East-West Cultural Differences in Depression

Reported cases of anxiety and mood disorders are much less common in China than in the United States. In this country, lifetime prevalence for an anxiety disorder is nearly 30 percent but only 5 percent in China. Likewise, about 20 percent of Americans will experience a major depressive disorder at some time in their lives, but for their Chinese counterparts, it’s only 2 percent.

That’s not to say that China is an especially happy country. Cross-cultural studies of subjective well-being find Americans to be among the happiest people in the world, along with other Western nations, such as Canada and Australia. However, happiness ratings place China and other East Asian countries, like Japan and Korea, right in the middle—neither extremely happy nor extremely unhappy.

This is the conundrum that has perplexed cross-cultural psychologists for decades. Western nations report high levels of subjective well-being but also high rates of anxiety and depression. In contrast, Eastern societies appear to be less happy, but they also experience fewer emotional disorders.

For many years, psychologists believed this paradox occurred because anxiety and depression were underreported in Asia. According to this view, the stigma against mental illness is so high that Asians convert psychological disorders into physical symptoms, complaining of headaches, stomach aches, and insomnia instead.

However, Australian psychologist June De Vaus and her colleagues argue that there’s no evidence to support this conjecture. Furthermore, rates of schizophrenia are similar in the East and the West, suggesting that there's no reporting bias despite being highly stigmatized. So these researchers instead propose that cultural differences in emotional disorders are due to the way Easterners and Westerners think about and respond to emotions.

Over the past several decades, cross-cultural psychologists have documented fundamental differences in worldview between Eastern and Western cultures. Westerners approach the world from an analytical perspective. They tend to divide the world into mutually exclusive categories—self versus other, good versus evil, happiness versus sadness. They also have the habit of mentally isolating people, objects, and events from the broader context in which they occur. Westerners tend to think of themselves as independent, viewing the self as a kind of free agent in interactions with others.

In contrast, people in Eastern cultures tend to view the world in a holistic fashion. They don’t think in terms of mutually exclusive categories. In fact, they expect opposites to coexist, as symbolized by yin and yang—a bit of darkness in the light, and a spot of light in the darkness. Furthermore, when attending to a person or object, they’re more likely to also consider the influence of the broader context. Easterners also see themselves as interdependent with others, defining the self in terms of relationships and mutual obligations.

These disparate worldviews extend back millennia, and they’re deeply ingrained in the cultures of the East and the West. We learn a particular worldview growing up in a specific culture, and these patterns of thought permeate our psychology. As we mindlessly muddle through the day, we think in the patterns our culture has given us. But when we’re mindful, we can certainly adopt an alternative worldview. For example, “holistic” Easterners think analytically when they’re doing math or logic, and “analytic” Westerners think holistically when they’re engaged in creative or innovative work.

If the incidence of emotional disorders is so much lower in Asia, De Vaus and colleagues argue, we may be able to learn some effective coping strategies by studying how Asians deal with negative emotions. In their research, they found three ways of thinking about emotions that differ between Eastern and Western cultures. These ways of thinking then give rise to particular responses that reduce the likelihood that setbacks in life will lead to depression or anxiety.

• Emotions co-occur. Westerners tend to view happiness and sadness as opposites and therefore as mutually exclusive. In their unbridled pursuit of happiness, they avoid sad feelings at all costs, believing these will diminish their well-being. Easterners, however, are open to experiencing contradictory emotions at the same time. There’s always some sadness on any happy occasion, and some happiness can be found even in the darkest times. Thus, negative experiences are less threatening because they don’t preclude happy feelings.
• Emotions change. Westerners tend to think of emotions as arising from a stable self. If I think of myself as a happy person, then I need to discount any negative experiences as anomalies—not really part of who I am. Likewise, those who suffer from depression often think that’s the way they’ll always feel. Easterners, in contrast, view emotions—as well as the self—as constantly changing. Thus, negative experiences are less threatening because they’re only temporary.
• Emotions arise from context. Unlike Westerners, who view emotions as arising from within themselves, Easterners see emotions as emerging from the situation they’re in. This means that moods can be changed by altering the context, in particular by aligning thoughts and behaviors with the expectations of their social groups. By distancing themselves from their emotions, Easterners are better at regulating them. Thus, negative experiences are less threatening because there’s something you can do about them.

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De Vaus and colleagues then consider how these cultural differences in ways of thinking about emotion impact two common behaviors that people engage in when they’re feeling sad—suppression and rumination. Westerners often try to cope with negative moods by pushing them out of mind. But suppressing bad feelings in this way usually backfires, increasing the likelihood of sinking into depression.

Easterners also suppress negative emotions, but in a different way. Although they feel bad, they try not to show it because they don’t want to affect other people. The upshot of this is that when Asians feel sad they remain socially engaged, which generally boosts their mood.

When we're sad, we also have a tendency to focus our thoughts on our feelings. Westerners tend to ruminate about their negative emotions by thinking: “What’s wrong with me?” In contrast, Easterners are more likely to think: “What’s wrong with the situation?” Thus, while ruminating leads Westerners into a vicious cycle of negative thoughts about themselves, the same process leads Asians to seek solutions to their problems.

As we consider cross-cultural differences, it’s important not to think of one worldview as superior. On the one hand, the Western worldview—analytical and independent—leads to high levels of subjective well-being for most people, but at the expense of greatly increased risk of anxiety and depression. On the other hand, the Eastern worldview—holistic and interdependent—provides protection from emotional disorders, but it also reduces overall levels of happiness.

You aren’t a captive of your culture. By learning how others view the world, you can selectively adopt worldviews to your benefit. When you’re feeling blue, try taking a holistic perspective. Remind yourself that bad times eventually give way to good times. And keep in mind that your moods are telling you something about your current situation. Start focusing on how to change the situation, and you’re well on your way to feeling much better about yourself.