151
CULTURAL DIFFERENCES IN INTERPERSONAL RESPONSES TO DEPRESSIVES’ NONVERBAL BEHAVIOUR PHILIPPOS VANGER, ANGELA B. SUMMERFIELD, B.K. ROSEN & J.P. WATSON
SUMMARY The Social Impression and Interpersonal Attraction of British depressed patients rated by British and German subjects on the basis of the patients’ videorecorded nonverbal behaviour. Depressives were rated negatively by all subjects. Males in both cultural groups agreed in their ratings of depressives but German females expressed a more negative attitude than British females. This is attributed to cultural differences in sex-appropriate interactive behaviour. The importance of studying the expression of depression and its meaning within a particular cultural context is indicated and the role of cultural differences in interactive behaviour is discussed with respect to intercultural assessment and treatment of depression. was
INTRODUCTION
experience as well as experimental research suggests that depressives are responded to negatively by normal others with whom they come into contact socially. Coyne (1976) reported that subjects interacting with depressed persons tended to reject and avoid them. The findings of the above study were supported and expanded by Hammen & Peters (1978) who showed that subjects conversing with a depressed person felt themselves depressed and socially rejected their partner. Howes & Hokanson (1979) also reported that a confederate enacting a depressed role was responded to in a rejecting manner and was perceived as unattractive and undesirable. Rejecting responses elicited by depressives may be mediated by their inability to adequately reinforce the others in interactions and behave according to rules and expectations regarding interpersonal interactions. Depressives have been shown to emit greatly decreased verbal and nonverbal reinforcers in dyadic interactions (Vanger et al. 1990). It seems, then, that depressives’ interactive behaviour elicits negative responses and social rejection from others which is attributed to unfavourable perception of depressives and to induced negative affect from interacting with them. Furthermore, depressives exhibit restricted and inadequate nonverbal behaviours in their interactions (Jones & Pansa, 1979; Prkachin et al. 1977; basis On the of nonverbal cues alone presented on videoLewinsohn, 1980). Youngren & was be affect found to recordings depressive readily recognisable (Waxer, 1974; 1976). Triandis and Brislin (1984) have pointed out that cross-cultural research indicated the existence of cultural differences in the manifestation of psychopathological states such as depression (Chang, 1985;_Perris et al. 1987). On the basis of a detailed case report of a Clinical
Downloaded from isp.sagepub.com at UNIV OF MASSACHUSETTS on April 8, 2015
152 woman possessed by a demon Obeyesekere (1970) showed that the manifestation of symptoms of mental illness is closely related to the cultural idiom and the world view of the community thus making the illness existentially meaningful to the patient and facilitating the mobilisation of group resources. Weisz et czl. (1987) found substantial differences in the problems for which youngsters were referred for treatment in the United States and in Thailand. These differences are attributed to culturally mediated values and socialisation practices which suppress development of some problems and foster others. Social norms and rules of interaction differ greatly across cultures and dictate correspondingly different sets of perceiving and judging interpersonal behaviour. Koutrelakos and Zarnari (1983) provided evidence showing that attitudes to the mentally ill vary between American and Greek social workers. This suggests that interpersonal responses to the mentally disturbed and especially to depressives may also be expected to vary across cultures. Different cultures have developed different rules about social interactions and particular expressive-communicative styles which have instrumental value since they facilitate effective communication and elicit desirable responses from the social environment (Lomax, 1975). Non-adherence to culture-specific interactive rules may lead to breakdown of communication and result in rejecting responses. Cultural groups have been shown to differ in their interactions with respect to the way they utilise cues such as Thomson, 1980). Oddou and Mendenhall (1984) age, sex and social class (Davidson & review a number of crosscultural studies indicating differences in person perception. Cross-cultural differences in interpersonal interactions have also been reported particularly with respect to nonverbal behaviour. Shuter (1979) found that Protestant and Jewish Americans differed in nonverbal communication and that Jewish females differed from males with respect to gestural patterns. Use of gestures in interactions was investigated by Graham and Argyle (1975) for British and Italian subjects and showed that gestures which are an integral part of the interactive process in Italians are less important in interaction between British persons. An investigation of interpersonal distance among American, Swedish, Greek, Italian and Scottish subjects (Little, 1968) revealed that the Mediterranean cultural groups exhibited closer interaction distances than the northern European groups and that females tended to place themselves closer than males in samesex interactions. The above studies suggest that there are differences in interactive style even between cultural groups that are closely related and that sex-appropriate interactive behaviours are to a great extent defined by culture specific norms. The purpose of the present study was firstly to study the quality of interpersonal responses to the nonverbal behaviour of depressed patients in two different cultural groups and secondly to investigate sex differences in these responses.
