The socio-cultural significance of the diagnostic label “neurasthenia” in Japan's mental health care system

This paper is an attempt to explore the socio-cultural significance of deliberately disguising schizophrenia as neurasthenia, neurosis or malfunction of autonomic nervous system. To understand its significance, the socio-cultural background of Japanese attitudes toward mental illness and Japan's mental health care system is also examined from a non-Western standpoint.     

Measures of taste discriminability for sweet, salty and umami stimuli: Japanese versus Americans

Japanese and American subjects performed triangle tests withvarious concentrations of sucrose. NaCl and MSG. Both sets ofsubjects were tested in their own countries in their own languages.The Japanese discriminated significantly better for sucroseand MSG, while for NaCl there were no significant differencesbetween the groups. To protect against variation in water puritybetween the American and Japanese laboratories. 10 mM NaCl wasused as the solvent, while judges were pre-adapted to the solventto render it tasteless. Changing from purified water to 10 mMNaCl as the solvent, alters the discriminability of the stimuli.     

Priorities for mental health research in Europe: A survey among national stakeholders' associations within the ROAMER project

Within the ROAMER project, funded by the European Commission, a survey was conducted with national associations/organizations of psychiatrists, other mental health professionals, users and/or carers, and psychiatric trainees in the 27 countries of the European Union, aiming to explore their views about priorities for mental health research in Europe. One hundred and eight associations/organizations returned the questionnaire. The five most frequently selected research priorities were early detection and management of mental disorders, quality of mental health services, prevention of mental disorders, rehabilitation and social inclusion, and new medications for mental disorders. All these areas, except the last one, were among the top ten research priorities according to all categories of stakeholders, along with stigma and discrimination. These results seem to support the recent argument that some rebalancing in favor of psychosocial and health service studies may be needed in psychiatric research.     

Spirit possession in South Asia,dissociation or hysteria?

Psychoanalytic theory appears flawed in its notions of universal oedipal conflict and repression, and unsuitable for the study of pathological spirit possession in South Asia. The biological theory of contemporary psychiatry is no more effective in this analysis because mental illnesses are constituted within culture-bound categories of experience. Dissociation theory offers a better theoretical tool for this type of research. A summary of the history of paradigm shifts in psychiatric theory relevant to spirit possession is presented.     

STRUCTURED AND UNSTRUCTURED 9-POINT HEDONIC SCALES: A CROSS CULTURAL STUDY WITH AMERICAN, JAPANESE AND KOREAN CONSUMERS

The range of scores elicited by a structured, an unstructured and a 'labels-only'version of the 9-point hedonic scale were compared using consumers from USA, Japan and Korea. It was found that the unstructured scale elicited a wider range of scores for American and Japanese consumers. After correction for hedonic ranges, it was found that Japanese had smaller ranges of scores on all three scales, although the effect was less pronounced for the unstructured scale. The Korean consumers were the exception. Their ranges were less than Americans but their ranges on the unstructured scale did not increase. The results were discussed in terms of the effects of inhibition of use of categories by the scale labels, effects of translation from the English, psychophysical style and order effects.     

Are culture-bound syndromes as real as universally-occurring disorders?

This paper asks what it means to say that a disorder is a "real" disorder and then considers whether culture-bound syndromes are real disorders. Following J.L. Austin I note that when we ask whether some supposed culture-bound syndrome is a real disorder we should start by specifying what possible alternatives we have in mind. We might be asking whether the reported behaviours genuinely occur, that is, whether the culture-bound syndrome is a genuine phenomenon as opposed to a myth. We might be wondering whether the condition should rightly be considered a disorder, as opposed to some sort of non-disorder condition (for example, a non-disorder form of deviance, or a potentially valuable condition). We might want to know whether the culture-bound syndrome is really a distinct disorder, in the sense that scientific classification systems should include it as a separate category, or whether it is just a variant of a universally occurring disorder. I argue that some specific difficulties can arise with determining whether a culture-bound syndrome is a real disorder in each of these three senses. However, the frequent assumption that real disorders will necessarily occur universally, and that those that occur only in certain environments are suspicious is not generally justified.     

Taste sorting and naming: can taste concepts be misrepresented by traditional psychophysical labelling systems?

Japanese and American subjects were required to sort filterpapers, soaked in taste stimuli, into categories that had conceptuallythe same taste. Both Japanese and Americans sorted in the samemanner, indicating similar conceptualization. Taste names weregiven to the taste categories obtained by using the traditional‘four basic taste’ naming system, common in tastepsychophysics. This method was seen to underestimate the numberof categories actually present. This suggests a re-assessmentof current psychophysical taste-naming techniques.     

