中国躯体化?中国人抑郁与焦虑症状的文化表达

Chinese Somatization? The Cultural Presentation of Depression and Anxiety among Chinese

中国人倾向于以躯体化的方式表达心理社会问题,即中国躯体化,是文化心理病理学的一个经典课题。自Kleinman(1982)关于中国抑郁躯体化表达的经典研究以来,研究者从躯体化和心理化角度,对中国人心理病理的症状表现进行了深入的探索与研究。对中国抑郁患者的长期研究显示,临床病人的症状表现具有较为稳定的躯体化特点,但随着中国社会快速的现代化进程,心理症状逐渐显现。近年对中国焦虑症症状表现的探索研究发现,与抑郁躯体化表现相反,焦虑病人呈现心理化表达的趋势。本研究从文化-心理-大脑这一多维整合系统出发,认为躯体化是中国抑郁症的文化文本。这一文本既包含面对心理社会压力,直接报告躯体体验的反应方式,又包含谈论不会带来麻烦的躯体症状的交流策略,是体验派和症状交流派解释的整合。心理化可能是当前中国焦虑症的文化文本,这一文本既涉及情绪、心理症状的“释放”,同时又包含现代中国文化对责任、家庭、友情等人际因素的关注与重视。最后,我们从文化、心理、大脑的相互建构角度,讨论了中国文化下的抑郁症和焦虑症的症状表达这一课题还需进一步研究的问题和方法。

The tendency of Chinese people to emphasize somatic symptoms in the presence of psychosocial difficulties,well known as "Chinese somatization",is a classic topic in cultural psychopathology. Since Kleinman’s( 1982)study on the somatic tendency among Chinese clinical patients,researchers examined the psychopathology of Chinese patients in terms of somatization and psychologization. Reviewing the literature on depressed symptoms,Chinese patients indeed showed somatic tendency. However, as Chinese rapid modernization,psychological symptoms gradually expressed. Recently,researchers turn to anxiety symptoms. Contrary to somatization related to depression,anxiety patients tend to emphasize psychological symptoms. From the view of "culture-mind-brain ",we propose that somatization is a cultural script for depression among Chinese patients,which includes direct reports of bodily experiences in response to psychosocial stressors,as well as a communication strategy in which open acknowledgement of psychosocial distress is discouraged,reflecting the integration of experience and expression of distress and conceptualization and communication of distress. Preliminarily,we propose that psychologization might be a cultural script for anxiety among current Chinese patients,which involves the unleash of emotion or psychological symptoms,as well as a cultural emphasis on responsibility and interpersonal relationship. At last,we discuss the further research questions and methods related to the cultural presentation of depression and anxiety among Chinese people,from the view of the mutual constitution between culture,mind and brain.