Ceylonese
METHOD
Subjects
college students and staff took part in this study. The British group consisted of 10 male and 18 female subjects between 18 and 25 years old with a mean age of 19.6 years. The German group consisted of eight male and 15 female subjects between 20 and 37 years old with a mean age of 25.8 years. A total of 51 British and German
Downloaded from isp.sagepub.com at UNIV OF MASSACHUSETTS on April 8, 2015
153
Stimulus material Eight British female depressed patients were video-recorded while conversing about a neutral topic with a confederate naive to their condition. Their age ranged between 38 and 66 years old with a mean of 49.3 years of age. The video-recordings were produced employing a split-screen technique which allowed the patient’s whole body in profile as well as the face in close-up to be simultaneously observable. The first minute of each video-recording was played back to the subjects. There was no sound to the video clips and their order of presentation was kept constant for all subjects. Procedure
Subjects were presented with the video clips without being informed that the persons they were depressed patients. No information was provided to the subjects as to the nationality of the stimulus persons. After viewing each video clip subjects recorded their responses to the patients on a handout they had been provided with. The handouts for British and German subjects had identical format and were translated in the corresponding language. Fourteen attributes of interpersonal behaviour were selected from Anderson’s (1968) list of adjectives. The list included both socially desirable (helpful, friendly, reliable, cooperative, sociable, cheerful, pleasant, confident) and socially undesirable attributes (aggressive, shy, complaining, depressed, quarrelsome, boring). Subjects’ Social Impression of the patients was assessed by means of seven-point scales. That is, next to each attribute a scale was provided ranging from (1): &dquo;not at all&dquo; to (7): &dquo;very much&dquo;. For example: English/German viewed
not at
all very much 1 2 3 4 5 6 7
friendly/freundlich
confident/selbstbewustt boring/langweilig Also, subjects’ Interpersonal Attraction to the patients was assessed by their responses on an identical seven-point scale to the question &dquo;Would you be interested to meet this person?&dquo; RESULTS
Firstly,
British and German groups
were
considered
separately.
Within each cultural
Mann-Whitney U tests did not reveal significant differences between males and females on their ratings on socially desirable and undesirable attributes and on interpersonal attraction. Mean ratings of males and females in each cultural group on the desirable and undesirable adjective groups and on the Interpersonal Attraction scales group
calculated for each stimulus depressive. Both sexes in both cultural groups perceived depressives as socially undesirable and as unattractive for further interaction as indicated by their overall ratings on the socially desirable and socially undesirable attributes and on the Interpersonal Attraction question (Table).
were
Downloaded from isp.sagepub.com at UNIV OF MASSACHUSETTS on April 8, 2015
154 Table Mean ratings on a seven-point scale by males and females of both cultural groups on Social Impression and Ir~terpers®~eal Attraction of depressives
In order to investigate further culture specific differences in interpersonal responses, males and females of each cultural group were treated separately and compared with each other.
Social Males
Impression
Mann-Whitney U tests were performed between the mean ratings by British and German judges separately for the desirable and for the undesirable attribute groups and both differences were found to be not significant. It seems that males in both cultural groups formed a similar impression of the stimulus persons along the lines of desirable and undesirable characteristics. Females
~Iann-~hitney U tests were performed between the mean ratings by British and German judges separately for desirable and undesirable attributes of the depressed
female
patients. With respect to the desirable attributes differences between British and German females were not significant. On the other hand, differences between undesirable attribute ratings were significant (U 11, p < 0.014, n 8). These findings demonstrate that British and German females agreed as to the positive attributes of the stimulus persons. However, they differed significantly in their ratings of the patients with respect to undesirable characteristics. British females rated them as significantly less undesirable than German females did. This indicates that British females were more sympathetic towards British =
=
stimulus persons whereas German females were more critical. This difference could imply either different approaches in the two cultures with respect to the use of negative descriptive terms and personality characteristics or cultural differences in interactive style. The interactive style of the British stimulus persons is perceived by German judges as inappropriate and is responded to unfavourably. It is, on the other hand, responded to more leniently by British subjects who do not perceive a discrepant interactive style.
