Groups of hospitalized psychiatric patients in Japan and in the United States were compared in their discrete symptom manifestations as well as in their dominant roles (turning against self, turning against others, avoidance of others) and spheres (thought, affect, somatization, action). With differences in social competence, age and diagnosis reduced to a minimum by application of individual matching across cultures, male Japanese patients were found to exceed their American counterparts in thought dominance; among women, the role of avoidance of others was disproportionately encountered in the United States. In both sex groups, Japanese patients tended toward general and diffuse symptoms; among Americans, the trend was toward elaboration and specificity. Parallels were sought for these findings in the accumulated store of information concerning Japanese cultural patterns, socialization practices and personality characteristics. It was concluded that a degree of continuity obtains between the adaptive and pathological features prevalent within a cultural milieu. Likewise, it appears to be more than a fortuitous convergence that modes of therapeutic intervention favored in Japan stress relationship, intuition and somatic treatment and underemphasize self-understanding and insight.