The health sciences and professions are undergoing a revolution in theory and practice that promises to alter radically traditional notions about the nature of human health and disease. At the core of this revolution is the belief that human behavior and its social determinants are critical variables for understanding the etiology, treatment, and prevention of many disorders previously attributed to biological substrates (Galtung, 1983 ; World Health Organization, 1984). Among the many categories of human behavior to receive special attention from health researchers and practitioners, coping has emerged as the most popular (Marsella & Dash Scheuer, 1985).
Coping provides the health sciences and professions with a new and contrasting framework for conceptualizing health and disease. Rather than forcing us to focus on disease, distress, disability, and other failures in human functioning, the use of coping permits us to address health, abilities, resources, and other positive aspects of human functioning.
According to Pearlin and Schooler (1978), coping protects us by (a) eliminating or modifying conditions that give rise to problems ; (b) perceptually controlling the meaning of the experience in a manner that neutralizes its problematic character ; and (c) keeping the emotional consequences of the problern within manageable bounds. These funetions provide a behavioral basis for treating and preventing disease and for promoting health.
COPING : THE PIVOT POINT BETWEEN DEFENSE AND GROWTH
The differentiation between defensive behavior and coping was first made by Norma Haan and Theodore Kroeber in an unpublished report circulated in late 1960 and by Lois Murphy (1960, 1962) in her reports i the Menninger Foundation Coping Project. In a subsequent report, Haan (1963) wrote :
This paper assumes that the mental processes involved in the various coping mechanisms and the classical defense mechanisms are identical. On the other hand, it is on the basis of the properties or qualities of each that the distinction between coping and defense mechanisms is drawn. (Haan, 1963, p. 1)
Both Haan and Kroeber considered ego functions to be general mechanisms that « may take on either defensive or coping functions. » In ntrast to defensive behavior, however, which was considered. « rigid, tomatized, pushed from the past, distorting of the situation, primary ocess based, largely unconscious in origin, and permitting of impulse gratification through subterfuge, » coping behavior was considered to be urposive, flexible, pulled toward the future, oriented toward the Reality of the present situation, primarily conscious or preconscious in igin, and allows impulse gratification in an open and ordered way. »
We believe the concept of coping should be expanded beyond the finitional limits proposed by these early pioneers. In particular, we believe that coping behavior spans a continuum of processes that extends hierarchically from simple reflexive responses to complex patterns of thought and action implicated in human growth and change a species. The function of coping behavior is not simple adjustment rt rather the pursuit of human growth, mastery, and differentiation. It in these pursuits that new alternatives for human variability and olution can emerge. In other words, coping is considered by us to be intimately linked with human evolution and survival. Coping is the key the development of our potential for evolving in the face of the ever-changing demands of the world.
In our opinion, the pivotal point in the hierarchical continuum of hunan behavior is « coping. » Not all behavior is coping. Rather, coping fers to a distinct class of behavior that seeks to resolve problems. We construe coping as the dividing point between those behaviors that are random, defensive, or adjustive and those behaviors that strive toward mastery and différentiation. Coping behavior is the best way to resolve tensions present in the organism-environment interface. It is the pivotal point in the promotion of hurnan growth,
As an organism engages in coping behavior, it creates possibilities for mastery and différentiation. As it moves toward these stages, there is an increased sense of becoming, efficiency, well-being, and integration. In contrast, as an organism retreats from coping behavior and moves toward random behavier, there is an increased sense of stasis, înefficiency, distress, and fragmentation. The stasis-becoming dimension refers te our organismic ability te grow and différentiate rather than remaining static and unchanged. The inefficiency-efjiciency dimension refers te the ratio of diffuse te focused energy expenditure required for a particular demand situation. Diffuse energy reduces the energy pool available for effective adaptation (Wishner, 1955). The distress-wellbeing dimension refers te our subjective sense of harmony and meaning. Finally, the fragmentation-integration dimension refers te our sense of organization, wholeness, and cohesion.
When coping begins, the organism is opened te a new range of possibilities for mastery and différentiation. It is by coping that the organism begins the process of becoming something new, Prier te coping, the organism expends energies on preserving the status quo rather than evolving toward a new level of functioning. From this viewpoint, coping can be considered the basis of human evolution for it leads te mastery of the milieu and différentiation of the organism and thus promotes survival.
