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HOW UNIVERSAL IS HAPPINESS?

Ruut Veenhoven

Chapter 11 in Ed Diener, John F. Helliwell & Daniel Kahneman (Eds.) International Differences in Well-Being, 2010, Oxford University Press, New York, ISBN-13: 978-0-19- 973273-9

ABSTRACT There is a longstanding discussion on whether happiness is culturally relative or not. The following questions are addressed in that context: 1) Do we all assess how much we like our life? 2) Do we appraise our life on the same grounds? 3) Are the conditions for happiness similar for all of us? 4) Are the consequences of happiness similar in all cultures? 5) Do we all seek happiness? 6) Do we seek happiness in similar ways? 7) Do we enjoy life about equally much?

The available data suggest that all humans tend to assess how much they like their life. The evaluation draws on affective experience, which is linked to gratification of universal human needs and on cognitive comparison which is framed by cultural standards of the good life. The overall appraisal seems to depend more on the former, than on the latter source of information. Conditions for happiness appear to be quite similar across the world and so are the consequences of enjoying life or not. There is more cultural variation in the valuation of happiness and in beliefs about conditions for happiness. The greatest variation is found in how happy people are.

Key words: happiness, life satisfaction, cultural relativism, human nature, utilitarianism

INTRODUCTION

The recent rise of interest in happiness has revived classic discussions about the nature of happiness. One of these discussions centers on whether happiness is similar for all humans or rather something that varies across cultures. In the universalist view, happiness is comparable to “pain.” All humans know what pain is, will experience pain when touching a hot stove, and tend to avoid pain. In the relativistic view, happiness is more comparable to “beauty,” the idea of which varies across time and culture. Picasso’s paintings are not appreciated by everybody, nor does everybody seek only beauty1.

This discussion links up with wider issues, among which is the longstanding debate about the merits of utilitarian moral philosophy. Its “greatest happiness principle” assumes that happiness is something universal. If different in different cultures, happiness cannot serve for the evaluation of cultures. If culturally variable, the definition of happiness can also

Correspondence: Prof. Dr. Ruut Veenhoven Erasmus University Rotterdam, Faculty of Social Sciences, P.O.B. 1738 3000 DR Rotterdam, Netherlands. www2.eur.nl/fsw/research/veenhoven

change over time, and happiness is therefore not a strong criterion for public choice within cultures. These arguments have been presented repeatedly, with few conclusions arising from the discussions, due to a lack of empirical proof for either position.

In this chapter, I inspect what our new knowledge about happiness can tell us about this old controversy. Has a decade of empirical research made us any wiser on this matter, or are we still as much in the dark as the nineteenth-century armchair philosophers who criticized utilitarianism on this ground?

1.1 Concept of happiness A preliminary step is to define happiness, since some of the things denoted using this word can be less universal than others things called by the same name. I use the word “happiness” for a subjective state of mind, which I define as the overall appreciation of one’s life as –a whole. I have elaborated this definition in earlier publications (Veenhoven, 1984 chapter 2; Veenhoven, 2000). This definition fits Jeremy Bentham’s classic notion of happiness as “the sum of pleasures and pains.” Happiness in this sense is synonymous with “life satisfaction” and “subjective well-being”2.

Additionally, I distinguish two “components” of happiness: an affective component and a cognitive component. The affective component is how well one typically feels. I call this the hedonic level of affect. The cognitive component is the perceived difference between what one has and what one wants in life, which I call contentment. I assume that these components serve as subtotals in the overall evaluation of life.

1.2 Sub-questions The question “How universal is happiness?” is too broad to answer, since there are different

facets of happiness, which may be more or less universal. Hence I will break down the main question into the following sub-questions: 1) Do we all appraise how much we like life? 2) Do we appraise life on the same grounds? 3) Are the conditions for happiness similar for all humans? 4) Are the consequences of happiness similar around the globe? 5) Do we all seek happiness? 6) Do we seek happiness in similar ways? 7) Are we about equally happy in all cultures?

Since the focus of this chapter is on cultural variations in the nature of happiness, I do not deal with the cross-cultural measurement of happiness. Cultural measurement bias may distort the data on which this chapter builds in several ways, but the literature suggests that the degree of distortion is not alarming (see, e.g., Diener & Oishi, 2004; Veenhoven, 2008c). Some issues in cross-cultural measurement of happiness are discussed in the chapter by Oishi (2009) in this volume.

1.3 Data source Most of the empirical data used in this chapter are taken from the World Database of Happiness (Veenhoven, 2008), which is a collection of research findings on happiness as defined above. References are made to sections of this database. In each of these sections one can find standardized descriptions of research findings and links to the original publication. Citing these all separately would be unwieldy.

2 Question 1: DO WE ALL APPRAISE HOW MUCH WE LIKE LIFE?

Above, I distinguished between overall happiness and its components and assumed that the components serve as subtotals in the overall evaluation of life. Do all humans appraise their life in these ways?

2.1 Hedonic level of affect Like other higher animals, humans experience positive and negative affects. This is not just something we know from our own experience, it is also something we can recognize in the facial expressions of other people all over the world (Ekman, 1970). Using brain imaging we can now also observe part of the neural processes that make us feel so (e.g., Davidson, 2004) and these neurological structures do not differ across cultures either3.

The balance of positive and negative affects is reflected in the hedonic tone of “mood.” Though mood is something we are aware of, it is mostly not in the foreground of our consciousness. Still, it is assessable, and we can estimate how well we feel most of the time. Babies are not yet able to engage in such reflection, but they still experience happy or unhappy moods. Although they cannot report how they typically feel, their mood level can be assessed using behavioral indications. This case of babies illustrates that one can be happy without having a concept of happiness in mind.

Adult humans know typically how well they feel most of the time and this appears in the practice of measurement. When asked how well they usually feel, people answer instantly. The non-response rate tends to be small. Self-ratings of average hedonic level do not differ much from the balance scores scientists compute from responses to multiple questions about specific affects4 and do not differ substantially from ratings based on experience sampling5 or from ratings by intimates6.

2.2 Contentment Unlike their fellow animals, humans can develop ideas of what they want from life and then

compare these aspirations with the realities of their life. This faculty is not present from birth on, but develops on the road to adulthood. There is no doubt that all adults have wants, even ascetics who want to denounce all wants still have the desire to denounce wants. There is also no doubt that most adults have an idea of how well their wants are being met, at least about important wants. Wants are often not very specific, and few people have clear priorities in

mind; nevertheless, most people have no problem in estimating of how successful they are in getting what they want from life.

Several survey studies have involved questions about what one wants from life and the degree to which one sees these wants being met. A common question is: “So far, I have gotten the important things I want in life” (item in Diener’s “Satisfaction with Life Scale,” Diener et al., 1985). The responses tend to be prompt, and the percentage of respondents who use the “Don’t know” option is very low. So, apparently, this question links up with something people have in mind.

Even if people have no overall judgment of success already in mind, they appear able and willing to make one when asked. This appears in the practice of focused interviews, in life-review interviews in particular. Like in the case of hedonic level it is not required that people have made up their mind: an external observer can estimate someone’s overall contentment based on that person’s reported success in meeting specific wants.

2.3 Overall happiness Given the above, it is no surprise that people have no problem in reporting how much they like their life-as-a-whole. Responses to questions on overall happiness are typically prompt. If not, happiness would not be such a common item in survey research. The non-response level to questions on happiness is typically low. Fewer than 1 percent use the “Don’t know” option7, and few people skip the question8. (See Scheme 1.) Non-response is much higher on questions about other issues such as income and political preference. Questions on life- satisfaction are also easily answered in non-modern societies, such as the Inughuit, the Amish, and the Maasai (Biswas-Diener et al., 2005).

3 Question 2: DO WE APPRAISE LIFE ON THE SAME GROUNDS?

As mentioned above, I assume that we appraise our life in two ways: affectively, by assessing how well we feel; and cognitively, by comparing life-as-it-is with how we want-life-to-be. This theory is summarized in Scheme 2.

3.1 Hedonic level depends on gratification of universal “needs” Why can we experience pleasure and pain? The biological function is evidently to signal that things are good or bad for us. Evolution has programmed us this way. What, then, is the function of mood? Clearly not to signal specific benefit or danger: unlike pleasure and pain, moods are typically not related to specific stimuli and certainly not average mood level over longer periods of time. Mood level seems to function as a meta-signal and indicates how well we are doing on the whole. Feeling good means that all lights are on green and that we can go ahead, while feeling bad means that there is something wrong and that we should check what

that is. This affective signal mechanism seems to exist in all higher animals, and its neural basis is found in the evolutionarily eldest parts of the human brain.

What, then, is “doing well”? I assume, but cannot prove, that this is meeting innate “needs.” Needs are requirements for functioning that are so essential that evolution has safeguarded their gratification by linking these functions to affective signals. This is pretty evident in the case if “deficiency needs” such as hunger, but it seems also to apply to “growth needs” such as curiosity9.

In this view, happiness is rooted in the gratification of basic needs that are part of human nature. In that respect happiness draws on universal grounds. I have discussed this theory in more detail elsewhere (Veenhoven, 1991, 2009).

3.2 Contentment depends on meeting culturally variable “wants” Why do we have wants? Mainly to gratify universal needs. In lower animals, needs are met by means of instinctive behaviors. The human strategy is more flexible than that and allows need gratification though planned behavior. “Wants” are a part of that planning.

What do we want? Part of the answer is that we tend to adopt current standards of the good life; e.g., the standard of what material level of living is desirable and possible. These standards vary across time and culture; today we want more material comfort than our great- grandparents could dream of, and standards are higher in American business circles than in Tibetan monasteries.

In this view, happiness is rooted in social standards and in this respect is culturally relative. For a recent statement of this view, see Chambers (1999).

3.3 Affective experience dominates in the overall evaluation of life In this line of thought, the question of how universal “happiness” is boils down to the question which of these two ways of appraising life is the most important. I have considered this question in earlier publications (Veenhoven, 1991, 2009) and concluded that affective experience dominates the overall evaluation of life. Below I will summarize the main arguments and present some more evidence.

3.3.1 Theoretical plausibility From an evolutionary point of view it is not plausible that cognitive contentment dominates our overall appraisal of life. Cognition developed much later and serves as an addition to affective appraisal rather than a substitute. Reason helps explain why we feel good or bad and allows detection of false affective signals, although it is difficult to ignore these, as depressives can tell you. Affective appraisal tends to precede cognitive decision (Zajonc, 1984), and without affective appraisal we cannot come to a decision, as cases of brain damage demonstrate (Damasio, 1994). From this perspective it is also unlikely that humans orient by variable cultural standards in the first place, rather than by needs that are rooted in biological evolution10.

The limited role of cognitive comparison is also illustrated by the fact that it does not exist in little children, who as yet have no idea of what they want from life. Still, it is clear

that children can be happy or unhappy, and there is typically no great change in happiness when they develop wants.

3.3.2 Empirical indications Since we cannot (yet) look into people’s heads, there is no direct empirical evidence of the relative strength of both ways of appraising life. Still, there are several indirect indications.

Overall happiness more correlated to affect than contentment: If affective experience dominates the overall appraisal of life, this must appear in sizable correlations with overall happiness and more sizable correlations than with contentment. Unfortunately, there are no reports of studies involving measures of all three of these variants of happiness, so we must make do with studies that correlated either happiness with affect or overall happiness with contentment. The findings of such studies are stored in the World Database of Happiness, which distinguishes measures of overall happiness (coded “O”), measures of affect level (coded “A”) and measures of contentment (coded “C”).

Eight studies link self-ratings of overall happiness and average affect and find an average correlation of +.7011. Another 13 studies relate responses to global questions on overall happiness and contentment and find an average correlation of +.4612. Not surprisingly, the correlation between hedonic level and contentment is weaker. The average in three studies is +.4013. An even lower correlation was observed in the recent Gallup World Poll, the correlation between Best–Worst possible life and Yesterday’s Affect being around +.20 (Harter & Arora, 2009).

Happy with unfulfilled aspirations: If happiness depends on seeing one’s wants met, people must be unhappy when they have unfulfilled aspirations and increasingly unhappy the more unfulfilled aspirations they have. Yet people with unfulfilled aspirations appear to be happier than people without, and more so the more unfulfilled aspirations they have (Wessman, 1965, p. 210)14. This finding fits better with the theory that we have an innate need to use our potentials, since unfulfilled aspirations provide an aim to achieve.

Happy in spite of value–reality gap in nation: If contentment drives happiness in the first place, we can expect that people are happier in nations where the values endorsed are perceived to be met than in nations where a gap between value and reality is perceived to exist. This is not always the case; for instance, not with “gender equality” and “human orientation” as measured in the Globe study in 62 societies (House et al., 2004). Average happiness is higher in nations where the widest gaps between ideal and reality are perceived to exist on these issues, probably because this marks respect for humanistic values.

Happiness drives contentment rather than the reverse: The right arrow in Scheme.2 denotes a “bottom-up” effect of contentment on overall happiness. Above, I have interpreted the observed correlations in this way. Yet causality can also be “top-down,” overall happiness affecting the perception of the gap between what one wants and what one has. Analysis of a panel study has shown that causality typically works this way. In this study, discrepancies (gaps) were assessed between how respondents rated their present life on a 20-step scale and ratings of what they wanted from life (expectations, aspirations, entitlements) on the same ladder scale. Comparison over time showed a significant top-down effect but no bottom-up effect (Headey & Veenhoven, 1989, p. 117). So it seems that contentment is largely driven by happiness. If we feel good, we infer that we have most of the things we want, and if we feel bad we start looking for what we might miss.

Though affect seems to dominate the overall appraisal of life, it does not dominate equally everywhere. Correlations between overall happiness and affect balance tend to be stronger in individualistic nations than in collectivist ones (Suh et al., 1998). Likewise, the relative weight of positive and negative affect differs somewhat across cultures. Negative affect is more strongly correlated to overall happiness in individualistic nations than in collectivist ones, while positive affect correlates more with overall happiness in nations where self-expression values are endorsed than in nations where the focus is more on survival (Kuppens et al., 2008). (Scheme 3)

4 Question 3: ARE CONDITIONS FOR HAPPINESS SIMILAR ACROSS CULTURES?

Do we need the same conditions to be happy? Or can some people be happy in conditions that render other people unhappy? Below, I will consider this question on two levels: the macro level of nations and at the micro level of individuals within nations.

4.1 Much uniformity in societal requirements for happiness Average happiness differs markedly across nations: the highest average on a 0 to 10 scale is currently observed in Denmark (8.4) and the lowest in Zimbabwe (3.2)15. There is a clear system in these differences. People live more happily in the most modern nations, in particular in nations characterized by economic development, freedom, rule of law, and good governance. The societal characteristics set out in Scheme 4 explain no fewer than 75 percent of the differences in average happiness in nations16. Societal progress in these matters is likely to have fostered the recent rise of happiness in modern nations (e.g., Inglehart et al., 2008).

Interestingly, the societal conditions that make people happy are not always the conditions they value. For instance, average happiness is markedly lower in nations where women are discriminated against (ChinHonFoei, 2007), but this practice is widely approved

in most of these countries. Likewise, corruption brings down happiness even in societies where favoritism is seen as a moral obligation.

4.2 Much uniformity in required living conditions within nations There are also differences in individual happiness within nations. In a happy country like Denmark, 5 percent of the people still rate 5 or lower on the 0–10 scale, and in an unhappy country like Zimbabwe, some 13 percent score 8 or higher. Are the reasons for high and low scores similar across nations? Below, I consider some living conditions for which cross- national data are available.

Freedom Not only is average happiness higher in free countries, but within countries individuals are also happier the more control they have over their life. This appears, among other things, in strong correlations between personal happiness and perceived freedom and control all over the world17.

Social rank People are typically happier on the upper steps of the social ladder than at the bottom. This appears in findings on relative income position18, occupational prestige19, subjective class identification20 and indexes of socio-economic status21. The differences tend to be bigger at the lower end of the hierarchy. Though the correlations with happiness differ in size, they are positive all over the world. This finding fits the view that we have an innate need for social respect. Like other group animals, we are hardwired to avoid a bottom position.

Marriage Adults are typically happier when living with a spouse than when single. The difference is around half a point on scale from 0–10 and is largely independent of income, gender, and age. Again the size of the difference varies somewhat across time and nations, but the pattern is clearly universal22. This finding fits the view that we are social animals, hardwired to form pairs.

Personality Cross-national research on the relationship between happiness and personality is limited as yet, but the available data suggest that extroverted people tend to be happier23 across a variety of nations (Lucas et al., 2000) and that neurotics tend to be less happy in all cultures. Once more, there is difference in the size of the effects. For instance, the effect of self-esteem appears to be stronger in individualistic cultures than in collectivist cultures (Oishi et al., 1999). Still the direction is the same everywhere.

This is not to say that all conditions for happiness are universal. One notable exception is “education.” Although there is a correlation between average happiness and level of education

in countries, the most highly educated individuals are not always happier. Correlation between happiness and education vary between –.08 and +.2724.

5 Question 4: ARE THE CONSEQUENCES OF HAPPINESS SIMILAR?

Research into happiness has focused on its determinants in the first place; however, there is also a strand of investigation into the consequences of enjoying life or not (Veenhoven, 1989a; Lyubomirsky et al., 2005). Fredrickson (2004) has summarized much of the findings in the “broaden and build theory” of positive affect. Although most of this research has been done in Western nations, the observed effects are also likely to exist in other parts of the world.

5.1 Happiness fosters functioning Happiness appears to encourage engagement, while unhappiness tends to instigate withdrawal. This appears as greater engagement in activity at work25 and in leisure26. The energizing effect of happiness manifests also in social behavior: happiness predicts the formation of friendships27, entering marriage28and participation in voluntary organizations29. There is also experimental evidence of happy moods’ broadening perception and enhancing creativity30. All this is compatible with the above-mentioned theory that happiness works as a “go signal”, and that this effect seems to exists also in other higher animals. If so, the effect is likely to be universal.

5.2 Happiness lengthens life Another illustrative finding is that happiness fosters physical health31 and that happiness therefore lengthens life considerably32. One of the mechanisms seems to be that happiness encourages the full functioning of mind and body and thus keeps us in shape. Another mechanism is probably that unhappiness triggers the fight or flight response, since it signals that there is something wrong. It is well known that this automatic reaction makes an organism economize on other functions, among them the immune response. In this line, Cohen (1995) has demonstrated experimentally that unhappiness makes people more susceptible to catching a common cold. The above are essentially biological reactions that are unlikely to differ much across cultures.

Possibly there are effects of happiness that do differ across cultures, but for the time being, it is the universality strikes the eye.

6 Question 5: DO WE ALL SEEK HAPPINESS?

It is rather evident most humans prefer a happy life to an unhappy one. Still, this does not mean that happiness is the main driver in human motivation, nor that happiness is valued universally.

6.1 Happiness is a universal human striving, though not innate In the first lines of his famous Principles of Morals and Legislation, Jeremy Bentham (1789) stated that human behavior is governed by the pursuit of pleasure and the avoidance of pain. There is much truth in this theory of motivation, yet happiness is not the only driver of human behavior, at least not happiness in the sense of overall life-satisfaction.

Like other mammals, we are driven by different needs, such as hunger, sex, love, and curiosity, which have developed subsequently through evolution. All these needs are linked to hedonic signals, but their gratification is not only sought for the sake of pleasure. For instance, we want sex for the sex, and we do not settle for the esthetic pleasure of reading poetry instead.

Still, pleasure is a main driver of human behavior. Yet pleasure is not quite the same as life-satisfaction. Short-term pleasures can be at the cost of long-term happiness, and in such cases humans do not always look to the long term.

Our fellow animals are driven by primary motives, but in humans consciousness also gives rise to secondary motives, such as figuring out who we are and seeking an answer to questions about the meaning of life. Wentholt (1980) calls this “universal strivings”, which he distinguishes from “organic needs”. The pursuit of long-term happiness is one of these universal strivings. Though not “innate” as such, it is an inclination that develops in most humans as a result of their consciousness. While this inclination manifests in all cultures, it does not necessarily appear in all individuals. Happiness is typically not an issue for people who are trying to survive in the first place, and some opt to forsake happiness for ideological reasons.

6.2 Happiness is valued in most societies, though possibly not in all Happiness seems to be positively valued in all nations of our time. This is at least suggested by a study among university students in 47 nations in the 1990s (Diener, 2004). These students were asked to rate the importance of several values, such as wealth, health, and love. Happiness ranked highest in the importance rating, with an average of 8 on a scale of 1 to 9. Ratings ranged between 8.7 and 7.3, and there is thus no country in this study where happiness is deemed unimportant.

This is not to say that happiness has always been prized in all human cultures. Though all humans have a natural inclination to pursue happiness, cultures can go against that inclination just as some cultures go against the natural drive for sex. What cultures denounce happiness? Unfortunately cultural anthropology cannot tell us, since this discipline has a blind eye for happiness (Thin, 2006). Still, there are indications that in the past, miserable societies tended to glorify suffering rather than happiness33, and that collectivist cultures emphasize the well-being of groups rather than the well-being of individuals.

One can think of reasons why cultures come to depreciate happiness. When life is miserable, it may be comforting to believe that happiness is no good after all, and renouncing happiness may be functional for engaging people in common causes such as war. Next to such macro-societal functions, internal factors can be involved, such as cultural distinctions between groups in a society. This seems to have been one of the reasons for the sexual

abstention of religious people during the Middle Ages. The campaign “against happiness” of some present-day philosophers34 could be placed in a similar vein as intellectual “distinction.”

7 Question 6: DO WE SEEK HAPPINESS IN A SIMILAR WAY?

To the extent that they seek happiness, do humans do this in similar ways? This question is easier put than answered, since behavior is typically guided by multiple motives that cannot be observed as such. Still we can get a clue by looking at beliefs about conditions for happiness. Do universal themes dominate these beliefs or do these lay theories of happiness tend to be culture-specific? This question can be answered in principle, but a shortage of data sets limits.

7.1 Variation in philosophical views gives no answer Can we answer this question on the basis of what prominent thinkers have said on this subject in different times and cultures? We can draw on a large philosophical literature about ways to lead a happy life35, and reviews of this literature show wide differences. Yet even though philosophers differ so much, public opinion need not be equally diverse. Philosophers often seek the difference from common opinion. Moreover, philosophers often use the term happiness in a broader sense than defined here and typically write about how we should seek happiness rather than how we actually do. So, to answer this question we need to look at survey research into beliefs about happiness.

7.2 Survey research shows much similarity As yet there is more comparative research on degrees of happiness around the world than on beliefs about conditions for happiness. The available research on presumed conditions for happiness is limited to present-day nation states. These data suggest that there is quite some similarity across nations.

Most of the available research findings are about perceived sources of one’s own happiness36. The bulk concerns modern Western people, who tend to believe that happiness depends on health and good relations in the first place, and less so on material affluence and social prestige.

Only a few studies have compared cultures. Chiasson & Dubé (1997) found striking similarities in North America and Latin American countries. Likewise, Lee et al. (1999) found that students in Canada and Korea employed essentially the same ordered set of perceived sources for happiness, in spite of considerable difference in average level of happiness. A recent Gallup World Survey found that a happy family life and good health are ranked high all over the world (see Scheme 5).

Belief about conditions for happiness was addressed indirectly in Cantril’s (1965) landmark study, “The Pattern of Human Concerns” in 16 nations in the early 1960s. This study involved open-ended questions about what constitutes the “best possible life” and the “worst possible life.” Analysis of the responses showed much similarity; the same themes

8

popped up in all countries, though not equally frequent everywhere (pp.162–167). The observed differences appeared to correspond more with the country’s stage of societal development than with its ideology (p. 302). Cantril explained these observations in terms of need theory (Chapter 16).

Studies by Tsai et al. (2007) address differences in both ideal and actual affect across cultures and suggest that culture influences ideal affect more than actual affect. Still, a look at their findings shows much similarity in ideal affect, and in particular, similarly high ratings for the desirability of happiness.

Question 7: ARE WE ABOUT EQUALLY HAPPY IN ALL CULTURES?

The last question is about degree of happiness. Are humans about equally happy in all cultures, or do they live happily in some cultures and unhappily in others?

Some variants of the comparison theory of happiness imply that humans are about equally happy in all cultures. If happiness depends on social comparison with one’s compatriots, the average level will be about neutral in all societies. If happiness depends on comparison with earlier experiences over the lifetime, the average will tend to be neutral as well. Yet other variants of comparison theory imply that happiness can differ across cultures. If happiness depends on meeting local standards of the good life, happiness can be high in cultures where these standards can be easily met and low where the meeting of these standards is out of reach for most people.

Need-theory also implies that the level of happiness can differ across cultures. If happiness depends on the degree to which human needs are met, average happiness will be higher in societies that fit human nature well than in societies that do not. From a functional point of view, it is unlikely that we are equally happy irrespective of conditions. At best, evolution has resulted in a tendency to feel happy once conditions are tolerable.

The data are quite clear on this matter. There are wide differences in average happiness across nations (see Scheme 6). Average happiness37 is 8.2 in Denmark and only 3.2 in Zimbabwe. Average happiness is above neutral in the present-day world38. As we have seen in Scheme 4, most of these differences can be explained by national characteristics such as wealth, freedom, and security, which are part of “modernity.”

Average happiness not only differs among contemporary cultures, but also varies over time. The level of happiness has risen in most nations over the last 30 years, but declined in some (Veenhoven & Hagerty, 2006; Inglehart, 2008). Average happiness fell dramatically in the Russia and China following the great social changes that have taken place since the 1980s (Brockmann et al., 2008). Though people live more happily in modern society, the change to modernity tends to reduce happiness temporarily.

