Nonverbal Expressions Across Cultural Boundaries


smileAn assuring smile. A fleeting frown. A playful wink. A friendly pat on the back. These are examples of nonverbal expressions that often occur without conscious awareness, without premeditated thought, and yet they can function better than words to communicate meaning between people. On the flip side, they can also pack more nuance and controversy than the words we say.

My research hones in on how nonverbal expressions, specifically the under-explored areas of eye contact and touch, can translate across different cultures. Are they interpreted the same universally, or are they culture-specific? Nowhere are these exchanges more high-stakes than in the interaction between a doctor and patient. The Empathy and Relational Science program I work with at Massachusetts General Hospital has done extensive research into the neurobiology and physiology of empathy, and how they can be leveraged to improve relationships with patients.

My research hones in on how nonverbial expressions, specifically the under-explored areas of eye contact and touch, can translate across different cultures.

We are conducting a literature review that has combed through scores of databases for papers with keywords ‘empathy’, ‘culture’, ‘eye contact’ or ‘touch’, with the plan of submitting a critical review of the research conducted up to date. Here is a snapshot of our findings so far:

  • American psychologist Paul Ekman has found that facial expressions, even though they seem to be learned and reinforced through social interactions, are actually universal. When he showed pictures of Americans showing a range of facial expressions to people Japan, Chile, Argentina, and even isolated communities in Papua New Guinea, his subjects arrived at remarkably similar conclusions. Interpreting facial expressions, however, becomes more complicated in social settings. Ekman found that Japanese and Americans showed the same facial expressions while watching a gory video, but when seated beside a scientist, Japanese participants were more likely than Americans to conceal their negative emotions with a smile. The principle underlying this is known as display rules, which posits that management of expressions in public settings is socially learned and depends on local culture.
  • Many nonverbal expressions may be deeply ingrained in our biology. Children who are born blind can smile, laugh, and clap their hands for joy, even though they’ve never seen anyone else expressing joy. This raises the question: are eye contact and touch also universal, or are they governed by ‘display rules,’ which can change depending on social setting and culture?
  • A series of research studies have looked into how strangers are able to communicate universal emotions (ie. anger, fear, disgust, love, gratitude, sympathy) and prosocial emotions (happiness, sadness, surprise) through touch alone. In an experiment where the toucher was instructed only to touch the subject’s arm, participants successfully communicated universal emotions. When not restricted to the arm alone, both universal and prosocial emotions were effectively communicated.
  • In clinical settings, there are generally two types of touch: diagnostic and therapeutic. While diagnostic touch serves a clinical purpose, such as placing the stethoscope on a patient’s chest, therapeutic touch can be a handshake or a pat on the back. In a preliminary study, researchers found that therapeutic touch was positively correlated with how connected patients felt with their clinicians. However, the frequency of therapeutic touch per consultation only increased ratings to a certain point. Further research could pinpoint exactly how much touch would make for the ideal doctor-patient relationship.

Upon completion of the review, we plan to test some hypotheses ourselves on the cross-cultural perception of empathy through nonverbal expressions, which would contribute to an understudied area that remains crucial to the patient experience.

Linda Zhang is a Brevia staff writer. She can be reached at