Seperti katak dibawah tempurung – Like a frog under a coconut shell.
Culture, for all its shadow and light, is essential and intimate to humanity. And like any intimacy, no one ‘from outside’ can ever fully share it, and no one ‘from inside’ can ever fully describe it. Such is human culture. Veling 2005, p. 159.
This example from my work illustrates one of the reasons for the focus of this article: that of communicating and understanding emotions across cultural spectra. International students, by the very nature of crossing cultural boundaries and stepping well out of their comfort zones, are perhaps most likely to face feeling low because of the strains of cross-cultural adaptation. This has been defined as ‘culture shock’ or ‘culture stress’. Merriam-Webster's dictionary defines culture shock as ‘a feeling of confusion, doubt, or nervousness caused by being in a place (such as a foreign country) that is very different from what you are used to’. See
The complicated nature of depression and diagnosis thereof has been covered extensively by many authors and practitioners. It is a contentious topic and there are many opinions and theories about its diagnosis and treatment. Indeed, Blazer challenges the notion that depression is simply to be viewed as an individualised, medicalised disease and points to a wider, sociological dimension to research about depression. Blazer 2005, pp. 6–8. Christodoulou 2012, p. 14.
While the focus of this article is not on depression, it has been helpful to look into research about it in order to gain greater clarity about expressions of depression in different cultures, but also to see how culture stress could perhaps be misconstrued as depression. I have also looked into material covering different communication styles, wondering whether there is a connection between a cultural style of communication and a more cultural response to struggle and depression. The World Health Organization estimates that 350 million people are affected by depression worldwide, a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration. Moreover, depression often comes with symptoms of anxiety. These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. Marcus, Taghi Yasamy, van Ommeren, Chisholm and Saxena 2012, p. 6.
This heightened awareness of depression among the medical profession is helpful for the millions of sufferers who need to be heard and treated appropriately. In my own work I have seen how culture stress has led to depression, and it is important that those ministering to international students are aware of this reality and know how to enable students to seek help where necessary. However, culture stress and indeed depression may look different, depending on each culture, and support may be more usefully received in a variety of ways. Christodoulou 2012, p. 14.
This article, therefore, comes out of a desire to look more deeply at experiences of struggle that many international students face and express when they come to study in the UK – or indeed with reverse culture shock when they return back home. Returning home and experiencing reverse culture shock can sometimes affect international students even more than the initial culture shock on arrival in the UK. Butcher 2002, p. 361.
A body of research exists that shows that humans around the world hold various emotions in common with one another – amusement, anger, fear and sadness. Nauert 2015; SparkNotes Editors 2005; Altarriba, Basnight and Canary 2003. Although, see Sartorious 1983, pp. 57 and 125–126, and Bond 1991 p. 92. Grant 1999, p. 115. The psychotherapeutic process as practised in the West is extremely verbal, focused on the self and on the disclosure of personal information, change orientated, and non-directive . . . As such, it is simply not compatible with Chinese culture. Bond 1991, p. 105.
Bond quotes a Chinese adage, that ‘problems within the family should not be discussed outside the family’, Bond 1991, p. 91. Bond 1991, p. 106. Robinson 2004, p. 150.
Of course, within the same culture, an individual will express his or her emotions differently, going through a struggle process at a different pace from another, or perhaps getting stuck in one particular ‘phase’, while others move on quickly and seemingly without as much pain. Butcher 2002, p. 356. Holder 1992, p. 98.
In the story of any international student coming to study in the UK, there will be a variety of main characters: the international student herself/himself, the institution that the student is studying in, and people that the student comes into contact with. However, there also exists a far more important layer, one which is almost entirely invisible to people whom they meet: that of their home culture and background. This is made up of language, family, friends, food, weather, temperament, unspoken ‘norms’ and subconscious reactions to social cues. Couple this with the new social norms, pedagogy, academic standards and expectations of the academic institution that they have arrived to study in and a more complicated picture emerges. This process of cultural acclimatisation fits into the ‘adaptive’ model Christodolou wrote about, Christodoulou 2012, p. 14.
I am mindful that I also come with my own background: representing the organisation that I work for, my own culture that I grew up in, my own family situation and the experiences that I go through each day. Part of the training that I go through is to be more aware of my own responses and the responses of those around me, having time to understand the students and thinking through their needs, as well as recognising my own. David Augsberger, an Anabaptist minister, who specialises in pastoral care across cultures and with people in conflict, describes this process of observation as having a ‘bidirectional strength’ – being able to see ourselves and to see others as we and they are. Augsberger 1986, p. 30. Augsberger 1986, p. 18.