There are also indications that average happiness has varied considerably over human history. Our forefathers seem to have been fairly happy when living as hunter-gatherers, but less so in the agrarian phase of societal evolution. The industrial revolution brought not only more material comfort, but also an unprecedented rise in happy life years (Veenhoven, 2008).

9 DISCUSSION

9.1 Limitations In his book The Pattern of Human Concerns, Headley Cantril (1965, p. 315) notes that “differences between individuals and groups are often easier to detect than the similarities they obscure.” An illustrative case is eating; cultural differences in eating behavior catch the eye: for example, when you find snake on your plate at a business dinner in China. Yet all humans want to eat, do eat, and need about the same nutrients. It is difficult to express this universality in numbers, since it depends rather on an interpretation of what is most essential. As such, my argument may not convince everybody.

A more tangible limitation is in the data used in this chapter. Since anthropology has failed to inform us about happiness in pre-modern societies (Thin, 2007), we must largely make do with data gathered in more or less modern societies, in particular in rich Western societies. The few studies of pre-modern societies I have mentioned (Biswas Diener, 2005; Kilpatric & Cantril, 1960) do not cover all the questions addressed here. Furthermore, the data are not free from cultural measurement bias. For instance: Latin Americans value positive affect more and may for that reason report more positive affect than Asians do (Diener & Oishi, 2004). Lastly, the question about variation across cultures is largely answered using data on happiness in nations.

9.2 Why is the idea of cultural relativity so popular? In spite of these limitations, it is pretty clear that happiness is not only in the minds of Western people, and that there is a striking similarity in conditions for happiness across cultures. This elicits the question of why so many social scientists believe that happiness is culture-specific. One answer to that question is that theory plays them false; most social scientists have been raised with the idea that human experience is socially constructed and are trained to see human behavior as guided by malleable preferences. Another answer is a moral aversion to utilitarianism that gives rise to discounting the significance of happiness. I have discussed this question in more detail in Veenhoven (2006).

10 CONCLUSION

The available data suggest that all humans tend to appraise how much they like the life they live. In appraising life we draw on how well we feel in the first place, which in its turn draws on how well our universal human needs are gratified. The overall appraisal of one’s life draws less on cognitive comparison with cultural standards of the good life. Consequently, conditions for happiness appear to be quite similar across the world. The consequences of enjoying life are also largely universal. There is more cultural variation in the valuation of happiness and in beliefs about conditions for happiness. The greatest variation is to be found in how happy people are.

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NOTES

1 This is not to say that appraisals of beauty are entirely culturally specific, since there is good evidence of universal tendencies on this matter.

2 In other chapters of this book the term subjective well-being is used for this concept, while the terms happiness and life-satisfaction denote survey questions using these words. I cannot follow that terminology since this chapter draws on the World Database of Happiness, which is organized on the basis of a different idiom.

3 There is some cultural variation in recognition of “fear,” “anger” and “disgust” in facial expressions (see, e.g., Russell, 1994). Still, the pattern is largely universal, and recognition of “happy” emotion stands out as the most universal. Expression of emotion may be more universal than the recognition of it in other people.

4 World Database of Happiness, Correlational Findings, subject section “Current Happiness” (H6.2.2.2), one study that observed a correlation of +.56.

5 World Database of Happiness, Correlational Findings, subject section “Current Happiness” (H6.2.2.3), one study.

6 World Database of Happiness, Correlational Findings, subject section “Reputation of Happiness” (H8.2), four studies that observed correlations between +.43 and +.64.

7 World Database of Happiness, States of Nations, Variable Happiness_DKLS_1980_2000. Average percent “don’t know” in 76 nations: 0.75; range, 0.4 to 4.5.

8 Analysis of non-response to the questions on happiness and life-satisfaction in the World Values Survey shows some variation across cultures. The percentage of “don’t know” responses is slightly higher in nations where unhappiness prevails (r = +.10) and also higher in collectivist cultures (r = +.21). Still, these are variations on an otherwise universal pattern.

9 The distinction between deficiency needs and growth needs is part of Maslow’s (1970) theory of human motivation.

10 Rayo and Becker (2007) have a different view and argue that we are hardwired to compare and prefer the best, since this is evolutionarily advantageous. Their argument is appealing. Still, more is not always better and can even be detrimental. The tendency to compare can also be explained on the basis of innate needs that are not exclusively human, such as the need for social status and the need to use and develop one’s potentials. I do buy that we tend to see things in a comparative perspective, but see that rather as a consequence of cognition than as a “need” in itself. The distinction between consequences of human consciousness and innate “needs” is further discussed in the response to Question 5.

11 This analysis involved eight studies, the results of which are summarized in the World Database of Happiness, Collection of Correlational Findings, Section H6.1.2, “Current Happiness: Overall Happiness by Hedonic Level of Affect.” The analysis is limited to

studies among general population samples using comparable single, direct questions on overall happiness (type O-HL, O-SL, O-DT, O-QOL) and affect (type A-AOL). Correlation with affect balance (type A-AB) is lower (+.50 in 70 studies), but in this case the correlation is depressed by the timeframe of the questions, which is typically ‘the last few weeks’.

12 This analysis involved seven studies, the results of which are summarized in the World Database of Happiness, Collection of Correlational Findings, Section H6.1.3, “Current Happiness: Overall Happiness by Contentment.” The analysis is limited to studies among general population samples using comparable single, direct questions on overall happiness (type O-HL, O-SL, O-DT) and contentment (type C-BW).

13 This analysis involved three studies, the results of which are summarized in the World Database of Happiness, Collection of Correlational Findings, Section H6.23 “Current Happiness: Hedonic Level of Affect by Contentment.” The analysis is limited to studies among general population samples. Hedonic level was measured using affect balance Scales (type A-AB) and contentment using the Cantril Ladder (type C-BW) and questions about perceived realization of wants (type C-RW).

14 Wessman wrongly interpreted Table 44 as showing that unfulfilled aspirations go with unhappiness.

15 World Database of Happiness, Happiness in Nations, Rank Report 2009-1.

16 Similar results are obtained when average happiness is measured using an affect balance scale instead of a single direct question on satisfaction with life-as-a-whole (Variable in data file “states of Nations”: HappinessYesterdaysAffect3_2006).40

17 World Database of Happiness, Correlational Findings, subject section “Personality, Inner Locus of Control (P4.58). For a recent cross-national study, see Verne (2008).

18 World Database of Happiness, Correlational Findings, subject section “Current Income” (1.2). For a recent cross-national comparison, see Ball and Chernova (2008).

19 World Database of Happiness, Correlational Findings, subject section “Current Occupational Level” (O1.3.1).

20 World Database of Happiness, Correlational Findings, subject section “Subjective Social Rank” (S9.2.2).

21 World Database of Happiness, Correlational Findings, subject section “Objective Social Status” (S9.2.1).

22 World Database of Happiness, Correlational Findings, subject “Marital Status” (M2.1). See also Diener et al. (2000).

23 Schimmack et al. (2002) found that the link between extroversion and hedonic level of affect is more universal than the link between extroversion and overall happiness and suggest that the influence of personality on the emotional component of happiness is pan­

cultural, whereas the influence of personality on the cognitive component of happiness is more moderated by culture.

24 World Database of Happiness, States of Nations, variable r_LS_Education_1990.

25 World Database of Happiness, Correlational Findings, subject “Later Work Performance”(code W6.1.4).

26 World Database of Happiness, Correlational Findings, subject “Later Leisure”(code L3.1.4).

27 World Database of Happiness, Correlational Findings, subject “Later Friendships” (code F6.1.4).

28 World Database of Happiness, Correlational Findings, subject “Later Marriage” (code M1.4). See also Veenhoven (1989b).

29 World Database of Happiness, Correlational Findings, subject “Later Organizational Participation”(code S7.1.4).

30 See, e.g., Isen (1998).

31 World Database of Happiness, Correlational Findings, subject “Later Physical Health” (code P6.1.4).

32 World Database of happiness, Correlational Findings, subject “Longevity” (code P6.1.4.1). See also Veenhoven (2008b).

33 This appears, for instance, in the history of philosophical thought. Happiness was a common theme in the prosperous Antique city societies, but disappeared in the dark Middle Ages and popped up again in the seventeenth century, together with a rise in quality of life of the new middle class.

34 See, e.g., Bruckner (2000), and Wilson (2008).

35 World Database of Happiness, Bibliography of Happiness, subject “Perceived Sources of Happiness” (code 15a2). For a recent review, see MacMahon (2008).

36 World Database of Happiness, Bibliography of Happiness, subject “Perceived Sources of One’s Own Happiness (code 15c1).

37 Overall happiness measured with a survey question on life-satisfaction. Average contentment, as measured with Cantril’s Best-Worst Possible Life question, is closer to neutral, which fits the prediction of comparison theory.

38 World Database of Happiness, Happiness in Nations, Rank Report 2009-1. See also Diener, 1996.

40 The data file “States of Nations” is available on request. The variables used here are: HappinessBWLS11_2006, RGDP_2000_2004, FreeEconIndex2_2002, DemocracyIndex2_2004, PeaceIndex_2007, Corruption3_2006, RuleLaw_2006, IncomeInequality1_2005, GenderEqualIndex2_2005, EduEnrolGross_2000_04, IQ_2006. These variables are described on the website: http://www.worlddatabaseofhappiness.eur.nl/statnat/statnat_fp.htm

Scheme 1

“Don’t Know” response to survey questions about happiness.

USA 0.19%

Zimbabwe 0.26%

China 0.49%

France 0.65%

Russia 1.42%

India 2.69%

Average in 78 nations 0.75%

Source: World Values Surveys, life-satisfaction item, average waves 1 to 4

Scheme 2 Concepts of happiness: Overall happiness and components

global assessment OVERALL HAPPINESS Satisfaction with one's life-as-whole

sub-totals: Hedonic level of affect Balance ofpleasant and unpleasant affect

Contentment Perceived realization of wants

information bas is Affective experience Cognitive comparison

Source: Veenhoven 1984

Scheme3 Theories of happiness: significance of two causal paths

global assessment

sub-assessment:

Information basis

underlying process

substrate

OVERALL HAPPINESS Satisfaction with one's life-as-whole

Hedonic level of affect Balance ofpleasant and unpleasant affect

Affectiv.e experience

Need gratification

Human nature

Contentment Perceived realization ofwants

Cogniti e comparison

Standard setting

Culture

Source: Veenhoven 2007

___________________________________________________________

___________________________________________________________

Scheme 4 Average happiness by societal characteristics in 136 nations 2006

Zero order wealth controlled

Wealth - Income p/c +.79 --

Freedom - economic freedom +.62 +.11 - political freedom +.50 +.07

Peace +.39 +.15

Justice - corruption -.77 -.14 - rule of law +.70 +.06

Equality - income equality +.27 -.33 - gender equality +.67 +.19

Education - school enrolment +.57 +.12 - intelligence +.63 +.21

Source: World Database of Happiness (Veenhoven 2008, datafile States of Nations ) 40

Schemes Perceived sources ofhappiness

Responses to question: 'What matters most in life? Tell me only the two things that matter the very most in life.

Good health

Happy family life

A job

Freedom

No war

No violence and corruption

Standard of living

F aithfull to regligion

An education

Don' know 1,1

42,7

Source: Gallup })..fillennium World Survey (Spogard 2005)

Scheme 6 Happiness in nations around 2000, averages on scale 0–10.

Denmark 8.2

Sweden 7.7

USA 7.4

Germany 7.2

France 6.5

Philippines 6.4

Japan 6.2

Turkey 5.2

Russia 4.4

Zimbabwe 3.3

Average in 86 nations 6.5

Source: World Database of Happiness, Happiness in Nations (Veenhoven, 2008).

20 Comparing Subjective Well-Being

across Cultures and Nations The "Whatn and "Whyn Questions

EUNKOOK M. SUH andjAYOUNG Koo

Diener's (1984) landmark review paper published in Psychological Bulletin sparked numerous lines of research activities under the heading of subjective well-being. One research area that started to create its own niche i:n the early 1990s was the field of culture and subjective well-being. This period overlapped with the publi ­ cation of prominent articles on culture (Markus & Kitayama, 1991; Triandis, 1989), and also :with the growing recognition that subjective well-being should be understood as an individual-level as well as a collective-level phenomenon.

A number of early articles set the stage for this field and challenged some of the prevalent opinions of the time. In particular, three papers are noteworthy. Diener, Diener, and Diener (1995) found that one of the strongest predictors of national differences in subjective well-being was the degree of collectivism­ individualism (even after controlling for national income level). This was a very important finding because at the time economic factors were deemed most criti ­ cal for the occurrence of national differences in subjective well-being. An article by Diener and Diener (1995) also drew attention because it suggested that self­ esteem, a psychological factor traditionally deemed indispensable for mental health in the West, seemed far less crucial in determining subjective well-being

414

415 Subje~tive Well-Being across Cultures and Nations

m other cultures. Finally, Diener, Suh, Smith, and Shao (1995) demonstrated that several methodological artifacts that may plague cross-cultural research (e.g., response bias, translation) do not completely explain the subjective well-being differences between cultures. The reasons underlying cultural differences in sub­ jective well-being levels seemed to be substantial ones (e.g., difference in emo­ tion norms) rather than methodological errors .

Prompted by these initial research issues, the field of culture and subjective well-being has grown rapidly in a short span of time. Figure 20.1 shows the number of publications Gournal articles, books, dissertations) · found by PsycINFO using the combined keywords of culture and well-being from 1991 to 2005. In a single decade (from 97 during 1991-1995 to 481 during 2001-2005), there has been roughly a fivefold increase in the sheer number of publications on this topic! Along with the quantitative increase, a special issue published by the Journal ef Happiness Studies (Suh & Oishi, 2004), an Annual Review ef Psychology chapter (Diener, Oishi, & Lucas, 2003), and an edited volume (Diener & Suh, 2000) has been recently devoted to the topic of culture and subjective well­ being.

Given the highly vibrant research activities during the past decade, it seems like an C?PPOrtune time to evaluate and digest the major findings from this pro­ ductive period and to target the set of issues that warrants more concentrated research attention in the upcoming years. Although a wide array of questions ,has been investigated during the decade, many of those were serial efforts prompted by the two large questions set up by the early papers. What are the key compo­ nents of subjective well-being across cultures (Diener & Diener, 1995)? Why do national/cultural differences in mean levels of subjective well-being occur (Diener, Diener, & Diener, 1995; Diener et al., 1995)?

500 450 400 350

Number of 300 Publications 250

200 150 100

50 0

1991-1995 1996-2000 2001-2005

Period

FIGURE 20. 1. Total number of publications on culture and well-being from 1991 to 2005. Data from PsycINFO.

416 SUBJECTIVE WELL-BEING IN THE INTERPERSONAL DOMAIN

It is not the goal of this chapter to offer an exhaustive review of the latest research. Rather, attention is selectively centered on a few lines of findings that have been particularly influential in informing us of the interplay between cul­ ture and subjective well-being. Also, because the vast majority of empirical data come from East Asian (e.g., Japan, Korea, China) and U.S. samples, discussions focus most often on these two cultural regions.

What Makes Up Happiness across Cultures?

Virtually all human beings-from Nigerians to Peruvians to French-Canadians­ think happiness is a desirable state. The precise affective experiences, the recom­ mended means, and the conceptualizations surrounding this ultimate human desire, however, seem to show cultural variations.

An analogy is provided by humor: Everyone across the globe enjoys humor, but each cultural group is drawn to particular types of humor and has different ways of telling a joke. This analogy naturally raises two questions. First, what are the most popular types ofjokes in each culture and how are they delivered? This is akin to asking what the culture-specific contents of happiness are. The second (and tougher) question is whether the jokes in some cultures are intrinsically more hilarious than those of others, and if so, why (i.e., why are some cultures happier than others?). A decade of research offers some insights on these two questions. Let's begin with the relatively easier one-what makes up happiness in different cultures? .

To begin, there seem to be some cultural differences in the definitional accounts ofhappiness. Although this idea is hardly surprising, empirical investiga­ tion on this topic has been scarce, in part because of the practical and method­ ological difficulties posed by qualitative data. However, Lu and Gilmour (2004) recently asked Chinese and U .S. students to write essays on "What Is Bappi­ ness?" Although both groups agreed that happiness is a positive, desirable state of the mind, the Chinese emphasized spiritual cultivation and transcendence of the present, whereas the Americans' account of happiness was comparably more uplifting, elated, and emphasized the enjoyment of present life. Also importantly, the Asian respondents expressed the desire for a balanced emotional life and underlined the importance offulfilling social expectations in their overall sense of happiness. The Americans, in · contrast, asserted the importance of personal agency over social restrictions and believed that the pursuit of personal happiness cannot be compromised in any way.

Recent empirical findings (for review, see Diener et al., 2003; Uchida, Norasakkunkit, & Kitayama, 2004) strike a similar cord with the open-ended responses documented by Lu and Gilmour (2004). Generally speaking, the criti­ cal predictors of happiness among W estem cultural members are comprised of

417 Subjective Well-Being across Cultures and Nations

elements that promote, signify, and maintain a highly independent and agentic mode of being. Important predictors of happiness in the East, on the other hand, seem to affirm the fundamental interconnectedness between the self and signifi­ cant others (Kitayama & Markus, 2000). Among the wide array of specific affec­ tive, cognitive, and motivational phenomena that support this general picture, several findings stand out.

First, the role of emotion in people's judgment and experience of subjective well-being seems to vary. Compared to individualistic cultural members, collec­ tivists are less inclined to equate an emotionally "happy life" with a "good, satis­ fying life." The correlation between affect balance (relative frequency of pleasant minus unpleasant emotions) and overall life satisfaction is much weaker in collec­ tivist than in individualistic nations (Schimmack, Radhakrishna, Oishi, Dzokoto, & Ahadi, 2002; Suh, Diener, Oishi, & Triandis, 1998). The relatively idiosyn­ cratic and unique nature of emotional experience may embody less significance compared to social cues, such as the opinions held by others in one's life (c£ Pot­ ter, 1988) . In direct support of this idea, when the social connectedness of self­ identity is primed, individuals pay greater attention to how their life is appraised by significant others than to their inner emotions in their life satisfaction judg­ ment process (Suh, Diener, & Updegraff, in press).

Another interesting finding in the affect and subjective well-being area is that pleasant emotional experience, such as happiness, explicitly requires a social component in East Asian cultures. According to Kitayama, Markus, and Kurokawa (2000), happiness is associated more strongly with interpersonally engaging emotions (e.g., friendly feelings) in Japan, whereas it is more closely related with interpersonally disengaging emotions (e.g., pride) in the United States. In a related line, Park, Choi, and Suh (2006) recently found that the amount of pleasantness reported by Koreans while engaging in a task varied sig­

. nificantly between interpersonal conditions-whether they collaborated with a friend or a stranger. This discriminative emotional experience pattern was espe­ cially prominent among individuals with a strong interdependent self In other words, the "with whom" factor seems to loom large in determining the experi­ ence of pleasant emotions of those with a strongly relation-oriented identity.

Research on motives and goals is another piece in the what puzzle. Given the centrality of others in conceptualizations of self-identity, the happiness of Asian Americans, more so than European Americans, is elevated after fulfilling goals that are directed to please or receive approval from significant others (Iyengar & Lepper, 1999; Oishi & Diener, 2001; Oishi & Sullivan, 2005). On surface, these findings may seem inconsistent with recent claims that, regardless of culture, self-directed goals are more conducive to subjective well-being than externally imposed goals (e.g., Chirkov, Ryan, & Wiliness, 2005; Sheldon et al., 2004).

How should we reconcile this latest controversy on goals and subjective well-being? The key seems to be the degree of internalization of the culturally

418 SUBJECTIVE WELL-BEING IN THE INTERPERSONAL DOMAIN

sanctioned values. Even among East Asians, not all derive greater pleasure from fulfilling parental expectations than from engaging in personally rewarding activi­ ties. It depends on whether the person following the parent's desires feels coerced and obligated or is acting spontaneously with sincere pleasure. The cultural dif­ ference is that the probability of encountering a person who genuinely prefers to satisfy his or her parents' wishes before his or her own is higher in the East than West. Regardless of the content of the behavior, it seems reasonable to conclude that humans, by design, have a greater chance of experiencing positive experi­ ences when they do "what they enjoy and believe in" (Sheldon et al., 2004, p. 220). Much of the cultural variations documented in this area seems to be about the "what" part; the "enjoy and believe in" part seems universal.

Finally, several dispositional qualities that were traditionally believed to be essential for mental health are being reevaluated in a cross-cultural context. For instance, recent findings suggest that psychologists might have overestimated the importance of having a strong sense of personal control (Morling, Kitayama, & Miyamoto, 2003), high self-esteem (Diener et al., 1995; Chen, Cheung, Bond, & Leung, 2006), and a consistent self-identity (Suh, 2002) in the achievement of mental health. These are important findings that highlight the power of cultural influence. At the same time, however, it is important not to overinterpret the data. At an intracultural level, even in Eastern cultures, individuals with high self­ esteem and a more consistent self-identity are happier than those who score low on these dimensions. These constructs seem less critical in predicting the person's subjective well-being in the East only in an intercultural sense (compared to the West). To date, no psychological quality has been found that strongly and consis­ tently correlates with subjective well-being in opposite directions between cul­ tures.

Returning to our humor analogy, the types of jokes that are most popular in one culture may not be the most enjoyed ones in another. That is, a great deal of cultural nuance exists in the conceptualization of, and in the shades of experiences related with happiness. However, are these differences simply a matter of different cultural tastes, or do they partly explain why some cultures are happier than others? With this key question in mind, we move on to the next section.

Why Are Some Cultures Happier Than Others? ·-.

Arguably-one of the most solid findings from the cross-cultural/national research on subjective well-being is that individualistic nations are happier than collec­ tivistic countries (Diener et aL, 1995; Diener & Suh, 1999; Veenhoven, 1999). The mean-level difference between individualistic and collectivistic cultures, to some extent, arises from societal and political factors confounded w:ith individu­

419 Subjective Well-Being across Cultures and Nations

alism (e.g., income level , Diener et al., 1995; democracy, Inglehart & Klinge­ n1ann, 2000; political empowerment, Frey & Stutzer, 2002).

However, a decade of research makes it clear that these socioeconomic con­ ditions alone are insufficient for explaining why individualistic nations consis­ tently report higher levels of happiness than collectivistic nations. Besides income level or political structure, cultures also vary along a wide spectrum of psycho­ logical habits and characteristics that are related to the experience and expressions of happiness. For instance, emotion norms (Eid & Diener, 2001), socialization of emotions (Diener & Lucas, 2004), and cognitive biases (Diener, Lucas, Oishi, & Suh, 2002; Oishi, 2002) associated with happiness vary considerably across cul­ tures.

A recent study by Rice and Steele (2004) further implies that cultural differ­ ences in subjective well-being may reflect something more than the objective conditions of life. They found that the relative ranking of the subjective well­ being levels ofAmericans with ancestors from 20 different nations is quis..e similar to the subjective well-being levels obtained from the citizens of the correspond­ ing nations. By surveying U.S. residents only, this study controls for many of the confounding social-condition factors between cultures/nations. The findings by Rice and Steele suggest that the cultural agents that influence subjective well­ being might be quite amorphous and stubborn, and this might partly explain why national differences in subjective well-being are temporally so stable (Inglehart & Klingemann, 2000; Veenhoven, 1999).

One key reason for examining mean differences in subjective well-being between nations/cultures is to gain insights about the collective conditions that enhance or suppress human happiness. At first brush, individualism and collectiv­ ism neither seems to have a clear edge in producing higher subjective well-being (c£ Diener & Suh, 1999). Different cultural members may prefer different activi­ ties and experiences in their pursuit of happiness, but one might think that the different paths are equally potent means for reaching the destination. If this is the case, should we expect the "perfect Japanese" to be every bit as happy as a "per­ fect American"? Many of the current investigators in this field may answer "yes" to this question; however, it is quite plausible that the answer is "no."

A strong version of cultural relativism (i.e., different cultural strategies for achieving happiness are equally viable; they are merely different in content) would find it difficult to explain why the difference in subjective well-being level between individualistic and collectivistic societies remains so robust. All cultures are evolved to efficiently resolve pressing human needs, such as reproduction or safety needs. However, ecological opportunities and restrictions configure the nuts and bolts that sustain each cultural system, including its norms, values, prac­ tices, and central ideologies (Triandis & Suh, 2002). Among the various meta­ assumptions held by cultures, particularly significant is the one concerning the re­ lation between the individual and the society. Certain cultures are built around

420 SUBJECTIVE WELL-BEING IN THE INTERPERSONAL DOMAIN

the premise that the individual exists for the larger collective unit; in other cul­ tures, the opposite is assumed. Crudely speaking, collectivism is prototypical of the former type of culture, and individualism is a prime example of the latter.

Most important to our discussion, these two contrasting cultural schemes may not be designed to produce the same type of cultural capital (see Ahuvia, 2002). Collectivism has its ultimate sight on social order and harmony, and hence the system constantly reinforces and idealizes the type of self that is able to keep its desires in check for the greater goods of the family, group, and community. Self-regulation is sanctioned over self-expression, and fulfillment of social obliga­ tions comes before discussions of personal rights and preferences. In contrast, individualism believes in the irrevocable value, power, and capabilities of, ·liter­ ally, the individual. The normative cultural expectation is that each person should be self-directive and self-sufficient, and find, consolidate, and uplift the best within the sel£ Self-actualization, the key word in the discussion of ideal liv­ ing in the West, encapsulates these beliefs. In the East, in contrast, people are encouraged to perfect the inner attributes of the self for a social reason-to be used appropriately for the service of the larger society (Cho, 2006).

