Social anxiety (phobia) and east Asian culture

Since the introduction of the concept of social anxiety (or phobia) to the American nosological system in DSM-III (1980), it has become increasingly apparent that the condition is also prevalent in other cultures. In Japan, for example, the condition, called taijinkyofusho (usually abbreviated as TKS in English), is widespread and has been extensively discussed since the turn of the century, a fact not well known in the English-speaking psychiatric community. In comparing social phobia in Japanese society (and in other East Asian societies) with North American societies, two questions stand out. First, if TKS is social phobia, why is it so different from the American form of social phobia? In particular, why do typical TKS patients fear the possibility of distressing, and even harming, others, whereas their American counterparts feel anxious at the possibility of being embarrassed by others? In other words, why is TKS other-oriented (allocentric), whereas social phobia is self-oriented (egocentric)? Second, is TKS specific to Japanese culture? In this paper, I suggest that the allocentric nature of TKS reflects those elements of Japanese culture that are common to East Asian societies as seen in their pattern of child-rearing practices, language, and social ideals. In short, TKS is an East Asian cultural patterning of social anxiety (phobia).