Culture Knowledge and Taijin Kyofusho

Due to the increasing diversity of the US population, it is vital for clinicians to possess the skills to work effectively with clients of different cultures (Ramirez & Smith, 2007). Earlier studies also recognise the importance of considering a client's culture during evaluation and treatment (Lopez & Hernandez, 1986, 1987; Ramirex, Wassef, Paniagua, & Linksey, 1996; Ramirez, Wassef, Paniagua, Linskey, & O'Boyle, 1994, as cited in Ramirez & Smith). This paper will begin by addressing the importance of gaining knowledge of cultures different from one's own. Followed by, ways a clinician could increase their knowledge to achieve an understanding of cultural diversity. Lastly, Taijin Kyofusho, a culture- bound syndrome will be introduced along with reasons why this syndrome could be perceived as different DSM-IV-TR (Diagnostic and Statistical Manual of Mental disorders, 4th edition Text Revision) diagnoses.

Understanding a client's culture is important because failure to do so during an evaluation can hinder the chances for successful treatment (Caplan, Caplan, & Erchul, 1995, as cited in Ramirez & Smith, 2007). A possible explanation for ineffective treatment may be cultural differences between the clinician and the client. Different cultures may have differing views on what symptoms are acceptable to express (Trang, 2004; Bussema & Nemec, 2006), what the meaning behind mental illnesses is, and what is considered safe and effective treatment (Bussema & Nemec). It is also possible for members of one group to not have the same beliefs and practices. Therefore, it is important for a clinician to have cultural competence to collaborate with their client to understand their client's specific health problems (Flaskerud, 2007) without failing to identify any important cues; behaviours believed to be normal in one society may be abnormal in others (Trang).

Learning about and understanding cultural diversity is a lifelong journey (Bussema & Nemec, 2006). However, there are a few ways a clinician can gain knowledge of different cultures. Some practical ways to gain knowledge include listening, interacting, and responding to clients from our own and different cultures in a mutually respectful way (Flaskerud, 2007). Language can often be a barrier for client's to express their psychological needs, either because there is little English known, or their own language does not have the exact same diagnostic expressions of psychologists (Trang, 2004). Hence, professional language translators or interpreters may be required. Another way to understand other cultures and their beliefs is to explore one's own culture to acknowledge how culture can shape oneself and how one responds to the world around them (Bussema & Nemec). This can help clinicians to become more open-minded and acknowledge differences in beliefs and values which can affect the service provided. Greater efforts to conduct research can increase knowledge about cultures (Trang).

The DSM-IV-TR describes Taijin Kyofusho as "A culturally distinctive phobia in Japan, in some ways resembling Social Phobia in DSM-IV". The disorder is characterised by fear or excessive sensitivity to interpersonal relations (Ono et al., 2004; Tarumi, Ichimiya, Yamada, Umesue, & Kuroki, 2004). Clients with Taijin Kyofusho report feeling extremely anxious when they are in the presence of other people (Ono et al.). Without knowledge of culture-bound syndromes, a client who presents with the symptoms of Taijin Kyofusho may be diagnosed with 'social phobia' or 'body dysmorphic disorder' because of their similar symptoms. For example, both Taijin Kyofusho and social phobia describe the fear of social or performance situations. Fear of making eye contact and blushing of the face (Nuckolls, 2006) are also shared by both disorders, but there are still differences. What distinguishes the two disorders is that clients' with social phobia are concerned about their own embarrassment, whereas Taijin Kyofusho worry about embarrassing or disturbing others due to their imagined ugliness or body odour (Ono et al.). Taijin Kyofusho may also fulfil criteria for 'body dysmorphic disorder' because both are concerned with an