Quantitative Questions, Qualitative Answers: The Cultural Meaning of Externally Oriented Thinking in a Chinese Psychiatric Sample

Adaptive emotional norms are frequently assumed, and often go unexamined, when emotional constructs originating from the West are exported to other cultural contexts. The current study uses a mixed-methods design to examine alexithymia, whose underlying normative assumptions may be leading to over-pathologization and psychometric difficulties in cross-cultural usage. The externally oriented thinking (EOT) component of alexithymia, measured by the 20-Item Toronto Alexithymia Scale (TAS-20), shows well-recognized poor psychometric properties and potentially different but adaptive normative levels in non-English samples. In this two-part study, I first replicate and demonstrate past findings of poor internal consistency and weak model fit of the EOT subscale of the TAS-20 in a Chinese clinical sample (N = 276). To explain the quantitative observations, I then conduct a thematic analysis of audio-recorded interview responses using a subset of the sample (n = 23), who were administered the Toronto Structured Interview for Alexithymia. The qualitative results reveal that Chinese respondents demonstrated EOT tendencies such as organizing and analyzing experiences based on factual attributes, as well as engaging in more consideration of norms and less mentalization of feelings than normatively expected for Euro-Canadians. These findings provide explanations for EOT measurement issues from both task and conceptual levels. Integrating cultural emotion theories, I also consider the relative adaptiveness of EOT in service of specific cultural goals while challenging the appropriateness of its original ‘Western’ pathological assumptions. Implications of current findings for clinical practise, acculturative adjustment, and future empirical studies of attention to emotions are discussed