THE DEFINITION OF COPING
The word coping is derived from the word cope, whose roots come from the ancient Greek word kolaphos, which means « te strike. » This early meaning came te rnean « te meet, » « te encounter, » or « te strike against. » In contemporary tîmes, the carly meanings have evolved te new definitions that imply its early roots but that embody yet new connotations. For example, Websters Deluxe Unabridged Dictionary (1979) defines « coping » as « To strive or contend with successfülly or on equal terms … te be a match for. »
To clarify the definitionn of coping, the authors reviewed numerous definitions of the terra in various behaviorall science publications. As a group, these definitions were characterized by several key elements including(a) successful utilization of resources, (b) active behavior, and (c) the reductionn of demands through effective solutions. A concordance of these definitions yields a new and more comprehensive definition of coping :
Coping is the promotion of human growth and developrnent through the active utilization of biological, psychological, and social resources which assist in controlling, mastering, and preventing the distress imposed by external and / or internal demands experienced by the organism. (Marsella & Dash-Scheuer, 1985, p. 7)
This definition acknowledges the active nature of the organisra in utilizing the coping resources available to it. It also emphasizes the growth promotion function. Folkman, Schaeffer, and Lazarus (1979) and others have pointed out that coping resources reside within the person and the enviroriment. They contend that personal coping resources include (a) health and energy, (b) morale, (c) problem-solving skills, and (d) systems of belief ; while environmental coping resources include (a) material. resources and (b) social supports.
Much of the conceptualization and research on coping has largely occurred within the context of Western thought and practices. Yet, it is clear that coping is not unique to Western people or cultures. It is, in fact, a universal process. But, the particular coping behaviors and patterns associated with a given culture are not universal. because of distinct psychocultural. traditions and socioenvironmental demands. As we enter the arena of cross-cultural studies of coping, we are confronted with a new set of problems regarding the conceptualization, identification, and measurement of coping. And we are provided with a new opportunity to understand the nature of the coping process and its function in human growth, development, and transcendence.
CROSS-CULTURAL ASPECTS OF COPING
Current Status of Cross-Cultural Coping Research
Although the Western literature on coping is extensive, there are few articles published in English on coping across cultures. This state of affairs is obviously unfortunate because it provides only an ethnocentric %riew of one of the most important concepts in the field of health. It is reasonable to assume that there are certain universals in coping but it is also realistic to assume that there are many ethnocultural différences in coping behavior because of variations in environmental demands, social structures, and community and economic resources.
One reason for the lack of cross-cultural research on coping may be the cultural blindness of Western researchers, who view coping as primarily a direct action emanating from a conscious personal decision. Lee and Newton (198 1) wrote :
The current predominance of Western cultural ideals in the United States has led to a general ignorance of the possible cultural differences in stress coping mechanisms….
The tacit assumption seems to have been made that either cultural différences in coping strategies are not of sufficient importance to warrant further study, or that acknowledged différences are somehow temporary phenomena which will resolve with further acculturation and are therefore not relevant to modern civilization. (Lee & Newton, 1981, p. 13)
The Nature of Culture
Although the terni culture is used a great deal in both technical and popular discussions, its definition is controversial. Kroeber and Kluckhohn (1952) summarized 150 definitions of culture found in the anthropological literature. They pointed out that preferences for definitions were a function of theoretical orientations. We favor a modification of the definition of culture offéred by Ralph Linton (1945). He defined culture as « the configuration of learned behavior and results of behavior whose component elements are shared and transmitted by the members of a particular society » (Linton, 1945, p. 32). To Linton’s words, we would add the phrase, « for purposes of individual and societal adaptation, adjustment, growth and development. »
The definition suggested stresses a functional orientation to the word culture. In contrast to descriptive definitions, this definition acknowledges that culture is a dynamic force in human life that encompasses not only the human effort for survival, but also the human urge toward growth, mastery, and actualization.
Culture is represented both externally and internally. Externally, culture is manifested in our institutions, artifacts, material forms, and role and status structures and processes. Internally, culture is represented in our values, beliefs, attitudes, cognitive styles, epistemologies, and consciousness levels (Marsella, 1985). Both the external and the internal representations of culture reflect its active dynamie nature and the functional role that it plays in human behavior, It is a force that can facilitate and promote human survival and evolution.