Between the two cultural systems, which one has an edge in producing "happy individuals"? This chapter suggests two general possibilities for why indi­ vidualistic cultures may have the advantage. First, greater sacrifice of instinctive needs and desires is required to live an "appropriate" collectivist than an individ­ ualist life. As Freud (1930/1961) claimed in Civilization and Its Discontents, con­ flict and friction between individual desires and social constraints is the rule rather than an exception. In the continuous bargain between the self and society, the individual gives up his or her instinctive impulses in exchange for social rewards. One of the biggest social awards is social acceptance by others (Baumeister, DeWall, Ciarocco, & Twenge, 2005), which is more crucial for the functioning of a collectivistic than an individualistic pattern of life. As a result, by necessity, collectivist cultural members are more likely than individualists to curb their instinctive, self-gratifying desires (often including personal happiness) in their bargain for social approval.

One might argue that the social gains (e.g., social approval, respect) may fully make up for the negatives of giving up personal desires in collectivistic cul­ tures. This would be a valid argument only if one unit of social reward translated to an exactly equivalent amount of personal happiness in Eastern cultures. This idea seems rather unrealistic:. AJ.though it is true that social rewards constitute a very important part of the collectivist's sense of personal happiness, incorµmensu­ rable differences still remain between the two. Social rewards are strongly related to happiness in the East, but still, it is not happiness itself

In fact, several scholars have argued that even in collectivistic cultures, peo­ ple who adopt individualistic values report higher levels of subjective well-being and self-esteem than the more collective-minded ones (Heine, Lehman, Markus,

421 Subj ective Well-Being across Cultures and Nations

& Kitayama, 1999). Preliminary findings from Korean university samples indicate that subjective well-being is related positively with independent self-construal and negatively with the interdependent self-view (Koo & Suh, 2006). Similarly, from mainland Chinese and Taiwanese samples , Lu and Gilmour (2006) found that the frequency of experiencing positive emotions is related more closely with the independent than the interdependent self.

The above findings have an important implication. They seem to go against the idea that those who enjoy high levels of happiness are people who have psy­ chological dispositions that fit into the cultural template (e.g., being interdepen­ dent in collectivistic cultures). Rather, these latest findings imply that, regardless of the cultural context, the independent styles of thinking and behaving may have a more direct connection to personal happiness than the collectivistic approach. However, the individualistic strategies will meet a "tipping point" where the personal costs incurred by ignoring collective demands start to out­ weigh the positive payoffs. Collectivist cultural members confront this tipping point more often, and in more domains of life, than individualist cultural mem­ bers.

Secondly, collectivism may nurture various dispositional qualities that unin­ tentionally create potholes in the road to happiness. It seems that the East Asian self-system is optimized for maintaining social connections with others. How­ ever, a self that is preoccupied with social concerns m.ay acquire a wide range of psychological characteristics-motivational, cognitive, emotional, and behavioral-that create friction in the pursuit of personal happiness (see Suh, in press, for a detailed discussion). For instance, at a cognitive level, the highly socially oriented self construes and evaluates itself more often by concrete and specific social criteria (e.g., gaining admission to a top college) than by idiosyn­ cratic terms. Many findings demonstrate that chronic reliance on explicit external criteria, such as social comparison information, is related with lower levels of subjective well-being (Lyubomirsky & Ross, 1997; White & Lehman, 2005) . This is because external social standards allow less latitude in interpretation and therefore are more difficult to tailor to the advantage of the self than idiosyncrati­ cally defined standards (e.g., Dunning & McElwee, 1995).

Other disadvantages could occur at the motivational and behavioral levels for the highly collectively oriented East Asians. When the focal concern is fulfill­ ing social obligations and living up to the expectations of others (as in Japan), failing to meet these standards ha,_s a bigger blow than the rewards for surpassing them (Heine et al., 2001). In the long run, individuals in such cultures find themselves framing goals more in prevention-oriented than in promotion­ oriented terms (Elliot, Chirkov, Kim, & Sheldon, 2001). This is unfortunate because a large body of evidence indicates that positive emotions and subjective well-being are inherently related to approach-oriented behaviors, thoughts, and neurological processes (e.g., Elliot & Thrash, 2002; Lee, Aaker, & Gardner,

422 SUBJECTIVE WELL-BEING IN THE INTERPERSONAL DOMAIN

2000; Updegraff, Gable, & Taylor, 2004; Urry et al., 2004). Finally, at the level of emotion, the experience and expression of positive affect are not as much ide­ alized in Eastern cultures as in the West (Eid & Diener, 2001; Diener & Lucas, 2004; Diener & Suh, 1999). This is probably because East Asians believe that strong positive emotions (pride, happiness) have a potential to disrupt interper­ sonal harmony or lead to negligent behaviors. Such beliefs may have a cost. They could discourage individuals from engaging in various behavioral and cognitive practices that are found to enhance or prolong subjective well-being (see Larsen & Prizmic, Chapter 13, this volume), such as capitalizing on positive life events (Gable, Reis, Impett, & Asher, 2004).

In conclusion, it is worth questioning whether the ultimate blueprint of all cultures is to enhance happiness at a personal level. Some cultures, such as East Asian collectivistic societies, might have arrived at the present form because it maximized the chances of maintaining collective harmony and order. Believing that happiness is meant to be the goal of life could be a view most representative of contemporary Western cultures.

For the Future

Merely a decade ago, the terms subjective well-being and culture were rarely paired together in the research agendas of psychologists. In a relatively short span of time, however, the almost nonexistent field has become a highly active research area of subjective well-being. Much research has accumulated during the past decade, thanks to innovative studies, bold ideas, and improvements in measure­ ments and data analyses strategies. In short, the past decade has been an extremely fruitful one. Following are a few research agendas that might make the upcoming decade an even more productive one.

First, it is hoped that the methodological arsenals in this field continue to develop and expand in the upcoming years. Various developments have occurred in the areas of measurement (e.g., Kim, 2004; Scollan, Di~ner, Oishi, & Biswas­ Diener, 2004; Suh & Sung, 2006) and statistical methods (e.g., Eid & Diener, 2001). Particularly promising is the finding by Scallon et al. that different mea­ surements render similar conclusions about the relative position of the subjective well-being of different cultural groups. Hopefully, future studies will include two types of powerful data that are currently missing in the field: longitudinal and brain imaging techniques. .

At the conceptual level, two questions seem particularly worthy of future investigation. First, what are the consequences of happiness in different cultures? Lyubomirsky, King, and Diener (2005) offered compelling evidence that positive affect, at least in the United States, is a cause of many desirable life outcomes. Does this finding hold· true in cultures that express somewhat ambivalent atti ­

423 Subjective Well-Being across Cultures and Nations

tudes about happiness? It seems extremely unlikely that happiness is a personal liability in any culture. However, the particular life domains in which the happy person benefits the n1ost and the magnitude of this outcome need to be deter­ mined empirically, especially through longitudinal data.

Another highly promising research candidate is the study of lay theories about happiness. One important reason for why various aspects of subjective well-being differ across cultures is because different cultural members have dif­ ferent ideas about the genesis, attainability, desirability, and outcomes of happi­ ness. Whether such lay beliefs are really true is not the point; what is impor­ tant is the fact that the way happiness is represented in people's mind (even if incorrectly) affects virtually every decisions and judgments made about happi­ ness.

To illustrate, unlike Western cultural members, East Asians take a more dia­ lectic perspective on the relation between happiness and unhappiness (Kitayama & Markus, 1999; Suh, 2000). One outcome of such belief is the prediction of future happiness. For instance, the happiness that has linearly increased since the past is expected to reverse its future trajectory by Chinese, whereas Americans believe that the trend will continue Gi, Nisbett, & Su, 2001). Prediction of hap­ piness is related to another type of lay belief In an ongoing line of research (Koo & Suh, 2006), we are examining people's belief about whether a fixed or an unlimited amount of happiness exists in their personal lives and in the world. As expected, the "finite amount" theory holders were reluctant to capitalize on pos­ .itive events (probably fearing that happiness would vanish), predicted that future fortune would reverse the current trend, and perceived overly happy people as being naive and immature. Understanding the lay beliefs about happiness will offer refreshing insights about why, when, and how people feel happy in differ­ ent cultures.

In Closing

There is limited scientific value in merely describing cultural differences in sub­ jective well-being. Such descriptive efforts, however, are necessary for under­ standing the various why questions that arise in the study of culture and subjective well-being. One question that has occupied the minds of many researchers is why happy people are more easily found in individualistic than in collectivistic cultures. In search for the ans~er, the possibility that cultures are not equally enthusiastic about the idea ofpromoting individual happiness needs full consider­ ation. This line of thinking does not imply that certain cultures are intrinsically better than others; it simply means that different cultures might have different opinions about what is most worth the pursuit. The opinion may change over time. But, very slowly.

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424 SUBJECTIVE WELL-BEING IN THE INTERPERSONAL DOMAIN

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Culture and Subjective Well-Being: Conceptual and Measurement Issues By Shigehiro Oishi, Department of Psychology, University of Virginia

Citation: Oishi, S. (2018). Culture and subjective well-being: Conceptual and measurement issues. In E. Diener, S. Oishi, & L. Tay (Eds.), Handbook of well-being. Salt Lake City, UT: DEF Publishers. DOI:nobascholar.com

Abstract: The present chapter reviews conceptual and measurement issues related to culture and subjective well-being (SWB). Historically, the concepts of happiness gradually shifted from good luck and fortune to the satisfaction of desires and goals. There are still large cultural variations in the concepts of happiness (e.g., fragility). The majority of the popular scales (e.g., the Satisfaction with Life Scale, the Subjective Happiness Scale) have been successfully translated into various languages. However, most scales have not been subjected to sophisticated psychometric analyses (e.g., Item Response Theory). Cross-cultural mean comparisons require some caution due to cultural differences in response style, self-presentational concerns, and memory and judgmental biases. In addition to the use of advanced statistical techniques, the use of qualitative and non-invasive measures is recommended. Key Words: Culture, Subjective Well-Being, Measurement, Concepts of Happiness Happiness is used to describe at least two distinct psychological states. The first common use is to describe an individual’s momentary affective state (e.g., feeling happy at this very moment, which is typically accompanied by a smile on the face). The second common use is to depict an individual’s relatively permanent state of being well (e.g., feeling happy about one’s life in general or how one’s life is going). Subjective well-being (SWB) researchers are typically interested in the latter happiness, as it reflects one’s entire life more closely than the momentary affective state of happiness. Among researchers, the term SWB has been used since Diener (1984) to refer to an individual’s relatively longstanding state of being well. Since some researchers think that a relatively permanent state of well-being should include other dimensions of human excellence, other terms such as psychological well-being (PWB) and eudaimonic well-being have been used (Ryan & Deci, 2001; Ryff, 1989). Yet, other researchers have advocated that meaning in life is another aspect of being well (Heintzelman & King, 2014; Steger, Frazier, Oishi, & Kaler, 2006). Among psychologists, the main debate concerning the concepts of well-being has centered on hedonic versus eudaimonic well-being (Kashdan, Biswas-Diener, & King, 2008; Ryan & Deci, 2001; Ryff, 1989). Among philosophers, the main debate has centered on the meaning of eudaimonia, the term ancient Greeks used to describe a good life or living well. For some, eudaimonia means living a virtuous life, while for others it is living a complete life with a sense that nothing is missing (Nussbaum, 1986/2001). Yet, other philosophers attach non-moral excellence to the notion of eudaimonia. For instance, Haybron (2016) argues that eudaimonia could be best described as nature-fulfillment in terms of capacity-fulfillment and goal-fulfillment. Thus, there is not yet a consensus on the notion of eudaimonia among philosophers (see 41 definitions of eudaimonia in Vittersø, 2016). However, it is clear that most philosophers view eudaimonia to capture living well in terms of virtues, excellence, and fulfillment of human potentials that go beyond a much narrower notion of meaning or purpose in life. In the current chapter, we will focus on cultural and historical variations in the concepts and measurements of happiness and life satisfaction, as empirical research on SWB has focused on happiness and life satisfaction (Diener, Oishi, & Lucas, 2015; see Oishi & Gilbert, 2016; Uchida & Oishi, 2016 for a

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general review on culture and SWB). Then, we will discuss substantial measurement-related issues on cross-cultural comparisons of SWB. Historical and Cultural Variations in Concepts of Happiness The historian Darrin McMahon (2006) provides a comprehensive review on historical changes in the concept of happiness. The ancient Greek term eudaimon consists of eu (good) and daimon (god, spirit, demon). Thus, the concept of eudaimonia “contains within it a notion of fortune-for to have a good daimon on your side, a guiding spirit, is to be lucky” (McMahon, 2006, p .3-4). He went on to state that “happiness is what happens to us, and over that we have no control” (p. 19). Similarly, the philosopher Martha Nussbaum (1986/2001) argues that “events beyond our control may affect, for good or ill, not only our happiness or success or satisfaction but also central ethical elements of our lives; whether we manage to act justly in public life, whether we are able to love and care for another person, whether we get a chance to act courageously” (p. xiv). Whereas ancient Greek philosophers such as Socrates and Plato (but not Aristotle) denied the role of luck in ethical understanding, Nussbaum observes that ancient Greek poets recognized the central role of luck in human happiness. Nussbaum goes on to argue that “by ascribing value to philia in a concept of the good life, we make ourselves more vulnerable to loss” (p. 361, philia = love). Overall, the ancient Greek concepts of happiness centered on fortune and good luck, which are external and fragile. According to McMahon (2006), the concept of happiness became less fragile and more controllable in the 13th century. Specifically, McMahon describes that St. Thomas Aquinas proposed a new view on happiness, namely that happiness was attainable via achieving theological virtues of charity, hope, and faith. The result was a divine gift of being blessed. In the 16th century, with the rise of Lutheranism and Calvinism, the concept of happiness became even more agentic in that not just the achievement of theological virtues but also calling to engage in some economic activities would bring happiness. Over time, the ancient concept of happiness that centers on being “beyond one’s control” has gradually transformed to the agentic concept of happiness that is within one’s reach. Although there is a historical change in the concept of happiness described by McMahon (2006), it is also true that the luck and fortune notion of happiness has not completely disappeared. For instance, dictionary definitions of happiness in 30 nations (Oishi, Graham, Kesebir, & Galinha, 2013) revealed that 24 of the 30 nations studied (Australia, Brazil, China, Estonia, France, Germany, Guatemala, Indonesia, Iran, Israel, Italy, Japan, Kenya, Korea, Malaysia, Mozambique, Norway, Pakistan, Portugal, Romania, Russia, Senegal, Singapore, and Turkey) had good luck and fortune as definitions of happiness. Related to the cultural differences in the dictionary definitions of happiness, the linguist Anna Wierzbicka (2004) observed that the English terms ‘happy’ and ‘happiness’ are broad and could describe a minor positive event, whereas the French, Polish, German, and Russian terms are more specific and describe only a rare positive event. Wierzbicka states, “Happy-unlike heureux, scastlivyj, and glucklich -is not restricted to exceptional states (like bliss), but rather is seen as referring to states within everyone’s reach. There is nothing exceptional about being happy” (p. 38). It is possible that the good luck and fortune definition of happiness connotes a relatively rare state of bliss, whereas other definitions (e.g., satisfaction of desires) imply that happiness is common. Interestingly, earlier definitions of happiness in Webster’s Unabridged English Dictionary (e.g., 1850, 1853, 1861, 1888, 1895, 1910) had good luck and fortune as the primary definition (Oishi et al., 2013). However, in the 1961 edition, the definition of “good luck and good fortune” was denoted as “archaic.” Oishi et al. (2013, Study 2) then analyzed the use of the terms happy and happiness in the State of the Union addresses from 1790 to 2010 and found that the good luck and fortune use disappeared around 1920. In addition, the Google Ngram Viewer search of “happy nation” and “happy person” showed that “happy nation” appeared more frequently than “happy person” in published books in the U.S. from 1800 until around 1920. However, since then, “happy person” has appeared more frequently in American books (Oishi et al., 2013, Study 3). These analyses show that until around 1920, the terms “happy” and “happiness” in American English might have been referring to lucky external conditions. Several programs of empirical research have also revealed cultural variations in the connotation of happiness. For instance, Lu and Gilmour (2004) found that Americans tend to associate excitement and success with happiness, whereas the Chinese tend to associate peace and calm with happiness. Similarly, Jeanne Tsai and her colleagues found that Taiwanese and Hong Kong Chinese value low-arousal positive affect such as calmness, whereas Americans typically value high-arousal positive affect such as excitement (Tsai, Knutson, & Fung, 2006). Interestingly, Taiwanese children’s books depicted a mild smile more often than a wide smile, whereas American children’s books depicted a wide smile more often than a mild smile (Tsai, Louie, Chen, & Uchida, 2007). Similarly, Christian texts often use high arousal positive emotions, whereas Buddhist texts often use low arousal positive emotions (Tsai, Miao, & Seppala, 2007). Given that

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American concepts of happiness center on achieving of one’s goals, it makes sense that the resulting emotions are excitement and pride. In contrast, given that Chinese conceptions of happiness center on luck, the resulting emotional state might not be excitement but rather akin to gratitude and satisfaction. Uchida and Kitayama (2009) also explored Japanese concepts of happiness using free associations. They found that Japanese spontaneously mentioned that happiness could disrupt interpersonal relationships via evoking envy and jealousy in others. In contrast, Americans’ descriptions were concerned mostly with personal achievement and positive hedonic experiences (e.g., joy, smiling). Whereas happiness is construed among Americans as a bond between people (e.g., smile is a gateway to a new friendship), happiness in Japan is a potentially dangerous emotion that could disrupt important social relationships. Interestingly, several studies showed that Chinese expect a bad thing after a series of good things, whereas Americans tend to expect a good thing after a series of good things (Ji, Nisbett, & Su, 2001). This particular Chinese thinking style, dialecticism, has an important implication for the concepts of happiness. Namely, those who believe in dialecticism should be worried about their current happiness, as happiness is likely to be followed by unhappiness. Indeed, when Joshanloo and colleagues (2014) explored the potential pitfalls of happiness using the fear of happiness scale (sample items include “I believe the more cheerful and happy I am, the more I should expect bad things to occur in my life,” “disasters often follow good fortune” and “excessive joy has some bad consequences”), Hong Kong Chinese endorsed the fear of happiness items far more than Brazilians and New Zealanders. Similarly, Koreans tend to hold the belief that there is a fixed amount of happiness one can experience akin to a fixed amount of luck (Koo & Suh, 2007). Thus, if a Korean person feels happy (lucky) today, she is likely to say she might not be happy (lucky) tomorrow because she is using up all her happiness (luck) today. Just like ancient Greek poets (Nussbaum, 1986/2001), many East Asians today hold the fragile view of happiness (see also Miyamoto & Ma, 2011). Related to the fragility of happiness, the Hindu notion of happiness is dramatically different from the American notion of happiness today. Srivastava and Misra (2003) argue that Hindu Indians view happiness and sorrow as the results of past lives and not just the present ones. To the extent that one has no control over past lives, Hindu concepts of happiness appear to be consistent with the ancient Greek view. Furthermore, Srivastava and Misra observe that Hindu Indians tend to feel happiness when they sacrifice their material possessions and/or respond to others’ needs. Like Buddhist traditions, Hindus see attachment to objects as a cause of suffering. Thus, Hindu happiness is concerned with the attainment of ananda, or “a transcendental journey from a lesser self fraught with hedonistic concerns to a greater self that involves realization of connectedness or oneness” (Nagar, in press). Islamic conceptions of happiness are also quite different from the American notion of happiness. Joshanloo (2013) argues that Islamic conceptions of happiness are fundamentally anti-hedonic. He cites Shiite writer Musawi Lari: “One who seeks happiness through the pursuit of pleasures will find nothing except anxiety and bafflement…The more that we succeed in subduing our lusts and desires, the closer shall we move to happiness” (p. 1862). In addition to stoicism, the Islamic view of happiness is squarely centered on the fear of, total submission to, and worship of God. It also includes the concept of perishable body and an everlasting soul. Finally, in some cultures, the concepts of happiness are more physical in nature. For instance, the Fante speakers of Ghana describe happiness/excitement literally as “eye-get” (“anigye”) and joy/contentment as “eye-agree/reach” (“anika”), in contrast with shame as “eye-die” (“aniwu”) and guilty as “eye-put” (“anyito” in Dzokoto & Okazaki, 2006). These descriptions suggest that among the Fante speakers of Ghana, happiness and associated positive emotions are eye-catching and easy on the eyes, whereas shame and guilt are hard on the eyes. Interestingly, Dzokoto and Okazaki (2006) found that the Dagbani speakers of Ghana describe happiness as “white heart,” peace as “heart at rest,” anger as “agitated heart,” and sadness as “destruction of the heart.” These descriptions suggest that for the Dagbani speakers of Ghana, positive emotions are physically low arousal states, whereas negative emotions are physically aroused, agitated states. These physical descriptions of happiness suggest that for the Fante and the Dagbani speakers of Ghana, the concepts of happiness are tied to objective bodily reactions to external events and less concerned with the satisfaction or fulfilment of one’s desires and goals, which tend to be more subjective, internal, and mentally constructed. In sum, good luck and fortune has been a dominant definition of happiness around the world since antiquity (McMahon, 2006; Oishi et al., 2013). However, the meaning of happiness has expanded and changed over time in different parts of the world (due in part to different religious beliefs and economic, social, political, and physical conditions). The diversity in the concepts of happiness across cultures and time poses a major challenge to empirical research on happiness (see below how scientists have approached this issue). However, it is also important to note that the inquiry into diverse concepts of happiness using

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diverse methods has enriched our understanding of what it means to be in a relatively permanent state of being well. Measurement of Happiness Across Cultures One of the first happiness scales was developed by George Hartmann (1934). He asked respondents to rate on the following single item: “If you compare yourself with others of the same sex and age, how would you rate your own general happiness? Use this definition as a guide: ‘A relatively permanent state of well-being characterized by dominantly agreeable emotions ranging in values from mere contentment to positive felicity.’ Give due weight to both inner and outer factors or manifestations: most unhappy of all, a great majority of persons are happier than you are, a slight majority of other people are happier than you are, about average, somewhat happier than the general run of mankind, far happier than the great majority of human beings, the happiest of all” (p. 206). One-month test-retest reliability was .70, and the correlation with informant reports was .34. In 1946, a 3-point happiness item (“Take altogether, how would you say things are these days-would you say you are very happy, pretty happy, or not too happy”) was included in a national survey (Easterlin, 1974). In 1965, Hadley Cantril used a single-item ladder scale (0 = the worst possible life; 10 = the best possible life). Unlike Hartmann, Cantril’s scale was used to measure the subjective evaluation of life accomplishments (more similar to life satisfaction than the feeling of happiness). These single-item measures of happiness and life satisfaction have been used widely in large international surveys such as the World Values Survey and the Gallup World Polls. Multiple-item scales. Bradburn (1969) was the harbinger of positive psychology that emerged in the late 1990s. He was already concerned that researchers in the 1950s and the 1960s were preoccupied with mental illness and not paying enough attention to mental health. He used the conceptual model of well-being similar to “older pleasure-pain or utility models that view an individual’s happiness or well- being in terms of the degree to which pleasure predominates over pain in his life experiences” (p. 9). To measure the degree to which pleasure predominates pain in life, Bradburn developed a 10-item scale called the affect balance scale (ABS). The five positive items were as follows: (1) “Pleased about having accomplished something?” (2) “That things were going your way?” (3) “Proud because someone complimented you on something you had done?” (4) “Particularly excited or interested in something?” (5) “On top of the world?” (answered in the Yes/No format). Bradburn overturned the prevailing assumption about positive and negative affect being the opposite ends of one dimension and showed that positive affect and negative affect are relatively independent; that is, there are people who are high in both positive and negative affect, as well as those who are low in positive and negative affect. It is also noteworthy that decades later the Gallup World Polls adopted the affect items similar to Bradburn’s ABS, using the yes-no format. Devins et al. (1997) explored cross-cultural equivalence of the affect balance scale with Chinese, Vietnamese, and Laotian refugees to Canada (those who arrived in 1979-1981). The researchers could not translate the item “Have you been feeling on top of the world?” into South Asian languages. Thus, they used only 9 items that were translatable. Confirmatory factor analyses showed that the remaining 9 items formed two factors (positive and negative affect), just like in an English-speaking Canadian sample. It should be noted, however, that these items capture mostly high arousal positive emotions that are deemed more ideal for North Americans than East Asians. Furthermore, MacIntosh (1998) analyzed the World Values Survey data from 38 nations, and found that the full 10-item, 2-factor solution did not fit data in most nations. (Curiously, the 2-factor model fit best in Nigeria, where CFI was .90 and RMSEA was .056, and South Africa, where CFI was .94, and RMSEA was .061; in other nations, fit was worse.) Watson (1988) criticized the affect balance scale for having relatively low internal reliability (alpha = .54 for positive, .52 for negative affect) and poor convergent validity with other affect measures. Instead, Watson, Clark, and Tellegen (1988) developed the 20-item Positive and Negative Affect Schedule (PANAS). Like the ABS, the PANAS items focused on high arousal positive affect such as excited, enthusiastic, and inspired. When Japanese psychologists, Tokihiro Ogawa and colleagues (Ogawa, Monchi, Kikuya, & Suzuki, 2000), developed an emotion scale, they included items such as ゆっくりした (slow/relaxed), のどかな (rustic/peaceful),　静かな (quiet/tranquil), and the low arousal positive affect formed a distinct factor from general positive and negative affect. The general emotion scale created by these Japanese psychologists did not include pride. Similarly, Hamid and Cheng (1996) asked Hong Kong Chinese to nominate 10 emotion words and created the Chinese Affect Scale. This scale included low arousal states such as comfortable, relaxed, and peaceful, as well as agreeable (more interpersonal affective state). The Chinese Affect Scale also does not include pride. Therefore, it is not surprising that pride is not a part of the positive affect factor among Asian samples (Scollon, Diener, Oishi, & Biswas-Diener, 2005), nor does it correlate highly with general positive emotion (Kitayama, Markus, & Kurokawa, 2000). It is also noteworthy that when Thompson (2007) created the international PANAS by testing out the original PANAS items with culturally diverse samples, the resulting positive affect items were determined,

