Culture-bound syndrome explained

In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. There are no objective biochemical or structural alterations of body organs or functions, and the disease is not recognized in other cultures. The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) which also includes a list of the most common culture-bound conditions (DSM-IV: Appendix I). Its counterpart in the framework of ICD-10 (Chapter V) is the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.[1]

More broadly, an endemic that can be attributed to certain behavior patterns within a specific culture by suggestion may be referred to as a potential behavioral epidemic. As in the cases of drug use, or alcohol and smoking abuses, transmission can be determined by communal reinforcement and person-to-person interactions. On etiological grounds, it can be difficult to distinguish the causal contribution of culture upon disease from other environmental factors such as toxicity.[2]

Identification

A culture-specific syndrome is characterized by:

Some culture-specific syndromes involve somatic symptoms (pain or disturbed function of a body part), while others are purely behavioral. Some culture-bound syndromes appear with similar features in several cultures, but with locally specific traits, such as penis panics.

A culture-specific syndrome is not the same as a geographically localized disease with specific, identifiable, causal tissue abnormalities, such as kuru or sleeping sickness, or genetic conditions limited to certain populations. It is possible that a condition originally assumed to be a culture-bound behavioral syndrome is found to have a biological cause; from a medical perspective it would then be redefined into another nosological category.

Medical perspectives

The American Psychiatric Association states the following:

The term culture-bound syndrome is controversial since it reflects the different opinions of anthropologists and psychiatrists.[3] Anthropologists have a tendency to emphasize the relativistic and culture-specific dimensions of the syndromes, while physicians tend to emphasize the universal and neuropsychological dimensions.[4] Guarnaccia & Rogler (1999) have argued in favor of investigating culture-bound syndromes on their own terms, and believe that the syndromes have enough cultural integrity to be treated as independent objects of research.[5]

Guarnaccia and Rogler demonstrate the issues that occur when diagnosing cultural bound disorders using the DSM-IV. One of the key problems that arise is the "subsumption of culture bound syndromes into psychiatric categories", which ultimately creates a medical hegemony and places the western perspective above that of other cultural and epistemological explanations of disease. The urgency for further investigation or reconsideration of the DSM-IV's authoritative power is emphasized, as the DSM becomes an international document for research and medical systems abroad. Guarnaccia and Rogler provide two research questions that must be considered, "firstly, how much do we know about the culture-bound syndromes for us to be able to fit them into standard classification; and secondly, whether such a standard and exhaustive classification in fact exists".

It is suggested that the problematic nature of the DSM becomes evident when viewed as definitively conclusive. Questions are raised to whether culture-bound syndromes can be treated as discrete entities, or whether their symptoms are generalized and perceived as an amalgamation of previously diagnosed illnesses. If this is the case, then the DSM may be what Bruno Latour would define as "particular universalism". In that the Western medical system views itself to have a privileged insight into the true intelligence of nature, in contrast to the model provided by other cultural perspectives.[6]

Some studies suggest that culture-bound syndromes represent an acceptable way within a specific culture (and cultural context) among certain vulnerable individuals (i.e. an ataque de nervios at a funeral in Puerto Rico) to express distress in the wake of a traumatic experience.[7] A similar manifestation of distress when displaced into a North American medical culture may lead to a very different, even adverse outcome for a given individual and the individual's family.[8] The history and etymology of some syndromes such as brain-fog syndrome, have also been reattributed to 19th century Victorian Britain rather than West Africa.[9]

In 2013, the DSM 5 dropped the term culture-bound syndrome, preferring the new name "cultural concepts of distress".[10]

Cultural collision between medical perspectives

Within the traditional Hmong culture, epilepsy (qaug dab peg) directly translates to "the spirit catches you and you fall down" which is said to be an evil spirit called a dab that captures one's soul and makes one ill. In this culture, individuals with seizures are seen to be blessed with a gift: an access point into the spiritual realm which no one else has been given.[11] In westernised society, epilepsy is recognized as a serious long-term brain condition that can have a major impairment on an individual's life. The way the illness is dealt with in Hmong culture is vastly different due to the high status epilepsy has in the culture, compared to individuals who have the condition in westernised societies. Individuals with epilepsy within the Hmong culture are a source of pride for their family.[12]