Culture and Coping
Any discussion of coping across cultures must begin with the recognition that all cultures reflect the patterns of coping that characterize a given people. Cultures emerge and develop as part of the human effort to adapt to a particular socioenvironmental milieu.
Every culture is a unique solution to the myriad forces imposed on individuals. It is indeed a tribute to the adaptive potential of the human species that so many diverse cultures have evolved over the course of human history. Culture is coping !
Each culture transmits itself through the process of socialization. Throughout this process, what is conditioned are both gencral and specific behavioral patterns for promoting human survival and growth. What is learned are acceptable standards and idealized norms that reflect the hard-won wisdom of previous generations. Through culture, man’s biological adaptive capacities are extended to deal with environmental demands. By understanding the ways that individuals from various cultural traditions cope, health researchers and practitioners can gain unique insights into the promotion of human health and the prevention of human disease.
Cross-Cultural Research on Coping
Perhaps the carliest cross-cultural study of coping was the international collaborative project « Coping Styles and Achievement : A Cross-National Study of School Children, »which was sponsored by the United States Office of Education. This study was directed by Robert Peck and began as a United States-Mexico project but expanded to include comparisons among 6400 children from seven countries including Brazil, England, Italy, Japan, Mexico, the United States (Chicago, Illinois, and Austin, Texas), and Yugoslavia (see Diaz-Guerrero & Peck, 1967 ; Havighurst, 1971 ; Peck & Diaz-Guerrero, 1967).
One of the major instruments used in this study was the « Active versus Passive Views of Life Scale, » a forced choice scale of 60 pairs of statements reflecting active versus passive life philosophies and attitudes (Diaz-Guerrero, 1967). A factor analysis of this scale yielded 22 factors including locus of control, action, instrumentality, emotional control, confrontation, and so forth (Diaz-Guerrero, 1973). The active-passive dimension in coping was also measured using a sentence completion test (Ahumada & Michelis, 1967).
The results of this study indicated that across all cultural settings, « es were more active than females, lower-class children were more passive than upper-class children, and older children were more active than vouriger children. These findings were related to industrial development and the promotion of task achievement orientations. Because no indices of psychological or physical health were included, tbere were no data on the health consequences of the active-passive dimension.
Dunîng this saine time period, however, Leslie Phillips and his coUtagues at Worcester State Hospital in Massachusetts initiated a selies of studies on the relationship between social competence levels and psychopathology in which they argued that a persons style of life (coping) influenced the pattern of mental disorders they developed (Phillips, Broverman, & Zigler, 1966, 1968 ; Phillips & Zigler, 1961). PLIlips and Zigler (1961) wrote :
For every maturity level there exists effective patterns of adaptation as well as pathological deviations froin these patterns, and that both the normal and pathological aspects of the individual’s functioning reflect the maturity level he has attained. This position is in essential agreement with the view that mental disorders are continuing processes in which the pre-morbid, initial, middle, and ultimate stages are interrelated. (Phillips & Zigler, 196 1, p. 19 1)
This hypothesis was tested in several countries including Argentina, Japan, and Israel (e.g., Draguns, Nishimae, Caudill, Broverman, & Phillips, 1971 ; Fundia, Draguns, & Phillips, 1971). Regardless of the country, the results indicated that social competence levels were related to psychopathology. Specifically, individuals with high social coinpetence levels and a style of turning inward evidenced depressive disorders or neuroses while those with low social competence levels and styles of turning against others or withdrawing from others developed schizophrenia or psychopathic problems. These findings indicate a continuity between psychopathology and personality or life orientation style.
The first cross-cultural study to investigate the relationship among stressors, coping, and psychiatric symptomatology was conducted by Marsella and his coworkers (e.g., Marsella, Escudero, & Gordon, 1972 ;Marsella, Escudero, & Santiago, 1969 ; sec Marsella & Snyder, 1981, and Marsella, 1984, for elaborations of this model). This study was conducted in the Philippines and it was subsequently replicated in Taiwan (Hwang, 1976) and Korea (Lee, 1978 ; Marsella, Kim, & Lee, 1973).
