Somatization: A Transcultural Perspective

The term ‘somatization' carries a wide range of meanings and its use in transcultural psychiatry needs to be placed in context. Somatic presentations of psychiatric disorders are common in all ethnic groups; particularly high rates are reported in non-Western cultures and among ethnic minority groups in the West. An analysis of the language of emotion in different cultures indicates three basic modes of expression: somatic sensations, somatic metaphor, and abstract psychological language. Examples of all three modes can also be found in ancient literature, such as the Hebrew Bible and the epics of Homer. The absence of specific words for depression or anxiety is not associated with any lack of psychological-mindedness. Transcultural research in psychiatry needs to pay close attention to methodological issues to avoid ethnocentric bias. Currently-available instruments for cross-cultural research on somatic symptoms are reviewed. These have been used to examine the extent of cultural differences in the experience and expression of somatic symptoms. In the light of these findings, the validity of the concept of ‘somatization' is questioned, particularly because of its inherent dualism. Finally, a new model of somatic symptom formation is proposed which takes account of language, cultural beliefs and cultural norms of illness behaviour.