Culture-bound syndrome

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. While a substantial portion of mental disorders, in the way they are manifested and experienced, are at least partially conditioned by the culture in which they are found, some disorders are more culture-specific than others. Folk illnesses tend to carry psychological and/or religious overtones. http://en.wikipedia.org/wiki/Culture-bound_syndrome#DSM-IV_list_of_culture-bound_syndromes The identification of culture-specific syndromes A culture-specific syndrome is characterized by: 1. categorization as a disease in the culture (i.e., not a voluntary behaviour or false claim); 2. widespread familiarity in the culture; 3. complete lack of familiarity of the condition to people in other cultures; 4. no objectively demonstrable biochemical or tissue abnormalities (symptoms); 5. the condition is usually recognized and treated by the folk medicine of the culture. 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 anothernosological category. Amok (Malaysia) Cafard or Cathard (Laos, Polynesia, the Phillipines) Mal de pelea (Puerto Rico) Iich'aa (Navajo) The origin of the English phrase "running amok", this is a dissociative episode featuring a period of brooding followed by an outburst of aggressive, violent or homicidal behavior aimed at people and objects. It seems to occur only among males, and is often precipitated by a perceived slight or insult. It is often accompanied by persecutory ideas, automatism, amnesia or exhaustion, following which the individual returns to their premorbid state. The victim, who is almost always a male between 20-45, has often experienced a loss of social status or a major life change. It is now rare, and occurs primarily in rural regions.

Symptoms commonly include uncontrollable shouting, attacks of crying, Ataque de nervios trembling, heat in the chest rising into the head, and verbal and physical (Latin America, Latin aggression. Some prominently feature dissociative episodes, seizure-like or Mediterranean, fainting episodes, and suicidal gestures, while others lack those features Caribbean) entirely. A key feature is a sense of being out of control, and it is usually triggered by a stressful event within the family. It is commonly thought to be

a result of a chronic build up of anger over time. People may not remember what they did during the ataque, and usually return to normal following the incident. The cause of this disorder is seen to be a strongly expressed anger or rage, which disrupts the balance of both emotional and physical humors. Symptoms may include acute nervous tension, headache, trembling, screaming, stomach disturbances such as nausea, vomiting or diarrhea, and even loss of consciousness. Chronic fatigue may result from an acute episode. The words bilis and clera translate into bile and cholera, terms that are medical terms used to describe a bacterial disease (cholera) and the Bilis or clera or muina secretions of the intestines. This refers to the idea of humors, which has had (Latinos) a longstanding effect on medicine, and is based on the doctrine of Hippocrates. For instance, our term melancholy refers to the earth humor. A person who is raging may be described as spewing bile, and has a choleric humor. The concept of humor did not lose influence in the United States until the mid-20th century. It continues to be used in traditional medical systems and has an influence on the way we perceive our emotional states. Humors are about balance, and the disruption of balance leads to negative physical or emotional effects. A sudden outburst of agitated and aggressive behavior, marked confusion and psychomotor excitement. It is an acute, nonaffective and nonschizophrenic psychosis, accompanied by visual and auditory hallucinations and/or paranoid ideation. A distinctive feature is a complete remission after an acute episode. Patients are typically under age 30, and do not have previous diagnoses of Boufe delirante (West psychological or neurological disorders. It strikes "like a Africa, Haiti) thunderbolt." Duration is typically brief, and the patient may never have another episode. This term was used in French psychology for some time, but is now declining. Although the DSM-IV lists West Africa and Haiti as locations, it appears to be more widespread across the Caribbean and areas that have traditionally been associated with French occupation, and within France itself. Source 1, 2. This disorder typically begins after an intensive period of intellectual activity, and is usually associated with college or high school students. Symptoms may include watering or dry eyes, dizziness, blurring of vision, difficulty concentrating or remembering, pain or feelings of pressure in the head or neck, fatigue and difficulty sleeping, shaking hands, rapid heartbeat, crawling sensations under the skin, feelings of weakness and depression. Brain fag or brain fog (West Africa) The term "brain fag" has been used in the United States in the past to Studiation Madness describe an overtaxed mind, especially among the elderly. However, (Trinidad) usage declined to non-existent by the 1950s. It began in its current form in Africa in the 1960s. We still refer to having a foggy mind when we feel confused, have difficulty remembering and can't concentrating. Although DSM-IV specifies West Africa as the cultural origin, the term and syndrome occur in many sub-Saharan areas, and appears to be most common among young men pursuing a western-style education.