These studies were based on the belief that the experience and manifestation of psychopathology is a function of the interaction of stressors and coping resources. Coping was assessed by measuring
(a) philosophies of life,
(b) crisis behaviors, and
(c) social supports.
Through factor analysis and regression equations, it was possible to establish relationships among demographic, stressor, coping, and psychopathology variables. For example, in the Marsella, Escudero, and Gordon study (1972), lower-class Filipino men reporting high levels of housing and employment goal-striving discrepancy stress, used the primary coping beliefi « All that is needed in life are the simple things like a comfortable house, food, and health. » The patterns of psychopathology associated with these variables could best bc described as somatic and psychological agitation (e.g., feels like breaking things in anger, bites fingernails, feels like life is a dream, has too much energy, cannot concentrate, remains in bed, heart palpitations, shortness of breath, stomach pains, drinks alcohol).
The Marsella et ai. studies found that Filipinos tended to rely on four categories of coping beliefs including projection, religion, optimistic fatalism, and self-responsibility. In the Taiwanese study, however, Hwang found that the largest category of attitudinal or cognitive coping was Jen-nai (perseverance, endurance in the face of adversity). This was followed by Mien-tui hsien-shih hsiang pan fa (face the problem and devise a solution), Nu-lifen tou (work hard and strive), seek help from friends, Ting-tlien yu ming (acceptance of ones fate, wait, leave to heaven), Shinn-shin (self-confidence), and appeal to a supernatural power. More than 250 normal male and female subjects from différent age groups and social classes were examined in the study. As was the case for the Filipino study, distinct patterns of psychopathology were associated with distinct stressors and coping beliefs. For example, a paranoid symptomatology pattern was related to the coping belief, « deciding and acting on one’s own, » and a hysterical/somatization pattern was associated with the coping beliefs « some people were born to suffer and others to succeed » and « things always happen according to the will of God. »
In general, the coping beliefs found in the Philippine, Taiwanese, and Korean studies can bc categorized into seven major categories :
(1) Projection : Assign blame to other or to external forces ;
(2) Acceptance :
(3) Religion : (4) Perseverance :
(5) Se r-Action :
(6) Goal Minimization :
(7) Social Support.
Accept one’s plight as destiny or God’s will ; Turn to prayer and other religious rimais ; Endure and persevere in the face of stress, work hard and things will pass ; Assume personal responsibility and choice in dealing with problems, rely on self ; Set low aspiration levels to reduce frustration and disappointment ; Turn to farnily and friends for assistance.
hown the wide arena of cultures in which these coping beliefs were tudied, it is reasonable to conclude that these categories represent a ood sampling of Asian coping belief patterns. It is noteworthy that they o not differ radically from those reported in coping studies using Vestem samples.
Handy and Pukui (1958), Heighton (1971), and Lee and Newton 1981) have all written about coping in traditional Hawaiian culture. )ne of the important conclusions that they reached is that all coping animated from a life orientation that linked the animate and inanimate world to al] of the Hawaiians’behavior patterns. Illness occurred when bere was a breakdown in the interrelationships of the different components. Handy and Pukui (1958) described this as the « psychic phase of relationship. » They stated :
A Hawaiians oneness with the living aspect of native phenomena, that is, with spirits and gods and other persons as souls, is not correctly described by such words a sympathy, empathy, abnormal, supernormal, or neurotic ; mystical or magical … it is part of natural consciousness for the normal Hawaiian-a second sense . . . [encompassing] every phase of sensory and mental consciousness. (Handy & Pukui, 1958, p. 117)
According to Lee and Newton (1981), coping among ancient Hawaiians began with adherence to the psychic-phase relationship. This led to supportive interpersonal relationships, especially among the Ohana (an extended family group) and a felt sense of harmony and place. Rationalization and externalization of the blame followed by mais (e.g., Holoponopono) that reestablished the psychic-phase relationship all provided effective culturally mediated coping mechanisms.
Alan Howard, an anthropologist who studied contemporary Hawaiians, wrote a valuable book titled A ini No Big Thing.- Coping Strategies in a Hawaiian American Community (l 974).