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attentive, alert, inspired, and active (i.e., enthusiastic, strong, interested, excited, and proud dropped out). Whereas the ABS, the PANAS, and other emotion scales were focused on happiness and other positive emotional experiences as an indicator of emotional well-being, other researchers assessed an evaluative dimension of a relatively permanent state of well-being, that is how an individual sees her/his life to be. Lyubomirsky and Lepper (1999) developed the 4-item subjective happiness scale (SHS), which is very similar to Hartmann’s (1934) scale. The SHS items are the following: (1) “In general, I consider myself…1 = not a very happy person to 7 = a very happy person” (2) “Compared to most of my peers, I consider myself…1 = less happy and 7 = more happy” (3) “Some people are generally very happy. They enjoy life regardless of what is going on, getting the most of out of everything. To what extent does this characterization describe you?” and (4) “Some people are generally not very happy. Although they are not depressed, they never seem as happy as they might be. To what extend does this characterization describe you?” (reversed item). As the SHS focuses on a trait-like happy person, test-retest reliability was quite high (one-month test-retest reliability, r = .85 to .90; one-year test retest reliability, r = .55). The SHS has been successfully translated into Japanese (Shimai, Otake, Utsuki, Ikemi, & Lyubomirsky, 2004), Malay (Swami, 2008), German and Tagalog (Swami et al., 2009). Among many scales to measure a relatively permanent state of being well, the Satisfaction with Life Scale (SWLS: Diener, Emmons, Larsen, & Griffin, 1985) is the most popular in psychology. The 5-item scale of life satisfaction captures several aspects of being well: favorable objective external conditions (Item 2: “The conditions of my life are excellent”), a small gap between reality and ideal (Item 1: “In most ways my life is close to my ideal”), goal-fulfillment (Item 4: “So far I have gotten the important things I want in life”), and positive evaluation of life (Item 3: “I am satisfied with my life,” Item 5: “If I could live my life over, I would change almost nothing”). Oishi (2006) evaluated the cross-cultural equivalence of the SWLS between Chinese and American university student samples. First, when the one-factor model with free factor loadings was examined using the multi-group structural equation model (SEM), the fit was acceptable (GFI = .981; RMSEA = .06). The standardized factor loadings were all above .67 among the U.S sample, whereas they were high for the first three items (.62, .66, .72) among the Chinese sample. The goal fulfillment item was .49, and the last item, “If I could live my life over, I would change almost nothing,” was the weakest with .38 (see similar results for Orang Asli, aboriginal people in Malaysia in Howell, Howell, & Schwabe, 2006). When factor loadings were constrained to be the same between the two samples, Item 5: “If I could live my life over, I would change almost nothing,” was the only item that showed an item bias (constraining this item to be equivalence decreased the fit significantly worse). When Oishi (2006) used the differential item function (DIF) analysis of the Item Response Theory (IRT), which models not only factor loadings but also item difficulty, 4 of the 5 items showed a significant item bias. In particular, Item 4: “So far I have gotten the important things I want in life” and Item 5: “If I could live my life over, I would change almost nothing” showed large DIFs. It is interesting to note that the most equivalent item was explicitly concerned with favorable external conditions: “The conditions of my life are excellent.” In contrast, two items regarding the past accomplishments showed a large discrepancy. Namely, among Chinese students, those who endorsed favorable external conditions were not necessarily those who endorsed goal fulfillment items. Among American students, those who endorsed favorable external conditions were those who endorsed past accomplishment items. Overall, the results of the IRT analyses were consistent with the conceptual analyses discussed above (Lu & Gilmour, 2004; Tsai et al., 2006). Furthermore, given that the good luck and fortune definitions are prominent in many cultures (Oishi et al., 2013), the first three items of the SWLS might be the most appropriate, least biased life satisfaction items across many cultures (see Tay, Huang, & Vermunt, 2016; Tay, Meade, & Cao, 2015 for the application of IRT in cross-cultural research). It is also noteworthy that some researchers modified the SWLS to fit a local culture and education levels of respondents. For instance, Biswas-Diener and Diener (2001) used the 7 faces (1 = frown to 7 = extreme smile) instead of 1 = strongly disagree to 7 = strongly agree when they administered the SWLS to slum dwellers and sex workers in Calcutta, India. Alternative measures. Global, retrospective measures of SWB have been criticized on various grounds (e.g., Kahneman, 1999; Schwarz & Strack, 1999). One issue is concerned with memory bias, in that global measures might not capture everyday affective experiences. To address this issue, experience sampling method (ESM), in which respondents were prompted to report their momentary mood at random moments, has been used in cross-cultural research on SWB (e.g., Oishi, 2002; Oishi, Diener, Scollon, & Biswas-Diener, 2004; Scollon et al., 2005). Some researchers used the time-contingent recording (e.g., noon, 3pm, 6pm, and 9pm in Mesquita & Karasawa, 2002). In addition, daily diary method has been utilized to gather daily life satisfaction and positive emotional experiences (Kitayama, Mesquita, & Karasawa, 2006; Oishi et al., 2007). Due to these methods often being taxing to participants, some researchers relied on Day Reconstruction Method (DRM: Kahneman, Krueger, Schkade, Schwarz, &

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Stone, 2004), in which respondents were asked to recall various episodes in the morning, in the afternoon, and in the evening of the previous day (Oishi, Kurtz, Miao, Park, & Whitchurch, 2011; see Diener & Tay, 2014 for a review on DRM). In addition to “online” measures, others have used informant reports to address some of the judgmental bias issues. Saeki et al. (2014), for instance, used informant reports and found that Japanese informants (the target’s friends) tended to view the target’s life satisfaction to be higher than the target him/herself, d = .51. Although in terms of domain satisfaction, the differences were much smaller (e.g., satisfaction with weather, d = .10; satisfaction with love life, d = .02). With the rise of implicit measures (e.g., Implicit Association Test: IAT), several researchers have attempted to develop an implicit, reaction-based measure of SWB. For example, Constantini et al. (in press) developed the IAT-based positive orientation scale and found a small but positive correlation with the SWLS, r = .24, p < .001 (however, it is equally strongly correlated with global self-esteem, r = .23, p < .001, as well). Yamaguchi et al. (2007) found that Japanese reported lower levels of global self-esteem explicitly than Americans, but their IAT-based self-esteem was as high as Americans. Thus, IAT-based measures of SWB could be promising in future cross-cultural research (see however Falk & Heine, 2015; Schimmack & Diener, 2003 for some cautionary notes). More recently, researchers have started to use social media data such as Facebook and Twitter to gather information regarding users’ state of the mind and feelings. Golder and Macy (2011) conducted the linguistic analysis of 509 million tweets from about 2.4 million individuals across the world, though limited to English speakers. They found that Indians were happier relative to North Americans in the morning, whereas Africans were relatively happier than Indians in early evening hours. Within the U.S., Eichstaedt and colleagues (2015) found that anger-related words used in Twitter predicted county-level heart disease mortality. This means that in the counties where heart disease mortality is high, residents were more likely to use anger in their Tweets than those living in counties where heart disease mortality is low. Similarly, Facebook Data Team (2011) applied automated sentiment analysis to the status updates and created an index of positivity and negativity. Techniques like this are extremely promising, as they capture a large number of individuals’ everyday moods naturally (that is, without making them think about the purpose of research). However, when Wang, Kosinski, Stillwell, and Rust (2014) compared daily, weekly, and monthly Facebook’s Gross National Happiness Index with daily, weekly, and monthly aggregate scores of self-reported life satisfaction (SWLS) among myPersonality Facebook application users, the Facebook positivity score was negatively associated with the SWLS in all three time frames. It should be noted that the linguistic analysis of Twitter updates also showed some discrepancies from self-reported SWB. For instance, conservatives typically report higher levels of happiness than liberals. However, Tweets were more positive and happier among the followers of the Democratic party than those of the Republican party (Wojcik, Hovasapian, Graham, Motyl, & Ditto, 2015). In short, social media present unprecedented large, ecological data. Although it is clearly promising in the context of cross-cultural research on SWB, it is also important to further validate specific indices in the future (see Kern et al., 2016 a review on how to use social media in psychological research). Another way to measure SWB is to code the sign of positive and negative affective state from non- verbal behaviors. For example, Harker and Keltner (2001) coded yearbook photos for genuine smile and found that yearbook smiles predicted self-reported well-being over 30 years later (see Seder & Oishi, 2012 for smile intensity in the Facebook profile photos). Oettingen and Seligman (1990) observed bar patrons’ non-verbal behaviors unobtrusively and found that East Berlin workers (then living in the communist country) smiled and laughed less and showed more slumped posture than did West Berlin workers. As many surveillance cameras are placed in public space (e.g., 33 permanent cameras in Washington DC), it might be possible to use scenes captured on these surveillance cameras for SWB across cultures (Tay, Jebb, & Woo, 2017). For instance, MIT Media Lab researchers Javier Hernandez, Mohammed Hoque, and Rosalind Picard (2012) set up a camera on 4 different locations on a university campus and assessed the degree to which people who passed by were smiling for 10 weeks. The researchers report that over the study period, thousands of people passed by the camera and showed the pattern expected from academic schedules such as exam periods, holidays, and graduation day. The “mood meter” like this could provide a naturalistic behavioral index of happiness that could be scaled up for cross- cultural comparison (e.g., Hernandez et al. (2012) calculated the average intensity of smile among people present in an image, thus the mood meter ranges from 0% to 100%). Finally, numerous researchers have attempted to identify biological markers of SWB. Richard Davidson and his colleagues used electroencephalography (EEG) asymmetry during the resting period as an indicator of SWB (Urry et al., 2004). Using EEG, Lun, Oishi, Coan, Akimoto, and Miao (2010) found that East Asians showed greater left prefrontal cortex activation (than European Americans) when they felt

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understood by others. Some researchers have examined cortisol outputs and found, for instance, that anger and tension are associated with higher levels of cortisol in the evening (Adam, Hawkley, Kudielka, & Cacioppo, 2006). Yet other researchers have explored heightened expression of genes associated with NF-κB and under- expression of genes associated with anti-inflammatory glucocorticoid response elements as indicators of ill-being (e.g., Cole et al., 2007). More recently, Fredrickson and colleagues (2013) used 53 genes to indicate the “conserved transcriptional response to adversity” (CTRA) and showed their associations with hedonic and eudaimonic well-being (see Nickerson, 2017 for a critique). Kitayama, Akutsu, Uchida, and Cole (2016) measured the same 53 genes’ expression status and found the similar patterns of correlations with self-reported hedonic and eudaimonic well-being. The central claim of Fredrickson et al. that eudaimonic well-being is more strongly associated with CTRA than hedonic well-being has been questioned due to the high correlation between two types of well-being (r = .79 in Fredrickson et al., 2013; r = .70 in Kitayama et al.). However, the gene expression of the CTRA appears to be reliably associated with self-reported well-being. Thus, CTRA and related RNA measures appear to be a promising biological index of well-being that might be of use to cross-cultural comparison in the future. Indigenous scales. Although the majority of cross-cultural research on SWB has taken the etic approach (translate an original scale), several researchers have used the emic approach. For instance, Hitokoto and Uchida (2015) developed the interpersonal happiness scale to capture the Japanese view on happiness, which is characterized by interpersonal harmony, relational worth, stability, and being above the minimum acceptable standard. Sample items include the following: “I believe that I and those around me are happy,” “I feel that I am being positively evaluated by others around me,” “Although it is quite average, I live a stable life,” and “I believe I have achieved the same standard of living as those around me.” Similarly, Lee et al. (2013) developed the peace of mind scale to capture the Chinese way of being well. Sample items include these statements: “My mind is free and at ease,” “I feel content and comfortable with myself in daily life,” “My life style gives me feelings of peace and stability” and “I have peace and harmony in my mind.” As expected, it is moderately correlated with the SWLS, r (135) = .54, p < .001. Furthermore, Lee et al. found that Taiwanese college students scored higher on the peace of mind scale than European American college students, t = 3.61, p < .001, d = .55. Singh, Raina, and Sahni (2017) created the Sukha-Dukha scale to capture uniquely Indian concepts of happiness. Sukha refers to favorable experiences, and Dukha refers to unfavorable experiences. The ultimate level of happiness is thought to be achieved when “dualities of sukha and dukha cease to exist” (p. 118). The 23-item sukha scale resulted in 4 factors: happiness due to contentment (“khush” “saubhagya”), happiness due to physical and mental well-being (“svastha” “sakaratmak”), happiness due to social well- being (“Santosh” “hita”), and happiness due to spiritual well-being (”utsah,” “rasa”). Finally, Wang, Wong, and Yeh (2016) created the dialectical coping scale to capture a uniquely Chinese way of coping: Sample items include these sentiments: “When I experience difficulties, I remind myself that misfortune coexists with blessings,” “I believe that the problems in my life don’t last forever,” and “In understanding the obstacles in my life, I can see the interconnections between negative and positive events.” Overall, indigenous scales might be able to capture aspects of SWB that cannot be adequately assessed by existing mostly Western measures. Qualitative approach. Because the concepts of happiness are diverse, some researchers have used a qualitative approach (see also Biswas-Diener, this volume; Thin, this volume for the utility of the qualitative approach). Kral et al. (2011), for instance, interviewed the Inuit people and asked them about meanings of happiness, as well as health, sadness, healing, and social change. The Inuit’s happiness was deeply intertwined with family. When asked about happiness, one respondent (male, age 47) said, “Summer life. Family. Having a good family relationship with my wife and with my daughters” (p. 430). Although family is often mentioned in the context of happiness across the globe, the second most frequently mentioned category among the Inuit was being on the land. This indicates the Inuits’ deep attachment to their land, which is very different from the residents of many developed countries. When Galinha et al. (2016) interviewed extremely poor people in Maputo, Mozambique, by far the most frequently mentioned happy events were concerned with family and weddings: “When I got married it was a happy time with a great party with his family and mine. As my grandfather had oxen, he offered an ox to me” (p.79). Whereas many focus exclusively on happiness or related concepts, others explore respondents’ life stories overall. For instance, Cox, Casablanca, and McAdams (2013) used the life story interview, asking interviewees to talk about their life overall, key events, challenges, beliefs, and future prospects. The life story interview shows some common themes of unhappiness among sex workers in Managua, Nicaragua: early family problems, early departure from home, difficult romantic relationships, and financial difficulties. The interview contents could be coded in terms of positivity and negativity.

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Substantive Measurement Issues With the introduction of internet, cross-cultural research has become much easier than decades ago. Yet, there still remain many challenges to cross-cultural research on SWB. In this chapter, we will focus on the three main issues: response style, self-presentation concerns, and judgmental biases. Response style. There appear to be cultural variations in the tendency to use a certain number in responding to the survey questions. Some cultures are more acquiescent than others. For instance, when asked “how introverted are you?” and “how extraverted are you?”, Koreans were more likely to agree with both introversion and extraversion items than Americans were (Choi & Choi, 2002). The researchers speculated that East Asians can think of the situations in which they felt introverted as well as extraverted and thus tend to endorse both items. This tendency could easily have an impact on emotional items. Namely, if East Asians are more likely than Americans to endorse both positive and negative emotion items, then the positive-negative emotion correlation should be positive among East Asians, whereas it should be negative among Americans. Indeed, Schimmack, Oishi, and Diener (2002) found that the frequency of positive-negative emotional experiences correlation was positive among Hong Kong (r = .09) and Japanese participants (r = -.07), whereas it was negative among Americans ( r = -.36) and Australians ( r = -.37). It is important to dissect the degree to which acquiescence affects SWB responses. For instance, researchers can use two conceptually identical items worded oppositely: “It should be forbidden completely to smoke in malls” and “It should ‘not’ be forbidden to smoke in malls” (Baron-Epel, Kaplan, Weinstein, & Green, 2010). Related to acquiescence, Chen, Lee, and Stevenson (1995) found that Americans use the extreme response more and the middle response less than Taiwanese and Japanese. Similarly, several large-scale cross-cultural surveys found systematic cultural variations in response styles (e.g., Smith et al., 2016). These findings present a major concern for the observed mean differences in SWB across cultures. For instance, when Americans report higher levels of life satisfaction than Japanese, would the difference be driven by extreme responding (or extreme response avoiding)? As an initial test of the role of extreme responding, Oishi (2010) re-coded the original 7-point scale of the SWLS to the 3-point scale (1 to 3 = 1; 4 = 2, 5 to 7 = 3). In this recoding, 5, 6, 7 responses were coded as the same. In the original 7-point scale, the U.S-Japan difference was substantial, d = .81. When the 3-point scale was used, the difference was almost identical, d = .79. To make sure this is not just specific to the U.S-Japan comparison, Oishi also tested the Chile-Japan difference. The magnitude of the mean difference remained virtually unchanged: d = 1.24 in the original 7-point scale, d = 1.25 in the 3-point scale. In addition, when the IRT scoring method was utilized, the U.S-China difference in the SWLS remained substantial, d = .71 (only 1 of the 5 items was equivalent, thus the IRT scoring weighed this one item more heavily than other “biased” items), whereas the U.S.-China difference in the original scale (sum score) was d = 1.18 (Oishi, 2006). These findings suggest that although extreme responding might affect the mean score, the magnitude of the mean difference seems to be relatively unaffected (it should be noted, however, that when a large number of respondents respond randomly or use extreme categories, the conversion could result in a dramatically different result, see Vittersø, Biswas-Diener, & Diener, 2005 for an example; see also Batz, Parrigon, & Tay, 2016 for the number conversion issue in cross-cultural comparisons). Related to the number use, self-presentation concerns could blur true mean differences. For instance, Americans typically say “Good” or “Great!” to answer “How are you?” In contrast, many East Asians typically say “OK” or “So-so.” It is not uncommon for Japanese to say “not so good” or “dying.” In the U.S., there is a pressure to be positive, whereas elsewhere there is a pressure not to be too positive. Then, the self-presentational concern (e.g., to appear modest) could be a serious issue. Kim, Schimmack, and Oishi (2012) utilized informant reports and found that European Canadians were more positive overall (positive toward themselves and positive toward others) than were East Asians. Once this general positivity bias was statistically removed, the mean difference in self-reported SWB disappeared. Although happiness is highly valued across cultures, there are cultural variations in the desirability of happiness (Diener, 2000). Americans, Australians, and Argentine value happiness far more than Chinese and Indian. It is noteworthy that when Americans are led to think that happiness is a particularly desirable quality, they tend to exaggerate their current levels of happiness (Wojcik & Ditto, 2014). Kim and Lee (2011) also found that American college students who are concerned about self-presentation (those who post only happy photos on Facebook) also reported being a happier person (the SHS). These findings present a possibility that observed mean differences in self-reports of SWB could be due to self- presentational differences rather than “real” differences. To address the self-presentation issue, Oishi (2010) examined the U.S.-Japan differences in the SWLS using informant reports as well as self-reports: In self-reports measured in two time points,

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American students reported higher levels of life satisfaction than Japanese students (Mus = 23.08 vs. Mjapan = 21.27, t [174] = 2.13, p = .035, d = .32 at Time 1, Mus = 23.78 vs. Mjapan = 20.77, t [174] = 3.74, p < .001, d = .57 at Time 2. American students’ life satisfaction rated by their informants was also higher than Japanese students’ life satisfaction rated by their informants, Mus = 23.15 vs. Mjapan = 21.77, t [174] = 2.06, p = .041, d = .31. Japanese informant reports were also similar to self-reports in terms of the means cores. Thus, these results suggest that self-presentation concerns might not play a huge role in cross- cultural comparisons of the SWLS scores. However, Saeki et al. (2014) found that Japanese informant reports were substantially higher than self-reports of the SWLS. It is unclear, however, whether the target’s friend exaggerated the target’s life satisfaction, or the target downplayed their life satisfaction. In order to ascertain the rater effect and the target effect, it is critical to have a Round Robin type measure (group member providing self-reports as well as ratings of all other members; see Kwan, John, Kenny, Bond, & Robins, 2004; Su & Oishi, 2011 for the use of Round Robin measure on culture and self-enhancement). Memory and judgmental bias . A potential memory bias emerges when two individuals or two groups of individuals do not differ in terms of daily experiences of happiness, yet they report different levels of overall happiness. Oishi (2002, Study 1) found that the mean of daily satisfaction over 7 days did not differ between European Americans and Asian Americans, yet European Americans evaluated the whole week to be more satisfying than did Asian Americans. A regression analysis suggested that Asian Americans took into account the best day and the worst day during the 7-day period when evaluating the whole week, whereas European Americans took into account only the best day. Oishi (2002) replicated this finding with an experience sampling method (Study 2) and the evaluation of life events. Furthermore, Oishi and Diener (2003) used a performance task such as an anagram and a free throw task and measured online emotional experiences, recalled emotional experiences, and replicated Oishi (2002). However, the third study of this kind, Scollon, Diener, Oishi, and Biswas-Diener (2004), in which online emotional experiences were assessed using an experience sampling method, did not replicate the findings from Oishi (2002). Instead, Scollon et al found that Japanese reported lower levels of happiness than Americans both online and retrospectively. Since Japanese reported less happiness online already, Scollon et al. did not find cultural differences in memory bias. It should be noted, however, that Oishi et al.’s (2007) 21-day daily diary study in the U.S., Japan, and Korea showed again that European Americans reported higher levels of life satisfaction (the SWLS) than Japanese and Koreans. However, the average daily satisfaction of European Americans was not different from Japanese. Oishi et al.’s (2011) DRM study in the U.S. and Korea further replicated these findings (i.e., no cultural difference in the average positive emotion felt across various episodes on the previous day, but difference in the SWLS). Kitayama et al.’s (2006) 14-daily diary study on engaging and disengaging emotions also showed that Japanese and Americans did not differ in the daily experience of socially engaging positive emotions (e.g., shitashimi [friendly feelings], although Americans reported more socially disengaging emotions such as pride than Japanese). Likewise, Oishi (2010) reports that the intensity with which Japanese and American respondents reported positive moods at the time of completing a questionnaire was virtually identical (Mus = 6.12 vs. Mjapan = 5.97, t [530] = .87, p = .38, d = .08), yet Americans reported being happier about their lives in general than Japanese (Mus = 6.10 vs. Mjapan = 5.69, t [530] = 2.35, d = .20). Overall, although some studies (e.g., Scollon et al., 2004) found cultural differences in online positive emotional experiences, the degree of cultural differences in online positive emotional experiences tends to be smaller than in global reports. Online reports are based on specific situations and events that just happened. Thus, a general belief about the typical level of happiness (e.g., “I am a happy person”) or cultural norm (“I should be happy”) play a relatively small role. In contrast, global reports are based on events that are remembered (Tov, 2012), as well as a general belief about the typical level of happiness (Robinson & Clore, 2002) and cultural norms. Therefore, global reports appear to magnify cultural differences in everyday emotional experiences, especially when cross-cultural comparisons involve two groups that differ in desirability of happiness (see Oishi, 2010 for more details). A related issue is concerned with a positivity bias, or the degree to which global domains are more positively evaluated than their corresponding, specific domains. For instance, overall satisfaction with education should be comparable to the average satisfaction with professors, lectures, and textbooks. Diener, Scollon, Oishi, Dzokoto, and Suh (2000) found that the positivity bias score (global domain ratings – average specific domain ratings) was higher among the countries with higher mean levels of life satisfaction measured by the SWLS, r = .57, p < .001. These findings suggest that countries where people report higher levels of life satisfaction might be evaluating the overall life more positively. However, at this point it is unclear whether it is fair to say this is a “bias” or a characteristic of a happy person/culture. One way to address the issue of positivity bias is to use vignettes and see how people from different

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cultures evaluate others’ lives. Angelini, Cavapozzi, Corazzini, and Paccagnella (2014) used such a method and found that there are indeed large cultural differences. For instance, John was described to be 63-years old, a widow, relatively poor, and with heart problems. However, his children and grandchildren visit him regularly. Over 20% of Germans and Dane thought John was satisfied or very satisfied with his life. In contrast, less than 10% of Italian respondents thought John was satisfied or very satisfied. Once researchers controlled for the vignettes’ ratings, cross-national differences in self-reported life satisfaction between Italy and Denmark disappeared. Like Diener et al. (2000), however, it is inconclusive whether vignette ratings are capturing judgmental biases or naturally positive inclinations. In addition, cultural differences in ratings of John’s life satisfaction might be shedding light on one’s values rather than positivity bias per se. For example, this example might tell us that Germans and Dane consider children and grandchildren’s visits more important than financial conditions. It is also possible to interpret the results as indicating that in Denmark and Germany, one can live happily without much money thanks to better social welfare programs and public goods, whereas in Italy one must have money to live a good life. It is important to discern values from judgmental biases in the future by perhaps creating diverse vignettes (Angelini et al. used only two vignettes). Conclusion The concepts of happiness are diverse across times and cultures (McMahon, 2006; Oishi et al., 2013). They contain the notions of good luck and fortune, bliss, the satisfaction of desires, and a physical sensation of “eye-get” (“anigye” in Fante, Ghana). At this point, however, the notions of happiness in Africa, Middle East, and South Africa are still relatively unknown. It is critical to explore various concepts of happiness in even more diverse cultural samples in the future. Over the last twenty years, researchers have developed many ways to assess different concepts of happiness using divergent terms (“on top of the world”, “calm,” etc.), assessing multiple concepts (e.g., the SWLS items) or multiple life domains, using indigenous scales (e.g., the Sukha-Dukha scale), using informant reports, assessing momentary moods, and analyzing non-invasive, social media (e.g., Twitter) or camera data (e.g., “mood meter”). Cross-cultural comparisons are challenging in many ways, ranging from conceptual and measurement equivalence to potential differences in number use, self-presentational concerns, and memory and judgmental biases. Researchers have access to ever more diverse and large cross-cultural datasets. The conceptual refinement goes hand-in-hand with the refinement of measures. Researchers should be fully aware of sophisticated statistical methods to test measurement equivalence (e.g., Eid & Diener, 2001; Kim et al., 2012; Tay et al., 2016; Tay, Woo, Klafehn, & Chiu, 2010) in cross-cultural research on SWB. At the same time, it should be recognized that qualitative approaches (e.g., life story interview, Cox et al., 2013; free associations, Dzokoto & Okazaki, 2006) shed a new light on the concepts of happiness. The advancement of culture and SWB research hinges largely on conceptual clarification and solid measurement. To this end, SWB researchers must be aware of diverse methods and measurement issues summarized above and strive to go beyond the extant “good enough” measures of SWB.