Downloaded from isp.sagepub.com at UNIV OF MASSACHUSETTS on April 8, 2015
155
Interpersonal attraction Males
Mann-Whitney U tests were performed between the mean ratings of British and German male judges for each stimulus person and the differences was found to be not significant. Males in both cultural groups showed a similar degree of interest in meeting the stimulus persons expressing thus a similar degree of interpersonal attraction. Female
Mann-Whitney U tests between the mean ratings of German and British females showed significant difference (U 14, p < 0.032, n 8). German females expressed less interest in meeting the stimulus persons than British females which reflects a difference in degree of Interpersonal Attraction. This is congruent with the results obtained on Social Impression indicating an overall negative judgement formed by German females. a
=
=
DISCUSSION
Overall, these results show a more negative response on the part of the German female judges towards British depressed females suggesting differences in criteria used by the two cultural groups. It seems that the norms and rules of female interactive behaviour and style are different for the two cultures. A British stimulus person not adhering to German norms is perceived as and responded to more negatively by German subjects. British subjects on the other hand respond to them more favourably because no deviation from the norms is detected. The difference in concordance and discordance between males and females respectively suggests a difference in knowledge and sensitivity about the norms of female interactive behaviour. Differences in the norms of interactive behaviour in females are probably fine and subtle so that they are perceived and attended to only by female judges who are more knowledgeable and sensitised about them. Males lack this specialised, sex-specific knowledge, which would allow them a finer discrimination of female interactive behaviour. For this German males did not respond in the same discriminatory fashion as German females. Sex differences in judgements of nonverbal behaviour reported by Cupchik and Poulos (1984), have also been interpreted in the light of a higher nonverbal sensitivity on the part of females. Sex differences obtained in the present research should be interpreted and understood in the light of future specific norms of sex-appropriate behaviour, roles and stereotypes. Sharpe (1976) argued that girls are under social pressure to adopt a female role which is generally unassertive. Furnham and Henderson (1981) provided empirical support that, in Britain, females are less assertive than males. An interesting account of sex-role stereotypes in Britain was provided by Manstead and McCulloch (1981), indicating that males and females are characterised by different attributes. In a future study, it would be of interest to employ also male stimulus persons in order to investigate further cross-sex responses to depressives in different cultures. Also, the interactive situation and the identity of the stimulus persons to be responded to seem to play a role (Doerfler & Chaplin, 1985). Studies of interactions with strangers (Coyne,
Downloaded from isp.sagepub.com at UNIV OF MASSACHUSETTS on April 8, 2015
156
1985) allow for the emergence of depressive behaviour patterns not mediated by a previous relationship as is the case in interactions between spouses (Biglan et al. 1985; Kowalik & Gotlib, 1987). The present study dealt only with stranger to stranger interactions. A future goal may be to compare the present findings with those of spouse interactions. Furthermore, in order to solidify and enhance the found cultural differences a further study may be conducted including a comparable group of normal control stimulus persons as well as employing a group of matched German depressed patients. On the whole the findings of the present study highlight the importance of studying interactive behaviour and its relation to depressive disorders within the particular sociocultural context. Cross-cultural research may contribute to a better understanding of psychopathological manifestations (Clark, 1987). Different cultural groups have been shown to exhibit different depression symptoms (Kolody et al. 1986; Chang, 1985; West, 1985). This may lead to misconceptions about the presenting psychiatric problem and result in misleading diagnosis. Mental health professionals from 10 different countries were found to diagnose differently the same clinical descriptions of five individuals (Baskin, 1984). Sensitisation to the particular cultural norms is an essential condition for cross-cultural psychiatric diagnosis (Westermeyer9 1985). Cultural differences in interactive style may also result in misunderstandings between the persons involved in therapy or counselling (Suinn, 1985). Cross-cultural misunderstandings firstly inhibit effective communication and secondly result in mutual rejection of the partners as socially incompetent. Efforts to train Westerners in the social ways and interactive behaviour of non-Western cultures produced improvement in intercultural contacts (Collett, 1971; Fiedler et al. 1971). The practical implications of the present findings are that it seems pertinent to educate clinicians about cross-cultural conceptual issues and teach them the clinical skills necessary for cross-cultural work (Westermeyer, 1987); gaining subjective experience in the particular culture may be essential in intercultural clinical assessment and treatment (Jones & Thorne, 1987). Kleinman (1987) in his discussion of the contribution of anthropology to cross-cultural research in psychiatry suggests that the concept of culture needs to be operationalised as a research variable and integrated in psychiatry’s own taxonomies and methods. The present study found that German as compared with British females exhibited less favourable interpersonal responses to British female depressives when asked to judge them on the basis of their nonverbal behaviour alone. Male subjects in both cultures, however, agreed in their judgements and responded more favourably than females to the same depressed patients. These differences have been interpreted in terms of culture and sex specific expectations and rules of interactive behaviour. The above findings suggest that interactive patterns and their meaning can be best understood in relation to the sociocultural environment in which they have developed (Triandis, 1972). For this, further research is needed in order to comprise a profile of habitual interactive patterns and delineate the characteristics of interactive style in different cultures separately for same-sex and cross-sex interactions. A comparison of profiles would help to identify areas of potential confusion and misinterpretation in intercultural contacts. Furthermore, on the basis of the above it will be possible to investigate the manifestation of depression in expressive interpersonal behaviour across
Downloaded from isp.sagepub.com at UNIV OF MASSACHUSETTS on April 8, 2015
157
cultures and understand its meaning within the particular sociocultural environment. This may have implications for both diagnosis and treatment of depression cross-
culturally. ACKNOWLEDGEMENTS The authors would like to thank Professor K.R. Scherer, Professor H.J. Ellgring and Dr. H. Wallbott for their kind cooperation in the collection of data in Germany.
