International Handbook of Cross-Cultural Neuropsychology

Barbara P. Uzzell, Marcel Ponton, Alfredo Ardila, Barbara P. Uzzell, Marcel Ponton, Alfredo Ardila

• Publisher: Psychology Press
• Year: 2007
• ISBN:
  9781135658151
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The role of culture is significant when measuring cognitive abilities during neuropsychological assessments. However, cultural diversity is a frequently overlooked moderating variable. The International Handbook of Cross-Cultural Neuropsychology emphasizes major distinctions among cultural groups in North and South America, Europe, Africa, Asia, an

Chapter 1
Grasping the Cross-Cultural Reality

B. P. Uzzell
Memorial Neurological Association

Since their inception, countries around the world have been participants in a gigantic, ongoing multicultural experiment filled with cultural diversity found in both separate and overlapping geographic locations. The final outcome of the experiment is unknown, because it is ongoing. Types of co-existences, interactions, and isolations of cultures are not always predictable during this experiment. Culture edicts may induce peaceful, or not so peaceful coexistence between countries, but what role do cross-cultural edicts play in identifying commonalities and differences among cultures? The focus of this book is to provide knowledge about cross-cultural neuropsychology with is assessment and rehabilitation techniques within the context of multiculturalism.

Cultural diversity in the world has provided data not only about itself, but also about cross-cultural events and multiculturalism. These data are currently being influenced and modified by rapid air travel time and satellite communications, such as, the availability of electronic communication via e-mail, Internet, and worldwide television and radio broadcasts transmitted to many culturally diverse groups. Some say the distinctiveness among cultural groups may begin to fade as the worldwide communication accelerates.

Cross-Cultural Reality and Multiculturalism

Grasping the cross-cultural reality requires defining several terms in order to communicate with a consensual understanding. Multiculturalism within psychology has been called a social–intellectual movement promoting cultural diversity as a core principle while insisting on equality and respect of all cultural groups. At times, conflict occurs between the core principle of cultural diversity and equality in cultural groups. The apparent value and validity of psychological theories and practices (including neuropsychological theories and practices) depend on how well they fare during genuine intercultural dialogue (Fowers & Richardson, 1996). Understanding concepts of both multiculturalism and cross-cultural features require knowledge about the basic unit common to both, namely, “culture.”

Cross-cultural considerations reflect a quest for universals across cultures that are common to several cultures. Determining suitable application of neuropsychological instruments developed within the United States or any other country requires recognition of cross-cultural findings. Whereas questions contained in a neuropsychological instrument may be understood and suitable in the culture in which it was developed, it may have a different meaning or no meaning in another culture. Principles of neuropsychology by necessity must include cross-cultural methods that defined and acknowledge diversity and universals between two or more different cultures or cultural areas.

A number of questions arise and require answers as cross-cultural principles in neuropsychology are derived. What happens when one cultural group crosses into the territory of another group? What is the effect of one culture on another? What are the opinions toward brain damage or brain injury within a given culture? How do different cultures assess and treat the brain damaged? Do neuropsychologists possess sufficient sensitivity and knowledge to assess and treat brain damaged outside of their own culture? If they do not, should neuropsychologists be trained to assess and treat brain-injured individuals outside their own culture? Assessment and treatment skills outside one’s own culture require understanding and appreciating cultural diversity as the first step in developing cross-cultural principles of neuropsychology.

To assist in probing answers to these and many other questions, cross culturists have identified three theoretical orientations; Absolutism, Relativism, and Universalism (Berry, Poortinga, Segall, & Dasen, 1992). Absolutism assumes human behaviors are basically the same in all cultures with cultural environment contributing little or nothing to the meaning of human behavior. This definition appears straightforward, but Absolutism can be a treacherous minefield for neuropsychologists. Assessments made with instruments in one culture, taken to another culture with a linguistic translation can lead to erroneous conclusions, if consequences of the culture on which the test instruments are based are not considered. Disastrous consequences of applying Absolutism are visible when tests of ability are taken cross-culturally without the same set of test assumptions being fulfilled across cultures.

Relativism is the opposite of Absolutism, and initially was an attempt to guard against ethnocentric judgments. This position warns against making invalid cross-cultural comparisons. Relativists seem to have little or no interest in group similarities or differences, and consider context-free concepts and their measurements to be impossible. Relativism approach collects no data, and thus is useless for diagnosing and rehabilitating brain damage cross culturally.