The intentionality of learning and observation is perhaps all the harder to undertake in the twenty-first century, where developed countries have access to speedy travel and ever-increasing sophistication in technology. It has particular relevance for the – increasingly – affluent international students studying in the UK, because a few hours of air travel leaves little time to reflect on the upcoming arrival in a new place. Technology enables cultural ‘norms’ of a host culture to be analysed from afar, along with ready communication with loved ones back home. However, the same technology can also provide escapism back to a previous life and it may switch people off to engaging with one another by ‘timing out’ into gadgets. These challenges illustrate further that those who listen to stories and engage in ‘shell lifting’ cannot operate in a vacuum. Lartey 2003, pp. 40–41.
This ‘bidirectional’ process is well illustrated in Tolkein's Tolkien 1937, p. 34.
Supporting students through their and my own journey means sitting both under and outside the shell: someone who is of my own culture, and yet one who also stands with a foot in someone else's. This enables a greater opportunity to listen and share life together. In my own experience, it is more comfortable to do this when things are positive. When struggle hits, it is natural for an individual to retreat under their familiar shell; not only that, but with an expectation for others to follow. When someone retreats for comfort because they’re struggling, it may be necessary to understand where it is they have found safety and perhaps try to go there with them. This love and ‘being with’ comes out of a Christian basis of the nature of God as love, Bennett Moore 2002, p. 1.
Amid the opportunities for many to travel and explore, some have criticised the growing trend of focusing on the similarities between cultures. Robert Hughes writes as Hughes 1993, p. 100. Grant 1999, p. 107. Lartey 2003, pp. 40–41. See, for example, Edinburgh University's ‘Equality and Diversity’ mandate:
Given inherent cultural differences from around the world and the sheer volume of material, my aim is to focus on a few cultures in the hope that through researching what others have written on the subject of communication, I can discover whether different ways of communication in cultures are echoed with different expressions of struggle and responses to it – for example, is a naturally talkative culture therefore more likely to talk about struggle? In order to do this, I have found a practical model created by Richard Lewis for helping businesses engage with cultural differences particularly helpful. This model has been used as a guide in Lewis's training to show ‘how our own culture and language affect the ways in which we organise our world, think, feel and respond,’
Richard Lewis's model divides cultures into three types:
Richard Lewis's culture model
Under these three different headings, Lewis describes attributes that he sees as common to these cultures. Those who fall into the Linear-active model – for example, the UK and the USA – Lewis suggests, have a tendency to be polite but direct, result-oriented, use restrained body language, and confront difficulties with logic. Multi-actives – for example, Spain and Italy – tend to multi-task, are emotional and relationship-oriented, use unrestrained body language and deal with situations by confronting with emotion. Finally, those from Reactive backgrounds – for example, Japan and China – have a tendency to listen more of the time, react to the actions of others, are polite and indirect, are harmony-oriented, using subtle body language, and tend not to use confrontation.
Notice that these headings do not suggest that Multi-actives are ‘more emotional’, nor that Linear-actives are incapable of multi-tasking. Just because those in the Reactive group tend to listen more and are perhaps more restrained in expression does not mean that they are not people-focused. It is important to note that these categories from Lewis's model are generalisations, highlighting particular traits, but do not mean that everyone from a particular culture will fit exactly within that cultural description.
In communication terms, the UK and the USA are included on the Linear-active scale, and research into emotional expression showed that people from these cultures tended to express emotion using individualistic words Robinson 2004, p. 157, and Tanaka-Matsumi and Marsella 1976, p. 389. Tanaka-Matsumi and Marsella 1976, p. 392.
Interestingly, it has also been noticeable how facial expressions seem to be much stronger for Linear-active cultures than for Reactive cultures. A study by Rachael Jack in 2011 found that Chinese participants relied more on the subtleties in the eyes, whereas British participants’ expressions were more noticeable around the mouth and eyebrows.
An illustration from research on perception of facial expressions
It is interesting to note the outward expressiveness of the WC faces. The subtler expressions from the EA participants links in with the careful need to establish and maintain harmony with one another, whereas a Westerner may seek to solve an issue using a logical and problem-solving attitude.