Another culture-bound illness is neurasthenia, which is a vaguely described medical ailment in Chinese culture that presents as lassitude, weariness, headaches, and irritability and is mostly linked to emotional disturbance. A report done in 1942 showed that 87% of patients diagnosed by Chinese psychiatrists as having neurasthenia could be reclassified as having major depression according to the DSM-3 criteria.[13] Another study conducted in Hong Kong showed that most patients selectively presented their symptoms according to what they perceived as appropriate and tended to only focus on somatic suffering, rather than the emotional problems they were facing.[14]

Globalisation

Globalisation is a process whereby information, cultures, jobs, goods, and services are spread across national borders.[15] This has had a powerful impact on the 21st century in many ways including through enriching cultural awareness across the globe. Greater level of cultural integration is occurring due to rapid industrialisation and globalisation, with cultures absorbing more influences from each other. As cultural awareness begins to increase between countries, there is a consideration into whether cultural bound syndromes will slowly lose their geographically bound nature and become commonly known syndromes that will then become internationally recognised.[16]

Anthropologist and psychiatrist Roland Littlewood makes the observation that these diseases are likely to vanish in an increasingly homogenous global culture in the face of globalisation and industrialisation.[17] Depression, for example, was once only accepted in western societies; it is now recognised as a mental disorder in all parts of the world. In contrast to Eastern civilizations such as Taiwan, depression is still much more common in Western cultures like the United States. This could indicate that globalisation may have an impact on allowing disorders to be spread across borders, but these disorders may remain predominant in certain cultures.

DSM-IV-TR list

The fourth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as culture-bound syndromes:

NameGeographical localization/populations
Running amokBrunei, Singapore, Malaysia, Indonesia, Philippines, Timor-Leste
Ataque de nerviosLatinos in the United States and Latin America
Bilis, cólera
Bouffée déliranteFrance and French-speaking countries
Brain fag syndromeWest African students
Dhat syndromeIndia
Falling-out, blacking outSouthern United States and Caribbean
Ghost sicknessNative American (Navajo, Muscogee/Creek)
HwabyeongKorean
KoroChinese, Malaysian and Indonesian populations in Southeast Asia; Assam; occasionally in the West
LatahMalaysia and Indonesia, as well as the Philippines (as mali-mali, particularly among Tagalogs)
LocuraLatinos in the United States and Latin America
Mal de peleaPuerto Rico
Evil eyeMediterranean; Hispanic populations and Ethiopia
PibloktoArctic and subarctic Inuit populations
Zou huo ru mo (Qigong psychotic reaction)Han Chinese
RootworkSouthern United States, Caribbean nations
Sangue dormidoCape Verde
Shenjing shuairuoHan Chinese
Shenkui, shen-k'ueiHan Chinese
ShinbyeongKoreans
SpellAfrican American, White populations in the Southern United States and Ethiopia
SustoLatinos in the United States; Mexico, Central America and South America
Taijin kyofushoJapanese
ZārEthiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies

DSM-5 list

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as cultural concepts of distress, a closely related concept:

NameGeographical localization/populations
Ataque de nerviosLatin America
Dhat syndromeIndia
Khyâl capCambodian
Ghost sicknessNative American
KufungisisaZimbabwe
Maladi mounHaiti
Shenjing shuairuoHan Chinese
SustoLatinos in the United States; Mexico, Central and South America
Taijin kyofushoJapanese

ICD-10 list

The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) classifies the below syndromes as culture-specific disorders:[1]