Universalism assumes human characteristics common to all members of the species produce psychological givens with culture influencing their development and display. Universalism proceeds cautiously by applying a wide variety of methods and safeguards while making interpretations based on alternative culturally meanings. The approach armed with appropriate linguistic translation, administration by a “native” tester with familiar content enables ability tests to go cross culturally. Universalism has become more acceptable in psychological practice in the United States with strong preferences for quantification and universal metrics for comparison purposes. Because ability tests depend on applying the same set of cultural assumptions, reliability and validity of measurements are doubtful cross culturally. Ultimately the goal is to specify culturally sensitive strategies to apply appropriately to assess abilities in a wide range of cultural contexts (Greenfield, 1997). Cautious comparisons using methodological principles and safeguards within the purview of similarities and differences and the context of alternative culturally based meanings are required.

Questions neuropsychology no doubt must address now and in years to come, center around the universality of human underlying physiological phenomena that can be measured behaviorally across cultures. For example, after a human head sustains sufficient force to induce a loss of consciousness and brain damage, what universal behavioral sequelae can be observed and measured? What behavioral observations and measurements are tied to culture, and what ones are not? What behavioral observations and measurements are physiologically based? After brain damage to the primary language area, are there universal physiological changes behaviorally observed and measured regardless of the language spoken? And what are the culturally based behavioral observations and measurements after damage to the primary language area?

Another factor influencing neuropsychological assessment is the onset of the disease process. Recent evidence showing an earlier onset of dementia of the Alzheimer’s type in Latinos than in Anglo individuals (Clark et al., 2005) may mean neuropsychological findings of such populations may be related to onset of disease process rather than cultural differences. Caution, however, advised further investigations of the disease processes of such cultural groups.

According to a published report (Berry & Dasen, 1974), the term, cross-cultural psychology, has been multicultural and inclusive. In contrast, another report (Segall, Lonner, & Berry, 1998) stated cross-cultural psychology was destined to become an unnecessary term when psychology finally takes into account the effects of culture on human behavior and vice versa. Although neuropsychology/psychology seems to be on the path of cultural awareness, it has not reached the point where all aspects of human behavior are clearly recognized within its culture milieu.

Culture, Acculturation, and Assimilation

Webster’s dictionary defines culture as “the integrated pattern of human behavior that includes thought, speech, action and artifacts and depends upon man’s capacity for learning and transmitting knowledge to succeeding generations.” The initial phrase of this definition, “the integrated pattern of human behavior” is striking. These words state aspects of culture (thought, speech, action, and artifacts) that blend together to generate the integrated pattern of human behavior.

The second part of Webster’s definition is concerned with the survival of a culture through a capacity of humans to learn an integrated pattern of human behavior and to transmit it to successive generations. The definition indicated culture exists not only in the present, but in the future as well. Perpetuation of culture requires absorption through learning and finding ways of transmitting knowledge to those yet to be born. Added to this mix is the influence of each successive generation with their ideas, concepts, and inventions on culture. The changing or fluid aspect of culture missing from Webster’s definition needs to be addressed in applying neuropsychological measures. Although inability to learn a cultural pattern or to transmit the cultural pattern has been observed in neuropsychological measurements when brain abnormalities are detected, it is not necessarily associated with disruption of cultural learning, but may represent generational differences or isolation from the current or prevailing culture for various reasons.

The term, culture, implies sharing or agreeing with what is called social convention (Greenfield, 1997). Integration of unique components within a given culture sets one culture apart from another culture. Acculturation is the process of learning manners and style of the dominant, prevailing culture (Dashefsky & Shapiro, 1976) that begins during childhood and becomes the basis for adult behavior. Acculturation begins in childhood, after birth, with a set of cultural factors shaping behaviors during infancy. Reactions of parents and caregivers during periods of helplessness, or infancy, contribute to establishment of behaviors. Behaviors derived from Attachment Theory are based on three core hypotheses related to: (1) sensitivity of mothers or caregivers to infant behaviors (smiling, crying, and approaching); (2) later social competency based on security of attachment with the mother or caregiver; and (3) initiation of environmental explorations once a secure base has been established in infancy. Evidence suggests these tenets within core hypotheses; sensitivity, competency, and secure base are not universal, but biased by western thinking and viewed differently in the Far East. For example, Japanese parents prefer to anticipate the needs of infants by identification of situations that may stress infants and take anticipatory steps to minimize stress. In the West, parents wait until infants communicate their needs before addressing those needs.