REFERENCES
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COLLETT, P. (1971) On training Englishmen in the non-verbal behavior of Arabs: an experiment in intercultural communication. International Journal of Psychology, 6, 209-215. COYNE, J.A. (1985) Comment: studying depressed persons’ interactions with strangers and spouses. Journal of Abnormal Psychology, 94, 231-232. CUPCHIK, G.C. & POULOS, C.X. (1984) Judgement of emotional intensity in self and others: the effects of stimulus context, sex, and expressivity. Journal of Personality and Social Psychology, 46, 431-439. DAVIDSON, A. & THOMSON, E. (1980) Cross-cultural studies of attitudes and beliefs. In Handbookof CrossCultural Psychology: Vol. 5 Social Psychology (eds. H.C. Triandis & W. Lonner). Boston: Allyn & Bacon, pp.
25-71.
DOERFLER, L.A. & CHAPLIN, W.F. (1985) Type II error in research on interpersonal models of depression. Journal of Abnormal Psychology, 94, 227-230. FIEDLER, F.E., MITCHELL, R. & TRIANDIS, H.D. (1971) The culture assimilator: an approach to crosscultural training. Journal of Applied Psychology, 55, 95-102. FURNHAM, A. & HENDERSON, M. (1981) Sex differences in self-reported assertiveness in Britain. British Journal of Clinical Psychology, 20, 227-238. GRAHAM, J.A. & ARGYLE, M. (1975) A cross-cultural study of the communication of extra verbal meaning of gestures. Internatlonal Journal of Psychology, 10, 57-67. PETERS, S.D. (1978) Interpersonal consequences of depression: responses to men and HAMMEN, C.L- & women enacting a depressed role. Journal of Abnormal Psychology, 87, 322-332. HOWES, M.J. & HOKANSON, J.E. (1979) Conversational and social responses to depressive interpersonal behavior. Journal of Abnormal Psychology, 88, 625-634. JONES, E.E. & THORNE, A. (1987) Rediscovery of the subject: intercultural approaches to clinical assessment. Journal of Consulting and Clinical Psychology, 55, 488-495. JONES, J.H. & PANSA, M. (1979) Some nonverbal aspects of depression and schizophrenia occurring during the interview. Journal of Nervous and Mental Disease, 167 , 402-409. KLEINMAN, A. (1987) Anthropology and psychiatry: the role of culture in cross-cultural research on illness. British Journal of Psychiatry, 151, 447-454. KOLODY, B., WEGA, W., MEINHARDT, K. & BENSUSSEN, G. (1986) The correspondence of health complaints and depressive symptoms among Anglos and Mexican-Americans. Journal of Nervous and Mental Disease, 174 , 221-228. KOUTRELAKOS, J. & ZARNARI, D. (1983) Opinions about mental illness: a comparison of American and Greek social work students in 1969 and 1979. Psychological Reports, 53 , 71-80.
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I.H. (1987) Depression and marital interaction: concordance between intent and perception of communication. Journal of Abnormal Psychology, 96, 127-134. LITTLE, K.B. (1968) Cultural variations in social schemata. Journal of Personality & Social Psychology, 10, 1-7. LOMAX, A. (1975) Culture-style factors in face-to-face interaction. In Organisation of Behavior in Face-to-Face Interaction (eds. R.M. Harris & M.R. Key). The Hague: Mouton Publishers. MANSTEAD, A.S.R. & McCULLOCH, C. (1981) Sex-role stereotyping in British television advertisements. British Journal of Social Psychology, 20, 171-180. OBEYESEKERE, G. (1970) The idiom of demonic possession: a case study. Social Science and Medicine, 4, 97-
111.
