Culture, Medicine and Psychiatry

, Volume 3, Issue 3, pp 231–245 | Cite as

Taijin Kyofusho: Diagnostic and cultural issues in Japanese psychiatry

  • Junko Tanaka-Matsumi
Article

Abstract

Taijin Kyofusho or ‘anthrophobia’ is a Japanese culture-specific diagnostic label for the presenting problems of various fear reactions in interpersonal situations. The starting point of the present study was accumulating studies on Japanese cases of Taijin Kyofusho and the assertion in Japanese psychiatry that the symptom complex called Taijin kyofusho is Japanese culture-bound. In light of previous works on culture-bound disorders, the present study examines whether or not American mental health professionals could diagnose Japanese case descriptions of Taijin Kyofusho and what kinds of labels they applied to these Japanese cases. The results showed that American judges were able to diagnose the Japanese cases nearly as well as American cases. However, there were considerable variability and inconsistency in their judgments of both the Japanese and American cases. The rate of diagnostic agreement dropped considerably as judges were asked to proceed from broad categories to specific categories. American judges grouped the Japanese cases of Taijin Kyofusho into a number of heterogeneous categories using labels such as paranoid schizophrenia, paranoid personality, phobic neurosis, and anxiety neurosis, among others. These results are discussed in terms of psychopathological diagnostic criteria and present conceptualization of culture-bound disorders, value judgments of mental health professionals, and the social contexts in which Taijin Kyofusho reactions occur.