Cultural differences later observed suggest that emotional openness, viewed as desirable in the United States, is not viewed similarly in Japan. Assertive, autonomous characteristics preferred by westerners are reportedly viewed by Japanese as immature and uncultivated. The secure base–explo o link viewed as necessary for social independence and self-reliance in the United States, is not preferred in Japan where more dependent/group behaviors are preferred (Rothbaum, Weisz, Pott, Miyake, & Morelli, 2000).

Aside from acculturation during development periods within a given culture, the term, acculturation, occurs in the context of continuous contact for extended periods of time of two or more groups from different cultures. Levels of acculturation are defined by the degree to which cultural values, beliefs, and practices are incorporated by members from another culture. It is most often applied to members of ethnic minority adopting the cultural values, beliefs, and practices of a dominant culture. Generally, the younger one is during emigration from the country of origin, and the longer one remains in a new culture, the more one becomes acculturated. This fact is recognized in some cultures. Japanese language contains a different word for first, second, third, fourth, and fifth generations of families living in an alternative culture specifying the degree of acculturation (Wong, 2000).

Methods of measuring acculturation are appearing and being applied to determine the effects of acculturation on neuropsychological measures. Such is the case with the application of a rating scale developed specifically for a study of Mexican Americans (Cuellar, Arnold, & Maldonado, 1995). Findings show higher levels of acculturation improved performances on a neuropsychological measure of interest, namely, the Wisconsin Card Sorting Test (Coffey, Marmol, Schock, & Adams, 2005). In another study, the degree of acculturation has determined neuropsychological outcomes following traumatic brain injury (TBI; Kennepohl, Shore, Nabors & Hanks, 2004).

Assimilation involves understanding and participating in institutions of a society-at-large. Through the process of participating, the society-at-large values are acquired. Both assimilation and acculturation have implications for selections and application of neuropsychological instruments and treatment techniques. Individuals from minority cultures not assimilated and not acculturated into a majority culture are more likely to hold on to the cultural norms of their minority cultures exclusively. As a result, it would be inappropriate to apply neuropsychological instruments of the majority culture to such groups. Neuropsychological instruments are suitable for individuals from minority cultures who have become fully assimilated and acculturated into a majority cultural group. Most difficult is selection of neuropsychological instruments for the in-between minority culture group who are partly acculturated and assimilated into the majority culture. How ...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Preface
• 1 Grasping the Cross-Cultural Reality
• 2 The Impact of Culture on Neuropsychological Test Performance
• 3 The Art of Clinical Neuropsychology
• 4 Environmentalists and Nativists: The IQ Controversy in Cross-Cultural Perspective
• 5 Qualitative Assessment Within and Across Cultures
• 6 Cognitive Abilities in Different Cultural Contexts
• 7 Speech, Language, and Neuropsychological Testing: Implications for African Americans
• 8 Developmental Perspectives: Culture and Neuropsychological Development During Childhood
• 9 Executive Functions in Hispanics: Toward an Ecological Neuropsychology
• 10 Illiterates and Cognition: The Impact of Education
• 11 Relationship Between Functional Brain Organization and Education
• 12 Educational Effects on Cognitive Functions: Brain Reserve, Compensation, or Testing Bias?
• 13 Visuospatial Assessment in Cross-Cultural and Nonwestern Settings
• 14 Neural Circuit of Reading and Writing in the Japanese Language
• 15 Cross-Cultural Issues in Neuropsychology: Assessment of the Hispanic Patient
• 16 Clinical Neuropsychology of Spanish Speakers: The Challenge and Pitfalls of a Neuropsychology of a Heterogeneous Population
• 17 Cultural Issues in Clinical Context With Asian Indian Patients: Guidelines for the Health Care Team
• 18 Epidemiological, Social, and Cultural Aspects of Illness: A Case Study of Brain Injuries, Stroke, and HIV/AIDS in South Africa
• 19 Natural Recovery: An Ecological Approach to Neuropsychological Recuperation
• 20 Emotions and Attitudes: Unbundling Sociocultural Influences
• Author Index
• Subject Index