Psychosomatic factors
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In the West, illness that cannot be classified as organic is labelled functional, often implying psychosomatic involvement, a concept still somewhat stigmatised (Hammer, 1990) and tentatively associated with hypochondria. Even in the instance of the latter, little consideration is given to the possibility that a patient may be presenting with a disturbance beyond the diagnostic capabilities and agenda of the dominant medical system (Hammer, 1990).

Rather than emphasize structural abnormalities, Chinese medicine addresses disharmonious distributions of Qi that may affect structure over time, but appear before clinically diagnosed disease emerges (Beinfield & Korngold, 1991). Chinese medicine may provide a model for how psychosomatic illness develops (Aung, 1996), and hypochondria is perpetuated, while acupuncture may provide a therapeutic intervention.

A misunderstood theme in western psychosomatic medicine is that emergence of physical dysfunction in the presence of a psychological stress is a hallmark of psychological weakness. In the Chinese view, physical symptoms instigated by stressors may develop when an individual is psychologically sound. The continuum of organ energy function allows for pathology to manifest anywhere along this spectrum. Adaptively this is logical, since maintaining full psychological capacity while experiencing physical symptoms may be preferable to sacrificing cognitive processes (Hammer, 1990). A person who develops a physical symptom when confronting emotional stress is demonstrating a resilient mental and emotional apparatus, by manifesting the less disorganizing, and culturally accepted option of a physical disease than the massively disorganizing one of mental dysfunction (Hammer, 1990). Understanding this possibility may be of benefit to western by health care professionals and patients, especially those tainted by the stigma of a psychological disorder in a society which is unsympathetic to psychosomatic origins of illness (Hammer, 1990).

The differences between oriental and occidental symptom detection, appraisal and diagnostic attribution (Draguns, 1973), is usually attributed to the stoicism reputed to be universal in the Asian culture and reluctance to be identified with stigmatised psychopathology (Hopkins et al., 1989 in McMHAP, 1996). Chinese patients tend to manifest psychopathology, particularly depression in a somatic form (Cheung & Leung, 1998, Zhang, Yu, & Yuan 1997). This has been identified as a Chinese cultural characteristic (Kleinman, 197; Lin, 1981; Tseng, 1975 in Cheung & Leung, 1998) and the preferred diagnosis for the condition is neurasthenia (Ying & Zhang, 1995). However this could also reflect the ideas that predominate in the traditional medical system of the culture, since manifestation of depression is a socio-cultural construct. Perhaps this culture's terminology and concepts can never approximate western notions of some mental illnesses. Many high scores on depression measures obtained by Chinese respondents have been attributed to cultural differences in endorsement of some items that characterise behaviours not considered to reflect depression in a Chinese cultural context (Cheung & Leung, 1998). Scale items must be valid indicators of the attribute being investigated within the specific culture in order to demonstrate adequate validity (Cheung & Leung, 1998). The cultural emphasis on somatic factors does not dictate that this manifestation of psychopathology is a culturally determined act of stoicism alone. Despite this somatic focus, western psychiatric depression symptoms were validated in a Chinese sample (Kleinman, 1982; Segal et al., 1993 in Zhang et al., 1997) suggesting that there is some similarity in manifestation, and that the discrepancy in experience may be founded in perceptual differences. Although there is sufficient overlap in symptoms between neurasthenia and depression to identify them as the same syndrome, the former involves more vegetative abnormalities (Ying & Zhang, 1995). However, there is a possibility that somatic symptoms may be reported more frequently due to the accepted ethos (Ying & Zhang, 1995). Since Chinese patients are more willing to admit somatic dysfunction and psychological disorders, comparative studies must be interpreted cautiously regarding incidence of disorders (Ying & Zhang, 1995). Discrepencies may be due to different cultural response patterns rather than difference in psychopathology (Cheung, 1986 in Ying & Zhang, 1995; Horgan, 1996).

Psychophysiological response to stressors is usually universal (Fabrega, 1989). How these reactions are processed differs according to expectancies and what aspects of sensory input originating in bodily experience, are attended to. This differs cross culturally (Angle & Thoits, 1987) and has been traced to culturally specific experiences of child rearing (Angle & Thoits, 1987). It has been suggested that more scientifically oriented cultures tend to distinguish between physical and emotional aspects (Angle & Thoits, 1987). Yet the current emphasis in western medicine on investigating different levels of dysfunction includes physiological correlates. Physiological reactions occurring with emotion (Angle & Thoits, 1987) are generally accepted, however, causation is still widely disputed. Interpreting neurobiological and neurochemical correlates of psychopathology, and addressing these aspects therapeutically does not constitute an act of cultural stoicism. It follows that addressing the somatic organ pathologies central to Chinese medical philosophy which are thought to have cellular correlates in western medicine, and treating them accordingly, is akin to pursuing a more holistic perspective, as is the current focus in the West. Investigating how current trends in psychopathology research affects the ideas and response to illness of individuals in different cultures would provide useful information.

Psychology has searched in vain for a physiology which demonstrates a clear connection between somatic events and psychological concepts of the mind that is not an ad hoc theory regarding the latter. To date, western science has been the uneasy partner of psychology. To deal effectively with problems involving mind it may be necessary to deviate from the standard medical paradigm in the directions of the core premises of the Chinese outlook (Hammer, 1990). Western psychology with a significant focus on mind rather than brain, and the arbitrary constructs this necessitates, is closer in principle to the tenants of the Chinese outlook than those of western medicine (Hammer, 1990). Even psychosomatic medicine fails to overcome this dualism by implying that "it is all in the mind," preserving the mind (psyche) and body (soma) duality (Turner, 1992 in Williams & Bendelow, 1996). These ideas are not confined to medicine and psychology but imbedded in the fabric of western social thought (Williams & Bendelow, 1996). The emerging field of psychoneuroendo-crinology has tentatively been regarded as the western equivalent of some aspects of the classical Chinese approach. (Hammer, 1990; Kao & McRae, 1986).

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