Based on both observation and experimental data, Howard concluded :
Hawaiian Americans learn to cope with problenis by relying on subtle interpersonal strategies and less by relying on personal [material or nonniaterial] assets than do middle class Caucasians … a higher value being placed on sociability and affiliation than on personal achievement. (Howard, 1974, p. 78)
Howard and others (e.g., Heighton, 1971) noted that Hawaiians also cope with stress by avoiding situations that have a potential for interpersonal conflict and by displaying apathy when under stress. The latter permits the Hawaiian to withdraw from an unpleasant experience and to rely on psychic relations and other spiritual resources.
Marsella, Higginbotham, and Jacobs (1977) interviewed 12 Samoan and 12 Filipino male immigrants to Hawaii to determine the major life problem areas, emotions, and coping behaviors associated with immigration. They found différences between the two ethnocultural groups and they also found that coping strategies were often specific to stressors. For example, in the area of employment, Filipinos tended to confront the problem or rely on an agency (e.g., union) while Samoans tended to avoid the problem or talk with relatives or friends. In the area of neighborhood and security problems, however, the Filipinos tended to avoid the problem while the Samoans sought out agency assistance. Différences were also present in such areas as housing, marriage, education, language learning, and so forth.
Murakami (1983) studied the coping responses associated with stresses in health, finances, and family life among Japanese American and Caucasian American citizens between the ages of 65 to 15 years. She found ethnocultural variations in the use of certain coping mechanisms. Japanese American subjects tended to utilize more social supports in coping with health problems while the Caucasian Americans tended to rely more on personal responsibility for their health. Active personal problem solving was also used by the latter group to resolve family life problems while the former group relied more on indirect coping styles that utilized go-betweens and avoidance. The latter reflects the Japanese value of gaman or avoidance of direct confrontation. No différences were found in dealing with financial stressors.
Murakami noted that while the Caucasiàn Americans relied on a broad spectrum of personal and social coping methods, the Japanese Americans relied mainly on social supports. She claimed that the major reason for this is the Japanese value of kimochi or the suppression of personal feelings. It is considered rude to assert ones individuality and to express one’s emotions openly. Rather, one is supposed to rely on the family for support and also to accept ones circumstances in life. Endurance in the face of problems is expected and encouraged. Oddly enough, she reported that increased use of coping mechanisms was associated with high overall life satisfaction for Caucasians but not for Japanese, whose quality of life appeared to be independent of using many coping mechanisms.
While locus of control cannot be considered a direct measure of coping, it does provide insights about an individual’s perceived control over events. There have been an extensive number of cross-cultural studies of locus of control, especially studies comparing Japanese and American subjects (e.g., Bond & Tornatzky, 1973 ; Evans, 198 1 ; Mahler, 1974 ; McGinnis, Nordholm, Ward, & Bhanthumnavin, 1974 ; Parsons & Schneider, 1974 ; Strassberg, Akimoto, & Kirchner, 1985). These studies have unanimously found that Japanese subjects have a significantly higher external locus of control in comparison to American subjects. Strassberg et al. (1985) contend the reason for this resides in Japanese values and social patterns. They stated,
In the Japanese society, there is a push toward conformity, less opportunity for social mobility, a relatively strong dependency on significant others, and a luck/fate orientation to life in general…
Employment with a company, for example, is virtually always a lifetime tenure, and such external agencies are often given more credit for control over the persons life than are his own initiatives. (Strassberg et al., 1985, P. 9)
Similar results for locus of control have been reported in studies of other Asian cultures including Chinese and Indian samples (e.g., Hsieh, Shybut, & Lotsof, 1969 ; Lao, Chuang, & Yang, 1977, Reitz & Groff, 1974). While locus of control is only one dimension of coping, it is an important one because it reflects a general orientation of relying on personal abilities to resolve difficulties. Clearly, Western culture emphasizes individual responsibility for problems and for their resolution while many non-Western cultures emphasize group or environmental orientations.
The question is not which one is better but rather which one is culturally congruent. If an internal orientation is imposed inappropriately, we may be creating further difficulties. Both the external and the internal approaches have utility within particular cultural contexts. Attempting to get a Japanese person to adopt an internal orientation could result in dislocating him or her from a cultural context. It is likely that their families and friends would construe them as being selfish, egotistic, and vain. Further, it serves to undermine a basic Japanese value like amae.
