The danger of a culture-bound syndrome lies in the fact that it can easily trigger delusional misidentification syndrome.

That is to say, in the current case, every time the patient sees something trivial, she tries to interpret it as a "curse".

And it's believed that as a result of the accumulation of these events in an understandable form, a delusional system is created, ultimately leading to paranoia.

Furthermore, the patient is also exhibiting slight signs of a personality disorder.

Of course, it's at a very mild level, and it's not causing any hindrance whatsoever to the patient's daily life.

It's common for even healthy individuals to have primary delusions in their daily lives.

But they usually ignore it automatically without recognition, since those delusions are nonsensical.

However, there are cases where these delusions accumulate despite being incomprehensible.

It largely depends on the particular characteristics of the individual, and it's believed that the patient shows relatively strong characteristics in this area.

I believe you're very much aware that primary delusions are categorized into three different kinds.

"Delusional mood" is the feeling of impending crisis without basis.

"Delusional intuition" is the feeling of a sense of duty or goal without basis.

"Delusional perception" is the feeling of a baseless cause against a baseless target.

In the patient's case, it's believed that these incomprehensible delusions accumulated, acted out simultaneously with the

culture-bound syndrome, which triggered a delusional misidentification syndrome.

And it ultimately caused the incomprehensible delusions to become understandable by interpreting them as a "curse".

The comprehensible delusional system induces understandable secondary delusions, further strengthening the patient's delusional system with the passage of time.

("The delusional parasitosis" mentioned earlier can be considered a secondary delusion.)

A common factor of all cases of paranoia is that even after an outbreak, they still appear perfectly normal with no change in their personalities.

The patients are unaware of their own ailments, and due to their personal interpretations of their delusional system,

there are many cases where patients arm themselves logically, making it extremely difficult for a third party to point out that they're having a delusion.

Furthermore, although it may depend on the tendency of the delusions, there are also cases where a "persecutory delusion" turns into a "pursuit delusion" or a "conspiracy delusion," resulting in the patient creating an imaginary enemy and taking up anti-social behavior.

(For example, there are cases where believers of a religious cult were deeply influenced by the cult founder's paranoid visions, which shifted the group into a conspiracy delusion, and that made them conduct anti-social behavior in the name of self-defense.

Although no such cases have been reported in Japan yet, it could very well happen in the near future.)

Fortunately, the patient hasn't reached that serious condition as of now.

With proper treatment, she should be able to make a full recovery.

Please make sure that her father also understands that this is not an unusual case,

but something caused by the accumulation of a number of innocent factors that anyone could have.

The patient can be treated only by deepening her bond with her father. As long as she has that bond, she can certainly be treated.

For the reasons above, if the patient is to return to her home village, I strongly recommend that the patient continue to receive guidance from specialized medical institutions.

Please excuse me for writing such a long letter.

Thank you for reading this until the very end.