NameGeographical localization/populations
AmokSoutheast Asian Austronesians
Dhat syndrome (dhātu), shen-k'uei, jiryanIndia; Taiwan
Koro, suk yeong, jinjin bemarSoutheast Asia, India, China
LatahMalaysia and Indonesia
Ataque de nerviosMexico, Central and South America
Pa-leng (frigophobia)Taiwan; Southeast Asia
Pibloktoq (Arctic hysteria)Inuit living within the Arctic Circle
Susto, espantoMexico, Central and South America
Taijin kyofusho, shinkeishitsu (anthropophobia)Japan
Ufufuyane, sakaKenya; southern Africa (among Bantu, Zulu, and affiliated groups)
Inuit living within the Arctic Circle
Fear of WindigoIndigenous people of north-east America

Other examples

Though "the ethnocentric bias of Euro-American psychiatrists has led to the idea that culture-bound syndromes are confined to non-Western cultures",[18] within the contiguous United States, the consumption of kaolin, a type of clay, has been proposed as a culture-bound syndrome observed in African Americans in the rural South, particularly in areas in which the mining of kaolin is common.[19]

In South Africa, among the Xhosa people, the syndrome of amafufunyana is commonly used to describe those believed to be possessed by demons or other malevolent spirits. Traditional healers in the culture usually perform exorcisms in order to drive off these spirits. Upon investigating the phenomenon, researchers found that many of the people claimed to be affected by the syndrome exhibited the traits and characteristics of schizophrenia.[20] [21]

Some researchers have suggested that both premenstrual syndrome (PMS) and the more severe premenstrual dysphoric disorder (PMDD), which have currently unknown physical mechanisms,[22] [23] [24] are Western culture-bound syndromes.[25] [26] However, this is controversial.[25]

Tarantism is an expression of mass psychogenic illness documented in Southern Italy since the 11th century.[27]

Morgellons is a rare self-diagnosed skin condition that has been described as "a socially transmitted disease over the Internet".[28]

Vegetative-vascular dystonia can be considered an example of somatic condition formally recognised by local medical communities in former Soviet Union countries, but not in Western classification systems. Its umbrella term nature as neurological condition also results in diagnosing neurotic patients as neurological ones,[29] [30] in effect substituting possible psychiatric stigma with culture-bound syndrome disguised as a neurological condition.

Refugee children in Sweden have been known to fall into coma-like states on learning their families will be deported. The condition, known in Swedish as Swedish: uppgivenhetssyndrom, or resignation syndrome, is believed to only exist among the refugee population in Sweden, where it has been prevalent since the early part of the 21st century. In a 130-page report on the condition commissioned by the government and published in 2006, a team of psychologists, political scientists, and sociologists hypothesized that it was a culture-bound syndrome.[31]

A startle disorder similar to latah, called (sometimes spelled imu:), is found among Ainu people, both Sakhalin Ainu and Hokkaido Ainu.[32] [33]

A condition similar to piblokto, called (sometimes meryachenie), is found among Yakuts, Yukaghirs, and Evenks living in Siberia.[34]

The trance-like violent behavior of the Viking age berserkers – behavior that disappeared with the arrival of Christianity – has been described as a culture-bound syndrome.[35]

