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

A cross-cultural look at clinical psychology and mental illness 

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 and interpersonal relationships and in the development of the self.

But a rapprochement of pathologies from one region to the other can be observed, due to the current socioeconomic 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 making its way to the West, and the number continues to grow. Piagetian theories of developmental development show similar patterns of maturation in different cultures, but in the case of psychopathologies, it can be observed that in adolescence and childhood, the first signs of the first symptoms of psychopathology begin to appear in the case of psychopathologies, it can be observed that in adolescence and childhood, the first signs of psychopathology begin to appear in the first years of life.

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 psychopathological disorders and symptoms can occur (Fonseca, 2013).

How do we perceive psychopathologies according to our cultural context?

The manifestation of psychopathologies is viewed differently according to the West and Japan. For example, the pictures classically qualified as hysteria are in sharp decline in Western culture. This type of reaction has come to be considered a sign of weakness and lack of self-control, and is an increasingly less socially tolerated form of emotional expression. Something very different from what happened, for example, in the Victorian era in which fainting was a sign of sensitivity and gentleness (Pérez, 2004).

The conclusion that can be drawn from the following could be that according to the historical moment and the patterns of behavior 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 near disappearance of conversive and hysterical disorders, being replaced mostly by anxiety and somatization disorders. 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 spreading around the world

In the case of the phenomenon called Hikikomori, whose literal meaning is "to withdraw, or to be secluded", it can be observed how it is currently trying to be 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, it does not yet exist as a psychological disorder, but rather as a phenomenon that acquires characteristics of different disorders (Teo, 2010).

To exemplify 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 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%), 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 schizoid personality disorder or avoidant personality disorder, among others (Teo, 2010). There is no consensus yet on the categorization of the Hikikomori phenomenon to enter as a disorder in the DSM-V manual, 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, it is necessary to study the socioeconomic and historical framework of the region. The context of globalization and global economic crisis shows 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 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 above mentioned about the development of pathologies in childhood and adolescence, we see in Japanese society how parental relationships have a great influence on the development of pathologies in childhood and adolescence. 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. Personality development in an environment with risk factors may be triggers of the Hikikomori phenomenon although direct causality has not been demonstrated due to the complexity of the phenomenon.

Psychotherapy and cultural differences

In order to provide effective psychotherapy for patients from different cultures, cultural competence is needed in two dimensions: generic and specific. Generic competence includes the knowledge and skills needed to perform competently in any cross-cultural encounter, while specific competence refers to the knowledge and skills needed to practice with patients from a particular cultural setting (Lo & Fung, 2003), cited by Wen-Shing (2004).

Patient-therapist relationship

Regarding the patient-therapist relationship, it should be kept 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 be effective and the perception of the therapist's respect towards the patient would be questioned. The transference y counter-transference should be detected as early as possible, but if psychotherapy is not given in a way that is in accordance with the culture of the recipient 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 the cognitive level. In Eastern cultures, a cognitive and rational approach is followed to understand the nature that causes problems and how to cope with them. An example of Asian therapy is the "Morita Therapy" originally called "New Life Experience Therapy". Unique to Japan, for patients with neurotic disorders, it consists of being in bed for 1 to 2 weeks as the first stage of therapy, and then beginning to re-experience life without obsessive or neurotic preoccupations (Wen-Shing, 2004). The focus of Asian therapies is on experiential and cognitive experience, such as meditation.

A very important aspect to be taken into account in the selection of therapy is the concept of the self y ego The self and the ego are culturally determined (Wen-Shing, 2004), since in addition to culture, the socioeconomic situation, work, resources for adapting to change, influence the creation of self-perception as mentioned above, as well as the communication with others of emotions and psychological symptoms. An example of the creation of 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. It affects the perception of reality and the assumption of responsibility.

In conclusion

There are differences in the manifestations of psychopathologies in the West and Japan or Eastern societies in the perception of them, constructed by culture. For this reason, in order 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 of coping with changes, all from different cultural perspectives, as they are part of the richness of collective knowledge and diversity.

And finally, to 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 the manifestations of them should not occur due to differentiation between sexes, socioeconomic classes or various distinctions.