Dhat (semen-loss anxiety) is a disorder found, obviously, among men only... except, not always. Although it is rare, women have experienced similar symptoms related to whitish vaginal discharge. The general psychosomatic symptoms are very similar. In Culture-bound syndromes: the story of dhat syndrome, dhat is defined as "vague somatic symptoms of fatigue, weakness, anxiety, loss of appetite, guilt and sexual dysfunction attributed by the patient to loss of semen in nocturnal emissions, through urine and masturbation." The anxiety related to semen loss can be traced back thousands of years to Ayurvedic texts, where the loss of a single drop of semen, the most precious body fluid, could destabilize the entire body. Shen-k'uei, a Chinese syndrome, is described in the same article as "A form of sexual neurosis associatedwith excessive semen loss due to frequent intercourse, masturbation, nocturnal emission or passing of white turbid urine which is believed to contain semen. Young people who think they Dhat (India) might be suffering from it become anxious and panicky, and complain of Jiryan (India) somatic symptoms (with no organic cause) such as dizziness,backache, Sukra Prameha (Sri fatigue, weakness, insomnia, frequent dreams and physical thinness," Lanka) essentially the same set of symptoms as dhat. Women may be seen as Shen-k'uei (China, stealing vital energy through sexual intercourse, and any form of semen loss Taiwan) could lead to an imbalance in chi. Shenkui (China) Semen-loss anxiety is known in the West, although it is largely considered to be a thing of the past. The Victorians, in particular, are particularly well known for being almost obsessive about masturbation and nocturnal emissions, blaming them for wasting away, paleness, cold sweats, hairy palms, tremors, exhaustion, muscle weakness, pimples, and a variety of other symptoms. In fact, one of the reasons circumcision became popular was because it was believed to reduce a man's urge to masturbate. Sumathipala, Siribaddana & Bhugra (2004), linked above, theorize that there is a connection between industrialization and semen-loss syndrome, with reported cases declining as the availability of modern technology increases. The same authors present a convincing argument that dhat is not as culture-bound as the DSM-IV says, and that its commonality in both the East and West requires further study. There may be an underlying mechanism that we don't yet recognize. It is definitely worth reading, and is available in full. The individual experiences dizziness and a spinning sensation before a Falling-out or blacking sudden collapse. Although the eyes may be open, the person reports out (Southern USA, being unable to see, although they hear and understand what is Caribbean) happening around them without being able to interact. Weakness, bad dreams, feelings of danger, confusion, feelings of futility, loss of appetite, feelings of suffocation, fainting, dizziness, hallucinations and Ghost Sickness (Navajo) loss of consciousness. May become preoccupied with death or with someone who died. The cause is usually considered to be ghosts or, less often, witches. The person may have hallucinations. 1. Wikipedia. Hwa-byung or ul-hwa- Literally translates to "fire illness", and most often occurs in middle-aged byeong or wool-hwa- women in their 40s and 50s who are less educated, come from a lower

byung (Korea)

