID before accepting their personal checks. However, the paper raised an interesting point regarding the relationship between culture and moral intensity. Literature indeed listed "Ethical values" as one element of culture along with traditions, religions, politics, philosophy, art/literature, and science/technology (Gilbert, 2009).
Different perceptions of ethical values do cause huge differences among cultures. For example, dog can be considered as a delicacy in some Asian countries while killing a dog can be a crime in the US. On the other hand, beef is Americans' favorite choice for food while people in some parts of Asia will never eat beef. Ethical values influence cultures which in turn, may influence the way important decisions are made, including decisions of going to war, shaping a country's socio-economic development strategy, developing legal systems, etc.
Rausch, Lindquist and Steckel wrote a paper on the possible differences among US and EU countries and agreed that "National culture is widely recognized in the literature as having an impact on various stages of ethical decision-making" (Rausch, Lindquist, Steckel, 2014, p. 3). For example, Americans tend to make decisions that benefit the whole, yet the self has to be protected first. Germans care more about the moral obligations with the communities and how decisions will be perceived by peers. It explains why American usually do not have problem with being a whistle-blower and why European firms are less likely to employ institutional ethics.
Moral intensity and perspectives have a dynamic relationship with culture and are reflected through the actions we make in our daily lives. By common sense, we ourselves usually have problems in dealing with the actions that were believed to be wrong and in making decisions on the actions that are either right or wrong. It might as well be the case with our future patients/targeted customers. Different views on the definition of "ethics" or "moral standards" may also cause conflicts on issues of race, religions, globalization, LGBTQ, etc.
Conclusion
No matter what the difference is, it depends on how an individual interpret the dynamics of contexts and adapt to cultural changes (Fitzpatrick, 2017). There are elements that can transcend cultures such as philosophy, arts, technologies and so on. For example, Communism was invented in Germany and was adopted by China. Everyone in the world enjoy classical pieces written by German composers. Chinese and Japanese love to go to the US for higher education. It was found that hacker cultures are very similar between those in China and US (Benjamin & Hsinchun Chen, 2012).
All existing cultural conflicts could be traced down to the issue of Differences vs Familiarity. Survival instincts keep humans safe by trying to "confine" humans in environments that are familiar. Familiarity implies "safe". The problem is the mind tends to over exaggerate risks per observations from "Black like me" (Griffin, 1960). Such inflations can be stacked and over time, lead to issues like prejudice, bias, racism, etc. In endurance sports, an individual is forced to be critical with his/her own mental stages (Lane & Wilson, 2011). A lot of things can happen during a full marathon (26 miles) or an ultra-marathon (greater than 26 miles). There will be conflicting thoughts and/or emotions happening from within and the runners will have to decide which thought/emotion will win. For example, you are at mile 20, you have only 5 miles to the finish line. You feel like dying. Worst yet, you actually see someone had a heart attack and is surrounded by medics. Should you quit or continue running to the finish line? The habit of using the analytical mind to analyze the exaggerations proposed by the unconscious mind is important and such skill is translatable to other domains, including cultural diversity.
In order to understand and then embrace the differences, one has to be open to differences. Unfortunately, typical human psychology prefers Familiarity. Future research can focus on how to change the human “protective mindset” through inter-discipline tools, through innovations in formal education channels, through new ways of management strategies, and last but not least, through the use of cutting-edge technologies to blur the barriers and really bring people together.
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