Conceptualizing Cross-Cultural Psychotherapy

Challenges and Theories

Photo by Amauri Mejía on Unsplash

Humans share numerous similarities in their emotions, but mental disorders appear to be substantially shaped by cultural context. Cultural Psychology presents hikikomori, acute social withdrawal, as a uniquely Japanese phenomenon. Though similar to disorders like agoraphobia, hikikomori appears to be outside the categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM), complicating treatment protocols (Heine, 2020). Therefore, conditions like hikikomori significantly impact both cross-cultural psychology and psychotherapy.

One may be tempted to compare hikikomori to ostensibly similar disorders, but such conflations could have disastrous effects (Heine, 2020). Analogously, ADHD and anxiety disorders have relatively similar symptomologies; however, pharmaceutically, both conditions are treated in dramatically different ways. ADHD is typically treated with a stimulant, which would be disastrous to a person with an anxiety disorder. One encounters similar issues in retrospective diagnoses of historical figures, which often grant a privileged position to modern diagnostic categories (Siena, 2005). For example, commentators have attempted to impose modern diagnoses like Major Depressive Disorder or Generalized Anxiety Disorder onto ancient Assyrian medical texts, which had relatively different ways of conceptualizing psychopathology (Al-Rashid, 2014; Love, 2021).

Such misdiagnoses present potential dangers when treating patients. For example, Americans might be tempted to intervene in hikikomori directly, while most Japanese families would not. However, direct interventions appear to have negative impact upon hikikomori, exacerbating symptoms (Heine, 2020). Indeed, educational programs in Japan geared toward destigmatizing hikikomori, especially for the families of those who experience this condition, have proven to be effective treatment aids (Kubo et al., 2020). This demonstrates the need to take a contextually-informed approach to culturally-contingent conditions like hikikomori, as opposed to cramming such conditions into preexisting diagnostic categories.

Modern neuroscience may provide an explanation for the specificity of mental health and treatment. Research suggests that the brain responds to external arousal…