socio-economic level and live in rural areas. The individuals typically live in traditional families, which stress the value of males while devaluing women. A woman's virtue is to quietly bear misfortune and unhappiness while maintaining harmony. This has been reinforced by long periods of war and occupation (continuing today with the North/South Korea division), along with a strict hierarchy in traditional Korean culture, has placed a tremendous amount of long-term burden on these women that continues to be a significant impact on their daily lives. Hwa-byung is believed to be caused by a build-up of unresolved anger, which disturbs the balance of the five bodily elements. The triggering cause is external events, particularly intra-familiar stressors such as spousal infidelity and conflict with in-laws. Because of the cultural emphasis on familial harmony and peace, expressing anger is not acceptable, so the anger is suppressed, and builds on itself over time. The supressed anger, hate and despair is known as haan, or "everlasting woe". This syndrome has a strong psychosomatic component. Anger is often experiences as a heavy mass which pushed up from the abdomen into the chest. Sufferers complain of sleeplessness, dizziness, headaches, indigestion, sexual dysfunction, intolerance to heat, dry mouth, hot and cold flushes, weakness, heart palpitations, and blurred vision. Along with the physical symptoms are a somewhat diffuse range of psychological symptoms. They show evidence of anxiety, pervasive depression, obsessions and compulsions, anorexia and feelings of hatred, shame, paranoia, fearfulness, destructive impulses, irritability, anxiety and absent mindedness. Western diagnoses range from major depression, anxiety disorders such as phobias, generalized anxiety and obsessivecompulsive disorder, and somatization disorders. 1, 2.

Koro is probably one of the better known of the culture-bound disorders. The primary symptoms is that the penis (in males) or the vulva and breasts (in women) are receding into the body, possibly causing death. It is more common in males, who will go to great lengths to stop this from happening. Similar to dhat, or semen-loss syndrome, Koro is sometimes believed to be caused by inappropriate sex, such as masturbation or sex outside of marriage, which result in an imbalance of the male/female Koro (Malaysia) principle (yin and yang). It may also be caused by outside causes - a Shuk yang or shook recent rise in cases was caused by reports that eating pork from pigs yong or suo yang inoculated against swine flu caused two cases of koro. (China) In other parts of the world, the belief may be that, rather than the genitals Jinjinia bemar (Assam) shrinking into the body, they are being stolen by supernatural methods. In Rok-joo (Thailand) the Guangdong region in China, it is believed that a fox spirit can steal Suudu (Tamil, India) penises, while it is more likely to be ascribed to sorcerers or black magic in regions of Africa. Often, those believed to be responsible are publicly accused. The theft is carried out when the sorcerer touches the affected person. The person may believe that, although his penis has been returned, it is smaller, malformed or the property of another person entirely. Koro: A Natural History of Penis Panic goes into great detail about the disorder around the world. Koro sometimes seems to be spread socially and may be a kind of mass

hysteria, causing widespread panics and concern, as well as a disorder of individuals. Afflicted persons may resort to clamps, ties, pegs or hooks to keep the genitals from fully receding, sometimes resulting in damage to the organs. Further information. Latah (Malaysia) Amurakh, irkunii, olan, myriachit or menkeiti (Siberian) Bah tschi, bah-tsi or baah-ji (Thailand) Imu (Ainu, Sakhalin, Japan) Latah is an exaggerated startle response, typically found among women. Being surprised may result in screaming, cursing, dancing and hysterical laughter that might last a half hour or more. They may imitate the people around them or things they see or hear in the media. Relatives and friends may provoke episodes for the entertainment value, but latah episodes can be very embarrassing in public. Latah often occurs following a traumatic episode. There are many cultures which have similar syndromes, but it is unclear how or if they relate to each other.

A chronic state of severe psychosis, attributed to multiple life stressors, Locura (Latin America, inherited vulnerability, or a combination of both. Symptoms include Latinos in US) agitation, incoherence, audio and visual hallucinations, inability to follow the rules of social interaction, unpredictability and possible violence. The "evil eye". Children and infants are especially at risk. With adults, women are more likely to be affected. Symptoms include fitful sleep, crying inconsolably without apparent cause, diarrhea, vomiting and fever. It is most widespread in the Mediterranean and Near East cultures. Mal de ojo is a Spanish phrase, and the idea is widespread in many Latino cultures. Typically, it is passed from someone who is strong to someone who ojo is weaker, whether by status, wealth, or power, so the person at the greatest risk are those who have the lowest position, usually women, infants and young children. It is usually treated by traditional curanderos. The evil eye dates back to the beginning of recorded history. Wikipedia has an interesting history and the name of the evil eye in many different languages, along with some of the effects it is believed to have, which are too numerous to list here. Refers both to a sense of vulnerability to stressful life experiences and the symptoms produced by that vulnerability. The person may experience (Latino emotional distress, somatic complaints and inability to function. Common symptoms are headaches, irritability, stomach disturbances, sleep difficulties, nervousness, inability to concentrate, easy tearfulness, trembling, tingling sensations and mareos (dizziness with vertigo-like sensations). Also known as Arctic hysteria, this often follows the loss or perceived loss of a valued person or object. Symptoms include brooding, depressive silences, loss or disturbances of consciousness, seizure-like episodes, tearing off clothes, fleeing or wandering, rolling in snow, speaking in tongues or echolalia (echoing other people's words).