Perceptions of Intentionality for Goal-Related Action: Behavioral Description Matters

Perceptions of intentionality critically guide everyday social interactions, though the literature provides diverging portraits of how such judgments are made. One view suggests that people have an "intentionality bias," predisposing them toward labeling behaviors as intentional. A second view focuses on a more complex pattern of reasoning whereby judgments of intentionality are shaped by information about social context and mental states. Drawing on the theory of action-identification, we attempt to integrate these two perspectives. We propose that people parse intentionality into two categories: judgments about concrete, low-level behaviors and judgments about relatively more abstract, high-level behaviors. Evidence from five studies supports this distinction. Low-level behaviors were perceived as intentional regardless of mental state information, supporting the “intentionality bias” view. In contrast, judgments about the intentionality of high-level behaviors varied depending on social context and mental states, supporting the systematic view of intentionality.     

Anxiety disorders in Japan: A Review of The Japanese literature on Shinkeishitsu and taijinkyōfushī

As culture-bound syndromes, Japanese shinkeishitsu (constitutional neurasthenia) and taijinkyfush (anthropophobia) have received considerable attention in the Japanese literature. While these disorders are viewed as diagnostically distinct from Western psychiatric categories, recent studies by the Japanese suggest some affinity with Western social phobias, depression, and schizophrenia. The paper reviews this literature and offers suggestions for further cross-cultural research.This paper was accepted for publication prior to the compilation of Volume 13, No. 2, Neurasthenia in Asian Cultures. Consequently it does not refer to the papers in that volume, several of which are very relevant to the discussion in this paper.     

Protein-energy malnutrition as a culture-bound syndrome

A new definition of the concept of culture-bound syndrome demonstrates that culture-boundedness is common and applies as well to Western biomedical disease categories as to nonWestern categories. Culture-boundedness is important when a common disorder with a large sociopsychological component is frequently treated, but unsuccessfully. To improve intervention success, therapists must recognize and accept that clients and interventionists may employ widely dissimilar culture-bound explanatory models. Therapists must learn to synthesize among models, neither rejecting nor discounting those of clients. The fact that Western notions of cause are culture-bound has gone largely unrecognized because of the tendency among biomedical scientists to treat science as if it were culture-free and universally comprehensible. This is of course a naive and invalid understanding. These points are illustrated for the case of protein-energy malnutrition. If those who design and facilitate intervention to alleviate hunger can come to understand that the scientific explanatory model of protein-energy malnutrition is only one among several cogent models, they will be in a strong position to understand intervention failure and possibly to overcome it.     

Psychosomatic problems and countermeasures in Japanese children and adolescents

In Japan there are a number of children and adolescents with emotion-related disorders including psychosomatic diseases (orthostatic dysregulation, anorexia nervosa, recurrent pains), behavior problems and school absenteeism. According to our previous report, the Japanese children had significantly higher score of physical symptoms and psychiatric complaints than did the Swedish children, and these were more strongly influenced by school-related stress than by home-related stress. To enforce countermeasures for psychosomatic problems in children, the Japanese Society of Psychosomatic Pediatrics (established in 1982) have started several new projects including multi-center psychosomatic researches and society-based activities. In this article, we present an outline of our study on mental health in Japanese children in comparison with Swedish children. Countermeasures including clinical guidelines for child psychosomatic diseases are reviewed and discussed.     

Les ��tats anxieux dans l��histoire de la m��decine Deuxi��me partie: de la neurasth��nie au trouble anxi��t�� g��n��ralis��e

