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 and interpersonal relationships and in the development of the self.

But it is possible to observe a rapprochement of the pathologies of 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 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 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 seen differently in the West and in Japan. For example, the pictures classically qualified as hysteria are in sharp decline in Western culture . This type of reaction has come to be seen as a sign of weakness and lack of self-control and would be a less and less socially tolerated form of expression of emotions. This is 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 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 conversive and hysterical pictures, being replaced mostly by anxiety and somatization pictures. This appears indifferently 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 the distress (Perez, 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 secluded”, 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 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 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, 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 culture-rooted syndrome 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), quoted 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 socio-economic and historical framework of the region . The context of globalization and the 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 within a rigid system. Under these circumstances, there are anomalous patterns of response to situations, where tradition does not provide methods or clues for adaptation, thus reducing the possibilities of diminishing the development of pathologies (Furlong, 2008).

In relation to the above-mentioned development of pathologies in childhood and adolescence, we see in Japanese society how parental relations have a great 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 a trigger for the Hikikomori phenomenon even if no direct causality has been demonstrated due to the complexity of the phenomenon.

Psychotherapy and cultural differences

In order to be able 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 needed to perform competently in any cross-cultural encounter, while specific competence refers to the knowledge and techniques needed to practice with patients from a particular cultural environment (Lo & Fung, 2003), cited by Wen-Shing (2004).

Patient-therapist relationship

With regard to the patient-therapist relationship, it must be borne in mind that each culture has a different conception of hierarchical relations, 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 situations would arise in which communication would not be effective and the perception of the therapist’s respect for the patient would be compromised. The transference and counter-transference should be detected as soon as possible, but if the psychotherapy is not given in a way that is in accordance with the culture of the receiver it will not be effective or it 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 the “logos” and the 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 deal with them. An example of Asian therapy is the “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 starting to re-experience life without obsessive or neurotic concerns (Wen-Shing, 2004). The aim of Asian therapies is to focus on experiential and cognitive skills, such as meditation.

A very important aspect to take into account in the selection of the therapy is the concept of self and ego in its entire spectrum depending on the culture (Wen-Shing, 2004), since in addition to the culture, the socio-economic situation, work, resources of adaptation to change, influences the creation of self-perception as mentioned above, as well as the communication with others of the emotions and psychological symptoms. An example of the creation of the self and ego can be given in the relations with the superiors or members of the family, it is necessary to mention that the passive-aggressive paternal relations are considered immature by the western psychiatrists (Gabbard, 1995), quoted by Wen-Shing (2004), whereas in eastern societies, this behavior is adaptive. This affects the perception of reality and the assumption of responsibility.

By way of conclusion

There are differences in the manifestations of psychopathologies in the West and Japan or eastern societies in the perception of them, built by the culture. Therefore, in order to carry out adequate psychotherapies these differences must be taken into account . The concept of mental health and the relationships with people are shaped by tradition and by the prevailing socio-economic and historical moments, since in the globalising context in which we find ourselves, it is necessary to reinvent mechanisms for facing changes, all of them from the different cultural perspectives, since they form part of the wealth 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 the different regions in the same way, but the manifestations of them should not occur due to differentiation between sexes, socioeconomic classes or various distinctions.

Bibliographic references:

  • Pérez Sales, Pau (2004). Transcultural psychology and psychiatry, practical bases for action. Bilbao: Desclée De Brouwer.
  • Fonseca, E.; Paino, M.; Lemos, S.; Muñiz, J. (2013). Traits of the disadaptive personality patterns of Cluster C in the general adolescent population. Actas Españolas de Psiquiatría; 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.
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