See also

Further reading

External links

Notes and References

  1. https://www.who.int/entity/classifications/icd/en/GRNBOOK.pdf Diagnostic criteria for research
  2. Encyclopedia: Porta, Miquel . A Dictionary of Epidemiology. 5th . Behavioral epidemic . 25 August 2013. 2008. Oxford University Press. 978-0-19-157844-1. 48.
  3. Perry, S. (2012, 13 January). The controversy over 'culture-bound' mental illnesses. Retrieved 27 January 2013 from MinnPost.
  4. Prince. Raymond H. June 2000. Transcultural Psychiatry: Personal Experiences and Canadian Perspectives. The Canadian Journal of Psychiatry. 45. 5. 431–437. 10.1177/070674370004500502. 10900522. 2159608. 0706-7437. free.
  5. Guarnaccia . Peter J. . Rogler . Lloyd H. . September 1999 . American Journal of Psychiatry . 156 . 9 . 1322–1327 . Research on Culture-Bound Syndromes: New Directions . 10484940 . 10.1176/ajp.156.9.1322 . free.
  6. Book: Latour . Bruno . We Have Never Been Modern . 1991 . Harvard University Press . Cambridge, Massachusetts . 105 .
  7. Schechter. Daniel S.. Marshall. Randall. Salmán. Ester. Goetz. Deborah. Davies. Sharon. Liebowitz. Michael R.. July 2000. Ataque de nervios and history of childhood trauma. Journal of Traumatic Stress. 13. 3. 529–534. 10.1023/a:1007797611148. 10948492. 33348909. 0894-9867.
  8. Schechter. Daniel S.. Kaminer. Tammy. Grienenberger. John F.. Amat. Jose. 2003. Fits and Starts: A Mother-Infant Case-Study Involving Intergenerational Violent Trauma and Pseudoseizures Across Three Generations. Infant Mental Health Journal. 24. 5. 510–528. 10.1002/imhj.10070. 0163-9641. 2078527. 18007961.
  9. Ayonrinde. Oyedeji A.. 2020-06-26. 'Brain fag': a syndrome associated with 'overstudy' and mental exhaustion in 19th century Britain. International Review of Psychiatry. 32. 5–6. 520–535. 10.1080/09540261.2020.1775428. 0954-0261. 32589474. 220121013. free.
  10. Book: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 2013-05-22. American Psychiatric Association. 978-0-89042-555-8. en. 10.1176/appi.books.9780890425596. 2027.42/138395.
  11. Web site: When Epilepsy Goes By Another Name . 2022-08-27 . Epilepsy Foundation . en.
  12. Khalil . Nadia . McMillan . Stephanie . Benbadis . Selim R. . Robertson . Derrick . February 2021 . Fish soup for the falling sickness: Tracing epilepsy through Hmong and Western beliefs . Epilepsy & Behavior . en . 115 . 107725 . 10.1016/j.yebeh.2020.107725. 33434883 . 231201804 .
  13. Kleinman . Arthur . 1982-06-01 . Neurasthenia and depression: A study of somatization and culture in China . Culture, Medicine and Psychiatry . en . 6 . 2 . 117–190 . 10.1007/BF00051427 . 7116909 . 23591895 . 1573-076X.
  14. Cheung . Fanny M. . Lau . Bernard W. K. . 1982-05-01 . Situational variations of help-seeking behavior among Chinese patients . Comprehensive Psychiatry . en . 23 . 3 . 252–262 . 10.1016/0010-440X(82)90073-6 . 7083852 . 0010-440X.
  15. Scholte . Jan Aart . 2007-09-14 . Defining Globalisation . The World Economy . 31 . 11 . en . 070916231942004–– . 10.1111/j.1467-9701.2007.01019.x . 219969085 . 0378-5920.
  16. Littlewood . Roland . 2008-10-04 . Illness in an anthropological context . The Lancet . English . 372 . 9645 . 1211–1212 . 10.1016/S0140-6736(08)61503-2 . 0140-6736. free .
  17. Littlewood . Roland . 2008-10-04 . Illness in an anthropological context . The Lancet . English . 372 . 9645 . 1211–1212 . 10.1016/S0140-6736(08)61503-2 . 0140-6736. free .