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Towards a positive cross-cultural lexicography: Enriching our emotional landscape through 216 ‘untranslatable’ words pertaining to well-being

Tim Lomas

To cite this article: Tim Lomas (2016) Towards a positive cross-cultural lexicography: Enriching our emotional landscape through 216 ‘untranslatable’ words pertaining to well-being, The Journal of Positive Psychology, 11:5, 546-558, DOI: 10.1080/17439760.2015.1127993

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Towards a positive cross-cultural lexicography: Enriching our emotional landscape through 216 ‘untranslatable’ words pertaining to well-being

Tim Lomas

School of Psychology, University of East London, London, UK

(Received 24 August 2015; accepted 25 November 2015)

Although much attention has been paid to culture-specific psychopathologies, there have been no comparable attempts to chart positive mental states that may be particular to certain cultures. This paper outlines the beginnings of a positive cross-cultural lexicography of ‘untranslatable’ words pertaining to well-being, culled from across the world’s languages. A quasi-systematic search uncovered 216 such terms. Using grounded theory, these words were organised into three cat- egories: feelings (comprising positive and complex feelings); relationships (comprising intimacy and pro-sociality) and character (comprising personal resources and spirituality). The paper has two main aims. First, it aims to provide a win- dow onto cultural differences in constructions of well-being, thereby enriching our understanding of well-being. Second, a more ambitious aim is that this lexicon may help expand the emotional vocabulary of English speakers (and indeed speakers of all languages), and consequently enrich their experiences of well-being. The paper concludes by setting out a research agenda to pursue these aims further.

Keywords: cross-cultural linguistics; lexicography; well-being; happiness

Introduction

Critical theorists have often accused positive psychology (PP) of developing a culturally specific understanding of well-being (Becker & Marecek, 2008). That is, since much of the empirical work in PP has taken place in Western countries, it is suggested that the concepts developed within the field tend to reflect a bias towards ‘Western’ ways of thinking. For instance, Izquierdo (2005) argues that PP has been strongly influenced by a North American tradition of ‘expressive individualism’ (defined by Pope (1991, p. 384) as the ‘unmitigated refer- ence to the value of the individual self’). However, PP has not been unmindful of these critiques, and indeed has developed a greater level of cross-cultural sensitivity than its critics give it credit for. This emergent sensitivity is reflected in studies exploring variation in the way differ- ent cultures relate to well-being, including in how it is defined (Joshanloo, 2014), experienced (Uchida & Ogihara, 2012) and reported (Oishi, 2010).

In the interests of adding to this burgeoning cross- cultural sensitivity, this paper follows one particular line of enquiry that has not yet been explored in depth: the sig- nificance of so-called ‘untranslatable’ words. Such words exert great fascination, not only in specialised fields like linguistics or anthropology (Wierzbicka, 1999), but also in popular culture. Part of the fascination seems to derive from the notion that such words offer ‘windows’ into other cultures, and thus potentially into new ways of being in

the world. As Wierzbicka (1997, p. 5) puts it, ‘words with special, culture-specific meanings reflect and pass on not only ways of living characteristic of a given society, but also ways of thinking’. Thus, ‘untranslatable’ words are not only of interest to translators; after all, many such pro- fessionals argue that it can be difficult to find exact transla- tions for most words, and that nearly all terms lose some specificity or nuance when rendered in another tongue (Hatim & Munday, 2004). Rather, ‘untranslatability’ reflects the notion that such words identify phenomena that have only been recognised by specific cultures. Per- haps the most famous example is Schadenfreude, a Ger- man term describing pleasure at the misfortunes of others. Such words are not literally untranslatable, of course, since their meaning can be conveyed in a sentence. Rather, they are deemed ‘untranslatable’ to the extent that other lan- guages lack a single word/phrase for the phenomenon.

The significance of such words is much debated. A dominant theoretical notion here is ‘linguistic relativity’ (Hussein, 2012). First formulated by the German philoso- phers Herder (1744–1803) and Humboldt (1767–1835), it came to prominence with the linguist Sapir (1929) and his student Whorf (1940). Their so-called ‘Sapir-Whorf hypothesis’ holds that language plays a constitutive role in the way that people experience, understand and even perceive the world. As Whorf (1956, pp. 213–214) put it, ‘We dissect nature along lines laid out by our native languages … The world is presented as a kaleidoscopic

Email: [email protected] Note: To view and/or contribute to the evolving lexicography, please visit www.drtimlomas.com/lexicography

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The Journal of Positive Psychology, 2016 Vol. 11, No. 5, 546–558, http://dx.doi.org/10.1080/17439760.2015.1127993

flux of impressions which has to be organized … largely by the linguistic systems in our minds’. This hypothesis comes in various strengths. Its stronger form is linguistic determinism, where language inextricably constitutes and constrains thought. For instance, Whorf argued that the Hopi people had a different experience of time due to par- ticularities in their grammar, such that they lacked a linear sense of past, present and future. This strong determinism has been criticised, e.g. by Pinker (1995), who argued that the Hopi experience of time was not particularly different to that of Western cultures. However, the milder form of the hypothesis, linguistic relativism, simply holds that lan- guage shapes thought and experience. This milder hypoth- esis is generally accepted by most anthropologists and other such scholars (Perlovsky, 2009).

A similar debate pertains specifically to ‘untranslat- able’ words. A strong deterministic view argues that unless a person is enmeshed within the culture that pro- duced a given word, he or she would be unable to understand or experience the phenomenon that the word refers to. Such a view is associated with the philosopher Charles Taylor (1985), who argued that there is no way out of the ‘hermeneutic circle’, in which concepts can only be understood with reference to other concepts within that language. As Taylor put it,

We can often experience what it is like to be on the out- side [of the circle] when we encounter the feeling, action, and experiential meaning language of another civilization. Here there is no translation, no way of explaining in other, more accessible concepts. (pp. 23– 24)

However, articulating a milder relativistic view, Wierzbicka (1999) suggests we can indeed escape the hermeneutic circle and get a feel for what ‘untranslat- able’ words refer to. Wierzbicka does acknowledge that people not emic to a particular culture may not appreci- ate the full nuanced richness of a term compared to peo- ple who are ‘inside’ the culture. As she puts it, ‘verbal explanations of such concepts cannot replace experiential familiarity with them and with their functioning in the local “stream of life,”’ (p. 8), to use Wittgenstein’s (1990) telling phrase. However, Wierzbicka argues that ‘it is not true that no verbal explanations illuminating to outsiders are possible at all’, since most culture-specific concepts are complex constructs that can be de-com- posed into simpler elements that are universally under- stood (p. 8).

If Wierzbicka’s perspective is correct, then encoun- tering ‘untranslatable’ words has the potential to enrich one’s conceptual vocabulary. (Of course, if incorrect, such an exercise would still have the valuable outcome of increasing one’s understanding of other cultures.) If applied to well-being specifically, as in this paper, such an exercise may enrich our emotional landscape, as

suggested by Perlovsky’s (2009) ‘emotional Sapir-Whorf hypothesis’. The existence of ‘untranslatable’ words per- taining to well-being implies that there are positive emotional states which have hitherto only been explic- itly recognised by particular cultures. However, this does not mean that people in other cultures may not have had a comparable experience. Yet, lacking a speci- fic term for it, such people have arguably not had the opportunity to specifically identify that particular state, which instead thus becomes just another un-conceptu- alised ripple in the on-going flux of subjective experi- ence. As Ferguson (2003, p. 10) says, it is possible that ‘entire feelings, entire concepts went unexpressed, sim- ply because no word had ever been coined to capture them’. However, the value of exploring ‘untranslatable’ words is that, if people are introduced to a foreign term, this may then be used to give voice to these hith- erto unlabelled states. We see this when foreign words are imported into other languages, like Schadenfreude. In such cases, although one’s language lacks an equivalent term, the phenomenon it refers to has been experienced, or does at least make sense. Consequently, given the lack of a native term, the foreign word is simply imported and used. Indeed, as De Boinod (2007, p. 5) puts it, ‘The English language has a long- established and voracious tendency to naturalise the best foreign words’.

So, with the aim of enriching the emotional vocabu- lary of the English language, this paper offers a quasi-sys- tematic review of ‘untranslatable’ words pertaining to well-being. It is quasi-systematic since there was insuffi- cient source material in academic journals, meaning that a true systematic review, utilising conventional academic databases, was not possible. It is notable that, while much attention has been paid to culture-specific psychopatholo- gies by fields like psychiatry and medical anthropology (Thakker & Ward, 1998), there have been no comparable attempts to chart positive mental states, hence the value of the current paper.

Methods

The quasi-systematic review undertaken in this paper proceeded in a number of stages. The first stage involved searching for relevant ‘untranslatable’ words. This stage featured three main search strategies. First, I examined 20 websites and blogs devoted to ‘untranslatable words’. These were located by entering the phrase ‘untranslatable words’ into google, and picking the first 20 such web- sites and/or blogs. Examining these websites/blogs, I selected any word pertaining roughly to well-being, using well-being in an expansive sense to incorporate positive emotions, valued qualities, beneficial relation- ships, physical health and psychospiritual development. This search strategy generated 131 words. Second, I

The Journal of Positive Psychology 547

searched google one language at a time. This involved entering ‘_____ concept of’ and ‘well-being’ into the search engine, with a different language in the under- lined space each time. I would proceed through the first ten pages for each search, looking for references to emo- tions or qualities relating to well-being that were pre- sented as being unique to a particular culture. This strategy generated a further 77 words. Third, I canvassed staff and students at my institution, as well as friends and acquaintances, which yielded another 8 words. As a result, 216 relevant terms were located. These words and their descriptions were checked for accuracy by consult- ing online dictionaries, as well as peer-reviewed aca- demic sources (if such were available for a given word). Thus, I based my analysis on the definitions provided by dictionaries and academic sources (rather than the origi- nal websites/blogs where I first located some terms). Since this study was undertaken by me alone, it must be acknowledged that there may be some subjective bias in my analysis. However, this paper is just the first step towards the development of a positive cross-cultural lexi- cography. As such, it is hoped that any inaccuracies or bias may be corrected in future by the involvement of other scholars in this project.

Having compiled a list of words, I analysed these using a qualitative methodology known as grounded the- ory (GT) (Strauss & Corbin, 1998). In GT, the aim is to allow theory to ‘emerge’ inductively from the data. GT involves three main stages: open coding, axial coding and selective coding. First, open coding involves exam- ining the data – which in this study was the list of 216 words – for emergent themes. Thus, I looked for words which appeared to share a common theme, and then I grouped these words together under that theme. For instance, I found five words which pertained to friend- ship (philotimo [φιλότιμο], cariño, confianza, nakama [仲間] and ah-un [阿吽]). I therefore grouped these words together under the label ‘friendship’. The next stage was axial coding, in which the themes themselves are clustered together into meta-themes. For example, I took the themes of ‘friendship’, ‘affection’, ‘desire’ and ‘love’, and grouped these into a meta-theme of ‘inti- macy’. Still within the stage of axial coding, meta- themes are in turn grouped into overarching categories. For instance, ‘intimacy’ and ‘pro-sociality’ together cre- ated a category of ‘relationships’. The resulting three main categories were: feelings, relationships and charac- ter. The final GT stage is selective coding, in which a single ‘core’ category is identified, which in this case was well-being. Attempts are then made to elucidate how the main categories relate to this core category, thus telling a ‘narrative’ which makes sense of the data. The three main categories are analysed in turn in the sections below.

Feelings

The first category is feelings, an umbrella term encom- passing affect, emotions, moods and sensations. Words here can be differentiated into two categories: positively qualified feelings, and more complex ambivalent feel- ings. These are considered in turn.

Positive feelings

This section includes a spectrum of words pertaining to positive affect. Perhaps the dominant state in this regard is happiness, for which most languages have a translative equivalent. Interestingly, many of these derive etymologi- cally from terms pertaining to luck (McMahon, 2004), including heureux (French), onni (Finnish), Gluck (German) and felicità (Italian). Indeed, the English term derives from the old Norse happ, which alludes to fate, as in ‘happenstance’. McMahon suggests this close inter- twining between happiness and luck derives from earlier generations experiencing a relative lack of control over their lives, with a resulting sense that happy people are those ‘blessed’ with good fortune.

However, happiness is a complex, polyvalent term, encompassing a multitude of positive feelings. Most languages not only possess terms that are translated as happiness, but moreover have numerous such terms, each of which captures different nuances. Urdu for example has at least 16 words that might be translated as happi- ness, including terms that articulate: enjoyment or merri- ment, such as kayf ( فیک ) and xurramii ( یمرخ ); pleasure, like suwaad ( داوُس ) and shaadmaanii ( یناْمداش ); gladness and good cheer, like dilshaadgii ( یگداشلد ); prosperity and fecility, like sazaadat ( تداعس ) and xushii ( یشوُخ ); more ‘elevated’ forms like joy and delight, such as masarrat ( تٰرََسم ) and farhat ( َتحَْرف ); and even stronger forms such as bliss, e.g. anand ( دَْننآ ) and sarshaarii ( یراشرس ). Thus, happiness functions as an overarching label, enfolding a spectrum of positive feelings. As such, this section aims to get ‘under the hood’ of happiness, looking for words that tease apart its components and nuances.

To begin with, there are words capturing specific flavours of pleasure and enjoyment. Some pertain to sati- ating appetites: Spanish uses gula for the desire to eat simply for the taste, while shemomedjamo (Georgian) describes eating past the point of satiety due to sheer gustatory enjoyment. Many cultures acknowledge the importance of sharing such pleasures with friends; e.g. Spanish has sobremesa for when the food has finished but the conversation is still flowing. Relationships are one of our three main categories, and are considered at length below. Nevertheless, here we can situate words given to socialising around food and drink – each with their own cultural nuances – including fika (Swedish), borrel (Dutch), sahar ( رهس ; Arabic) and parea (Παρέα;

548 T. Lomas

Greek). Further forms of merrymaking include: mbuki- mvuki (Bantu), to ‘shuck off one’s clothes in order to dance’ (Rheingold, 2000, p. 28); utepils (Norwegian), i.e. drinking beer outside on a hot day; and Schnapsidee (German), an ingenious plan one hatches while drunk. This whole area of revelry is encapsulated by the Bali- nese ramé, namely something at once chaotic and joyful. We might also mention: desbundar, Portuguese for shed- ding one’s inhibitions in having fun; the neglected Eng- lish verb deliciate, which refers to luxuriating in pleasure; Thai sabsung, which signifies being revitalised through something that livens up one’s life; German Feierabend, which articulates the festive mood that can arrive at the end of a working day; and the multipurpose Dutch adjective lekker, which can mean anything from relaxed and comfortable to pleasurable and sexy.

A slightly more complex class of words also pertains to pleasure, yet encompasses feelings of safety. Perhaps on account of their cold climes, Northern European cul- tures have terms for ‘cosiness’ that are highly valued, going beyond mere physical comfort to express emo- tional and even existential warmth and intimacy (van Nes, Abma, Jonsson, & Deeg, 2010). These include koselig (Norwegian), mysa (Swedish), hygge (Danish), gezellig (Dutch), and both Gemütlich and Heimlich in German. (That said, as Freud (1955) pointed out, the lat- ter has ambivalent nuances. In signifying ‘homely’, it can also allude to that which is concealed from outsiders, and in requiring secrecy in this way, becomes ‘uncanny’ and frightening.) Related to these are terms articulating contentment, including: tilfreds (Danish), meaning satis- fied and ‘at peace’; Geborgenheit (German), expressing the feeling of being protected and safe from harm; Swedish trygghet, embodying ‘security, safety, confi- dence, certainty and trust’ (Andersson-Segesten, 1991, p. 43); and the Welsh cwtch, literally meaning to hug, but also a safe, welcoming place.

In contrast, cultures in more temperate climates have fashioned words for more expansive and outgoing expe- riences of savouring. Such savouring includes leisurely strolling the streets, captured by the French verb flâner and the Greek volta (βόλτα). These not only refer to tak- ing in the sights and conversing with passers-by, but in their lack of destination, also a sense of freedom and possibility. Emphasising fresh air and health, the Dutch uitwaaien means to walk in the wind for fun. Also with an appreciation of nature, Japanese shinrin-yoku (森林 浴) is the relaxation gained from ‘bathing’ in the forest (figuratively and/or literally), while Swedish gökotta means waking up early with the purpose of going out- side to hear the first birds sing.

Then we find words expressing stronger states of happiness. Some pertain to joy, like: simcha (Hebrew); me yia (με γεια; Greek), which is a blessing of good health for others; and suaimhneas croi (Gaelic), depicting

a state of happiness encountered specifically after a task has been finished. Others surpass even joy, including: njuta (Swedish), a profound experience of appreciation, verging on bliss; tarab ( سوماق ; Arabic), a ‘musically- induced state of ecstasy [or] enchantment’ (Racy, 2004, p. 6); Herrliches Gefühle (German), made famous by Goethe, described as ‘glorious feelings’ (Wierzbicka, 1999, p. 18); and eudaimonia (ευδαιμονία; Greek). The latter is used in PP to depict a sense of fulfilment and flourishing (Ryan, Huta, & Deci, 2008), but in its original context refers to being infused with the grace of the divine.

Finally, there are terms depicting states of happiness which, while intense, are yet stable and lasting, less dependent on specific situations, such as the Chinese xìngfú (幸福) and Sanskrit sukha (सुख). In Buddhism, sukha is used to mean ‘genuine’ happiness, in contrast to the more fleeting hedonic forms captured by anand (आनन्द) or khushii (खुशी). However, sukha does not generally refer to positive feelings that one ‘happens’ to experience, but is a state of flourishing rooted in ethical and spiritual maturation (Wallace, 2007). Indeed, tradi- tions such as Buddhism are replete with even more posi- tively qualified mental states, like nirvāna (निर्वाण; Sanskrit), an ‘ultimate’ form of happiness, involving complete and lasting freedom from suffering (Kang & Whittingham, 2010). We shall touch further on the idea of pursuing ‘deeper’ forms of happiness through spiritual practices in the third section below.

Complex feelings

Not all feelings pertaining to well-being are strictly posi- tive per se. Here, we consider a class of states that are more complex and ambivalent, but are nevertheless highly culturally valued. Some appear ostensibly nega- tive, but there is a sense that these are somehow integral to life, as if one would not be living fully without being able to experience these. Indeed, all capture the notion that flourishing is dialectical, a complex blend of light and dark elements (Lomas & Ivtzan, 2015), as reflected in the Chinese symbol yin-yang (陰陽). Separately, yin means cloudy/overcast, and yang ‘in the sun’ (i.e. shone upon), and together these imply the two sides of a moun- tain (one sunlit, one in shadow). This image is thus used to articulate the idea of ‘holistic duality’, i.e. that reality comprises co-dependent opposites (Fang, 2012). In their various ways, then, the feelings here are a dialectical blend of positive and negative states of mind, together producing a rich and complex sensibility.

Some of these feelings concern hope and anticipa- tion. As Lazarus (2003) pointed out, these heightened emotions are ‘co-valenced’, a tantalising blend of savour- ing the future combined with fear that it will not come to pass. There is magari (Italian), roughly meaning

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‘maybe’, but which also encompasses ‘in my dreams’ and ‘if only’, articulating both a hopeful wish and wist- ful regret. Similarly, Indonesian belum means ‘not yet’, but with an optimistic tint that an event might yet hap- pen. In Inuit, iktsuarpok refers to the anticipation one feels when waiting for someone, whereby one keeps going outside to check if they have arrived. In German, Vorfreude is the intense, joyful anticipation derived from imagining future pleasures, although this does depend on a strong likelihood of attainment. Rather more melan- cholic is the Korean han (한), a culturally important term expressing sorrow and regret, yet also a quiet sense of waiting patiently in the hope that the adversity caus- ing the sadness will eventually be righted.

Related to han are words pertaining to longing and yearning that are often at the heart of their respective cultures. In Portuguese, saudade is a melancholic long- ing/nostalgia for a person, place or thing that is far away – either spatially or in time – a vague, dreaming wistful- ness for phenomena that may not even exist (Silva, 2012). Similarly, toska (tocкa; Russian) and hiraeth (Welsh) articulate a complex mix of nostalgia, wistful- ness and longing for one’s homeland (Wierzbicka, 1999). In Japanese, natsukashii (懐かしい) is a nostalgic longing for the past, with happiness for the fond memory, yet sadness that it is no longer. The German Sehnsucht trans- lates as ‘life longings’, i.e. an ‘intense desire for alterna- tive states and realisations of life’, even (or especially) if these are unlikely to be attained (Scheibe, Freund, & Baltes, 2007, p. 778).

Related to terms of longing are those expressing a desire for freedom. These include Fernweh in German, described as the ‘call of faraway places’, or a homesick- ness for a place one has never been to (Gabriel, 2004, p. 155), and the well-known Wanderlust. Similarly, in Spanish, vacilando depicts the idea of wandering, where the act of travelling is valued more than the destination. In Russian, prostor (простор) captures a desire for spa- ciousness, roaming free in limitless expanses, not only physically, but creatively and spiritually (Pesmen, 2000, p. 67). Finally, German Waldeinsamkeit articulates the feeling of solitude when alone in the woods, a mysteri- ous state described by Schwartz (2007, p. 201) as the ‘pseudo-magical pull of the untamed wilderness; a place of living nightmares caught between the dreamscape and Fairyland’.

Finally, there are words capturing the complex aes- thetic feelings evoked through contemplation of the world. Both Swedish and Turkish have terms for the glim- mering that moonlight makes on water, mangata and gumusservi, respectively, and there are words for the sound of wind rustling through trees (psithúrism; ψιθύρισμ; Greek), falling leaves (listopad; лиcтoпaд; Russian) and sunlight filtering through leaves (koromebi; 木漏れ日; Japanese). Then there are words that articulate

the act of appreciation itself. Japanese is particularly rich in these. Aware (哀れ) is the bittersweetness of a brief, fading moment of transcendent beauty, while mono no aware (物の哀れ) is the pathos of understanding that the world and its beauty are transient in this way. Similarly, ukiyo (浮世絵), literally ‘floating world’, expresses a sense of living in these moments of fleeting beauty, detached from the pains of life. Wabi (侘) refers to imper- fect beauty, and sabi (寂) to aged beauty, and as a com- pound (wabi-sabi) articulate a potent sense of ‘dark, desolate sublimity’ (Prusinski, 2013, p. 25). Finally, yūgen (幽玄) is described as the most ‘ineffable’ of aesthetic concepts (Suzuki, 1959/1973, pp. 220–221); both yū and gen mean ‘cloudy impenetrability’, and together express ‘unknowability’ and ‘mystery’, a feeling of being moved to one’s core by the impenetrable depths of existence.

Relationships

While feelings inevitably constitute a large portion of the words pertaining to well-being, there are a wealth of terms that serve to emphasise that well-being is not only about feelings. As this section elucidates, many of these words pertain to relationships, suggesting that perhaps chief among our sources of positive feelings are the bonds we form. These fall into two categories: intimacies with select people, and pro-sociality more broadly.

Intimacy

Here, intimacy covers close relationships of varying strengths, from friendship to the most intense feelings of love. With friendship, I highlighted above the pleasures of socialising with friends. Added to these words are terms that speak to the value of close friendship. In Greek, philotimo (φιλότιμο), translated as ‘friend-hon- our’, is a culture-defining characteristic of respecting and honouring one’s friends. For even more intense friend- ships, there are words for friends who one effectively considers family and has developed deep platonic love for, including nakama (仲間) in Japanese, and both car- iño and confianza in Spanish, while the Japanese ah-un (阿吽) describes the unspoken communication one has with such friends.