Just as, culturally, Linear-actives tended to apply logic and task-oriented methods to a problem, so also their approach to dealing with struggle was to focus on a solution, found often through one-to-one therapy, with a GP in seeking medication, and being up-front about what they felt.
A further question arose when looking at the categories of mental disorders, namely that Western wording and references used specifically Western psychotherapeutic models. Tanaka-Matsumi and Chang 2002, p. 8, and Tsai and Chentsova-Dutton 2010. Tanaka-Matsumi and Marsella 1976, p. 380. Tanaka-Matsumi and Marsella 1976, p. 380. Tanaka-Matsumi and Marsella 1976, p. 386. Tanaka-Matsumi and Marsella, 1976, p. 392.
Linear-active cultures on the Lewis model are said to communicate in a logical way and are result-oriented in purpose. Perhaps some would think that admitting to depression would not be an acceptable part of that cultural background. However, the overwhelming amount of research shows that people within Western cultures have an open expression of struggle within an individualised model and that they benefit from a boundaried, psychotherapeutic and/or medical model of care. It is interesting to note from Jeanne Tsai and Yulia Chentsova-Dutton Tsai and Chentsova 2010, p. 467. Tsai and Chentsova 2010, p. 467. Welch 2011, p. 1. Christodoulou 2012, p. 14.
Based on the large volume of research from Linear-active cultures, there is much more I could say. However, the very availability of this research by comparison to the more limited amount available for Multi-active and Reactive cultures demands noting here, as it demonstrates the dominance of the Western psychotherapeutic model in this topic and the accessibility of help for depression within these cultures.
Reactive cultures include Japan, China and other East Asian cultures. The natural style of communication, represented on the Lewis model, is one of being good listeners, eager to compromise, accommodating and polite. The key to understanding communication in Reactive cultures is to recognise that social harmony is of paramount importance. Reading Michael Bond's book, Bond 1991, p. 27. Bond 1991, p. 32. Bond 1991, p. 17. Bond 1991, p. 36. Bond 1991, p. 66. Bond 1991, p. 55. Chinese adage, quoted in Bond 1991, p. 53. Bond 1991, p. 83.
This focus on social harmony isn’t unique to Chinese culture. I have already recorded that research conducted by Tanaka-Matsumi and Marsella revealed that the descriptions of depressive feelings were different across the Western/Eastern divide more generally. It is perhaps not surprising to hear that Japanese nationals used ‘external’ words such as ‘rain, dark, worries, grey, cloudy, suicide, solitude, exams,’ Tanaka-Matsumi and Marsella 1976, p. 384. Tanaka-Matsumi and Marsella 1976, p. 386. Tanaka-Matsumi and Marsella 1976, p. 389. Augsberger 1986, p. 40. Bond 1991, p. 103. Bond 1991, p. 91.
Quite apart from who to talk to, however, is the issue of whether to talk at all. One therapist wrote about her observations of being a therapist in Japan:
Back in the 1980s I remember hearing young mothers encouraging their toddlers to have Hitchens 2013, p. 8.
This raises a question about different models of care through a time of suffering. The idea of Bond 1991, p. 93.
On Lewis's model of communication, Multi-actives – for example, Hispanic and Mediterranean cultures – are said to be naturally outgoing and emotional, expressive about feelings and very warmly focused on relationships. Interestingly, though, finding research from Multi-active cultures about depression was much harder and there were fewer results about counselling for depression, in comparison to Linear-active (and even Reactive) cultures. Some have suggested this may be to do with economic conditions in Spanish-speaking countries, perhaps leading to fewer resources to input into research about the prevention and treatment of depression. Dimitra 2013, p. 9; Munizza, Argentero, Coppo, Tibaldi and Di Giannantonio, Picci and Rucci 2013; and Comas and Alvarez 2004, pp. 371–376. Atanassov 2013, p. 25. Bond 1991, p. 91. Munizza, Argentero, Coppo, Tibaldi, Di Giannantonio, Picci and Rucci 2013; Comas and Alvarez 2004, p. 371.
Where Reactive cultures have a more collectivist mentality, perhaps reflecting a less individually expressive system, Multi-active cultures tend towards being more individualistic in expression; therefore, they ‘reinforce verbal expression of negative emotion . . .’ because ‘sharing emotions represents a good form of coping’.
