Differences in mental disorders between the West and Japan

Differences in the expression of psychopathologies between Japan and the West they 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 and interpersonal relationships, and in the development of the self.

But it is possible to observe an approach of the pathologies from one region to the other, due to the current socioeconomic context derived from the globalization.

Psychological disorders: differences and similarities between the West and Japan

A clear example could be the proliferation of the phenomenon Hikikomori in the West. This phenomenon initially observed in Japan is making its way into the West, and the number continues to grow. The Piagetian theories on evolutionary development show similar patterns 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 an object of interest due to the relevance of childhood and adolescence as a developmental period 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 seen differently according to the West and Japan. For example, the paintings 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 it would be treated in a socially less and less tolerated way of expressing emotions. Something very different from what happened, for example, in the Victorian era in which fainting spells were 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, shape the expression of psychopathologies and intra- and interpersonal. If we compare epidemiological studies carried out on soldiers in World War I and II, we can observe the almost disappearance of the conversational and hysterical pictures, being replaced mostly by anxiety pictures Y somatization. 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 around the world

In the case of the phenomenon called Hikikomori, whose literal meaning is "to withdraw, or to be confined", it can be observed how it is currently about classify as a disorder within the DSM-V manual, but due to its complexity, comorbidity, differential diagnosis, and poor specification diagnostic, It does not yet exist as a psychological disorder, but as a phenomenon that takes on the characteristics of different disorders (Teo, 2010).

To exemplify this, a recent three-month study led psychiatrists Japanese children 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 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 posttraumatic stress, major depressive disorder or other mood disorders, and Schizoid personality Disorder or avoidant personality disorder, among others (Teo, 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 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, the socio-economic and historical framework of the region must be studied. 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 while in a system rigid. Under these circumstances, there are anomalous patterns of response to situations, where tradition does not provide methods or clues for adaptation, thus reducing the chances of reducing the development of pathologies (Furlong, 2008).

Relating to the aforementioned about 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 personality in an environment with risk factors, can 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 apply a psychotherapy effective for patients from different cultures, a cultural competence in two dimensions is necessary: ​​generic and specific. Generic competence includes the knowledge and skills necessary to perform your job competently in any cross-cultural encounter, while generic competence 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, it must be borne in mind that each culture has a different conception of relationships hierarchical, 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 remain in interdict. The transfer Y against transfer it should be detected as soon as possible, but if psychotherapy is not given in a way that is consistent with the culture of the recipient, it will not be effective or could be 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 inheritance of "logos" and Socratic philosophy becomes apparent, and more emphasis is given to the experience of the moment even without a level understanding. 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 "Morita Therapy" originally called "New Life Experience Therapy". Unique in Japan, for patients with neurotic disorders, consists of being in bed for 1 or 2 weeks as the first stage of therapy, and then starting to re-experience life without obsessive or neurotic worries (Wen-Shing, 2004). The objective of Asian therapies focuses on the experiential and cognitive experience, as in the 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 the culture (Wen-Shing, 2004), since in addition to the culture, the socioeconomic situation, work, adaptation resources to the change, influences when creating self-perception as mentioned above, in addition to communicating with others about emotions and symptoms psychological. 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 results adaptive. This affects the perception of reality and the assumption of responsibilities.

In conclusion

There are differences in the manifestations of psychopathologies in the West and Japan or Eastern societies in the perception of them, built by culture. Thus, 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 socioeconomic and historical moments prevailing, since in the globalizing context in which we find ourselves, it is necessary to reinvent coping mechanisms to 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 the same way to the different regions, but the manifestations of them should not be given by differentiation between sexes, socioeconomic classes or distinctions several.

Bibliographic references:

• Pérez Sales, Pau (2004). Cross-cultural psychology and psychiatry, practical bases for action. Bilbao: Desclée De Brouwer.
• Fonseca, E.; Paino, M.; Lemos, S.; Muñiz, J. (2013). Characteristics of the adaptive patterns of the personality of Cluster C in the general adolescent population. Spanish Acts of Psychiatry; 41(2), 98-106.

• Teo, A., Gaw, A. (2010). Hikikomori, a Japanese Culture-Bound Syndrome of Social Withdrawal?: A Proposal for 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 among young people. The Sociological Review; 56(2), 309-325. doi: 10.1111 / j.1467-954X.2008.00790.x.

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

• Villaseñor, S., Rojas, C., Albarrán, A., Gonzáles, A. (2006). A cross-cultural 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.