Differences in the expression of mental disorders between the West and Japan

The differences in the expression of psychopathologies between Japan and the West have a large cultural component, and this includes the different manifestations of pathologies according to region, gender and environmental pressures. The philosophical differences between the West and Japan are tangible in family, interpersonal relationships, and personal development.

But an approach to pathologies can be observed from one region to another, due to the current socio-economic context resulting from globalization.

Psychological disorders: differences and similarities between the West and Japan

A clear example could be the proliferation of the Hikikomori phenomenon in the West. This phenomenon initially observed in Japan is gaining ground in the West, and the number continues to grow. Piagetian theories of evolutionary development show similar maturation patterns in different cultures, but in the case of psychopathologies, we can observe how in adolescence and childhood the first signs begin to appear.

The high rate of maladaptive personality models found in this sector of the population is interesting because of the relevance of childhood and adolescence as a period of development in which a wide variety of psychopathological disorders and symptoms ( Fonseca, 2013).

How do we perceive psychopathologies according to our cultural context?

The manifestation of psychopathologies is seen differently in the West and in Japan. For example, paintings classically described as hysteria are in sharp decline in Western culture. Such reactions are now considered a sign of weakness and lack of self-control and are said to be a socially less tolerated form of expression of emotions. Something very different from what happened, for example, in the Victorian era when fainting was a sign of sensitivity and delicacy (Pérez, 2004).

The conclusion that can be drawn from the following could be that depending on the historical moment and the patterns of behavior considered acceptable, they model the expression of psychopathologies and intra and interpersonal communication. If we compare the epidemiological studies carried out on soldiers during World War I and WWII, we can see the virtual disappearance of conversion and hysterical images, replaced mainly by images of anguish and somatization. This appears regardless of social class or intellectual level of military ranks, indicating that the cultural factor would predominate over the intellectual level when determining the form of expression of distress (Pérez, 2004).

Hikikomori, born in Japan and expanding around the world

In the case of the phenomenon called Hikikomori, the literal meaning is “to turn away or be confined”, one can see how it is currently classified as a disorder in the DSM-V manual, but due to its complexity, comorbidity, diagnosis differential and poor diagnostic specification, does not yet exist as a psychological disorder, but as a phenomenon which acquires the characteristics of different disorders (Teo, 2010).

To illustrate this, a recent three-month study led Japanese child psychiatrists to examine 463 cases of young people under the age of 21 with the signs of so-called Hikikomori. According to the criteria of the DSM-IV-TR manual, the 6 most detected diagnoses are: generalized developmental disorder (31%), generalized anxiety disorder (10%), dysthymia (10%), adaptive disorder (9%), obsessive – Compulsive disorder (9%) and schizophrenia (9%) (Watabe et al, 2008), cited by Teo (2010).

The differential diagnosis of Hikikomori is very broad, we can find psychotic disorders such as schizophrenia, anxiety disorders such as post-traumatic stress disorder, major depressive disorder or other mood disorders, and disorder of the schizoid personality or personality avoidance disorder, among others (Teo, 2010). There is still no consensus on the categorization of the Hikikomori phenomenon as a disorder in the DSM-V manual, considered a syndrome of cultural origin according to the article (Teo, 2010). In Japanese society, the term Hikikomori is more socially accepted because they are more reluctant to use psychiatric labels (Jorm et al, 2005), cited by Teo (2010). The conclusion drawn from this in the article might be that the term Hikikomori is less stigmatizing than other labels for psychological disorders.

Globalization, economic crisis and mental illness

To be able to understand a phenomenon rooted in a type of culture, it is necessary to study the socio-economic and historical framework of the region. The context of globalization and the global economic crisis shows a collapse of the youth labor market, which, in societies with deeper and tighter roots, is forcing young people to find new ways of dealing with transitions despite be in a rigid system. In these circumstances, abnormal response patterns to situations are presented, where tradition does not provide methods or clues for adaptation, thus reducing the chances of decreasing the development of pathologies (Furlong, 2008).

In connection with the above on the development of pathologies in childhood and adolescence, we see in Japanese society how parental relationships greatly influence. Parenting styles that do not promote emotional communication, overprotection (Vertue, 2003) or aggressive styles (Genuis, 1994; Scher, 2000) cited by Furlong (2008) are linked to anxiety disorders. The development of the personality in an environment with risk factors, can be triggers of the Hikikomori phenomenon although the direct causality is not demonstrated 1 hour due to the complexity of the phenomenon.