Percentage of respondents endorsing stigmatising attitudes towards depression
Having seen the descriptions from Richard Lewis's model, I wonder whether Linear-active cultures see Multi-active cultures as just ‘more expressive and exuberant’ versions of themselves; and perhaps Multi-active cultures see Linear-actives as being more repressed! And yet, at the point of need, these cultures seem to shift in expression – Multi-actives becoming cautious about expressing depression, but Linear-actives now becoming more overt in naming how they feel. Reactive cultures, while being less forthright in expression most of the time, may come across as more positive when struggling, especially when with people in seniority – in contrast to Linear-active participants, who tended to be consistent in behaviour whatever the context. Callow 2014, p. 14. Bond 1991, p. 29.
Another interesting issue to note at this point is about symptoms of struggle and depression: that of ‘guilt feelings’ in Western cultures, and notably that of presenting depressive symptoms in feelings of guilt. Some have connected this with the Judeo-Christian tradition and individualism that grew from out of Western cultures. Tanaka-Matsumi 2001, p. 272. Kendall and Hammen 1995, p. 229.
A Western model of treating mental illness ‘with medication and some cognitive restructuring’ has been challenged by some who see it as an inadequate model in comparison to community providing the first and main line of support. Lister-Ford 2007, p. 81, and Welch 2011, p. 2. Tanaka-Matsumi and Marsella 1976, p. 391.
Take an example of a student from China, whose fear of failure and the shame that would bring to his family drives him to work longer and longer hours. His moods become lower and his health deteriorates. He doesn’t understand his lecturer, but to express this would bring shame to the lecturer – someone older than him and in a position of authority – so he works all the harder. This problem is not just about struggling to understand, but is about honouring relationships with his family back home – who are counting on him to succeed – as well as his seniors in his host culture. A tutor may observe the work output and see it as a huge achievement – which it is – but the tutor may not realise that the student may well be crying out for help.
I started this article with a concern for international students and how to spot struggles they may experience, particularly given that different cultures may express struggle and depression differently. The Lewis model gave me tools to understand how different cultures communicate, and how that presents in voicing – or not voicing – struggle and depression. Cultures where people use more logical methods of communication on Lewis's model do not necessarily shy away from discussing the complexities of struggle and depression; and yet people from more expressive cultures seem to hold a greater stigma with regards to depression and tend not to reveal so much of their struggle. More private and hierarchical cultures sometimes hold the group in higher regard than the individual, but struggle is communicated within intimate family groups and handled together more openly. The combination of the variety of ways in which cultures communicate and, separately, the different ways that people express struggle, make it that much harder to work through it when in a cross-cultural environment. Learning to be aware of my own ‘shell’ and the very different ‘shells’ of those from other cultures increases awareness of the problems of cross-cultural communication. Being able to lift those shells, even a little, helps to take that first significant step of comprehending the complexities of another's culture and experiences, which are so hard to understand without exposure and interaction. Veling 2005, p. 159. Lyall 2001, p. 181.
I began with a story about Linda's knitting and I think it is right to finish here too as I reflect on what it means for me and other Christians engaging with international students to accompany them. These small moments of deep significance for international students are so easily missed. Seeing the background behind the story being told is very hard to spot, particularly when communicated across cultures. In Lyall 2001, p. 31.
Journeying with international students as they struggle in no way detracts from the importance and necessity of professional care, but it has been helpful to reflect on a complementary paradigm of care. This pattern of care began in a different culture, and evolved over thousands of years before the Western psychotherapeutic model grew. It continues to take place in everyday stories that people live and tell around the world today. Drawing alongside international students is a multifaceted ministry, most particularly because, while it comes out of a desire to reflect God's love incarnate (Philippians 2:5–8), it also requires careful consideration of doing so among people of different faiths and backgrounds, who live on the edge of the culture they now inhabit, and often particularly on the edge of the church community in which I dwell and from which I operate.
It can be hard to spot our own cultural idiosyncrasies until we step outside them, hard to recognise that what is normal for one seems strange to another. Meeting one another not only provides the genuine possibility of discovering another person's story – and for the other to do the same about us – but also for us to better understand ourselves. I think a crucial part of my own journey in ministry has been learning both the joys of journeying with others from around the world and also the often inherent awkwardness of it. There are times when it is uncomfortable to communicate and easier to retreat. It has brought a new light and perhaps a deeper meaning for me to the text, ‘And the Word became flesh and lived among us’ (John 1:14). NRSV.