ODDOU, G. & MENDENHALL, M. (1984) Person perception in crosscultural settings: a review of crosscultural and related cognitive literature. International Journal of Intercultural Relations, 8, 77-96. PERRIS, C., GASZNER, P., PERRIS, H., LACZAY, G. & EISEMANN, M. (1987) Depressive symptomatology at admission in Hungarian and Swedish depressed patients. Psychopathology, 20, 1-7. PRKACHIN, K.M., CRAIG, K.D., PAPAGEORGIS, D. & REITH, G. (1977) Nonverbal communication deficits and response to performance feedback in depression. Journal of Abnormal Psychology, 86, 224-234. SHARPE, S. (1976) Just likea girl: how girls learn to be women. London: Penguin Books. SHUTER, R. (1979) A study of nonverbal communication among Jews and Protestants. Journal of Social Psychology, 109, 31-41. SUINN, R. (1985) Research and practice in cross-cultural counseling. Counseling Psychologist, 13, 673-684. Transcultural Research in Mental TRIANDIS, H.C. (1972) An approach to the analysis of subjective culture. In Health
(ed. W.P. Lebra).
Hawaii:
University Press.
TRIANDIS, H.C. & BRISLIN, R.W. (1984) Cross-cultural psychology. American Psychologist, 39 , 1006-1016. VANGER, P., SUMMERFIELD, A.B., ROSEN, B. & WATSON, J.P.(1990) Verbal and nonverbal activity of depressives in dyadic interaction. Psychotherapy. Psychosomatik, medizinische Psychology - DiscJournal. 1. 198.
WAXER, P. (1974) Nonverbal cues for depression. Journal of Abnormal Psychology, 83, 319-322. WAXER, P. (1976) Nonverbal cues for depth of depression: set versus no set. Journal of Consulting and Clinical Psychology, 44, 493. WEISZ, J.R., SUWANLERT, A., CHAIYASIT, W. & WALTER, B.R. (1987) Over- and undercontrolled referral problems among children and adolescents from Thailand and the United States: The Wat and Wai of cultural differences. Journal of Consulting and Clinical Psychology, 55, 719-726. WEST, J. (1985) Comparison of depressive symptomatology between Saudi and American psychiatric
outpatients in an Eastern Province medical center, Saudi Arabia. International Journal of Social Psychiatry, 31, 230-234.
WESTERMEYER, J. (1985) Psychiatric diagnosis across cultural boundaries. American Journal of Psychiatry, 142, 798-805. WESTERMEYER, J. (1987) Cultural factors in clinical assessment. Journal of Consulting and Clinical Psychology, 55, 471-478. YOUNGREN, M.A. & LEWINSOHN, P.M. (1980) The functional relation between depression and
problematic interpersonal
behavior. Journal
of Abnormal Psychology, 29,
333-341.
Philippos Vanger, Forschungstelle für Psychotherapie, Christian-Belser-Straße 79a, 7000 Stuttgart 70, F.R.G. Angela B. Summerfield, Divison of Psychiatry, United Medical and Dental Schools of Guy’s and St. Thomas’s Hospitals, University of London, UK. B.K. Rosen, Division of Psychiatry, United Medical and Dental Schools of Guy’s and St. Thomas’s Hospitals, University of London, UK. J.P. Watson, Division of Psychiatry, United Medical and Dental Schools of Guy’s and St. Thomas’s Hospitals, University of London, UK. Correspondence to Dr. Vanger
Downloaded from isp.sagepub.com at UNIV OF MASSACHUSETTS on April 8, 2015
CULTURAL DIFFERENCES IN INTERPERSONAL RESPONSES TO DEPRESSIVES’ NONVERBAL BEHAVIOUR PHILIPPOS VANGER, ANGELA B. SUMMERFIELD, B.K. ROSEN & J.P. WATSON
SUMMARY The Social Impression and Interpersonal Attraction of British depressed patients rated by British and German subjects on the basis of the patients’ videorecorded nonverbal behaviour. Depressives were rated negatively by all subjects. Males in both cultural groups agreed in their ratings of depressives but German females expressed a more negative attitude than British females. This is attributed to cultural differences in sex-appropriate interactive behaviour. The importance of studying the expression of depression and its meaning within a particular cultural context is indicated and the role of cultural differences in interactive behaviour is discussed with respect to intercultural assessment and treatment of depression. was
INTRODUCTION
experience as well as experimental research suggests that depressives are responded to negatively by normal others with whom they come into contact socially. Coyne (1976) reported that subjects interacting with depressed persons tended to reject and avoid them. The findings of the above study were supported and expanded by Hammen & Peters (1978) who showed that subjects conversing with a depressed person felt themselves depressed and socially rejected their partner. Howes & Hokanson (1979) also reported that a confederate enacting a depressed role was responded to in a rejecting manner and was perceived as unattractive and undesirable. Rejecting responses elicited by depressives may be mediated by their inability to adequately reinforce the others in interactions and behave according to rules and expectations regarding interpersonal interactions. Depressives have been shown to emit greatly decreased verbal and nonverbal reinforcers in dyadic interactions (Vanger et al. 1990). It seems, then, that depressives’ interactive behaviour elicits negative responses and social rejection from others which is attributed to unfavourable perception of depressives and to induced negative affect from interacting with them. Furthermore, depressives exhibit restricted and inadequate nonverbal behaviours in their interactions (Jones & Pansa, 1979; Prkachin et al. 1977; basis On the of nonverbal cues alone presented on videoLewinsohn, 1980). Youngren & was be affect found to recordings depressive readily recognisable (Waxer, 1974; 1976). Triandis and Brislin (1984) have pointed out that cross-cultural research indicated the existence of cultural differences in the manifestation of psychopathological states such as depression (Chang, 1985;_Perris et al. 1987). On the basis of a detailed case report of a Clinical
