Kirmayer L J, Young A
Sir Mortimer B. Davis-Jewish General Hospital, and Division of Social & Transcultural Psychiatry, McGill University, Montreal, Quebec, Canada.
Psychosom Med. 1998 Jul-Aug;60(4):420-30. doi: 10.1097/00006842-199807000-00006.
The cross-cultural prevalence of somatization and the limitations of current nosology and psychiatric theory for interpreting cultural variations in somatization are reviewed.
Selective review was conducted of recent research literature and research findings from an epidemiological survey and ethnographic study of help-seeking and health care utilization of a random sample of 2246 residents in a Canadian urban multicultural milieu.
Somatization is common in all ethnocultural groups and societies studied to date. However, significant differences in somatization across ethnocultural groups persist even where there is relatively equitable access to health care services. Analysis of illness narratives collected from diverse ethnocultural groups suggests that somatic symptoms are located in multiple systems of meaning that serve diverse psychological and social functions. Depending on circumstances, these symptoms can be seen as an index of disease or disorder, an indication of psychopathology, a symbolic condensation of intrapsychic conflict, a culturally coded expression of distress, a medium for expressing social discontent, and a mechanism through which patients attempt to reposition themselves within their local worlds.
Major sources of differences in somatization among ethnocultural groups include styles of expressing distress ("idioms of distress"), the ethnomedical belief systems in which these styles are rooted, and each group's relative familiarity with the health care system and pathways to care. Psychological theories of somatization focused on individual characteristics must be expanded to recognize the fundamental social meanings of bodily distress.
综述躯体化的跨文化患病率以及当前疾病分类学和精神病学理论在解释躯体化文化差异方面的局限性。
对近期研究文献以及一项流行病学调查和人种志研究的结果进行了选择性回顾，该研究对加拿大一个城市多元文化环境中随机抽取的2246名居民的求助行为和医疗保健利用情况进行了调查。
在迄今为止研究的所有种族文化群体和社会中，躯体化现象都很常见。然而，即使在获得医疗保健服务相对公平的情况下，不同种族文化群体之间在躯体化方面仍存在显著差异。对从不同种族文化群体收集的疾病叙述的分析表明，躯体症状存在于多种意义系统中，这些系统具有不同的心理和社会功能。根据具体情况，这些症状可以被视为疾病或障碍的指标、精神病理学的迹象、内心冲突的象征性浓缩、痛苦的文化编码表达、表达社会不满的媒介，以及患者试图在其当地世界中重新定位自己的一种机制。
种族文化群体之间躯体化差异的主要来源包括表达痛苦的方式（“痛苦习语”）、这些方式所植根的民族医学信仰体系，以及每个群体对医疗保健系统和就医途径的相对熟悉程度。专注于个体特征的躯体化心理学理论必须加以扩展，以认识到身体痛苦的基本社会意义。
