Kirmayer L J
Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montréal, Québec, Canada.
J Nerv Ment Dis. 1991 Jan;179(1):19-28. doi: 10.1097/00005053-199101000-00005.
The place of culture in psychiatric nosology is explored through the example of taijin kyofusho (TKS), a common Japanese psychiatric disorder characterized by a fear of offending or hurting others through one's awkward social behavior or an imagined physical defect. Although variants of this disorder have been described in other cultures (e.g., dysmorphobia), the full spectrum appears to be confined to Japan. TKS can be understood as a pathological amplification of culture-specific concerns about the social presentation of self and the impact of improper conduct on the well-being of others. Both social interaction and constitutional vulnerability may contribute to the cognitive processes that underlie TKS. The salience of cultural differences for psychiatric nosology then depends on whether the clinical focus is on disordered biology, individual psychology and experience, or the social context of behavior. Any attempt to include cultural variation in psychiatric diagnoses must begin by making explicit the intended use of the classification because different social contexts and clinical goals demand alternative diagnostic schemes.
通过“恐人症”（TKS）这一实例，探讨文化在精神疾病分类学中的地位。“恐人症”是一种常见的日本精神疾病，其特征是担心自己笨拙的社交行为或想象中的身体缺陷会冒犯或伤害他人。尽管这种疾病的变体在其他文化中也有描述（如畸形恐惧症），但其全貌似乎仅限于日本。“恐人症”可被理解为对特定文化中关于自我社会表现以及不当行为对他人幸福影响的关注的病态放大。社会互动和体质易感性都可能促成“恐人症”背后的认知过程。文化差异对精神疾病分类学的重要性，进而取决于临床关注的是紊乱的生物学、个体心理和经历，还是行为的社会背景。任何将文化差异纳入精神疾病诊断的尝试，都必须首先明确分类的预期用途，因为不同的社会背景和临床目标需要不同的诊断方案。
