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 depending on region, sex, and environmental pressures. The philosophical differences between the West and Japan are tangible in family and interpersonal relationships and in the development of the self.
But an approach of pathologies from one region to another can be observed, 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 initially observed in Japan is making its way to the West, and the number continues to grow. Piagetian theories on evolutionary development show similar patterns of maturation in different cultures, but In the case of psychopathologies, it can be observed how the first signs begin to appear in adolescence and childhood..
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 can occur. psychopathological (Fonseca, 2013).
How do we perceive psychopathologies according to our cultural context?
The manifestation of psychopathologies is seen differently depending on the West and Japan. For example, the paintings classically classified as hysteria are in sharp decline in Western culture. These types of reactions have come to be considered a sign of weakness and lack of self-control and are an increasingly less socially 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 depending on the historical moment and the behavioral 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 conversion and hysterical symptoms, being mostly replaced by anxiety and somatization symptoms. This appears regardless of 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 expression of distress (Pérez, 2004).
Hikikomori, born in Japan and expanding throughout the world
In the case of the phenomenon called Hikikomori, whose literal meaning is “to withdraw, or to be secluded”, it can be seen how it is currently being 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 (Theo, 2010).
To exemplify 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: pervasive developmental disorder (31%), generalized anxiety disorder (10%), dysthymia (10%), adjustment 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 schizoid personality disorder or avoidant personality disorder, among others. (Theo, 2010). There is still no consensus on the categorization of the Hikikomori phenomenon to enter as a disorder in the DSM-V manual, being considered 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 socioeconomic and historical framework of the region. The context of globalization and the 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 though they are in a rigid system. . Under these circumstances, anomalous patterns of response to situations occur, where tradition does not provide methods or clues for adaptation, thus reducing the possibilities of reducing the development of pathologies (Furlong, 2008).
Relating to what was mentioned above about the development of pathologies in childhood and adolescence, we see in Japanese society how parental relationships greatly influence. Parenting 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 personality in an environment with risk factors can trigger the Hikikomori phenomenon, although direct causality has not been proven due to the complexity of the phenomenon.
Psychotherapy and cultural differences
In order to apply effective psychotherapy for patients from different cultures, cultural competence is necessary in two dimensions: generic and specific. Generic competence includes the knowledge and skills necessary to perform your job competently in any cross-cultural encounter, while 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).
Patient-therapist relationship
Regarding the patient-therapist relationship, we must keep in mind that each culture has a different conception of hierarchical relationships, including the patient-therapist, and act based on the concept constructed from the patient’s culture of origin (Wen-Shing , 2004). The latter is very important to be able to create a climate of trust towards the therapist, otherwise situations would arise in which communication would not be effective and the therapist’s perception of respect for the patient would be called into question. The transfer and against transfer It should be detected as soon as possible, but if psychotherapy is not given in a way that is consistent with the recipient’s culture, it will not be effective or could become complicated (Comas-Díaz & Jacobsen, 1991; Schachter & Butts, 1968), cited by Wen-Shing (2004).
Therapeutic approaches
Also the focus between cognition or experience is an important point, in the West the heritage of “logos” and Socratic philosophy is evident, and greater emphasis is given to the experience of the moment even without an understanding at a cognitive level. 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 “Morita Therapy” originally called “New Life Experience Therapy.” Unique in Japan, for patients with neurotic disorders, it consists of being in bed for 1 or 2 weeks as the first stage of therapy, and then beginning to re-experience life without obsessive or neurotic concerns (Wen-Shing, 2004). The objective of Asian therapies focuses on the experiential and cognitive experience, such as meditation.
A very important aspect to take into account when selecting therapy is the concept of self and ego in its entire spectrum depending on culture (Wen-Shing, 2004), since in addition to culture, the socioeconomic situation, work, resources for adaptation to change, influence when creating self-perception as mentioned above, in addition to communicating with others about emotions and psychological symptoms. An example of the creation of the self and ego can occur in relationships with superiors or family members. It is worth mentioning that passive-aggressive parental 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 assumption of responsibilities.
By way of conclusion
There are differences in the manifestations of psychopathologies in the West and Japan or Eastern societies in their perception, constructed by culture. Therefore, To carry out adequate 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 socioeconomic and historical moments, since in the globalizing context in which we find ourselves, it is necessary to reinvent mechanisms for coping with changes, all of them from different cultural perspectives, since 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 the culture, since it affects different regions in the same way, but their manifestations should not occur due to differentiation between sexes, socioeconomic classes. or various distinctions.
