Tai/in Kyofusho or 'anthrophobia' is a Japanese culture-specific diagnostic label for the presenting problems of various fear reactions in interpersonal situations. The starting point of the present study was accumulating studies on Japanese cases of Tai/in Kyofusho and the assertion in Japanese psychiatry that the symptom complex called Tai/in kyofusho is Japanese culture-bound. In light of previous works on culture-bound disorders, the present study examines whether or not American mental health professionals could diagnose Japanese ease descriptions of Taiiin Kyofusho and what kinds of labels they applied to these Japanese cases. The results showed that American judges were able to diagnose the Japanese cases nearly as well as American cases. However, there were considerable variability and inconsistency in their judgments of both the Japanese and American cases. The rate of diagnostic agreement dropped considerably as judges were asked to proceed from broad categories to specific categories. American judges grouped the Japanese cases of Taijin Kyofusho into a number of heterogeneous categories using labels such as paranoid schizophrenia, paranoid personality, phobic neurosis, and anxiety neurosis, among others. These results are discussed in terms of psychopathological diagnostic criteria and present conceptualization of culture-bound disorders, value judgments of mental health professionals, and the social contexts in which Tai/in Kyofusho reactions occur.
Patients with the presenting problems of phobic behavior in social situations have been in the forefront of Japanese psychiatry (Kasahara 1972). Historically, these patients with the diagnosis of Taifin Kyofusho, a name equivalent to "social phobia" (Marks 1969) or "anthrophobia" (Kate 1964), became visible to Japanese psychiatrists during the 1920's when Shoma Morita, a Japanese psychiatrist and the founder of Morita psychotherapy (Reynolds 1976), established the classificatory system of Shinkei-shitsu, which refers to "much of what is covered under the several Western headings of neurasthenia, anxiety neurosis, and obsessive-compulsive reactions" (Caudill and Doi 1963:386). Taifin Kyofusho is a subcategory ofShinkeishitsu.
In light of actively developing interest in cross-cultural psychiatric assessment (Draguns 1977), the present paper examines diagnostic and cultural issues regarding Taijin Kyofusho reactions through the use of case materials of Japanese patients.
TAIJIN KYOFUSHO
Taijin Kyofusho as a diagnostic label first appeared in the 1920s about 30 years after the adoption of Austrian-German psychiatry by Japanese medical academia (Ohara, Aizawa and Iwai 1970). Taifin is a Japanese word for 'interpersonal' and Kyofusho stands for 'phobia' or 'fear'. Taifin Kyofusho is a symptom complex