Beyond friendship, there is a rich lexicon of words depicting forms of love, from the familial to the passion- ate. In the Aboriginal Pintupi language, kanyininpa refers to ‘an intimate and active relationship between a “holder” and that which is “held,”’ capturing the deep feeling of nurturance and protection a parent feels for a child (Myers, 1991, p. 146). Some words are rather play- ful. For instance, in the Philippine Tagalog language, gigil refers to the irresistible urge to pinch or squeeze someone because they are loved or cherished. Then there are words articulating desire, including the Tagalog kilig

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(the feeling of butterflies in the stomach arising from interacting with someone one loves or finds attractive), and mamihlapinatapei from the Chilean Yagán language (a look between people that expresses unspoken but mutual desire). Other words capturing romantic affection include: cafune in Portuguese, i.e. tenderly running one’s fingers through a loved one’s hair; queesting (Dutch), meaning to allow a lover access to one’s bed for chitchat; and retrouvailles (French), expressing the joy people feel after meeting loved ones again after a long time apart.

These are augmented by words for deeper or more intense forms of love. Some refer specifically to falling in love, such as forelsket in Norwegian; drawing on notions of fate, Japanese koi no yukan (恋の予感) refers to the feeling on meeting someone that falling in love will be inevitable, while Chinese yuán fèn (緣分) describes a ‘binding force’ that impels a relationship ordained by destiny. Some words capture the bittersweet feeling of love fading. These include onsra in the Boro language of India, which means ‘To love for the last time’, used by those who know their love won’t last (Abley, 2005, p. 124), and razljubít (разлюбить) in Rus- sian, articulating the feeling a person has for someone they once loved. Then there are words for lifelong feel- ings of love, like the Korean sarang (사랑), which expresses the wish to be with someone until death. Simi- larly, in Arabic, ya’burnee ( ينربقي ) means ‘you bury me’, indicating that one would rather die (first) than be with- out one’s loved one. Similarly, ishq ( قشع ) is a ‘true’ love that is all-consuming, as reflected in the saying that ‘ishq is a fire that burns down everything but the object of desire’ (Faruqi, 1999, p. 8). Finally, in Urdu, naz ( زان ) is the assurance and pride one can feel in knowing that the other’s love is unconditional and unshakable.

Pro-sociality

Beyond words that express intimacies with select others, the world’s languages are rich in terms articulating the value of pro-sociality for people ‘in general’. With these, well-being is recognised as not simply an individual con- cern, a self-contained state attained without regard for others. Rather, well-being is seen also as a social phe- nomenon, arising out of harmonious connections with others and the world around. This conceptualisation of well-being is sometimes seen as lacking in more ‘indi- vidualistic’ cultures, e.g. North America. As such, given the bias in PP towards such cultures, as alluded to in the introduction, the field has tended to somewhat overlook these social dimensions of flourishing (Lomas, 2015).

For a start, there is a rich lexicon of prosocial feel- ings around kindness. In Nguni Bantu, ubuntu refers to the culturally valued notion of being kind to others on account of one’s common humanity. As Archbishop

Desmond Tutu put it, ‘It speaks of the fact that my humanity is caught up and inextricably bound up in yours. I am human because I belong. It speaks about wholeness; it speaks about compassion’ (cited in Bowen, 2014, p. 83). Kindness is similarly valorised in words such as pittiarniq (Inuit), maitrī (मैत्री; Sanskrit) and gemilut hasadim (Yiddish), all of which refer specifically to the potent compound ‘loving-kindness’ (Blumberg, 2006, p. 724). Closely related to these words is the San- skrit ahimsa (अहिंसा); although being negatively formu- lated (himsā means harm, with ‘a’ being a negative prefix), it retains positive overtones of love which are not preserved if translated into English simply as non- harm (Ostergaard, 1977).

Related to kindness is a swathe of words articulating the value of empathy and compassion, such as karuna (करुणा) in Sanskrit, and koev halev in Hebrew. These both refer to identifying with the suffering of others so closely that one’s own heart aches in sympathy. Similarly, there are terms for ‘vicarious embarrassment’, in which one shares in sympathy the shame of others, including myötähäpeä (Finnish), Fremdschämen (German) and pena ajena (Spanish). In Thai, kreng-jai translates as ‘deferential heart’, and articulates the wish to not trouble someone by burdening them with a request that might cause them hassle. More positively, there are words revelling in the joys of others, including muditā (मुदिता; Sanskrit), which translates as sympa- thetic joy, and k’velen (Hebrew) and fargin (Yiddish), which mean to glow with pride and happiness at the successes of others (often family members). Finally, gunnen (Dutch) means to allow someone to have a pos- itive experience, especially if that means one won’t have it oneself.

In addition to expressions of kindness and empathy are words pertaining to morality more generally, valoris- ing the development of ethical sensibilities. For instance, in Pashto, imandari ( ةماقتسإلا ) expresses a culturally val- ued ideal of ‘righteousness’, of cultivating good words and deeds. Likewise, tarbiya ( ميلعت ) refers to ongoing moral/ethical and spiritual education and development. Indeed, many cultures view ethical and spiritual growth as intertwined, so this section intersects with that of spiri- tuality below. For instance, in Buddhism, a key concept is karma (कर्म; Sanskrit), a theory of causality with respect to ethical behaviour, wherein ethical actions lead to future positive states, and unethical actions have adverse consequences (Jones, 2012). Indeed, karma is an excellent example of a foreign term being adopted whole- sale in English. Related to karma are other Sanskrit words concerning the importance of ethical development, including as a vehicle for spiritual growth. For instance, apramāda (अप्माद) articulates a sense of ‘moral watch- fulness’ (Rao, 2007, p. 69), i.e. being aware of the ethical implications of one’s actions.

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Ideals of ethics also find their expression in words which capture more specifically what ethical behaviour consists of. For instance, numerous cultures have forged words to extol the virtues of hospitality. In Pashto, mel- mastia ( ایتسملېم ) encapsulates the sense of moral obliga- tion and honour in offering sanctuary and respect to all visitors, without expectation of recompense, and is seen as a defining attribute of the culture (Ambreen & Mohyuddin, 2013). Similar themes are expressed by xenia (ξενία; Greek), and the Yiddish terms hachnasat orchim (‘welcoming the stranger’) and tzedaka (‘required righteous giving’) (Blumberg, 2006, p. 724). Then there are related words pertaining to social decorum in interac- tion, such as the complex Farsi term ta’ârof ( فراعت ); although often translated as politeness, this incorporates much nuance, such as in relation to receiving and offer- ing hospitality and gifts. Finally, there are concepts that express the building up of good social ‘karma’, i.e. when one does good deeds and might reasonably expect favours in return, such as betmoun ( نومتب ) in Arabic and guān xì (關係) in Chinese.

Words pertaining to relationships include terms for positive or skilful communication. There are terms which express appreciation and recognition for others and their efforts, like xīn kǔ (辛苦) in Chinese. Somewhat simi- larly, in Hebrew, hirgun is the act of saying nice things to another simply to make them feel good. Then there are terms pertaining to getting along, such as: the Cata- lan enraonar, namely to discuss in a civilised, reasoned manner; the French reflexive verb s’entendre, literally meaning to hear each other, but which refers to under- standing between people; and the Fijian Hindi talanoa, which describes the way apparently purposeless idle talk functions as a ‘social adhesive’ (Rheingold, 2000, p. 66). There are terms capturing the emotive power of story- telling, like the Italian commuovere, which translates as ‘heartwarming’ but refers to being moved to affectionate tears. There are also words for non-verbal communica- tion skills, like Korean nunchi (눈치), which literally means ‘eye-measure’, and captures the ability to ‘read’ emotions and situations and to respond skilfully. Finally, the Australian aboriginal term dadirri describes a deep, spiritual act of reflective and respectful listening.

Words pertaining to pro-sociality culminate in terms articulating a valued sense of social communality. The Arabic asabiyyah ( ةـيـبـصـع ) describes a sense of ‘community spirit’, as does tuko pamoja (Swahili), translated as ‘we are together’, and piliriqatigiinniq (Inuit). All these terms denote a shared sense of purpose and working together for the common good. More specifically, Scandinavian languages have words for collectively pursuing a given task, e.g. talkoot (Finnish), dugnad (Norwegian) and talko (Swedish), as does Indonesian with rojong. Com- munality is also reflected in the Dutch word janteloven, i.e. a set of rules which discourages individualism in

communities. Lastly, there are words describing harmony and congruence in life, a sense of ‘resonance between cosmic harmony, intellectual and aesthetic correctness, and cooperative family relationships’ (Rheingold, 2000, p. 37). These include: friluftsliv (Norwegian), articulating a sense of living in tune with nature; simpatía (Spanish), describing accord within relationships and society gener- ally; and tjotjog (Javanese), which literally means ‘to fit, as a key does in a lock’ (Geertz, 1973, p. 129).

Character

This final category reflects the notion, shared among many cultures, that well-being is not just about positive feelings and nourishing relationships, but also involves the development of what we might call ‘character’. Words here fall into two meta-themes. First, resources, which refers to qualities and skills that help a person live well. Second, spirituality, featuring terms which imply that the deepest forms of well-being are found through psychospiritual development.

Resources

With resources, to begin with are words valorising char- acter attributes of perseverance or grit. In Arabic, sumud ( دومص ), translated as steadfastness, describes a determined struggle to persist, a quality that has been particularly valorised in the context of oppression in the Middle East (Nassar, 2011). Similarly, Finnish exhorts sisu, charac- terised as extraordinary determination in the face of adversity. Somewhat relatedly, there are terms capturing the ability or willingness to persevere through tasks that are hard or even just boring, including að jenna (Ice- landic) and Sitzfleisch (German), which literally means ‘sit meat’. There are also exhortations towards persever- ance, such as the Japanese ganbaru (頑張る), translated as ‘to do one’s best’. Somewhat similarly, there are words extolling the importance of being energised, such as jaksaa (Finnish) and orka (Swedish). Likewise, Greek kefi (κέφι) captures a spirit of joy, passion, enthusiasm, high spirits, even frenzy. On a more mystical level, the Arabic baraka ( ةكرب ) is described as a gift of spiritual energy or ‘sanctifying power’ that can be transferred from one person to another (Safi, 2000, p. 264). Simi- larly, orenda, from the Native American Huron language, describes the power of the human will to change the world in the face of powerful forces such as fate.

Related to perseverance and spirit are words eulogising resourcefulness and skill. Some describe the ability to ‘make do’ or ‘get by’, particularly in difficult circum- stances, such as jugaad (जुगाड; Hindi) or arrangiarsi (Italian). Related to these is the Portuguese desenrascanço, i.e. to artfully disentangle oneself from a troublesome situ- ation. Pertaining to skill more generally (not simply as a

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coping resource), German Fingerspitzengefühl (literally ‘fingertip feeling’) describes the ability to think clearly about numerous phenomena and to understand how they relate on multiple levels. Reflecting a different manifesta- tion of skill, the Italian sprezzatura articulates a certain nonchalance, wherein all art and effort are concealed beneath a ‘studied carelessness’. Similarly, saper vivere describes the ability to handle people and situations with charm, diplomacy and verve. Hungarian pihentagyú, literally meaning ‘with a relaxed brain’, describes quick- witted people who can come up with sophisticated jokes or solutions. Likewise, Polish kombinować refers to working out an unusual solution to a complicated problem, and acquiring coveted skills or qualities in the process. Pertaining more to creative skill, Greek meraki (μεράκι) depicts a sense of ardour, specifically in relation to one’s own actions and creations, such that one puts all one’s effort and creativity into these. Finally, Chinese yuán bèi (圓備) articulates a sense of complete and perfect accomplishment.

Of course, grit, spirit and resourcefulness are not the only character strengths valued across cultures. Most lan- guages have specific terms for particularly valorised traits, many of which touch upon notions of decency. For instance, in German, brav is an adjective used to commend children, encompassing qualities including being pleasant, earnest and well-behaved. Similarly, majime (真面目) in Japanese, and kào pǔ (靠譜) in Chinese, depict someone who is reliable, responsible and able to get things done without causing problems for others. Relatedly, Japanese sunao (素直) could be trans- lated as ‘meek’, ‘docile’ or even ‘submissive’; however, whereas these terms generally carry negative connota- tions, sunao is positive, exemplified in the respect given by a student towards a teacher. In Hungarian, szim- patikus identifies a person as a decent human being, while Chinese fēng yùn (風韻) describes personal charm and graceful bearing. Switching tack slightly, Swedish lagom captures a sense of moderation, of doing anything to just the right degree. Finally, in the Tshiluba language of the Democratic Republic of Congo, ilunga – rated by linguists as the world’s most difficult word to translate (Conway, 2004) – refers to a person who is ready to forgive abuse the first time, and tolerate it a second time, but never a third time.

Beyond these personal characteristics are words artic- ulating a sense that a person is living well, that they are flourishing. In Japanese, ikigai (生き甲斐) translates as a ‘reason for being’, capturing the feeling that life is ‘good and meaningful’ and that it is ‘worthwhile to continue living’ (Yamamoto-Mitani & Wallhagen, 2002, p. 399). Similarly, genki (元気) refers to being healthy, energetic and full of life. In French, joie de vivre articulates a zest for life, the ‘knack of knowing how to live’ (Lopate, 1986, p. 11). It is, as Harrow and Unwin (2009, p. 19)

put it, ‘a Weltanschauung [a German term for “philoso- phy of life”], a behavioural mode and form of practice. It is joy generalised, a result of many experiences, a sus- tained and boundless enjoyment of the here and now’. Similarly, a bon vivant describes someone who luxuri- ates in the good life. Then there are terms for living fully, experiencing life deeply and intensely in the ‘here and now’, including Erlebnis (German) and vivencias (Spanish). Added to these are words signifying living a good life, i.e. being a good person, such as namus (Turkish), which reflects a combination of honour, chastity, decency and virtue. Likewise, menschlichkeit (Yiddish)

encompasses being a good human being in its fullest sense … to not only be human and humane, but also filled with reverence for life, compassion for others, concern for the health and well-being of the planet, and justice for all. (Blumberg, 2006, p. 724)

Then finally, there are words expressing the sense that one has lived well, such as míng mù (瞑目) in Chinese, meaning to ‘die without regret’. This sentiment is epito- mised by the Cherokee battle-cry yutta-hey, which trans- lates as ‘it is a good day to die’, embodying the feeling that one is leaving life at its zenith, departing in glory.

Spirituality

Finally, the world’s cultures have developed a rich lexi- con to reflect the notion that to truly flourish, to experi- ence life’s emotional peaks, one must cultivate some kind of spirituality. For a start, many languages have words to express the idea of a soul, some inner essence, removed from the accoutrements of personality and changing behavioural patterns, that reflects the truest, deepest core of a person. These include: Russian duša (дyшa), one’s inner heart and soul; Arabic fitra ( ةرطف ), an innate purity and closeness to God; and Hindi ātman (आत्मन्), i.e. breath or spirit. Moreover, in Hinduism, the atman is regarded as identical with brahman (ब्रह्मन्), the all-powerful and pervasive power that continually creates the universe (Ho, 1995). Somewhat similarly, Buddhism valorises the notion of conscious- ness through Sanskrit terms like smriti (स्मृति), a concept that, in a Buddhist context, emphasises the importance of present-moment awareness, and which is the source of the contemporary English word ’mindfulness’ (Lomas & Jnanavaca, 2015). In contrast to Hinduism, Buddhism generally denies the existence of a distinct individual soul or spirit, using the Sanskrit anātman (अनात्मन्) to reflect this. At the same time though, consciousness, as reflected in terms like smriti, is valorised within Bud- dhism as an important inner vehicle of psychospiritual development (Wallace, 2007).

The Journal of Positive Psychology 553

As the latter sentence suggests, for some cultures, the soul is not simply a static entity, but something that can be cultivated spiritually through practice. For instance, Hinduism and Buddhism share a concern with the dhárma (धर्म), a multifaceted, polyvalent term that refers both to what one should do (e.g. ethical norms), and why one should do it (e.g. so that one becomes aligned with the moral and spiritual ‘laws’ of the universe) (Creel, 1972). One may cultivate alignment with the dharma by following a mārga (मार्ग; Sanskrit), i.e. a spiritual path or way, which is called a ‘dō’ (道) in Japa- nese. This path would involve psychospiritual practices, notably meditation, referred to in Sanskrit as dhyāna (ध्यान). (When Buddhism was transmitted to China, dhyana became ch’án (禪), which in turn was pro- nounced Zen in Japan.) For instance, one might meditate on a mantra (मन्त्र), a Sanskrit term translated as ‘mind tool’, i.e. repeated words/phrases used to ‘leverage the power of our minds’ (Rheingold, 2000, p. 48). Or there are various physico-spiritual practices encompassed by the Japanese term budō (武道), which translates as ‘mar- tial arts’. Indeed, most religious traditions have evolved

comparable meditative practices, as evidenced by the Arabic muraqaba ( ةبقارم ) for example, a Sufi word mean- ing ‘to watch over’ or ‘to take care of’.

One of the goals of such practices is to cultivate an understanding of the dharma, of the nature of reality, and to bring oneself in alignment with it. This goal is cap- tured by the Sanskrit term prajñā (प्रज्ञ), which does not simply mean intellectual wisdom, but experiential insight (Kang & Whittingham, 2010). In a Buddhist con- text, developing insight means understanding what in Sanskrit are called the three lakṣaṇas (लक्षण), i.e. the three ‘marks of conditioned existence’. These refer to what Buddhism regards as the three fundamental proper- ties of the universe: anitya (अनित्य), i.e. impermanence; anātman (अनात्मन्), i.e. insubstantiality (as used above in relation to Buddhism denying the existence of a soul); and duḥkha (दुःख), i.e. suffering or dissatisfaction. Bud- dhism holds that it is the failure to appreciate anitya and anātman, and consequently the attempt to pursue and attach to phenomena that are intrinsically ‘empty’, that is the cause of suffering. (This notion of ‘emptiness’ is cap- tured by the Sanskrit term sūnyatā (शून्यता). This isn’t a

Figure 1. Thematic map of emergent positive cross-cultural lexicography.

554 T. Lomas

nihilistic concept which denies that phenomena exist. Rather, it articulates the idea that things are not self-sub- sistent, but come into being dependent upon conditions, and are therefore subject to change.) However, should one reach a deep understanding and appreciation of sūnyatā, this leads to sukha, described above as a form of ‘lasting happiness’, which is the antonym of duḥkha (i.e. suffering).

Most spiritual traditions have similar notions about bringing one’s understanding into alignment with the nat- ure of the universe. For instance, the Chinese dialectical symbol yin-yang, highlighted above, is central to the Chinese religious/philosophical tradition of Taoism. Taoism focuses on experiential understanding of the Tao (道; pronounced dō in Japanese, as featured above), a complex term that, like brahman means an all-powerful and pervasive power, but like dō also means path or way. Taoism thus extols the importance of aligning one’s understanding and behaviour with the Tao. This align- ment is represented by the ideogram te (德), which also carries connotations of integrity, virtue and inner power (Chang, 2013). A related concept of importance in Taoism is wú wéi (無為). This literally translates as ‘do nothing’, but means to act in such accordance with the Tao that one’s actions are entirely natural, uncontrived and effortless.

As practitioners progress in the context of their religious traditions, we find words that capture increasingly deep, transformative states of flourishing. For instance, in Bud- dhism, the zenith of psychospiritual development is referred to in Sanskrit as bodhi (बोधि), translated as ‘enlightenment’ or ‘awakening’. With bodhi, one has attained complete insight into the nature of reality, and accordingly has been ‘liberated’ from suffering. In Japanese, bodhi is referred to as satori (悟り), and also sometimes as kenshō (見性); how- ever, the latter refers more to a temporary ‘glimpse’ of awakening, while the former implies durability and even permanence. Once awakened and liberated, a person is said to have realised their ‘Buddha nature’, i.e. become perfected and enlightened just as the Buddha became. Buddha nature is referred to in Sanskrit as tathāgatagarbha; this is a com- pound of garbha (गर्भ), meaning ‘embryo’, and tathāgata (तथागत), which translates as ‘one who has thus come/gone’, and is the term the Buddha deployed to refer to himself. There are comparable concepts in other cultures. For instance, in Islam, tazkiah ( ةيكزت ) refers to the process of ‘purification of the self’, i.e. progressing towards purity and submission to Allah. This process culminates in fanaa ( ءانف ), the ‘annihilation’ of the ego, thereby enabling one to achieve enlightenment and union with God (Nilchian, 2011, p. 5). Such terms depict peaks of psychospiritual develop- ment and well-being that are described as far exceeding the positive feelings elucidated in the first section, and which chart the far possibilities of what it means to flourish as a person.

Conclusion

This exercise in collating and analysing ‘untranslatable’ words has revealed a rich lexicon of terms pertaining to well-being. Using an inductive ‘grounded theory’ approach (Strauss & Corbin, 1998), a tentative concep- tual framework was established. This framework was generated by grouping words into themes, themes into meta-themes and finally meta-themes into three overarch- ing categories (feelings, relationships and character). The themes, meta-themes and categories are illustrated in Figure 1 below. It must be emphasised that this figure is simply a visual representation of the thematic groupings that I identified in my analysis. It will require a compre- hensive future research agenda to turn this initial concep- tual framework into a sophisticated nomological network. This research agenda would need to include factor-analytic examinations of construct validity and of the interrelationships between the concepts, as elucidated further below.

In considering this emergent lexicography, there are two key questions. First, whether this taxonomy can enrich the conceptual landscape of PP, and help the field to develop a more nuanced understanding of well-being. Second, whether this taxonomy can similarly expand the emotional vocabulary of English speakers themselves (and indeed speakers of other languages), and likewise enrich their understanding of well-being. To be clear, these questions cannot be answered definitively here; this paper is simply a first step towards doing so. In develop- ing an initial lexicography here, the hope is that this will be the basis for a future research agenda aimed at answering these questions.

So, the first question is whether this taxonomy can enrich the conceptual landscape of PP. A research agenda based on this lexicography would go some way towards addressing present limitations of PP. Firstly, there is currently a bias towards the use of participants who Henrich, Heine, and Norenzayan (2010) refer to as ‘WEIRD’, i.e. from Western, Educated, Industrialised, Rich and Democratic societies. Secondly, there is a resulting tendency within PP to develop concepts and models of well-being based on the analysis of such par- ticipants. Thirdly, it is then widely assumed in PP that these concepts and models are generalisable across cul- tures (Izquierdo, 2005). Finally, there is a corollary assumption that Western psychology has little to learn from psychological constructs and models developed within non-Western cultures (with some exceptions, like the burgeoning enthusiasm for mindfulness and other Buddhist-derived concepts (Walsh & Shapiro, 2006)).

A research agenda based on this lexicography – using the lexicon to better understand well-being in a cultural context – would help address these limitations. So, what might such an agenda look like? We could

The Journal of Positive Psychology 555

imagine a number of stages. First, all 216 terms consid- ered here arguably warrant their own individual paper, explicating and analysing them in rich detail. Such papers could include analysis of the word’s etymology and cultural significance, as for example Silva (2012) did with saudade. Such papers would ideally also develop psychometric scales in English pertaining to these concepts, as Scheibe et al. (2007) did with Sehn- sucht. Moreover, it is a certainty that the present list is by no means exhaustive, and that there are many more words that could be deemed ‘untranslatable’. As such, this first stage could also see the expansion of this lexi- con by scholars who are intimate with other languages and cultures. Indeed, a webpage has been created at www.drtimlomas.com/lexicography to provide a platform for this expansion. Readers are encouraged to visit this site, and if they are aware of other relevant words to add these to the evolving lexicography. As relevant words and concepts are identified and added to the lexicogra- phy, scholars are again encouraged to develop etymolog- ical analyses and psychometric scales.

As the lexicon develops, and with it a battery of psy- chometric scales, this could lead to a second stage of research focused on establishing construct validity. This does not only mean assessing the validity of any poten- tial scales, but also the validity of the concepts them- selves, so-called ‘substantive’ validity (Messick, 1995). It will be important to explore where the concepts identi- fied in this lexicography sit within the nomological net- work of existing constructs within PP. We might ask, for instance, how the Finnish notion of sisu relates to con- ceptually similar terms in English, like perseverance or grit. This means exploring the ways in which these words overlap, and examining whether sisu incorporates qualities not found in these other terms. This second stage would therefore involve factor analytic research, comparing the new psychometric scales (based on terms in this lexicon) with existing scales (of constructs already recognised in PP). This will enable us to see how the concepts in this lexicography relate to and overlap with existing concepts within PP.

Once the validity of these constructs (and their scales) has been established, a third stage of research could then involve extensive cross-cultural assessment. This would enable us to explore the extent to which peo- ple in different cultures understand and experience the concept at hand. This does not only mean investigating whether English speakers can experience concepts found in other languages (as per this lexicography). A related line of enquiry is whether constructs in Western psychol- ogy are applicable to other cultures. For instance, Hormes and Rozin (2010) have noted that many lan- guages do not appear to have an equivalent for the term ‘craving’. These types of cross-cultural analyses will indicate whether, as per strong linguistic determinism,

one must be intimate with a culture in order to under- stand its ‘untranslatable’ words (Taylor, 1985). Or, con- versely, such analyses may corroborate Wierzbicka’s (1999) argument that we can indeed appreciate what such words refer to. That is, even if English does not possess a word for a particular feeling, we may find that English speakers can still recognise the feeling as some- thing they have previously experienced.