Psychotherapy and cultural differences

In order to be able to apply effective psychotherapy to patients of different cultures, two-dimensional cultural competence is necessary: ​​generic and specific. Generic competence includes the knowledge and skills necessary to perform their work competently in any intercultural encounter, while specific competence refers to the knowledge and techniques necessary to train with patients from a specific cultural environment (El & Fung, 2003), cited by Wen -Shing (2004).

Patient-therapist relationship

With regard to the patient-therapist relationship, it should be borne in mind that each culture has a different conception of hierarchical relationships, including the patient-therapist, and acts on the constructed concept of the patient’s culture of origin ( Wen-Shing, 2004). The latter is very important in order to be able to create a climate of trust in the therapist, otherwise situations would arise in which communication would not take place effectively and the therapist’s perception of respect for the patient would be called into question. Transference and countertransference should be detected as early as possible, but if psychotherapy is not administered in a manner consistent with the culture of the recipient, it will not be effective or may complicate it (Comas-Díaz & Jacobsen , 1991; Schachter & Butts, 1968), cited by Wen-Shing (2004).

therapeutic approaches

The focus between cognition or experience is also an important point, in the West the legacy of “logos” and Socratic philosophy becomes apparent, and the more emphasis is placed on the experience of the moment even without understanding at the level. cognitive. In Eastern cultures, a cognitive and rational approach is followed to understand the nature that causes problems and how to deal with them. An example of Asian therapy is “dead therapy” originally called “new life experience therapy”. The only one in Japan, for patients with neurotic disorders, is to stay in bed for 1 or 2 weeks as the first step in therapy, and then to start living life again without obsessive or neurotic worries (Wen-Shing, 2004). The aim of Asian therapies focuses on experiential and cognitive experience, as well as meditation.

A very important aspect to consider in choosing therapy is the concept of self and ego in its spectrum depending on culture (Wen-Shing, 2004), because in addition to culture, socio-economic status , work, resources to adapt to change, influence when creating self-perception as discussed above, as well as in communicating with others about emotions and psychological symptoms. An example of self and ego creation can occur in relationships with superiors or family members, it should be mentioned that passive-aggressive paternal relationships are considered immature by Western psychiatrists (Gabbard, 1995), cited by Wen-Shing (2004), while in Eastern societies this behavior is adaptive. This affects the perception of reality and the taking of responsibilities.

To conclude

There are differences in the manifestations of psychopathologies in the West and Japan or in Eastern societies in their perception, constructed by culture. For that, in order to perform appropriate psychotherapies, these differences must be taken into account. The concept of mental health and relationships with people are shaped by tradition and the prevailing socio-economic and historical moments, because in the context of globalization in which we find ourselves, it is necessary to reinvent the mechanisms to cope with the change, all from different cultures. perspectives, because they are part of the wealth of collective knowledge and diversity.

And finally, be aware of the risk of somatization of psychopathologies due to what is considered socially accepted according to culture, as it affects different regions in the same way, but their manifestations should not be given by differentiation between the sexes. , Socio-economic classes or various distinctions.

Bibliographical references:

  • Pérez Sales, Pau (2004). Intercultural psychology and psychiatry, practical bases of action. Bilbao: Desclée De Brouwer.
  • Fonseca, E .; Paino, M .; Lemos, S .; Muñiz, J. (2013). Traits of adaptive group C personality models in the general adolescent population. Spanish acts of psychiatry; 41 (2), 98-106.
  • Teo, A., Gaw, A. (2010). Hikikomori, a syndrome of social withdrawal from Japanese culture: a proposal for the DSM-5. Journal of Nervous & Mental Disease; 198 (6), 444-449. doi: 10.1097 / NMD.0b013e3181e086b1.

  • Furlong, A. (2008). The Japanese hikikomori phenomenon: acute social withdrawal of young people. Sociological review; 56 (2), 309-325. doi: 10.1111 / j.1467-954X.2008.00790.x.

  • Krieg, A .; Dickie, J. (2013). Attachment and hikikomori: a model of psychosocial development. International Journal of Social Psychiatry, 59 (1), 61-72. doi: 10.1177 / 0020764011423182

  • Villaseñor, S., Rojas, C., Albarrán, A., Gonzáles, A. (2006). An intercultural approach to depression. Journal of Neuro-Psychiatry, 69 (1-4), 43-50.
  • Wen-Shing, T. (2004). Culture and Psychotherapy: Asian Perspectives. Journal of Mental Health, 13 (2), 151-161.

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