Downloaded from isp.sagepub.com at UNIV OF MASSACHUSETTS on April 8, 2015
152 woman possessed by a demon Obeyesekere (1970) showed that the manifestation of symptoms of mental illness is closely related to the cultural idiom and the world view of the community thus making the illness existentially meaningful to the patient and facilitating the mobilisation of group resources. Weisz et czl. (1987) found substantial differences in the problems for which youngsters were referred for treatment in the United States and in Thailand. These differences are attributed to culturally mediated values and socialisation practices which suppress development of some problems and foster others. Social norms and rules of interaction differ greatly across cultures and dictate correspondingly different sets of perceiving and judging interpersonal behaviour. Koutrelakos and Zarnari (1983) provided evidence showing that attitudes to the mentally ill vary between American and Greek social workers. This suggests that interpersonal responses to the mentally disturbed and especially to depressives may also be expected to vary across cultures. Different cultures have developed different rules about social interactions and particular expressive-communicative styles which have instrumental value since they facilitate effective communication and elicit desirable responses from the social environment (Lomax, 1975). Non-adherence to culture-specific interactive rules may lead to breakdown of communication and result in rejecting responses. Cultural groups have been shown to differ in their interactions with respect to the way they utilise cues such as Thomson, 1980). Oddou and Mendenhall (1984) age, sex and social class (Davidson & review a number of crosscultural studies indicating differences in person perception. Cross-cultural differences in interpersonal interactions have also been reported particularly with respect to nonverbal behaviour. Shuter (1979) found that Protestant and Jewish Americans differed in nonverbal communication and that Jewish females differed from males with respect to gestural patterns. Use of gestures in interactions was investigated by Graham and Argyle (1975) for British and Italian subjects and showed that gestures which are an integral part of the interactive process in Italians are less important in interaction between British persons. An investigation of interpersonal distance among American, Swedish, Greek, Italian and Scottish subjects (Little, 1968) revealed that the Mediterranean cultural groups exhibited closer interaction distances than the northern European groups and that females tended to place themselves closer than males in samesex interactions. The above studies suggest that there are differences in interactive style even between cultural groups that are closely related and that sex-appropriate interactive behaviours are to a great extent defined by culture specific norms. The purpose of the present study was firstly to study the quality of interpersonal responses to the nonverbal behaviour of depressed patients in two different cultural groups and secondly to investigate sex differences in these responses.
Ceylonese
METHOD
Subjects
college students and staff took part in this study. The British group consisted of 10 male and 18 female subjects between 18 and 25 years old with a mean age of 19.6 years. The German group consisted of eight male and 15 female subjects between 20 and 37 years old with a mean age of 25.8 years. A total of 51 British and German
Downloaded from isp.sagepub.com at UNIV OF MASSACHUSETTS on April 8, 2015
153
Stimulus material Eight British female depressed patients were video-recorded while conversing about a neutral topic with a confederate naive to their condition. Their age ranged between 38 and 66 years old with a mean of 49.3 years of age. The video-recordings were produced employing a split-screen technique which allowed the patient’s whole body in profile as well as the face in close-up to be simultaneously observable. The first minute of each video-recording was played back to the subjects. There was no sound to the video clips and their order of presentation was kept constant for all subjects. Procedure
Subjects were presented with the video clips without being informed that the persons they were depressed patients. No information was provided to the subjects as to the nationality of the stimulus persons. After viewing each video clip subjects recorded their responses to the patients on a handout they had been provided with. The handouts for British and German subjects had identical format and were translated in the corresponding language. Fourteen attributes of interpersonal behaviour were selected from Anderson’s (1968) list of adjectives. The list included both socially desirable (helpful, friendly, reliable, cooperative, sociable, cheerful, pleasant, confident) and socially undesirable attributes (aggressive, shy, complaining, depressed, quarrelsome, boring). Subjects’ Social Impression of the patients was assessed by means of seven-point scales. That is, next to each attribute a scale was provided ranging from (1): &dquo;not at all&dquo; to (7): &dquo;very much&dquo;. For example: English/German viewed
not at
all very much 1 2 3 4 5 6 7
friendly/freundlich
confident/selbstbewustt boring/langweilig Also, subjects’ Interpersonal Attraction to the patients was assessed by their responses on an identical seven-point scale to the question &dquo;Would you be interested to meet this person?&dquo; RESULTS
Firstly,
British and German groups
were
considered
separately.
