Another possible Western illness in disguise is taijin kyofusho, which appeared in our quiz and is also listed in the DSM-IV appendix of culture-bound syndromes. Taijin kyofusho is an anxiety disorder, common in Japan, marked by a fear of offending other people, typically by appearance or body odor. Taijin kyofusho may be an Asian form of social phobia (also called social anxiety disorder), in which people dread behaving in a fashion that is potentially embarrassing—say, making a gaffe when speaking or performing in public. Because Japanese tend to be more concerned with group harmony and cohesiveness than are Westerners, taijin kyofusho may be a form of social phobia in a culture that is especially sensitive to the feelings of others.
Nevertheless, some culture-bound syndromes may be sufficiently different from Western disorders to merit separate diagnostic criteria. In the bizarre condition of koro, found primarily in Southeast Asia and Africa, people fear that their sexual organs are disappearing or shrinking. Koro sometimes spreads in waves of mass panic and is triggered by marked anxiety. In the Malaysian condition of amok, which has given rise to the expression “running amok,” afflicted individuals, almost all of whom are males, often respond to a perceived slight by withdrawal and brooding, followed by frenzied and uncontrolled violence.
And in the disorder of “2-D love,” recently reported in Japan and some other countries, men develop what appear to be amorous relationships with animated female characters; they may carry around pillows or other tangible reminders of these characters wherever they go. Whether these mysterious maladies bear any underlying commonalities to well-documented Western psychiatric illnesses is unknown. Koro, for example, could be a type of hypochondriasis (hypochondria), but this possibility has received little systematic research.
Scientific disagreements aside, experts concur that culture can shape the overt expression of mental illness in significant ways. As a consequence, psychotherapists ought to give further consideration to learning more about cultural influences on mental illness and incorporating them into their treatment plans. Meanwhile scientists should use personality and laboratory tests to investigate the causes and manifestations of culture-bound syndromes to determine which of these disorders, if any, are distinct from those in Western culture. If some of these syndromes turn out to be unique, mental health professionals may need to construct and implement psychological interventions that differ in significant ways from those we recognize.
This article was originally published with the title Foreign Afflictions.