Utoyo-Lubis (1984) examined coping mechanisms among groups of new and old migrants and nonmigrants in urban and rural Indonesia. She explored the relationship of différent coping beliefs to probleins in various areas of life functioning încluding employment, family life, housing, recreation, marriage, child rearing, security, and health. She found no différences across the various groups, a fact that she attributed to cultural homogeneity. All the subjects tended first to try to, solve problems by themselves ; however, if these efforts failed, the subjects tended to « surrenderto fate (pasrah) » and to rely on patience. The latter was attributed to their Islamic faith. Islam, the religion of much of the population in Africa, the Middle East, and Indonesia, means « obedience » or « submission » to the faith. The Arabic phrase, Inshallah, « If God wills it, » is a powerful coping belief because it absolves indivîduals of personal responsibility for the problems in their lives. Other coping methods used by the Indonesian subjects included reliance on social support networks when these were available.
Cheung, Lau, and Wong (1984) investigated the coping responses of 282 male and female Chinese psychiatric patients riesiding in Hong Kong. They reported that the majority of patients (42.0%) coped by approaching a professional resource ; this was followed in frequency by psychological coping (35.3%), somatically oriented coping (13.2%), and social support (7.617o). It is noteworthy that a sizable number of Chinese patients who used psychological coping approaches employed passive endurance, waiting, and avoidance of activity (22.2%).
SOME CONCLUSIONS ON CROSS-CULTURAL COPING STUDIES
These studies are not an exhaustive list of cross-cultural investigations. Rather, they represent a sampling of research efforts that encompass an array of différent methodologies and ethnocultural traditions. It is clear that many other studies, especially those published in non-Englishjournals, need to be reviewed and discussed. On the basis of those that have been covered, however, certain conclusions are warranted.
(1) Despite the fact that coping is fundamental to our understanding of human health, there are few cross-cultural coping studies. As a result, it is difficult to answer questions regarding ethnocultural variations in coping processes and mechanisms. Among the studies that have been conducted, cultural similarities are present in categories of coping bellefs and behavioral patterns. But, there is also evidence that cultures differ in coping patterns when confronted with similar stressors.
(2) All human beings and cultures are faced with stressors. The particular stressors faced by a culture help shape its specific coping responses. Culture is a dynamic force that emerges as part of our continual adjustment and adaptation processes.
(3) Coping cannot be understood apart from a culture’s basic orientation or worldview. The latter is a foundation for specific coping beliefs and actions. If a culture favors individual over group action in dealing with a stressor, then beliefs, attitudes, behaviors, and social resources will usually reflect this orientation. This assumption emphasizes the importance of studying conceptions of health and mental health across cultures. A great deal is known about standards of normality and abnormality among different ethnocultural groups but not much is known about optimum or preferred states of functioning. And, virtually nothing is yet known about « quality of life » among différent ethnocultural groups.
(4) An international research effort is needed to investigate crosscultural studies of coping. This effort could make use of anthropological, psychometric, and experimental research approaches. The World Health Organization may be an appropriate agency for such a coordinated effort. Such an effort could attempt to identify ethnocultural variations in the frequency and pattern of particular coping mechanisms in the face of in-vivo and analog stressor situations. It would be useful to monitor biological, psychological, and social dimensions of coping responses among différent ethnocultural groups to determine the health and disease consequences of coping successes and failures.
(5) If the World Health Organization goal of « Health for All by the Year 200OP’ is to be reached, it is clear that existing health policies, services, and activities will have to be dramatically altered to include the role of culture in human health and disease. To understand the cultural influences better, it will be necessary to understand ethnocultural similarities and différences in coping.
(6) Health is a complex state that involves harmony across biological, psychological, and social levels of functioning. Health also involves a process of becoming and growing toward a state of mastery and transcendence. The later states provide humans with the opportunity to develop new evolutionary alternatives. Coping is the key element in this process and cross-cultural studies of coping can reveal the spectrum of options available to the human race for evolution. Coping, culture, and health are interrelated concepts and our understanding of them is critical for our future survival and developinent.
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AUTHORS’ NOTE : Preparation of this chapter was partially supported by NIMH Research Grant 5R 12 MH 31016 05, The Psychosocial Determinants of Severe Mental Disorders, awarded to the senior author for participation in the WHO Collaborative Investigation : The Determinants of Outcome of Schizophrenic Disorders.