The last ??great neurosis,?? described by general practitioners before the Freudian classification, the neurasthenia (Beard, 1869, 1880; Charcot, 1887) originated between 1870 and 1900 in the USA and in Europe. It was then dismembered and annexed by the psychiatrists, through psychasthenia (Janet, 1903) and mild depressive states. It declined slowly at the beginning of the 20th century, but is still alive in the textbook of P. Guiraud (1956) and in the ICD-10 (1992). Helped by the works of E. Brissaud (1890) and E. Hecker (1892), Freud??s ??anxiety neurosis?? (1895) remains, however, the most famous clinical entity resulting from the dismemberment of neurasthenia. It includes anxious expectation, anxiety attacks, and somatic equivalents. Diffused in France by Hartenberg, Lalanne (1902), and then Heckel (1917), it was contested by G. Ballet, Pitres and Regis (1902) and F. Raymond (1911) ?? successor of Charcot at the Salpêtrière Hospital. After 1910, the hereditary ??emotive constitution?? of E. Dupré tended to gather the manifestations of anxiety neurosis, several hysterical symptoms, some depressive disorders, and post-traumatic disorders resulting from the lst World War (Devaux and Logre, 1917; De Fleury, 1924). But many French authors separated psychical anxiety and somatic anguish ?? later named panic disorder, (Brissaud, 1902; Claude and Lévy-Va1ensi, 1938; Ey, 1950). After 1945, the emergence of several somatic entities such as stress, vagotonia, and spasmophilia can be seen as new attempts by general practitioners for the annexation of anxiety disorders. After 1960, two opposite clinical orientations can be described: those inspired by psychoanalysis maintain the autonomy of anxiety neurosis; others separate, from psychopharmacological criteria, generalized anxiety and acute anguish. This last, named ??panic attack?? (D. Klein, 1962), gathers in fact the symptoms of paroxysmal anxiety (Brissaud), anxiety attack (Freud), emotive attack (Dupré), emotive or anxious crisis (Devaux and Logre), and the mental paroxysmal form of anxiety (Heckel). Though the clinical dichotomy between generalized anxiety and panic disorder has been emphasized by DSM-IV and ICD-10, a dimensiona1 approach of mental disorders would include most anxious and ??neurotic?? symptoms, beyond anxiety neurosis.     

Psychiatric Problems Affecting Dental Care of the Elderly1

The author reviews the major psychiatric disorders that can affect the dental care of the aged. Depression and dementia are the most common problems in the upper age groups. Other less frequent disorders include paranoid states, anxiety states, and alcohol abuse. All of these illnesses have both symptomatic and specific treatments so that a thorough evaluation and aggressive treatment plan should be pursued when psychiatric symptoms present in any elderly patient. Their treatment can have a considerable influence on the patient's dental care. Ageism, orality, preventive dentistry, xerostomia and periodontal disease are discussed in the context of these psychiatric illnesses of the aged.     

Experimental informational neuroses in dogs as sequelae of overloading short-term memory

In conditions of overloaded function of short-term memory, studied by the method of delayed reactions, with a prolonged deficit of time allotted for realization of the function, the animals exhibit substantial disturbances of higher nervous activity which by their etiological character belong to the group of informational neuroses. Appearance of the neurosis is preceded by a number of complex behavioral and vegetative changes reflecting activation of powerful compensatory mechanisms of the brain activity, aimed at elimating the time deficit and other neurotizing factors of the surroundings. Experimental neurosis caused by overloading the function of short-term memory is characterized by a severe course and is attended with motor and somatic disturbances as well as by memory and emotional disorders.     

Trauma and Humanitarian Translation in Liberia: The Tale of Open Mole

The focus of this paper is the intercultural process through which Open Mole and trauma-related mental illnesses are brought together in the postconflict mental health encounter. In this paper, I explore the historical dimension of this process by reviewing the history of Open Mole, and the ways in which it has been interpreted, acted on, and objectified by external observers over the last half-century. Moving into Liberia’s recent war and postconflict period, I examine the process by which Open Mole is transformed from a culture-bound disorder into a local idiom of trauma, and how it has become a gateway diagnosis of PTSD-related mental illnesses, and consider how it is produced as an objectified experience of psychiatric disorder in clinical humanitarian contexts. By studying how Open Mole is transformed in the humanitarian encounter, I address the structure and teleology of the humanitarian encounter and challenge some of the foundational assumptions about cultural sensitivity and community-based mental health care in postconflict settings that are prevalent in scholarship and practice today.     

Critical therapeutics: cultural politics and clinical reality in two eating disorder treatment centers

Recent studies suggest that eating disorders are increasing in Mexico and that this seems to correspond with Mexico's push to modernization. In this respect, Mexico exemplifies the acculturation hypothesis of eating disorders, namely, that anorexia and bulimia are culture-bound syndromes tied to postindustrial capitalist development and neoliberalist values, and that their appearance elsewhere is indicative of acculturation to those values. Available evidence for this claim, however, is often problematic. On the basis of five years of comparative fieldwork in eating disorder clinics in Mexico City and a small Midwestern city in the United States, I reframe this as an ethnographic question by examining how specific clinical practices at each site entangle global diagnostic categories with local social realities in ways that problematize existing epistemologies about culture and illness. In this regard, debates about acculturation and the global rise of eating disorders foreground issues of central epistemological and practical importance to contemporary medical anthropology more generally.