Mal de (Mediterranean)

Nervios societies)

Pibloktoq (Inuit)

Qi-gong (exercise of vital energy) is a Chinese method of meditation, Qi-gong Psychotic based on traditional Chinese medicine. The best known in the West is Tai Reaction (China) Chi, although there are around 2,200 methods in total. The DSM IV and Chinese Classification of Mental Disorders define it as an acute, time-limited

episode characterized by dissociative, paranoid and other psychotic and non-psychotic symptoms that occur after participation in Qigong. An alternate name for the syndrome is Qigong Deviation Syndrome. According to a recent study by Dr. Huaihai Shan, folk-beliefs attribute the condition to "adverse flow in the body," "uncontrollable behavior," "over-meditation" and "spirit possession". Over a third of 129 respondents described sensory problems (32%), mood symptoms (90%) and behavioral problems (37%). Other symptoms listed were memory problems (24%), attention difficulties (26%), thought disorders (18%) and disordered consciousness (2%). Nearly all patients report "the Qi moving within the body, and dashing or rushing into the head." Somatic symptoms may include headaches, dizziness or disorientation, and strange sensations in the lower abdomen (the Dan-Tian point). They may demonstrate hypochondriasis, anxiety, sadness and feelings of being out of control. In addition, they may experience visual and auditory hallucinations. The symptoms occur after Qigong practice and may last two weeks to a month. Rootwork (southern US, The conviction that illnesses are brought about by supernatural means, Caribbean) such as witchcraft, voodoo, or evil influence. Symptoms include anxiety, Mal puesto or brujeria gastrointestinal complaints, and fear of being poisoned or killed. (Latino societies) Sangue dormido "Sleeping blood," pain, numbness, tremor, paralysis, convulsions, stroke, (Portuguese Cape blindness, heart attack, infection and miscarriage Verde Islanders) Shenjing (Chinese) This disorder is the equivalent of neurasthenia, a disorder no longer recognized by the DSM-IV. It includes elements of depression and anxiety Shuairuo disorders, such as physical and mental fatigue, dizziness, headaches, gastrointestinal problems, difficulty concentrating, sleep disturbance, memory loss, sexual dysfunction, irritability and excitability. Anxiety and somatic complaints, such as general weakness, dizziness, fear, loss of appetite, insomnia and gastrointestinal problems, followed by dissociation and possession by ancestral spirits

Shin-byung (Korean)

Individuals communicate with deceased relatives or spirits. They may show Spell (Southern United distinct personality changes. Spell is not considered pathological in the States) culture of origin. Literally "fright", this generally falls into either natural or supernatural origin. Natural origins are cultural stressors, and are more likely to affect women than men. Supernatural origins may be thought to have been sent by a sorcerer, and may be triggered by witnessing supernatural phenomenon such as ghosts. Symptoms include nervousness, anorexia, insomnia, listlessness, fatigue, despondency, muscle tics and diarrhea. A feeling of intense anxiety centered around the dread of hurting or offending others. Taijin kyofusho is divided into four categories: sekimenkyofu (phobia of blushing), shubo-kyofu (phobia of a deformed body), jikoshisen-kyofu (phobia of eye-to-eye contact), and jikoshu-kyofu (phobia of a foul body odor).

Susto (Latino societies)

Taijin kyofusho (Japan)

Zar (North African and Those affected believe they are possessed by a spirit, and may experience Middle Eastern dissociative episodes when they shout, laugh, weep, sing or hit their heads

societies)

on the wall. They may also become apathetic, withdrawn and unable to carry out daily tasks. Some develop a relationship with the possessing spirit. It may not be considered pathological.

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