This third stage leads us into consideration of the sec- ond key question raised at the start of this conclusion. This was whether this lexicon could expand the emo- tional vocabulary of English speakers themselves, and likewise enrich their understanding of well-being. Even if the emotions depicted in this paper are unfamiliar to English speakers, it is possible that people can be trained to recognise these. For instance, in the context of devel- opmental psychology, interventions have been developed to enrich children’s emotional vocabulary, thereby help- ing them to develop ‘emotional competence’ (Saarni, 1999). It is possible that the lexicon developed here could be helpful in such situations, expanding their vocabulary even further. Such training has implications for well- being, including potentially addressing mental health issues. For instance, research with male meditators by Lomas, Edginton, Cartwright, and Ridge (2014) found that many had previously become emotionally ‘restricted’ due to gender socialisation pressures. However, through meditation, participants were able to develop emotional intelligence, which in turn enhanced their mental health. Part of their meditation training involved introspecting and attempting to label their emotional experience. Their training also featured practices to help them develop new emotional qualities, like maitrī (a Sanskrit term, featured above, which translates as ‘loving-kindness’). It is con- ceivable that this kind of ‘emotional training’ could be enhanced by a lexicon such as the one developed here. As such, in addition to the conceptual research agenda outlined above, this lexicography may also have practical applications.

In summary, it is hoped that this lexicography will improve our understanding of well-being, enhancing PP by bringing in ideas from other cultures. It is furthermore hoped that it may have applied benefits too, such as enriching the emotional landscape of native English speakers. However, this type of research is only in its infancy, with this paper merely offering the beginnings of a positive cross-cultural lexicography. This can hope- fully then be expanded, refined, tested and validated over the years ahead.

Acknowledgement I would like to thank my family, friends, colleagues and stu- dents for their suggestions of ’untranslatable words.’ Special

556 T. Lomas

thanks goes to my mother Jean Fitzpatrick, with whom the idea of this lexicography was first discussed, and also to Emilia Lahti, whose talks on sisu provided the inspiration for this paper. Finally, thanks to the editors and anonymous reviewers at The Journal of Positive Psychology, whose invaluable suggestions helped improve the paper.

Disclosure statement No potential conflict of interest was reported by the author.

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Available online at www.sciencedirect.com

Clinical Psychology Review 28 (2008) 211–227

A conceptual paradigm for understanding culture's impact on mental health: The cultural influences on mental health (CIMH) model

Wei-Chin Hwang a,⁎, Hector F. Myers b, Jennifer Abe-Kim c, Julia Y. Ting d

a Department of Psychology, Claremont McKenna College, 850 Columbia Avenue, Claremont, CA, 91711 United States b University of California, Los Angeles, United States

c Loyola Marymount University, United States d University of Utah, United States

Received 14 February 2007; accepted 3 May 2007

Abstract

Understanding culture's impact on mental health and its treatment is extremely important, especially in light of recent reports highlighting the realities of health disparities and unequal treatment. This article provides a conceptual paradigm for under- standing how culture influences six mental health domains, including (a) the prevalence of mental illness, (b) etiology of disease, (c) phenomenology of distress, (d) diagnostic and assessment issues, (e) coping styles and help-seeking pathways, and (f) treatment and intervention issues. Systematic interrelationships between each of these domains are highlighted and relevant literature is reviewed. Although no one model can adequately capture the complex facets of culture's influence on mental health, the Cultural Influences on Mental Health (CIMH) model serves as an important framework for understanding the complexities of these interrelationships. Implications for clinical research and practice are discussed. © 2007 Elsevier Ltd. All rights reserved.

Contents

1. The CIMH model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 1.1. Cultural issues in the development of illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 1.2. Culture and the expression of distress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 1.3. Expression of distress, diagnostic accuracy, and the prevalence of illness . . . . . . . . . . . . . . . . . . . 217 1.4. Culture, expression of distress, and help-seeking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 1.5. Help-seeking, diagnoses, and their relation to treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 1.6. Meeting the needs of ethnic minority and immigrant communities: policy implications . . . . . . . . . . . . 222

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

Recently in the United States, the Surgeon General and the Institute of Medicine reported that racial and ethnic health disparities exist, and that in general, ethnic minorities continue to be missing from the research from which evidence-based treatments (EBTs) are drawn (Smedley, Smith, & Nelson, 2003; USDHHS, 2001). In addition, there is

⁎ Corresponding author. E-mail address: [email protected] (W.-C. Hwang).

0272-7358/$ - see front matter © 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.cpr.2007.05.001

212 W.-C. Hwang et al. / Clinical Psychology Review 28 (2008) 211–227

a growing body of European and other international literature supporting these findings and suggesting that immigrants and ethnic minorities evidence a disproportionate burden of illness and unequal access to health care services (Department of Health, 2003; Fernando, 2005). This accumulating body of evidence underscores the idea that extant health care systems may not be adequately prepared to meet the needs of minority and immigrant populations. The importance of incorporating issues of culture, race, and ethnicity into research, teaching, and clinical practice are sorely needed. This task has proven to be quite complicated given the limited resources that have been invested towards improving our understanding of cultural influences on mental health. Without guiding frameworks from which to work from, the larger audience of mental health professionals will continue to acknowledge that culture is important, but struggle in articulating how culture makes a difference and be unprepared in addressing growing world-wide health disparities.

The goal of this article is to provide a conceptual framework, the Cultural Influences on Mental Health (CIMH) model, to help bridge this gap and increase cultural understanding and awareness (see Fig. 1). In this article, we define culture broadly as not only including the set of attitudes, values, beliefs, and behaviors shared by a group of people (Barnouw, 1985), but also as inclusive of culture-related experiences such as those related to acculturation and being an ethnic minority. The CIMH model argues that culture permeates and affects several core domains of the illness process. Culture contributes to differences in (a) the prevalence of mental illness, (b) etiology and course of disease, (c) phenomenology or expression of distress, (d) diagnostic and assessment issues, (e) coping styles and help-seeking pathways, and (f) treatment and intervention issues. Because of the multitude of ways that culture can influence mental health issues, these domains are not meant to be all-inclusive, but rather provide a starting point for understanding the more visible ways that culture influences the development and treatment of psychopathology.

Cultural influences each of the above domains, which are also clearly and logically related. For example, cultural differences in the expression of distress (e.g., emotional distress or physical symptoms) could influence diagnostic accuracy in the assessment of depression, which in turn, impacts our ability to reliably estimate the prevalence of depression. What one believes to be the causes of one's problems (e.g., bodily problems causing depression or depression causing physical health problems) also plays a role in where one seeks help (e.g., primary care or mental health facility), and one's confidence in the treatment provided (e.g., belief that talk therapy is effective versus feeling like talking about problems makes one feel worse). Research conducted to examine how culture impacts each of these domains as well as how they are systematically interrelated continues to be limited. Understanding these inter- relationships is integral to understanding how culture influences the development, progression, and treatment of mental illness.

The CIMH was initially developed to provide students and professionals with a broad and more sophisticated understanding of culture's dynamic influence on mental health. Specifically, in our teaching of culture and mental health issues, professionals and students often developed a simplistic understanding that culture matters, but often had difficulty understanding the dynamic and interactive nature of culture on interrelated mental health domains. The

Fig. 1. The Cultural Influences on Mental Health (CIMH) Model.

213W.-C. Hwang et al. / Clinical Psychology Review 28 (2008) 211–227

CIMHmodel serves as an illustrative roadmap to help students and professionals visualize the complexities involved in understanding culture's influence on mental health. We acknowledge that no single conceptual model can adequately capture the complexities involved in understanding cultural influences on mental health, but hope that the CIMHmodel will provide a solid foundation for those wanting and needing to improve their cultural awareness.

1. The CIMH model

1.1. Cultural issues in the development of illness

At a basic level, we understand that the cultural background and characteristics of the individual plays an important role in the etiology of disease and the resulting psychological distress and mental illness as illustrated by Pathways A and B in Fig. 1. For instance, we know that the day to day experiences of people from different backgrounds may be very different. We also know that ethnic minorities are likely to be exposed to a disproportionate burden of unique stressful experiences. A basic example would be that of the refugee experience. Many refugees immigrate to countries around the world having experienced a variety of traumatic experiences, including war, genocide, violence, famine, and political persecution (Gong-Guy, Cravens, & Patterson, 1991; Williams & Berry, 1991). Whether one escapes to another country or not, those exposed to violent experience evidence increased risk for depression and post traumatic stress disorder, as has been found among Southeast Asian, African, Bosnian, and Kurdistanian refugees (Chung & Kagawa-Singer, 1993; Hirschowitz & Orkin, 1997; Kinzie et al., 1990; Kroll et al., 1989; Sundquist, Johansson, DeMarinis, Johansson, and Sundquist, 2005; Wahlsten, Ahmad, Von Knorring, 2001). Traumatic experiences are culture-universal in that anyone exposed to such stressors would likely be negatively affected. However, refugees are much more likely than the general population to experience traumas (Gong-guy et al., 1991; Williams & Berry, 1991), and as a result, their vulnerability to developing psychological problems increase with accumulated stress burden. Refugee experiences can be very different from that of other ethnic minorities. For example, Native Americans who have suffered from the cumulative impact of colonization and generations of oppression also suffer from higher rates of lifetime trauma and violent victimization than other groups living in the U.S. (National Center for Injury Prevention and Control, 2002; Walters & Simoni, 1999).

Regardless of refugee status, many immigrants also experience acculturative stresses while trying to adapt to a new cultural environment that those in the majority population are unlikely to face (Hovey, 2000; Williams & Berry, 1991). Acculturative stress, defined as the stress related to transitioning and adapting to a new environment (e.g., linguistic difficulties, pressures to assimilate, separation from family, experiences with discrimination, and acculturation-related intergenerational family conflicts) refers to adaptational stressors that can increase risk for mental health problems (Berry, 1998; Berry & Sam, 1997). These stressors have been found to have a detrimental effect on immigrant health and mental health, especially among recent immigrants (Berry, 1998; Goater et al., 1999; Hovey, 2000; Jarvis, 1998; King et al., 2005; Myers, & Rodriguez, 2003; Oh, Koeske, & Sales, 2002; Organista, Organista, & Kurasaki, 2003; Schrier,Van de Wtering, Mulder, and Selten, 2001; Vega & Rumbaut, 1991; Veling et al., 2006). The degree to which acculturative stresses are likely to have a negative impact partially depends on a number of pre-post migration factors, such as educational status, linguistic ability, refugee status, access to thriving ethnic neighborhoods in the host country, and support networks available (Williams & Berry, 1991).

Cultural assimilation, or the process of gradually taking on the characteristics of a new environment, can also increase risk for health problems as immigrants acculturate, possibly due to a regression to the normative prevalence rates of illness in the general population (Berry, 1998). For example, there is a growing body of research indicating that U.S. born Latinos evidence higher rates of a variety of mental and physical health problems than foreign-born Latinos (Escobar, Nervi, and Gara, 2000; Ortega, Rosenheck, Alegria, and Desai, 2000). Chinese Americans also evidence this cultural assimilation effect in relation to major depression (Hwang, Chun, Takeuchi, Myers, & Siddarth, 2005). A similar problem is also developing in European countries. For example, several studies have found that the rate of schizophrenia was approximately 2–3 times higher for African immigrants, Afro-Caribbeans, Asian, Surinam, Netherland Antilles, Moroccan, and other immigrants than Whites in Great Britain and the Netherlands (Goater et al., 1999; Jarvis, 1998; King et al., 2005; Schrier et al., 2001; Veling et al., 2006). There is little empirical evidence that explains why this is happening, however, some believe that it may be due to a combination of accumulated stress burden, increased exposure to culturally unfamiliar environmental and psychosocial experiences, racism and dis- crimination, and the loss and attenuation of culturally protective factors.

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Immigrant issues aside, ethnic minorities are likely to be exposed to a number of other stressors that are unique to their minority status. For example, many minorities report negative experiences with racism and discrimination (Clark, Anderson, Clark, & Williams, 1999; Kessler, Mickelson, & Williams, 1999; Williams, 1996). Racial discrimination (whether overt, covert, or perceived) is likely to have a negative impact on health and mental health, and often leaves people with feelings of anger, disempowerment, fear, loss of control, and helplessness (Clark et al., 1999; Krieger, Sidney, & Coakley, 1999). Persistent ethnic and racial discrimination continues to be highly prevalent around the world with many citizens holding disparaging and negative stereotypes of ethnic minorities being dangerous, lazy, less intelligent, and so forth (Davis & Smith, 1990). Recent reports also indicate that ethnic and racial discrimination not only results in economic disadvantages for many ethnic minorities, but also persist in health care systems and exacerbate health disparities (Smedley et al., 2003).

In addition to being the target of racism, ethnic minorities are less likely to benefit from a number of privileges available to Whites (McIntosh, 1989; Rothenberg, 2005). In discussing White privilege, McIntosh (1989) notes, “I was taught to see racism only in individual acts of meanness, not in invisible systems conferring dominance in my group” (pp. 31). White privilege acts to confer a number of advantages to White people that ethnic minorities do not have. In the U.S., for example, Chin, Cho, Kang, and Wu (1999) note that:

For many people of color, racism has decreased the amount and value of economic, social, and cultural capital inherited from our ancestors. Not only did we receive less material wealth, we also received less “insider knowledge” and fewer social contacts so instrumental to one's educational and professional advancement. The fact that runners today might compete on more equal “footing” does nothing to change this fact…even if you are individually innocent of any racial discrimination, do you still enjoy its illicit fruits? After all, discrimination (by others) has shrunk your pool of competitors for admissions, public contracting, and jobs. (pp. 3, 5)

Because of this, White privilege not only reduces the amount of stressful experiences that White Americans face, but also serves as a protective factor and increases their resources for anticipating and coping with adversity relative to persons of color.

Some ethnic minorities are exposed to a different set of stressful experiences that White Americans are less likely to face. In addition, these experiences may affect different groups differently, and as a result, bias research findings. For example, African Americans, Latino Americans, Native Americans, and some Asian American groups evidence a higher burden of poverty in the U.S. (Proctor & Dalaker, 2003). Given the high rates of poverty and the cumulative and current exposure to racism and discrimination experienced by many of these groups, it is surprising that ethnic minorities do not evidence even higher disproportionate rates of mental dysfunction than White Americans (Chernoff, 2002). Chernoff (2002) noted that while positive coping resources (e.g., kinship, spirituality, ethnic pride, collective unity) may help to preserve the mental health of minority communities, the disproportionate risk burden they carry still takes its toll as evidenced by the disproportionate burden of medical morbidity in many of these groups.

Betancourt and Lopez (1993) caution that understanding the relationship between race and socioeconomic status (SES) is a complex process and vulnerable to methodological and statistical bias. For example, they note that the prevalence of depressive symptoms was found to be higher among Latinos than White Americans in a study conducted by Frerichs, Aneshensel, and Clark (1981), which provided evidence of an ethnic difference. However, this effect may be overestimated because when SES is controlled, the ethnic effect disappeared and SES became the significant predictor of depression. Because SES and ethnicity can be highly overlapped in some minority groups, both variables need to be included in statistical analyses. However, this overlap also effectively limits our ability to disaggregate shared variability. In order to properly understand these relations, they caution that a sufficient representation of ethnic groups in multiple SES stratum is required (Betancourt & Lopez, 1993).

Social factors such as familial relationships serve as an important risk and protective factor for all people, but may also affect ethnic minorities differently. For example, research examining expressed emotions found that while family interactions involving criticism was more predictive of relapse for White Americans returning home after hos- pitalization for schizophrenia, emotional distance and lack of warmth played a stronger role than emotionally negative interactions in predicting relapse for Mexican American families (Lopez et al., 2004). Chao (1994) also challenged what were believed to be culture-universal relationships between parenting styles and child outcomes by noting that Chinese American parents tended to be more “authoritarian” but that Chinese American children still performed well in school. She introduced the notion of a Chinese parenting style called “Xiao xun” or “child training,” and believes that this culture-specific parenting style, based on Chinese notions of filial piety, may better explain child-parent relations

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than predominant Western conceptualizations. More research needs to be done to examine operational differences in how family and social relations preserve or exacerbate mental health outcomes. In addition, more research needs to be conducted to examine how acculturation impacts family relations. Recently, Hwang (2006a) proposed a theory of Acculturative Family Distancing (AFD), noting how growing acculturative gaps place immigrant families at risk for developing AFD along two dimensions, a breakdown of communication and an increase of incongruent cultural values, both of which negatively impact family relations and increase risk for psychological distress and functional impairment.

1.2. Culture and the expression of distress

The cultural background of the individual not only influences the etiology and development of disease, but also plays a role in the definition and sociocultural meanings of illness. The sociocultural meanings in turn are shaped by cultural norms and beliefs, and ultimately serve as a filter to shape the manner in which distress is expressed as illustrated by Pathways C and D. People from all around the world experience mental illness, and for the most part, symptom profiles for the major disorders are similar (USDHHS, 2001). However, the manifestation of such difficulties (e.g., how they are communicated, experienced, whether they are expressed, and the social meanings of different symptom clusters) can vary by age, gender, and cultural background (Kleinman, 1978). For example, although there may be core symptoms of depression that are similar across cultures, there may also be differences in emphases placed on certain types of symptoms (e.g., differences in the loading of affective, cognitive, and somatic complaints) and/or symptoms associated with depression (e.g., headaches and stomachaches) that are not currently included in the U.S. Diagnostic Statistical Manual (DSM) or the International Classification of Disease (ICD) (APA,1994; WHO, 1992). The sociocultural environment may act as a contextual backdrop and influence cultural conceptions of illness (e.g., what an illness is), symptom recognition and tolerance, the manner in which it is expressed, social meanings associated with it, and the manner in which it is communicated (e.g., directly, indirectly, or not at all) (Marsella, 1980).

When considering cultural differences in the expression of distress, etic (culture-universal phenomena) and emic (culture-specific phenomena) distinctions are also important to make (Fischer, Jome, & Atkinson, 1998; Sue, 1983). Using depression as an illustrative example, the etic perspective assumes that all people express depression in similar ways and that our diagnostic criteria can be applied to people from all backgrounds without significant cultural bias. On the other hand, an emic perspective would argue that there are likely to be both universal forms of depressive symptoms (i.e. criterial symptoms), as well as cultural variability in symptom expression (Fischer et al., 1998; Sue, 1983).

Somatization, or the degree to which people express their distress through physical symptoms can vary across cultural groups, affect different parts of the body, and carry different social meanings. For example, in Asian cultures, research suggests that somatic expression of distress is very common place; whereas, in Western cultures, there is a greater emphasis on talking about problems and expressing oneself verbally and emotionally (Chun, Enomoto, & Sue, 1996). When comparing Chinese and American psychiatric patients with depressive syndromes, Kleinman (1977) found that 88% of Chinese patients compared to 20% of U.S. patients did not present affective complaints and reported only somatic complaints. In Taiwan, nearly 70% of psychiatric outpatients presented with predominantly somatic complaints at their first visit (Tseng, 1975). Chun et al., (1996) note that somatization may be more prevalent among Asians because open displays of emotional distress is discouraged, possibly because of differences in value orientation and strong stigma associated with mental illness. Displays of psychological symptoms of depression may be perceived as characteristic of personal or emotional weakness. As a result, Asians may deny, suppress, or repress the experience and expression of emotions. This is not to say that Asians and Asian Americans do not experience psychologically related depressive emotions per se. Instead, there may be cultural differences in selective attention (e.g., amount of focus on the mind vs. body), ordering of such foci (e.g., focusing on somatic symptoms first because this is more culturally acceptable and less stigmatized than acknowledging cognitive and emotional symptoms), and/or willingness to express distress based on what's culturally appropriate or accepted (e.g., greater stigma associated with mental illness and/or differences in divulging problems to people outside of the family). In some Latino groups for example, somatic disturbances take the form of chest pains, heart palpitations, and gas (Escobar, Burnam, Karno, Forsythe, & Golding, 1987); whereas, in some African and South Asians groups it is sometimes expressed through burning of the hands and feet and the experience of worms in the head or the crawling of ants under the skin (APA, 1994; USDHHS, 2001).

There may even be linguistic differences in the language available to describe, interpret, and communicate one's problems. For example, in Native American culture, words for many Western conceptualizations of illness such as

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depression and anxiety do not exist (Manson, Shore, & Bloom, 1985). In examining ethnic differences in the clinical presentation of depression, Myers et al. (2002) found that even after controlling for SES and severity of distress, African American and Latina women who were depressed reported more somatic complaints than White American women. Greater somatic manifestations among many ethnic groups may be associated with philosophical or cultural underpinnings that emphasize an integrated or holistic mind-body-spirit experience (Hwang, Wood, Lin, Cheung, & Wood, 2006). This can be seen in Traditional Chinese Medicine (TCM) where the mind and body are treated as one, inseparable, and a balance of yin (negative) and yang (positive) energies.

How psychological or emotional distress is initially expressed can also be culturally incongruent and open the door for social or self-criticism (Chun et al., 1996). In some cultures, extreme emotional reactions may elicit negative social responses (e.g., other perceiving this person as crazy, weak, or lazy); whereas, somatic expression of distress may elicit empathy and help rally support from social networks (e.g., the belief that this person has a real medical problem and needs help). Illnesses are dynamic in that they represent complex social constructs that are influenced by social norms and complex social feedback interactions between the person and their social environment (Chun et al., 1996). In some cultures, attribution of interpersonal distress to physical causes may also initially protect patients from feeling negative emotions and worry, and reduce feelings of shame, weakness, and loss of control.

Although Chinese patients may initially report more somatic symptoms and suppress or ignore emotional symptoms, this does not mean that they do not experience emotional and cognitive symptoms (Cheung, 1982; Cheung & Lau, 1982). In fact, clinical experience tells us that after developing a good therapeutic relationship, Chinese patients begin to feel more comfortable expressing more cognitive and affective symptoms. In addition, studies have found that although some patients were more likely to focus on physical complaints when they initially came into treatment, they were fully aware of and capable of expressing feelings and talking about the social problems that had brought them into treatment after a strong patient-therapist relationship developed (Cheung, 1982; Cheung & Lau, 1982).

Culture-bound syndromes, defined as culture-specific idioms of distress that form recognized symptom patterns and have distinct clinical characteristics, symptom constellations, and social meanings, have been documented in many cultures (APA, 1994; Levine & Gaw, 1995). Two of the most researched include ataque de nervios and neurasthenia. Ataque de nervios, often characterized as a form of panic attack among Latinos, is associated with feelings of being out of control due to stressful events relating to family difficulties (APA, 1994). Unlike traditional panic attack, it is not associated with the hallmark symptoms of acute fear or apprehension. Other symptoms include trembling, uncontrollable shouting or crying, somatic feelings of heat rising through the chest to the head, dissociative experiences, seizure-like fainting episodes, and aggressive behavior (APA, 1994). Recent evidence suggests that although a portion of those diagnosed with ataque de nervious also meet criteria for panic disorder, the majority of subjects with ataque de nervios do not, suggesting that ataque de nervios is a more inclusive construct (Lewis- Fernandez et al., 2002). Key features that distinguish ataque de nervious from panic include a more rapid onset of attack, being preceded by an upsetting event in one's life, and greater fears of losing control, going crazy, depersonalization, sweating, and dizziness (Lewis-Fernandez et al., 2002; Liebowitz et al., 1994).

Neurasthenia (NT) or shenjing shuairuo in Mandarin Chinese, commonly referred to as a Chinese form of depression, is characterized by two highly overlapping symptom domains including increased fatigue after mental effort (e.g., poor concentration, increased distractibility, inefficient thinking) or physical weakness or exhaustion that is accompanied by physical pains and inability to relax (e.g., headaches, dizziness, sleep difficulties, gastrointestinal problems, anhedonia, and bodily pain) (WHO, 1992). This diagnosis continues to be used in China and is included in the Chinese Classification of Mental Disorders, Second Edition (Neuropsychiatry Branch of the Chinese Medical Association, 1989). There continues to be controversy about whether neurasthenia is merely major depression with a cultural label or whether it is a distinct diagnostic entity. For example, Kleinman (1982) found that 87% of psychiatric patients diagnosed with NT in a Chinese clinic could be rediagnosed with major depression. In contrast, a recent epidemiological study of Chinese Americans in Los Angeles found that 78% of those diagnosed with neurasthenia did not meet criteria for major depression or an anxiety disorder, yielding a neurasthenia prevalence rate that was as high as that of major depression (Zheng et al., 1997).

Many other culture-bound syndromes have also been documented (Levine & Gaw, 1995). Unfortunately, there is less empirical research to help us understand these syndromes which affect people from all around the world. For example, many cultures believe in magical powers, spiritual possessions, and witchcraft or juju. In Northern Africa and parts of the Middle East, cases of “Zar” or a spiritual possession type culture-bound syndrome have been reported (Grisaru, Budowski, & Witztum, 1997). In Western Africa and different parts of Asia, similar but qualitatively distinct

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small-scale epidemics of genital shrinking distress have also been reported (Dzokoto & Adams, 2005). There is clearly a link between culture and the development, expression, and definition of psychiatric disorders. Because of the link between Westernization and increasing rates of eating disorders across the world, some have also begun to question whether commonly accepted psychiatric disorders which were believed to be culture-universal, such as anorexia nervosa and bulimia, are actually western culture-bound syndromes (Banks, 1992; Keel & Klump, 2003).