Within each cultural
Mann-Whitney U tests did not reveal significant differences between males and females on their ratings on socially desirable and undesirable attributes and on interpersonal attraction. Mean ratings of males and females in each cultural group on the desirable and undesirable adjective groups and on the Interpersonal Attraction scales group
calculated for each stimulus depressive. Both sexes in both cultural groups perceived depressives as socially undesirable and as unattractive for further interaction as indicated by their overall ratings on the socially desirable and socially undesirable attributes and on the Interpersonal Attraction question (Table).
were
Downloaded from isp.sagepub.com at UNIV OF MASSACHUSETTS on April 8, 2015
154 Table Mean ratings on a seven-point scale by males and females of both cultural groups on Social Impression and Ir~terpers®~eal Attraction of depressives
In order to investigate further culture specific differences in interpersonal responses, males and females of each cultural group were treated separately and compared with each other.
Social Males
Impression
Mann-Whitney U tests were performed between the mean ratings by British and German judges separately for the desirable and for the undesirable attribute groups and both differences were found to be not significant. It seems that males in both cultural groups formed a similar impression of the stimulus persons along the lines of desirable and undesirable characteristics. Females
~Iann-~hitney U tests were performed between the mean ratings by British and German judges separately for desirable and undesirable attributes of the depressed
female
patients. With respect to the desirable attributes differences between British and German females were not significant. On the other hand, differences between undesirable attribute ratings were significant (U 11, p < 0.014, n 8). These findings demonstrate that British and German females agreed as to the positive attributes of the stimulus persons. However, they differed significantly in their ratings of the patients with respect to undesirable characteristics. British females rated them as significantly less undesirable than German females did. This indicates that British females were more sympathetic towards British =
=
stimulus persons whereas German females were more critical. This difference could imply either different approaches in the two cultures with respect to the use of negative descriptive terms and personality characteristics or cultural differences in interactive style. The interactive style of the British stimulus persons is perceived by German judges as inappropriate and is responded to unfavourably. It is, on the other hand, responded to more leniently by British subjects who do not perceive a discrepant interactive style.
Downloaded from isp.sagepub.com at UNIV OF MASSACHUSETTS on April 8, 2015
155
Interpersonal attraction Males
Mann-Whitney U tests were performed between the mean ratings of British and German male judges for each stimulus person and the differences was found to be not significant. Males in both cultural groups showed a similar degree of interest in meeting the stimulus persons expressing thus a similar degree of interpersonal attraction. Female
Mann-Whitney U tests between the mean ratings of German and British females showed significant difference (U 14, p < 0.032, n 8). German females expressed less interest in meeting the stimulus persons than British females which reflects a difference in degree of Interpersonal Attraction. This is congruent with the results obtained on Social Impression indicating an overall negative judgement formed by German females. a
=
=
DISCUSSION
Overall, these results show a more negative response on the part of the German female judges towards British depressed females suggesting differences in criteria used by the two cultural groups. It seems that the norms and rules of female interactive behaviour and style are different for the two cultures. A British stimulus person not adhering to German norms is perceived as and responded to more negatively by German subjects. British subjects on the other hand respond to them more favourably because no deviation from the norms is detected. The difference in concordance and discordance between males and females respectively suggests a difference in knowledge and sensitivity about the norms of female interactive behaviour. Differences in the norms of interactive behaviour in females are probably fine and subtle so that they are perceived and attended to only by female judges who are more knowledgeable and sensitised about them. Males lack this specialised, sex-specific knowledge, which would allow them a finer discrimination of female interactive behaviour. For this German males did not respond in the same discriminatory fashion as German females. Sex differences in judgements of nonverbal behaviour reported by Cupchik and Poulos (1984), have also been interpreted in the light of a higher nonverbal sensitivity on the part of females. Sex differences obtained in the present research should be interpreted and understood in the light of future specific norms of sex-appropriate behaviour, roles and stereotypes. Sharpe (1976) argued that girls are under social pressure to adopt a female role which is generally unassertive. Furnham and Henderson (1981) provided empirical support that, in Britain, females are less assertive than males. An interesting account of sex-role stereotypes in Britain was provided by Manstead and McCulloch (1981), indicating that males and females are characterised by different attributes. In a future study, it would be of interest to employ also male stimulus persons in order to investigate further cross-sex responses to depressives in different cultures. Also, the interactive situation and the identity of the stimulus persons to be responded to seem to play a role (Doerfler & Chaplin, 1985). Studies of interactions with strangers (Coyne,
