Unpacking Somatization:A Cross-Cultural Study Among Chinese And South Koreans

The interdisciplinary field of cultural psychopathology has made considerable advances over the past few decades, bringing together work from many disciplines, including psychiatry, anthropology, and psychology. Although each of these disciplines provides its own perspective, the shared goal is to study the interrelation of culture and mental health. That "culture matters" in psychopathology is widely accepted. However, at least two problems exist:there is relatively little research in cultural psychopathology that aspires to explanation, to telling a culturally-framed story about the observed cultural variation; individuals from China, South Korean and Japan were regarded as sharing the same culture, namely East Asian Culture. The author starts from the emblematic finding in cultural psychopathology—Chinese somatizaiton, i. e., compared with people of European heritage, the tendency for people of Chinese heritage to emphasize somatic symptoms over psychological symptoms when depressed, tries to construct the mechanism models of Chinese somatization. Furthermore, the author extends these models to South Koreans and tests if the East Asian Culture assumption is reasonable.The thesis is consisted of five Chapters. Chapter one reviews concepts and studies related to depressive somatization and makes hypotheses. Two rival explanations of Chinese somatization are introduced. The first is experience explanations, which posit that the tendency for Chinese people to emphasize somatic symptoms is due to the experience of physical discomforts; the other explanations, i.e., social strategy explanations, believe that somatization is no more than a communicative act adapting to Chinese cultural contexts, Chinese do not differ from westerners in terms of symptom experiences. With view of culture-mind-brain, Ryder and the colleague (2012) integrated the two explanations. The integration offers the theoretical start point of the current empirical studies. Influenced by the East Asian Culture assumption, past studies also explain South Korean somatization from "experiences" and "social strategies" This provides the theoretical atmosphere for extending Chinese somatization mechanism models to South Koreans.Based on the review, four research questions are proposed: a) what are the cultural scripts related to Chinese somatization? b) what is the mechanism of Chinese somatization? c) can the Chinese somatization related cultural scripts help to differentiate the pathological and cultural components of alexithymia, a concept closely linking to somatization? d) can the Chinese cultural scripts, the Chinese somatization mechanism model and the Chinese alexthymia model extend to South Koreans?Two studies are designed to answer these questions in the following two chapters. Aiming at integrating experience and social strategy explanations, the author first identifies two sets of cultural scripts, i.e., body-sensation and communication scripts, corresponding to the two rival explanations, with confirmatory factor analysis; then explores the relationship between cultural factors, cultural, scripts and somatic symptoms using structure equation modeling. Chapter two uses Chinese college students as participants. To deal with the limitations in Chapter two, Chapter three uses Chinese clinic patients as participants. The results show that the two-factor model, representing body-sensation and communication scripts, has good model fit; the cultural factor â†'cultural scriptsâ†'somatic symptoms model and the cultural scriptsâ†'alexithymia model are supported by the data; the two cultural scripts each differently associate with different variables, meaning the two scripts work differently during the process of Chinese somatization; the two scripts also help to differentiate the pathological and cultural components of alexithymia. Chapter four extends the models of study two to South Korean clinic patients. The results demonstrate that there are both difference and similarity between South Korean models and Chinese models. Thus bring challenge to the East Asian Culture assumption. At last, chapter five concludes this thesis by discussing the mechanism of Chinese and South Korean somatization based on the results of the three studies, summarizes the contributions of the current researches, and the implication to the future studies and clinical practice.