1.3. Expression of distress, diagnostic accuracy, and the prevalence of illness

The ability to accurately identify and classify illness is an essential part of providing quality health care (Corey, Corey, & Callahan, 1993). Accurate diagnoses help practitioners properly identify the problem, prescribe an appropriate treatment, and understand the etiology, course, and prognosis of the illness. Moreover, the ability to accurately diagnose a problem helps us determine the prevalence of different illnesses and assess the public health needs of different populations. Diagnostic and assessment practices can be especially challenging because of cultural differences in the manifestation, presentation, and concealment of problems (Pathway I). As a result, current diagnostic systems, which are based on Western conceptualizations of mental illness, may be less accurate in diagnosing those from different cultural backgrounds. In fact, there is much literature documenting the fact that ethnic minorities are more likely to be misdiagnosed than Whites (Fernando, 2005; Smedly et al., 2003; USDHHS, 2001).

Differences in expression influence diagnostic accuracy and ultimately impact our ability to assess the prevalence and rate of psychiatric disorders across different groups as illustrated by Pathway L. Ability to differentially diagnose patient problems is necessary for accurate referral and treatment. In order to develop accurate assessment instruments, Marsella, Kaplan, & Suarez (2002) recommends the following considerations: (a) appropriate items and questions, including the use of idioms of distress; (b) opportunities to index frequency, severity, and duration of symptoms since groups vary in their reporting within certain modes; (c) establishment of culturally relevant baselines in symptom parameters; (d) sensitivity to the mode and context of response (i.e., self-report, interview, translation issues); (e) awareness of normal behavior patterns; and (f) symptom scales should be normed and factor-analyzed for specific cultural groups. In addition to having accurate assessment instruments, clinicians need to be culturally competent and aware so that diagnostic errors can be reduced.

Accurate clinical diagnoses are essential to providing appropriate and equitable services for all patients. Inaccurate diagnosis severely impairs our ability to properly assess the prevalence of problems in different communities, which in turn, impacts our understanding of the immediacy of the problem and our ability to respond with policy efforts (Pathway K). For example, epidemiological studies assessing the rates of depression among Chinese and Chinese Americans have found lower rates of depression than the general U.S. population (Chen et al., 1993; Hwu, Yeh, & Chang, 1989; Takeuchi et al., 1998; Yeh, Hwu, & Lin, 1995). However, community-based studies of Asian Americans have found higher rates of depressive symptoms among Asian Americans than White Americans (Abe & Zane, 1990; Kuo, 1984; Okazaki, 1997; Sue & Sue, 1987a). Is this because Asians Americans are truly less depressed, or is it because they exhibit a narrower range of symptoms, and consequently do not meet the five out of nine symptoms required to qualify for a diagnosis? If they only meet three or four of the five symptoms required, but evidence similar or greater severity in those symptoms or evidence equal or greater functional disability, should they not meet criteria for depression? Is this discrepancy due to methodological and/or reporting biases where some ethnic minorities may be less likely to reveal psychiatric difficulties to interviewers whom they do not personally know, but are willing to endorse experiencing a problem on a symptom checklist? Should an individual who evidences additional other symptoms be given a diagnosis of depression if these symptoms are not included in the DSM or ICD, but are indicative of cultural manifestations of depression (e.g., somatic difficulties)? Should an individual be given a diagnosis of major depression if they do not meet diagnostic criteria, but do meet criteria for a depressive culture-bound syndrome such as neurasthenia? Because health care insurance does not pay for services unless a diagnosis is provided, should individuals who evidence considerable illness burden but do not meet Western criteria for depression be excluded from coverage? These and other culture-related questions need to be answered if we are to provide appropriate care. If left unattended, biases in diagnostic practices may lead to inaccurate assumptions about how prevalent problems are in minority communities, and inappropriately influences funding and policy decisions, resulting in deficiencies in the type, quality, and amount of treatments provided (Pathways K and L).

When diagnosing those from different cultural backgrounds, practitioners must also be knowledgeable enough to understand whether symptoms and behaviors are culturally normative. For example, Egeland, Hostetter, and Eshleman

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(1983) pointed out that an insufficient understanding of Amish cultural values and norms can easily lead to misdiagnosis of bipolar illness. They pointed out examples of what would be considered to be normative behaviors by mainstream White standards would meet manic criteria for grandiosity, excessive involvement, and reckless behavior in Amish culture (e.g., driving a car, using machinery, dressing in nontraditional clothes, flirting with a married woman, smoking, taking vacations off season, and excessive telephone usage).

In addition, it is also important to understand within-group differences in psychiatric risk. For example, Brown, Ahmed, Gary, and Milburn (1995) found a significant within-group age effect indicating that African Americans between the ages of 20–29 and over age 65 evidenced the highest risk for major depression than those in their middle adulthood. In examining gender differences, the National Comorbidity Survey found that African American women between the ages of 35 to 44 were at particularly high risk for becoming depressed (Blazer, Kessler, McGonagle, & Swartz., 1994). Among Chinese Americans, elderly Chinese American women have been found to have the highest rates of suicide when compared to other groups (Yamamoto et al., 1997; Yu, 1986). Unfortunately, some ethnic groups such as Native Americans have been subject to the cumulative effects of devastating experiences, and as a result evidence more illness burden as a whole than White Americans (Robins, Chester, & Goldman, 1996).

1.4. Culture, expression of distress, and help-seeking

In raising the issue of culture, illness, and care, Kleinman (1978) introduced the notion of the explanatory model of illness. He proposed that how a patient understands and experiences an illness is embedded within a social context. As a result, those from different cultural backgrounds may experience and interpret their illnesses differently, as well as affix different labels to their sickness (Kleinman, 1978, 1988). These labels serve to prescribe a socially sanctioned sick role that can potentially minimize the social consequence and the amount of stigma experienced by those who are ill. Explanatory models may also impact the manner in which distress is expressed and experienced, and play a role in identifying what types of expression are more culturally normative. When both the practitioner and client are from the same cultural system, it is more likely that they will have matching explanatory models which reinforce socially constituted “clinical realities” (Kleinman, 1978). However, when the patient and clinician's explanatory models do not match, the cultural and clinical realities of what is perceived to be wrong, what caused the problem, and what type of treatment is most appropriate may conflict and lead to misdiagnosis, greater disbelief in the service provided, treatment dissatisfaction, noncompliance, and less than optimal outcomes.

Cultural meanings of illness are likely to influence the manner in which distress is expressed (Pathway D). The manner in which one experiences his/her illness and expresses his/her distress is embedded in a larger cultural milieu, and ultimately affects the who, why, when, how, and if people seek help and cope with problems as illustrated in Pathway E. Those who believe his/her problem is psychological might seek help from a psychologist, while those who believe his/her problems are somatic, and because there is a large amount of stigma associated with mental illness in many cultures, may choose to seek help from a primary care physician (Hwang et al., 2006). There is some research to suggest that ethnic minorities may be more likely to seek psychiatric help from their primary care physician than mental health practitioners, but that primary care doctors are at greater risk for not detecting mental health problems among various ethnic minority groups (Borowsky et al., 2000).

For many ethnic minorities, an additional choice has to be made, whether to seek help from a formal source (e.g., psychiatrist or physician), or whether to explore more indigenous or informal sources of treatment that they may be more familiar with, have greater access to, and have more confidence in (e.g., TCM, herbal treatment, or religious prayer). Research examining alternative services have found that even though use of alternative therapies are popular among U.S. citizens in general (Eisenberg et al., 1998), ethnic minority groups may be more likely to turn to indigenous or complementary treatments for physical and mental health care (Barnes, Powell-Griner, McFann, & Nahin, 2004; Becerra & Inlehart, 1995; Koss-Chioino, 2000).

The relation between cultural beliefs about the causes of illness and where one seeks helps also needs to be further researched. There is a growing body of research confirming that non-White groups hold different beliefs about the causes of their illness than Whites. For example when explaining why they developed schizophrenia, Bangladeshis and African-Caribbeans living in the U.K. are more likely to cite supernatural causes than Whites who more frequently cite biological reasons (McCabe & Priebe, 2004). Different beliefs about the causes of one's illness may result in differential usage of coping methods to deal with one's problems. For example, depressed Chinese Americans seeking health in primary care rarely reported depressed mood spontaneously and only 10% of patients labeled their illness as a

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psychiatric condition and 3.5% sought care from a mental health professional for their depression (Yeung, Chang, Gresham, Nierenberg, & Fava, 2004). Most of the patients sought help from primary care, lay help, and used alternative treatments.

Religion may also act as a powerful coping resource for all groups (George, Larson, Koenig, McCullough, 2000), there is some evidence to suggest that marginalized ethnic minorities such as African Americans may engage in more religious coping to deal with adversity than White Americans (Conway, 1985), and that they report having greater satisfaction with their religious coping efforts and feel more connected to God (McAuley, Pecchioni, Grant, 2000; Myers & Hwang, 2004). Better integration of indigenous and alternative health care services (e.g., herbal medicine, prayer, and TCM) may help facilitate the patient's “buy-in” to therapy because it establishes a cultural bridge that links the patient's cultural beliefs to the treatment.

Currently, most people suffering from a mental illness do not receive treatment (USDHHS, 1999). Ethnic minorities are also less likely to have access to and use mental health service than Whites, with many groups evidencing delayed help-seeking (Cheung & Snowden, 1990; Robins & Regier, 1991; Snowden & Cheung, 1990; Swartz et al., 1998; Sussman, Robin, Earls 1987). The underutilization of mental health services by minorities is likely the result of a combination of culture-related and economic barriers, such as lack of insurance and greater poverty in many minority communities (USDHHS, 2001). For example, African Americans, Native Americans, Latino Americans, and some Asian American groups have a much higher rate of poverty and are less likely to be insured than White Americans (Proctor & Dalaker, 2003; Brown, Ojeda, Wyn & Levan, 2000). Lack of insurance and financial barriers have been found to be related to decreased help-seeking rates among ethnic minorities (Abe-Kim, Takeuchi, & Hwang, 2002; Chin, Takeuchi, & Suh, 2000). However, even when health insurance plans do cover mental health services or when sociodemographic and need variables are controlled, it does not seem to increase treatment seeking as much for ethnic minorities as for Whites (Padgett, Struening, Andrew, Pittman, 1995; Swartz et al., 1998), indicating that financial barriers are not sufficient explanations of why ethnic minorities utilize mental health services at a lower rate.

Not enough research has been conducted on stigma, which is one of the most formidable obstacles to making mental health services available and accessible to the general public (USDHHS, 1999). Stigma towards mental illnesses is a worldwide phenomenon and operates by motivating the general public to reject, avoid, fear, and discriminate against those with mental illness (Corrigan, 2004). As a result, those with mental illness become ashamed, conceal their problems, and delay or do not seek help due to fear of being stigmatized and negatively labeled. Unfortunately, there is little comparative research examining the prevalence of mental illness stigma among different ethnic groups. However, many people believe that stigma operates more severely among non-White communities, and has a more detrimental impact on help-seeking behavior for a number of reasons, including ethnic communities being less educated about mental health issues or where to seek treatment, cultural incongruity between cultural beliefs and Western psychiatric services, decreased confidence in the treatments available, and collectivistic cultural orientation which places greater importance on social appearances (Ng, 1997; Uba, 1994). For example, Ng (1997) pointed out that stigma is such a powerful factor in Asian cultures that it not only reflects badly on the one who is ill, but it also diminishes the economic and marriage value for that person as well as his/her family. Because strong stigma towards mental illness is often equated with being “crazy” or “weak” in many ethnic minorities, community interventions that focus on public health education and decreasing stigma in community and clinical populations are sorely needed.

The shortage of ethnic minority mental health professionals and the limited availability of services available in various ethnic languages also act as a barrier to treatment. Some research suggests that ethnic minorities would prefer an ethnic-matched provider, but that few ethnic minority providers are available (USDHHS, 2001). This issue becomes even more salient because many ethnic minority groups have less than positive attitudes towards mental health services. For example, because of historical experiences with racism and discrimination, African Americans may have a greater fear and misunderstanding of mental health services than White Americans (Clark et al., 1999; Keating & Robertson, 2004). Mistrust of mental health providers was cited as a major barrier to receiving mental health treatment by ethnic minorities (USDHHS, 1999). Summative reports in the U.S. and England have also found that some ethnic minorities lack confidence in the mental health care system and feel that they have been mistreated and discriminated against by providers and the system (Smedley et al., 2003; USDHHS, 2001).

Reducing the impact of racism and addressing social inequalities that act as barriers to care needs to be properly addressed if we are to improve care for ethnic minorities. In summarizing the apparent failure of England's mental health system in treating ethnic minorities over the past 20 years, Fernando (2005) notes that ethnic minorities are more often than Whites to be diagnosed as schizophrenic, compulsorily detained in hospitals, admitted as offender patients,

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held by the police for observation for mental illness, transferred to locked wards from open wards when they are patients in hospitals, given high doses of medication when they are hospital patients, and are less likely to be referred for psychotherapy when suffering from a mental illness. Keating (2000) underscores that anti-racist perspectives and proper staff training is critical in fighting provider racist ideas, institutional racism, and discriminatory practices. Until these issues are adequately addressed, social inequalities, fear of discriminatory maltreatment, and dissatisfaction with services will continue to act as barriers to care.

1.5. Help-seeking, diagnoses, and their relation to treatment

The from who, when, why, how, and if one seeks help is likely to affect treatment quality, availability, access, and outcomes as illustrated by Pathway F, and also has important implications for treatment outcome if people are delaying treatment and coming in only when their problems get intolerably worse. Practitioners from different help-seeking sources such as primary care, mental health services, and indigenous medicines may also diagnose patients differently (Pathway G), leading to different types of treatment given as well as potentially different outcomes (Pathway H). Overall, the available research evidence indicates that ethnic minorities evidence higher levels of mental illness burden and disability, and that they are less likely to have access to and receive quality health and mental health services (Smedley et al., 2003; Sue & Chu, 2003; USDHHS, 2001). In addition, some ethnic minority groups are more likely to drop out of treatment prematurely and evidence worse treatment outcomes (Smedley et al., 2003; USDHHS, 2001). Given what we currently know about the relationship between culture and various mental health domains, there are a number of strategies that we can use to improve services.

For example, if we believe that stigma plays a large role in why minorities do not seek care (Ng, 1997; Uba, 1994), more efforts need to be placed on public health education and breaking down common stereotypes and misperceptions of mental illness and its treatment. In addition, if we know that minorities are likely to seek other sources of support first or to access alternative sources of care (Barnes et al., 2004; Becerra & Inlehart, 1995; Eisenberg et al., 1998; Koss- Chioino, 2000), a stronger coordination of services could be established and educational brochures and resources could be placed in strategic locales. If we know that some ethnic minorities may delay treatment seeking and as a result are more likely to be severely ill at point of entry and be hospitalized into the health care system (Breaux and Ryujin, 1999; Hu, Snowden, Jerrell, & Nguyen, 1991; Snowden and Cheung, 1990; Sue, 1977; Sue & Sue, 1987b), more effort should be placed on ensuring that the initial contact is culturally sensitive and that a smooth transition is made in referring clients to service centers that may be better able to serve their needs. In addition, greater emphasis on orienting clients to mental health services should help decrease stigma, misperceptions, and comfort in treatment which will hopefully reduce treatment outcomes. There is some evidence to suggest that treating patients in a more culturally sensitive manner (i.e., providing client-therapist ethnic matching and being treated at ethnic-specific services) can reduce premature treatment dropouts (Flaskerud & Liu, 1991; Sue, Fujino, Hu, Takeuchi, & Zane, 1991; Takeuchi, Sue, & Yeh, 1995). Among English speaking Asian Americans, the beneficial effects of being treated at a culturally sensitive treatment center seem to outweigh the positive effects of being matched with an ethnically similar therapist (Takeuchi et al., 1995), indicating that training therapists to be culturally competent and developing culturally congruent interventions can serve as a form of quality improvement, and should be a top priority in improving care.

Unfortunately, we still know little about the direct benefits of cultural competence in influencing outcomes for minority groups. There continues to be a lack of empirical research examining this issue, and as a result, we have yet to confirm the active mechanisms that might lead to more positive results. In order to improve cultural competency trainings, an integration of theory, clinical insight, and empirical findings will be needed to better inform our efforts. It is surprising that more resources have not been delegated to understand this very important issue. Other areas that need more work include building a better recruitment and training pipeline to address the shortage of ethnic minority mental health professionals.

Recently, the American Psychological Association (APA) published “Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (APA, 2003). Although these guidelines reinforce the idea that culture and diversity need to be taken into account when treating diverse clientele, they have been largely aspirational. Specifically, professionals who want and need to be culturally competent are left with the message that culture matters, but continue to struggle with how to be a more culturally competent provider in concrete terms.

It is still unclear how discrepancies in the availability of effective treatments for ethnic minorities are being addressed. There seems to be growing interest in understanding whether psychological treatments work in refugee

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populations. For example, a small body of outcome research indicates that various psychotherapies may be effective in treating PTSD in adult and child refugees in Africa, Sweden, and other European countries (Lustig et al., 2004; Neuner, Schauer, Klaschik, Karunakara, Elbert, 2004; Paunovic & Ost, 2001). However, there is little long-term outcome research and there is some evidence to suggest that refugees may continue to suffer form the enduring effects of war and trauma (Carlsson, Mortensen, Kastrup, 2005).

Recent reports indicate that ethnic minorities have for the most part been left out of the U.S. APA's initiative to establish, define, and validate empirically supported treatments. For example, the U.S. Surgeon General's report indicates that out of the 9266 participants involved in the efficacy studies forming the major treatment guidelines for depression, bipolar disorder, schizophrenia, and ADHD, only 561 participants were African American, 99 were Latino, 11 were Asian Americans or Pacific Islanders, and none were Native Americans or Alaskan Natives. Other reviews have also found that although there is a growing body of literature documenting that psychotherapeutic treatments work with some minority groups, there continues to be a dearth of research examining how they respond to Empirically Based Treatments (EBTs) (Miranda et al., 2005).

This critical lacuna in our knowledge along with our under-preparedness to effectively treat ethnic minorities suffering from mental illness is becoming more apparent. Mental health providers are faced with the dilemma of either (1) implementing an “as-is approach” to disseminating Empirically Based Treatments (EBTs) to ethnic groups who are culturally different, (2) adapting EBTs to be more culturally congruent in order to better fit the needs of ethnic clientele, or (3) developing new, culture-specific EBTs for each ethnic group (Hwang, 2006b). Implementing an “as is approach” or culturally unmodified EBT is likely to improve quality of care because ethnic minorities currently seldom receive EBTs. However, this may not fully address the discrepancy in treatment outcomes between ethnic minority and White patients, and we still do not know whether EBTs are ecologically valid or will be effective in treating ethnic minorities. Developing new ethnic-specific treatments may be prohibitively costly and not yet fully justified. Again, given the importance of these issues, it is surprising that so little treatment research has been conducted on ethnic minorities.

In trying to address this dilemma, some effort has been put forth to increase cultural competence, develop ethnic- specific approaches (Costantino, Malgady, & Rogler, 1986; Morita, Kondo, & LeVine, 1998), and adapt EBTs to better meet the needs of immigrant communities (Malgady, Rogler, & Costantino, 1990). Sue (1998) brought to the attention the issue of “dynamic sizing” or the skill of knowing when to generalize our cultural knowledge and when to flexibly individualize treatments. Awareness of dynamic sizing helps prevent the development of rigid overgeneralizations and stereotypes that may work to decrease the cultural effectiveness of those learning to be culturally competent. Hays (2001) also provided the “ADDRESSING” framework to help clinicians understand and respond to cultural complexities. Specifically, minorities possess many aspects of identity that may be even more salient than ethnicity and that should be included in the conceptualization of how best to treat the client, such as their (A) age and generation- al influences, (D) developmental or acquired disabilities (D), (R) religion and spiritual orientation, (E) ethnicity, (S) socioeconomic status, (S) sexual orientation, (I) indigenous heritage, (N) national origin, and (G) gender. For example, a client is not just Vietnamese American. Adapting therapy to be more culturally responsive can be incredibly difficult because culture can have both proximal and distal effects on the various domains of mental health, as illustrated by the CIMHmodel. This can be especially problematic when providers attempt to apply cultural knowledge to the therapeutic process because such knowledge is quite distal to therapeutic outcomes and practitioners have difficulty operationalizing this information (Sue & Zane, 1987).

In trying to bridge the gap between cultural understanding and helping practitioners think systematically about improving treatment efforts, Hwang (2006b) developed the Psychotherapy Adaptation and Modification Framework (PAMF) to help facilitate adaptation of psychotherapy for use with ethnic minorities. The PAMF framework consists of a three tiered framework consisting of 6 broad domains, 25 adaptable therapeutic principles, and corresponding rationales. Domains targeted for adaptation include: (a) dynamic issues and cultural complexities, (b) orienting clients to psychotherapy and increasing mental health awareness, (c) understanding cultural beliefs about mental illness, its causes, and what constitutes appropriate treatment, (d) improving the client-therapist relationship, (e) understanding cultural differences in the expression and communication of distress, and (f) addressing cultural issues specific to the population. This three-tiered approach to presenting cultural adaptations to therapy was developed in order to make the PAMF more accessible, user-friendly, and adaptable for use with other diverse populations.

Because many mental health professionals need and want to be more culturally competent, research and trainings that help practitioners conceptualize and actualize these hard to render and needed skills are sorely needed. Adaptation of treatments is especially important since the concept of therapy and the rationale behind therapeutic treatment may be

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culturally unfamiliar or foreign to those who have had little exposure or experience with mental illness, and to cultures where mental illness can be especially stigmatizing (Hwang, 2006; Hwang et al., 2006). Although the core healing elements of many therapies may generalize across cultures, packaging treatments to better fit with a patient's needs is integral to improving patient satisfaction, improving treatment involvement, compliance, outcomes, and reducing premature dropout. It is the responsibility of treatment providers to deliver culturally sensitive care that is easily translatable and understood by consumers, not the responsibility of patients to adjust to the requirements of treatment approaches that may be culturally dystonic. Because health disparities are very real, cultural sensitivity and modifications that make health care services more accessible to consumers are a necessity rather than a luxury.

1.6. Meeting the needs of ethnic minority and immigrant communities: policy implications

Given that many ethnic minorities and immigrants are culturally different from White Americans and Europeans, current health care systems may not be prepared to meet the needs of rapidly diversifying countries. This has become increasingly evident as recent reports reaffirm that racial and ethnic health disparities do exist, and that there may be biases in the health care system that influence whether people of differing backgrounds receive equitable services (Smedley, 2003; USDHHS, 2001). Concrete plans for preventing health disparities at all levels need to be implemented. These plans need to be global and international in nature. Recently, the World Health Organization (WHO) reported that mental illness accounts for five of the top ten leading causes of disability around the world and accounts for between 12–15% of the disease burden in the world (Murray & Lopez, 1996).

Yet few national and international policies have been developed to address this global problem. For example, when reviewing existing international policies across the world for child and adolescent mental health care, Shatkin and Belfer (2004) found that only 18% of countries worldwide had an identifiable mental health policy. This is especially problematic for developing countries where access to quality health and mental health care is less available. Patel, Saraceno, and Kleinman (2006) note that policies that help address international access to services need to be established and that it is unethical to deny effective and affordable care to those suffering from mental illness. For example, international property rights agreements deny developing countries the right to produce generic versions of drugs, resulting in unaffordable prices set by pharmaceutical companies. Civil rights abuses, including denial of basic rights, forced long-term residential treatment, treatment with older drugs with severe side effects, unsanitary conditions, and forced lockdowns of those who are mentally ill, also occur throughout the world. In addition to improving training and educational programs, policies that establish incentives for returning to one's country and reducing the brain drain among developing countries to more affluent countries need to be developed.

In the U.S., the President's New Freedom Commission (2003) and the Institute of Medicine (IOM, 2001) recommend that transformations in mental health delivery systems target 6 goals for improvement, including ensuring that people understand that mental health is essential to general health, mental health care is consumer and family driven, disparities in mental health services are eliminated, early screening, assessment, and referral services are established, quality mental health care is delivered and research is accelerated, and technology be used to access mental health care and information. These recommendations are surprisingly similar to targeted improvements in England (Beinecke, 2005), and could be applied to international services and a Global Alliance for Mental Health under the umbrella of the World Health Organization (Patel & Kleinman, 2006). When actualizing these goals, particular attention needs to be made to fulfilling these obligations to ethnic minority and immigrant populations.

Fernando (2005) notes that some of the more successful multicultural services in the UK tend to employ a number of “good practices,” including the use of multicultural multidisciplinary teams, specific cultural sensitivity and anti-racist practice trainings, anti-oppressive practices in establishing collaborative ties with communities and helping clients deal with racism, increasing the number of ethnic minority staff and improving the educational pipeline, linking psychological support to housing, providing advocacy to help clients deal with statutory services, integrating cultural spirituality and alternative treatments to psychotherapeutic services, and culturally adapting psychotherapy for clientele. For developing countries, these goals may only be aspirational and critical economic and social problems may need to be addressed more immediately.

There is much that we can do as mental health researchers, practitioners, and teachers to improve our cultural awareness and competence. However, mental health providers need to develop a more sophisticated understanding of how culture systematically affects several interrelated mental health domains. The CIMH conceptual framework was developed to help providers move beyond simplistic dyadic conceptualizations of cultural influences and to better

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understand the complexities involved in providing culturally competent and sensitive care. Although we acknowledge that this paradigm is far from comprehensive, we offer it as a basic framework for understanding systematic and interrelated cultural issues and their impact on mental health. We hope that the CIMH model can be used to help improve the teaching of psychological research and practice.

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