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References

  1. Adachi, H. 1961 About a patient who complains: “I am emitting a bad body odor.” Medical Journal of Juntendo University 7: 901 (in Japanese).Google Scholar
  2. American Psychiatric Association 1968 Diagnostic and Statistical Manual of the Mental Disorder (2nd ed.). Washington: American Psychiatric Association.Google Scholar
  3. Aoki, M., Oiso, H., Murakami, Y., Ishikawa, A., and Takahashi, T. 1975 On dysmorphobia. Seishin Igaku [Clinical Psychiatry] 17: 1267–1275 (in Japanese)Google Scholar
  4. Arieti, S., and Meth, J.M. 1959 Rare, unclassifiable, collective, exotic syndromes. In American Handbook of Psychiatry, Vol. 1. New York: Basic Books.Google Scholar
  5. Barnlund, D. C. 1973 Public and Private Self in Japan and the United States. Tokyo: Simul Press.Google Scholar
  6. Blashfield, R. K., and Draguns, J. G. 1976 Evaluative criteria for psychiatric classification. Journal of Abnormal Psychology 85: 140–150.Google Scholar
  7. Carlo-Giannini, G. D., and Giannini, A. 1975 Anthrophenomenological approach to dysmorphobia. In New Dimensions in Psychiatry: A World View. S. Arieti and G. Chranowski, eds. New York: Wiley.Google Scholar
  8. Can, J. 1978 Ethno-behaviorism and the culture-bound syndromes: the case of amok. Culture, Medicine and Psychiatry 2: 269–293.Google Scholar
  9. Caudill, W. 1973 The influence of social structure and culture on human behavior in Japan. Journal of Nervous and Mental Disease 157: 249–258.Google Scholar
  10. 1964 Thoughts on the contemporary emotional life in Japan and the United States. Seishin Igaku 16: 113–117.Google Scholar
  11. Caudill, W., and Doi, L. T. 1963 Interrelations of psychiatry, culture, and emotions in Japan. In Man's Image in Medicine and Anthropology. I. Galdston, ed. New York: International University Press.Google Scholar
  12. Cawte, J. E. 1976 Malgri: a culture-bound syndrome. In Culture-bound Syndromes, Ethnopsychiatry, and Alternative Therapies. W. P. Lebra, ed. Honolulu: The University Press of Hawaii.Google Scholar
  13. Cooper, J. E., Kendell, R. E., Gurland, B. J., Sharpe, L., Copeland, J. R. M., and Simon, R. 1972 Psychiatric Diagnosis in New York and London. London: Oxford University Press.Google Scholar
  14. Davison, G. C., and Neale, J. M. 1974 Abnormal Psychology: An Experimental Clinical Approach. New York: Wiley.Google Scholar
  15. Doi, L. T. 1973 Anatomy of Dependence. Tokyo: Kodansha International Press.Google Scholar
  16. Draguns, J. G. 1973 Psychopathology across cultures: issues, findings, directions. Journal of Cross-Cultural Psychology 4: 9–47.Google Scholar
  17. 1977 Advances in the methodology of cross-cultural psychiatric assessment. Transcultural Psychiatric Research Review 14: 125–143.Google Scholar
  18. Edgerton, R. B. 1969 On the recognition of mental illness. In Changing Perspectives in Mental Illness. S. C. Plog and R. B. Edgerton, eds. New York: Holt, Rinehart and Winston.Google Scholar
  19. Eisenberg, L. 1977 Disease and illness. Distinction between professional and popular idea of sickness. Culture, Medicine and Psychiatry 1: 9–23.Google Scholar
  20. Fujinawa, A., and Kasahara, Y. 1973 The psychiatric experience of having self or part of self escaping into the external world. In The World Biennial of Psychiatry and Psychotherapy. S. Arieti, ed. New York: Basic Books.Google Scholar
  21. Fijita, C. 1971 ‘Hitomishiri’ as a Japanese concept of stranger anxiety and anthrophobia. Folia Psychiatrica et Neurologica Japonica 25: 1–8.Google Scholar
  22. Goffman, E. 1971 Relations in Public. New York: Harper Colophon Books.Google Scholar
  23. Heron, J. 1970 The phenomenology of social encounters: the gaze. Philosophy and Phenomenological Research 31: 243–264.Google Scholar
  24. Kadushin, C. 1969 Why People Go to Psychiatrists. New York: Atherton.Google Scholar
  25. Kasahara, Y. ed. 1972 Fear of Eye-to-Eye Confrontation and Fear of Emitting Bad Odors. Tokyo: Igaku Shoin (in Japanese).Google Scholar
  26. Kasahara, Y., and Sakamoto, K. 1971 Erythrophobia and allied conditions. A contribution toward the psychopathological and cross-cultural study of a borderline state. In World Biennial of Psychiatry and Psychotherapy, Vol. 1. S. Arieti, ed. New York: Basic Books.Google Scholar
  27. Kato, M. 1964 On the problem of anthrophobia in Japan. Seishin Igaku 16: 107–112 (in Japanese).Google Scholar
  28. Katz, M. M., Cole, J. O., and Lowery, H. A. 1969 Studies of diagnostic process: the influence of symptom perception, past experience and ethnic background on diagnostic decisions. American Journal of Psychiatry 125: 109.Google Scholar
  29. Kiev, A. 1969 Transcultural psychiatry: research problems and perspectives. In Changing Perspectives in Mental Illness. S. Plog and R. B. Edgerton, eds. New York: Holt, Rinehart and Winston.Google Scholar
  30. Kiev, A. 1972 Transcultural Psychiatry. New York: Free Press.Google Scholar
  31. Kimura, B. 1972a Hito to Hito tono Aida [Interhuman Relations]. Tokyo: Kobundo (in Japanese).Google Scholar
  32. Kimura, B. 1972b Mitmenschlichkeit in der Psychiatrie. Zeitschrift fur Klinische Psychologie 20: 3–13.Google Scholar
  33. Kisker, G. W. 1964 The Disorganized Personality. New York: McGraw Hill.Google Scholar
  34. Kleinman, A. 1978a Three faces of culture-bound syndromes: their implications for cross-cultural research. Culture, Medicine and Psychiatry 2: 207–208.Google Scholar
  35. Kleinman, A. 1978b Clinical relevance of anthropological and cross-cultural research: concepts and strategies. American Journal of Psychiatry 135: 427–431.Google Scholar
  36. Kondo, A. 1964 On ‘mutual care’ a pattern of Japanese culture as reflected in ‘shinkeishitsu’ type of neurosis. Seishin Igaku 6: 97–106 (in Japanese).Google Scholar
  37. Kondo, A. 1970 Anthrophobia — From the Standpoint of Morita Therapy. Seishin Igaku 12: 383–388 (in Japanese).Google Scholar
  38. Kora, T. 1965 Morita therapy. International Journal of Psychiatry 1: 611–619.Google Scholar