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1985) allow for the emergence of depressive behaviour patterns not mediated by a previous relationship as is the case in interactions between spouses (Biglan et al. 1985; Kowalik & Gotlib, 1987). The present study dealt only with stranger to stranger interactions. A future goal may be to compare the present findings with those of spouse interactions. Furthermore, in order to solidify and enhance the found cultural differences a further study may be conducted including a comparable group of normal control stimulus persons as well as employing a group of matched German depressed patients. On the whole the findings of the present study highlight the importance of studying interactive behaviour and its relation to depressive disorders within the particular sociocultural context. Cross-cultural research may contribute to a better understanding of psychopathological manifestations (Clark, 1987). Different cultural groups have been shown to exhibit different depression symptoms (Kolody et al. 1986; Chang, 1985; West, 1985). This may lead to misconceptions about the presenting psychiatric problem and result in misleading diagnosis. Mental health professionals from 10 different countries were found to diagnose differently the same clinical descriptions of five individuals (Baskin, 1984). Sensitisation to the particular cultural norms is an essential condition for cross-cultural psychiatric diagnosis (Westermeyer9 1985). Cultural differences in interactive style may also result in misunderstandings between the persons involved in therapy or counselling (Suinn, 1985). Cross-cultural misunderstandings firstly inhibit effective communication and secondly result in mutual rejection of the partners as socially incompetent. Efforts to train Westerners in the social ways and interactive behaviour of non-Western cultures produced improvement in intercultural contacts (Collett, 1971; Fiedler et al. 1971). The practical implications of the present findings are that it seems pertinent to educate clinicians about cross-cultural conceptual issues and teach them the clinical skills necessary for cross-cultural work (Westermeyer, 1987); gaining subjective experience in the particular culture may be essential in intercultural clinical assessment and treatment (Jones & Thorne, 1987). Kleinman (1987) in his discussion of the contribution of anthropology to cross-cultural research in psychiatry suggests that the concept of culture needs to be operationalised as a research variable and integrated in psychiatry’s own taxonomies and methods. The present study found that German as compared with British females exhibited less favourable interpersonal responses to British female depressives when asked to judge them on the basis of their nonverbal behaviour alone. Male subjects in both cultures, however, agreed in their judgements and responded more favourably than females to the same depressed patients. These differences have been interpreted in terms of culture and sex specific expectations and rules of interactive behaviour. The above findings suggest that interactive patterns and their meaning can be best understood in relation to the sociocultural environment in which they have developed (Triandis, 1972). For this, further research is needed in order to comprise a profile of habitual interactive patterns and delineate the characteristics of interactive style in different cultures separately for same-sex and cross-sex interactions. A comparison of profiles would help to identify areas of potential confusion and misinterpretation in intercultural contacts. Furthermore, on the basis of the above it will be possible to investigate the manifestation of depression in expressive interpersonal behaviour across
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cultures and understand its meaning within the particular sociocultural environment. This may have implications for both diagnosis and treatment of depression cross-
culturally. ACKNOWLEDGEMENTS The authors would like to thank Professor K.R. Scherer, Professor H.J. Ellgring and Dr. H. Wallbott for their kind cooperation in the collection of data in Germany.
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Philippos Vanger, Forschungstelle für Psychotherapie, Christian-Belser-Straße 79a, 7000 Stuttgart 70, F.R.G. Angela B. Summerfield, Divison of Psychiatry, United Medical and Dental Schools of Guy’s and St. Thomas’s Hospitals, University of London, UK. B.K. Rosen, Division of Psychiatry, United Medical and Dental Schools of Guy’s and St. Thomas’s Hospitals, University of London, UK. J.P. Watson, Division of Psychiatry, United Medical and Dental Schools of Guy’s and St. Thomas’s Hospitals, University of London, UK. Correspondence to Dr. Vanger
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