  18. Prince . R. . Thebaud . E. F. . Is Anorexia Nervosa a Culture-Bound Syndrome? . Transcultural Psychiatric Research Review . 3 September 2016 . 20 . 4 . 299–302 . 10.1177/136346158302000419 . 144358885 .
  19. Grigsby RK, Thyer BA, Waller RJ, Johnston GA Jr. (February 1992). "Chalk Eating in Middle Georgia: A Culture-Bound Syndrome of Pica?" South Med J. (2): 190–192.
  20. Niehaus DJ, Oosthuizen P, Lochner C, Emsley RA, Jordaan E, Mbanga NI, Keyter N, Laurent C, Deleuze JF, Stein DJ . March–April 2004 . A culture-bound syndrome 'amafufunyana' and a culture-specific event 'ukuthwasa': differentiated by a family history of schizophrenia and other psychiatric disorders . . . 37 . 2 . 59–63 . 10.1159/000077579 . 15057028 . 23545601 .
  21. Campbell . Megan M . Sibeko . Goodman . Mall . Sumaya . Baldinger . Adam . Nagdee . Mohamed . Susser . Ezra . Stein . Dan J . The content of delusions in a sample of South African Xhosa people with schizophrenia . BMC Psychiatry . 24 January 2017 . 17 . 1 . 41 . 10.1186/s12888-017-1196-3 . free . 28118821 . 5259874 .
  22. Hunter. Melissa H.. Mazyck. Pamela J.. Dickerson. Lori M.. 2003-04-15. Premenstrual Syndrome. American Family Physician. 67. 8. 1743–1752. 12725453. 0002-838X.
  23. Richardson. J. T.. September 1995. The premenstrual syndrome: a brief history. Social Science & Medicine. 41. 6. 761–767. 0277-9536. 8571146. 10.1016/0277-9536(95)00042-6.
  24. Rapkin. Andrea J.. Akopians. Alin L.. June 2012. Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder. Menopause International. 18. 2. 52–59. 10.1258/mi.2012.012014. 1754-0461. 22611222. 25219334.
  25. Alia Offman, Peggy J. Kleinplatz (2004). "Does PMDD Belong in the DSM? Challenging the Medicalization of Women's Bodies". Canadian Journal of Human Sexuality, Vol. 13.
  26. Johnson. T. M.. September 1987. Premenstrual syndrome as a western culture-specific disorder. Culture, Medicine and Psychiatry. 11. 3. 337–356. 0165-005X. 3677777. 10.1007/BF00048518. 30238189.
  27. Russell JF . Tarantism . Med Hist . 23 . 4 . 404–25 . October 1979 . 390267 . 1082580 . 10.1017/s0025727300052054.
  28. Web site: 2011-07-09. Pathogens & People: Internet helps spread delusion that Morgellons a disease . Hometown Annapolis . 2020-08-08. https://web.archive.org/web/20110709190346/http://www.hometownannapolis.com/news/col/2007/07/01-25/Pathogens--PeopleInternet-helps-spread-delusion-that-Morgellons-a-disease.html. 9 July 2011.
  29. Mikhaylov B . 2010 . P02-34 -Statistical issues of the psychiatric care in Ukraine . European Psychiatry. 25. 652 . 10.1016/S0924-9338(10)70647-7 . 70674537 . 2 October 2016 .
  30. Kudinova. O.. Mykhaylov. B.. 2014. EPA-1025 - Integrative psychotherapy model of anxiety disorders. European Psychiatry. en. 29. 1. 1–10. 10.1016/S0924-9338(14)78319-1. 0924-9338. 24119631. 145677211.
  31. News: The Trauma of Facing Deportation. Rachel Aviv. 3 April 2017. The New Yorker. 1 July 2017.
  32. Book: Tseng, Wen-Shing . Handbook of Cultural Psychiatry . Academic Press . 250 . 9780127016320. 6 June 2001 .
  33. Book: Ohnuki-Tierney, Emiko . Illness and Healing among the Sakhalin Ainu . Cambridge University Press . 198 . 9781107634787. 8 May 2014 .
  34. Sidorov . P. I. . Davydov . A. N. . Ethnopsychiatric research in the national minorities of Northern Russia and Siberia . . Washington . 1992 . 1064-6930 . 0-88048-667-8 .
  35. Høyersten. Jon Geir. 2004-12-16. The berserks—what was wrong with them?. Tidsskrift for den Norske Laegeforening: Tidsskrift for Praktisk Medicin, NY Raekke. 124. 24. 3247–3250. 0807-7096. 15608781.