The importance of knowledge of the particular cultural influences on psychopathology is highlighted by the fact that cultural influences can mean the difference between a favorable and unfavorable prognosis. Studies of guest workers in Germany (eg. Pfeiffer, 1994; Larbig, Xenakis, & Onishi, 1979) illustrate this point. Many guest workers exhibited an acute paranoid reaction with dramatic emotional displays to stressful events, others expressed intense anxiety and subsequently intense distress. If the therapists took the cultural context of the symptoms into account, the prognosis was more favorable than if the symptoms were mistaken for a more serious problem. This brings us now to consider some of the differences that exist cross-culturally, particularly to culture-bound syndromes.
Culture-bound syndromes can be defined as psychopathological syndromes that are identified or observed only within a particular cultural group. We can expect that culture-bound syndromes are those that arise because of the specific demands and values of the culture in which they appear. The individualism/collectivism distinction appears to play an important role in the development of several of these disorders.
One example of a culture-bound syndrome is Anthropophobia, found in China. This disorder is characterized by a fear of being looked at. Individuals with this disorder are typically conforming, rigid and introverted. The etiology of Anthropophobia is thought to involve sexual curiosity, sexual embarrassment and guilt, and self-exploration (Zhang & Zhong, 1993). Further, anthropophobics were found to have a more collectivistic orientation than patients diagnosed with neurasthenia, a similar syndrome.
Perhaps one reason this syndrome appears in China and has not been specifically identified in Western models of psychopathology is that Chinese culture is more interdependent. In an interdependent culture, we might expect that there are more distinctions made in types of social anxiety than in western culture because of the emphasis interdependent cultures place on maintaining social harmony. We would expect that individuals in such cultures would worry more about offending others than individuals in individualistic cultures. It would also explain the origin of a similar Japanese culture-bound syndrome called Taijin Kyofusho (fear of offending others by blushing, emitting odors, staring inappropriately, etc.) (Tanaka-Matsumi, 1979). These culture-bound syndromes could also reflect the range of "other-focused" emotions found in collectivist cultures. In Japan, these emotions include a feeling of connection with someone, feeling of similarity to someone, feeling of respect for someone, feeling of indebtedness, etc. (Markus & Kitayama).
Although there is some debate about this, Anorexia Nervosa has been described as a primarily western phenomenon. In an individualist culture, we might expect to see such a syndrome because it emphasizes ego-focused emotions such as pride and feelings of superiority. The individual with anorexia nervosa may be attempting to get attention by doing something they think will make them more attractive, and thus make them better than others. The findings that intentional starvation may exist in some collectivist countries do not necessarily mean that these instances have the same motivators.
The expression of symptoms of a disorder like depression can also vary according to the individualism/collectivism of a culture. Matsumi and Draguns point out that somatization as a symptom of depression is prevalent in a number of collectivistic cultures, while in the western individualistic cultures it is manifested more as an "intrapsychic experience." This could possibly be explained when we consider the display rules of individualistic and collectivistic cultures. In collectivistic cultures, displays of emotion are less accepted so we would expect that disorders like depression would manifest themselves more through somatic symptoms.
In conclusion, individualism and collectivism play a role not only in the formation and articulation of various culture-bound psychopathologies, but also in the expression of more universal psychological problems.
References
Larbig, W., Xenakis, C., & Onishi, M. S. (1979). Psychosomatische Symptome und funktionelle Beschwerden bei Arbeitnehmern in Ausland. Zeitschrift fuer Psychosomatische Medizin und Psychoanalyse, 25, 49-63.
Markus, H. & Kitayama, S. (?). Culture and the self.
Pfeiffer, W. (1994) Transkulturelle psychiatrie, 2nd ed. Stuttgart, Germany: Thieme.
Tanaka-Matsumi, J. (1979). Taijin Kyofusho: Diagnostic and cultural issues in Japanese psychiatry. Culture, Medicine and Psychiatry, 3, 231-245.
Tanaka-Matsumi, J. & Draguns, J. (?). Culture and psychopathology.
Zhang, J. & Zhong, Y. (1993). Discussion on psychopathological nature and pathogenesis of anthropophobia. Chinese Journal of Neurology and Psychiatry, 19, 269-271.
