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 great cultural component, and this includes the different manifestations of the pathologies according to the region, sex and environmental pressures. The philosophical differences between the West and Japan are tangible in family, interpersonal and self-development relationships.
But one can observe an approach of the pathologies from one region to the other, due to the current socioeconomic context derived 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 observed initially in Japan is breaking through in the West, and the number continues to grow. Piagetian theories on evolutionary development show similar patterns in terms of maturation in different cultures, but In the case of psychopathologies, it can be observed how in adolescence and childhood the first signs begin to appear .
The high rate of maladaptive personality patterns found in this sector of the population is of interest due to the relevance of childhood and adolescence as a period of development in which a wide variety of disorders and symptoms may occur. psychopathological (Fonseca, 2013).
How do we perceive psychopathologies according to our cultural context?
The manifestation of psychopathologies is seen differently according to the West and Japan. For example, the pictures classically qualified as hysteria they are in clear decline in Western culture . This type of reaction has come to be considered a sign of weakness and lack of self-control and it would be a socially less tolerated form of expression of emotions. Something very different from what happened, for example, in the Victorian era in which fainting was a sign of sensitivity and delicacy (Pérez, 2004).
The conclusion that can be drawn from the following could be that according to the historical moment and the behavior patterns considered acceptable, they shape the expression of psychopathologies and intra and interpersonal communication. If we compare epidemiological studies carried out on soldiers in World War I and II, we can observe the almost disappearance of the conversion and hysterical pictures, being replaced mostly by anxiety and somatization pictures. This appears indifferently from the social class or intellectual level of the military ranks, which indicates that the cultural factor would predominate over the intellectual level when determining the form of distress expression (Pérez, 2004).
Hikikomori, born in Japan and expanding around the world
In the case of the phenomenon called Hikikomori, whose literal meaning is "to move away, or to be confined", it can be seen how it is currently classified as a disorder within the DSM-V manual, but due to its complexity, comorbidity, differential diagnosis and little diagnostic specification, It does not yet exist as a psychological disorder, but as a phenomenon that acquires 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 21 years of age with the signs of the so-called Hikikomori. According to the criteria of the DSM-IV-TR manual, the 6 diagnoses most frequently detected 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, major depressive disorder or other mood disorders, and schizoid personality disorder or personality avoidant disorder, among others. (Teo, 2010). There is no consensus yet on the categorization of the phenomenon Hikikomori to enter as a disorder in the manual DSM-V, being considered as a syndrome rooted in culture 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 could be that the term Hikikomori is less stigmatizing than other labels for psychological disorders.
Globalization, economic crisis and mental illness
In order to understand a phenomenon rooted in a type of culture, we must study the socio-economic and historical framework of the region . The context of globalization and global economic crisis reveals a collapse of the labor market for young people, which in societies with deeper and stricter roots, forces young people to find new ways to manage transitions even when they are in a rigid system . Under these circumstances, anomalous patterns of response to situations are presented, where tradition does not provide methods or clues for adaptation, thus reducing the possibilities of reducing the development of pathologies (Furlong, 2008).
Relating to the aforementioned on the development of pathologies in childhood and adolescence, we see in Japanese society how parental relationships greatly influence . Parental styles that do not promote the communication of emotions, overprotection (Vertue, 2003) or aggressive styles (Genuis, 1994; Scher, 2000) cited by Furlong (2008), are related to anxiety disorders. The development of the personality in an environment with risk factors can be triggers of the Hikikomori phenomenon even if a direct causality is not demonstrated due to the complexity of the phenomenon.
Psychotherapy and cultural differences
In order to apply effective psychotherapy for patients from different cultures, a cultural competence in two dimensions is necessary: generic and specific. The generic competence includes the knowledge and skills necessary to perform their work competently in any cross-cultural encounter, while the specific competence refers to the knowledge and techniques necessary to practice with patients from a specific cultural environment (Lo & Fung, 2003), cited by Wen-Shing (2004).
Regarding the patient-therapist relationship, we must bear in mind that each culture has a different conception about hierarchical relationships, including the patient-therapist, and act according to the constructed concept of the patient's culture of origin (Wen-Shing , 2004). The latter is very important in order to create a climate of trust towards the therapist, otherwise there would be situations in which communication would not arrive effectively and the perception of the therapist's respect for the patient would be compromised. The transfer Y against transfer it should be detected as soon as possible, but if psychotherapy is not given according to the receptor's culture it will not be effective or it could be complicated (Comas-Díaz & Jacobsen, 1991; Schachter & Butts, 1968), cited by Wen-Shing (2004).
Also the focus between cognition or experience is an important point, in the West the inheritance of the "logos" and the Socratic philosophy becomes patent, and the experience of the moment is given greater emphasis even without an understanding at the cognitive level. In Eastern cultures, a cognitive and rational approach is followed to understand the nature that causes the problems and how to deal with them. An example of Asian therapy is the "Morita Therapy" originally called "Therapy of the experience of a new life". Unique in Japan, for patients with neurotic disorders, is to stay in bed for 1 or 2 weeks as the first stage of therapy, then begin to re-experience life without obsessive or neurotic concerns (Wen-Shing, 2004). The objective of Asian therapies focuses on experiential and cognitive experience, as in meditation.
A very important aspect to take into account in the selection of therapy is the concept of self Y ego in all its spectrum depending on culture (Wen-Shing, 2004), since in addition to culture, socioeconomic situation, work, resources for adapting to change, influences when creating self-perception as discussed above, in addition to communicating with others about emotions and psychological symptoms. An example of the creation of self and ego can occur in relationships with superiors or family members, it should be mentioned that passive-aggressive parental relationships are considered immature by Western psychiatrists (Gabbard, 1995), quoted by Wen-Shing (2004), while in Eastern societies, this behavior is adaptive. This affects the perception of reality and the assumption of responsibilities.
There are differences in the manifestations of psychopathologies in the West and Japan or Eastern societies in the perception of them, constructed by culture. Thus, 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 by the prevailing socio-economic and historical moments, since in the globalizing context in which we find ourselves, it is necessary to reinvent mechanisms of coping with changes, all of them from the different cultural perspectives, since they are part of the wealth of collective knowledge and diversity.
And finally, be aware of the risk of the somatization of psychopathologies due to what is considered socially accepted according to culture, since it affects the different regions in the same way, but the manifestations of them should not be due to differentiation between sexes, socioeconomic classes or various distinctions.
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