Boundless syndromes in modern society: An interconnected world producing novel psychopathology in the 21st century

‘We believe that it is extremely likely that culture-bound syndromes will no longer be culturally bound but culturally influenced.’ (Ventriglio, Ayonrinde and Bhugra, pp. 3–6 in this issue of PCN1) Now, several decades into a global Internet society and the long progression of globalization with its interflow of cultures, the time to reconsider the concept of culture-bound syndromes is upon us. In this issue of Psychiatry and Clinical Neurosciences, Ventriglio et al. have proposed the reconstruction of culture-bound syndromes.1 Ventriglio et al. have emphasized the postmodern irony that ‘culture-bound’ syndromes are growing less and less culturally bound and are becoming cross-border cultural influences. They see this as the direct result of the forces of globalization, industrialization and urbanization. As a result, modern societies' ‘perceptions and idioms of distress’ have been transformed. Ventriglio et al. have pointed to the fact that cultures no longer remain within borders but rather influence each other. In Japan, novel sociopsychopathological phenomena, such as hikikomori and ‘modern type depression,’ have emerged, and recent international studies have revealed that such culture-influenced phenomena have also been observed outside Japan.2, 3 In this issue, Kato et al. have overviewed Japan's ‘modern type depression’ from multi-dimensional perspectives, proposing a novel diagnostic approach for the new syndrome.4 A more interconnected world due to globalization and the growing importance of ‘(Inter)net society’ may be major contributing factors behind these phenomena. These syndromes are yet to be listed in the latest versions of the ICD and DSM. Furthermore, there is a growing concern that diagnostic criteria have not only failed to keep up with the speed of social change but more importantly they may be unable to do so. It is easy to imagine the ever-increasing speed at which new syndromes will appear in our quickly evolving modern society. Ironically, by the time that a diagnostic criterion is developed, such syndromes may have morphed into other pathological phenomena. Thus, psychiatrists should not attempt to ‘bind’ patients within present diagnostic criteria but must fundamentally consider a biopsychosocial perspective in relation to patients, especially considering the issue of an interconnected world. An interconnected world is resulting in a boundless society and building a boundless psychological world in modern persons, which may form a variety of novel psychopathological conditions in the near future. Behind the increase of people with hikikomori there may be an interconnection with societies that are increasingly boundless. Ironically, this very interconnectedness may spur an increase in the number of people who need to drastically ‘disconnect’ (withdraw) from society. Can psychiatrists deal with these new syndromes? In modern psychiatry, the educational foundation of psychopathology and psychoanalysis, both classical subjects to learn the basic psychological and psychopathological mechanisms of mental illness, are lacking.5 However, we believe that psychopathological and psychodynamic understandings of psychiatric patients, beyond the categorical diagnostic systems, such as the ICD-10 and DSM-5, must help to deal with such sufferers, even though they do not match any present diagnostic criteria. The nurturing of psychiatrists with a well-balanced multi-axial perspective is a necessity to confront the boundless syndromes of the 21st century.