  39. 1976 Morita Rhoho no Jissai [Practice of Morita Therapy] Tokyo: Hakuyosha (in Japanese).Google Scholar
  40. Langer, E. J. and Abelson, R. P. 1974 A patient by any other name ...! Clinical group differences in labeling bias. Journal of Consulting and Clinical Psychology 42: 4–9.Google Scholar
  41. Leff, J. 1973 Culture and differentiation of emotion states. British Journal of Psychiatry 123: 299–306.Google Scholar
  42. 1974 Transcultural influences on psychiatrists' rating of verbally expressed emotions. British Journal of Psychiatry 125: 336–40.Google Scholar
  43. 1978 Psychiatrists' versus patients' concepts of unpleasant emotions. British Journal of Psychiatry 133: 306–13.Google Scholar
  44. Marks, M. I. 1969 Fears and Phobias. New York: Academic Press.Google Scholar
  45. Marks, M. I. and Gelder, M. G. 1966 Different onset ages in varieties of phobia. American Journal of Psychiatry 123: 218–221.Google Scholar
  46. Mizutsu, K. 1953 Developmental mechanisms of phobia and obsessive-compulsive neurosis. Seishinkeishi 55: 58 (in Japanese).Google Scholar
  47. Morita, S. 1922 The Nature of Shinkeishitsu and its treatment. Revised Edition (1960). Tokyo: Hakuyosha (in Japanese).Google Scholar
  48. 1932 Fear of blushing (or anthrophobia) and treatment. Shinkeishitsu 3: 172 (in Japanese).Google Scholar
  49. Morsbach, H. 1973 Aspects of nonverbal communication in Japan. Journal of Nervous and Mental Disease 157: 262–278.Google Scholar
  50. Murakami, Y., Oiso, H., Aoki, M., and Takahashi, T. 1970 Experience of abnormal conviction in adolescence. Seishin Igaku 12: 573–578 (in Japanese).Google Scholar
  51. Murphy, H. B. M. 1976 Notes for a theory on latah. In Culture-Bound Syndromes, Ethnopsychiatry, and Alternate Therapies. W. P. Lebra, ed. Honolulu: The University Press of Hawaii.Google Scholar
  52. Nakane, C. 1970 Structure of Japanese Society. Berkeley: University of California Press.Google Scholar
  53. Nishida, H. 1968 Passage of time and change in neurosis of adolescence. Japanese Journal of Child Psychiatry 9: 225 (in Japanese).Google Scholar
  54. Nishizono, M. 1970 Psychoanalysis of anthrophobia. Seishin Igaku 12: 375–379 (in Japanese).Google Scholar
  55. Ogino, K., and Mizutani, T. 1959 A case study of fear of glance. Seishin Bunseki Kenkyu 6: 21 (in Japanese).Google Scholar
  56. Ogino, K., Kuba, M., Mizoguchi, J., and Shoji, J. 1975 A review of transcultural psychiatric research in Japan. Seishin Igaku 17: 1434–1457 (in Japanese).Google Scholar
  57. Ohara, K., Aizawa, S., and Iwai, H. 1970 Morita Therapy. Tokyo: Bunkodo (in Japanese).Google Scholar
  58. Oiso, H., Kondo, H., Murakami, Y., Tomiyama, K., and Tonomura, T. 1972 Experience of abnormal conviction in adolescene. 2. Illness of worrying that one's state exudes. Seishin Igaku 14: 49–56 (in Japanese).Google Scholar
  59. Reynolds, D. K. 1976 Morita Psychotherapy. Berkeley: University of California Press.Google Scholar
  60. Rosenhan, D. L. 1973 On being sane in insane place. Science 179: 250–258.Google Scholar
  61. Shikano, T., Otsuka, T., Honsho, Y. 1960 Clinical study of chronic olfactory hallucination. Seishin Igaku 2: 37 (in Japanese).Google Scholar
  62. Siegel, S. 1956 Nonparametric Statistics for the Behavioral Sciences. New York: McGraw-Hill.Google Scholar
  63. Spitzer, R. L., and Fleiss, J. L. 1974 A reanalysis of the reliability of psychiatric diagnosis. British Journal of Psychiatry 125: 341–347.Google Scholar
  64. Stengel, H. 1959 Classification of mental disorders. Bulletin of the World Health Organization 21: 601–603.Google Scholar
  65. Suinn, R. M. 1975 Fundamentals of Behavior Pathology. New York: Wiley.Google Scholar
  66. Takahashi, T. 1976 Taijin Kyofusho: Analysis of Mutual Communication. Tokyo: Igaku Shoin (in Japanese).Google Scholar
  67. Tanaka-Matsumi, J. Cultural factors and social influence techniques in Naikan therapy: a Japanese self-observation method. Psychotherapy: Theory, Research and Practice (in press).Google Scholar
  68. Tanaka-Matsumi, J., and Marsella, A. J. 1976 Cross-cultural variations in the phenomenological experience of depression: I. Word association studies. Journal of Cross-Cultural Psychology 7: 379–396.Google Scholar
  69. Tazawa, H. 1907 On obsessions. Shinkeigaku Zasshi 6: 1–22 (in Japanese).Google Scholar
  70. Temerlin, M. K. 1968 Suggestion effects in psychiatric diagnosis. Journal of Nervous and Mental Disease 147: 349–359.Google Scholar
  71. Uchinuma, Y. 1971 The structure of anthropophobia. Psychiatrica et Neurologica Japonica 73: 359–396 (in Japanese).Google Scholar
  72. Uemoto, Y., Murakami, Y., Fujita, S., Ogasawara, T., Suzuki, T., Aoki, M., Tsuchikawa, T., and Oiso, H. 1967 Experience of abnormal conviction in adolescene. Japanese Journal of Child Psychiatry 8: 155 (in Japanese).Google Scholar
  73. Ullmann, L. P., and Krasner, L. 1975 A Psychological Approach to Abnormal Behavior, 2nd ed. Englewood Cliffs: Prentice-Hall.Google Scholar
  74. Yamamura, M. 1933 Psychoanalytic study of fear of blushing. Bulletin of Psychopathology of Tohoku Imperial University 2: 69 (in Japanese).Google Scholar
  75. 1936 On tendency to avoid people. Bulletin of Psychopathology of Tohoku Imperial University 5: 45 (in Japanese).Google Scholar
  76. Yap, P. M. 1962 Words and things in comparative psychiatry, with special reference to the exotic disease. Acta Psychiatrica Scandinavia 38: 163–169.Google Scholar
  77. 1969 The culture bound reactive syndrome. In Mental Health Research in Asia and the Pacific. W. Caudill and T. Lin, eds. Honolulu: East-West Center Press.Google Scholar
  78. Zigler, E., and Phillips, L. 1961 Psychiatric diagnosis and symptomatology. Journal of Abnormal and Social Psychology 63: 69–75.Google Scholar

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© D. Reidel Publishing Co 1979

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  • Junko Tanaka-Matsumi

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