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. 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). Counterpart within the framework of ICD-10 (Chapter V) are the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.[1]

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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:

  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 or misunderstanding of the condition to people in other cultures;
  4. no objectively demonstrable biochemical or tissue abnormalities (signs);
  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 another nosological category.

Medical perspectives

The American Psychiatric Association states the following:[3]

The term culture-bound syndrome denotes recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. Many of these patterns are indigenously considered to be "illnesses," or at least afflictions, and most have local names. Although presentations conforming to the major DSM-IV categories can be found throughout the world, the particular symptoms, course, and social response are very often influenced by local cultural factors. In contrast, culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations.

The term culture-bound syndrome is controversial since it reflects the different opinions of anthropologists and psychiatrists.[4] 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.[5][6] 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.[7]

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.[8] 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 his or her family.[9] The history and etymology of some syndromes such as Brain- Fag Syndrome, have also been reattributed to 19th century Victorian Britain rather than West Africa.[10]

In 2013, the DSM 5, dropped the term culture-bound syndrome, preferring the new name “Cultural Concepts of Distress”.[11]

DSM-IV-TR list

The fourth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as culture-bound syndromes:[12]

Name Geographical localization/populations
Running amok Brunei, Singapore, Malaysia, Indonesia, Philippines, Timor-Leste
Ataque de nervios Hispanophone, as well as in the Philippines where it is known as "nervous breakdown"
Bilis, cólera Latinos
Bouffée délirante West Africa and Haiti
Brain fag syndrome West African students
Dhat syndrome India
Falling-out, blacking out Southern United States and Caribbean
Ghost sickness Native American
Hwabyeong Korean
Koro Chinese, Malaysian and Indonesian populations in Southeast Asia; Assam; occasionally in the West
Latah Malaysia and Indonesia, as well as the Philippines (as mali-mali, particularly among Tagalogs)
Locura Latinos in the United States and Latin America
Mal de pelea Puerto Rico
Nervios Latin America, Latinos in the United States, Philippines
Evil eye Mediterranean; Hispanic populations and Ethiopia
Piblokto Arctic and subarctic Inuit populations
Zou huo ru mo (Qigong psychotic reaction) Han Chinese
Rootwork Southern United States, Caribbean nations
Sangue dormido Portuguese populations in Cape Verde
Shenjing shuairuo Han Chinese
Shenkui, shen-kʼuei Han Chinese
Shinbyeong Korean
Spell African American, White populations in the southern United States and Ethiopia
Susto Latinos in the United States; Mexico, Central America and South America
Taijin kyofusho Japanese
Zār Ethiopia, 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:[13]

Name Geographical localization/populations
Ataque de nervios Hispanophone, as well as in the Philippines
Dhat syndrome India
Khyâl cap Cambodian
Ghost sickness Native American
Kufungisisa Zimbabwe
Maladi moun Haiti
Nervios Latin America, Latinos in the United States
Shenjing shuairuo Han Chinese
Susto Latinos in the United States; Mexico, Central America and South America
Taijin kyofusho Japanese

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]

Name Geographical localization/populations
Amok Southeast Asian Austronesians
Dhat syndrome (dhātu), shen-kʼuei, jiryan India; Taiwan
Koro, suk yeong, jinjin bemar Southeast Asia, India, China
Latah Malaysia and Indonesia
Nervios, nerfiza, nerves, nevra Egypt; Greece; northern Europe; Mexico, Central and South America
Pa-leng (frigophobia) Taiwan; Southeast Asia
Pibloktoq (Arctic hysteria) Inuit living within the Arctic Circle
Susto, espanto Mexico, Central and South America
Taijin kyofusho, shinkeishitsu (anthropophobia) Japan
Ufufuyane, saka Kenya; southern Africa (among Bantu, Zulu, and affiliated groups)
Uqamairineq Inuit living within the Arctic Circle
Fear of Windigo Indigenous 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,"[14] a prominent example of a Western culture-bound syndrome is anorexia nervosa.[15]

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.[16] 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.[17]

Some researchers have suggested that both premenstrual syndrome (PMS) and the more severe premenstrual dysphoric disorder (PMDD), which have currently unknown physical mechanisms,[18][19][20] are Western culture-bound syndromes.[21][22] However, this is controversial.[21]

Morgellons is a rare self-diagnosed skin condition reported primarily in white populations in the United States.[23] It has been described by as "a socially transmitted disease over the Internet."[24]

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,[25][26] 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 uppgivenhetssyndrom, or resignation syndrome, is believed to only exist among the refugee population in the Scandinavian country, 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.[27]

A startle disorder similar to latah, called imu (sometimes spelled imu:), is found among Ainu people, both Sakhalin Ainu and Hokkaido Ainu.[28][29]

A condition similar to piblokto, called menerik (sometimes meryachenie), is found among Yakuts, Yukaghirs, and Evenks living in Siberia.[30]

gollark: I wonder if there's some convoluted way to autokill it.
gollark: Such as?
gollark: It's in the lexica.
gollark: You can just fight the gaia guardian.
gollark: Or universal bins, hmm...

See also

References
  1. Diagnostic criteria for research, p. 213–225 (WHO 1993)
  2. Porta, Miquel, ed. (2008). "Behavioral epidemic". A Dictionary of Epidemiology (5th ed.). Oxford University Press. p. 48. ISBN 978-0-19-157844-1. Retrieved 25 August 2013.
  3. American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision, American Psychiatric Pub, p. 898, ISBN 978-0-89042-025-6
  4. Perry, S. (2012, 13 January). The controversy over 'culture-bound' mental illnesses. Retrieved 27 January 2013 from MinnPost.
  5. Prince, Raymond H (June 2000). "Transcultural Psychiatry: Personal Experiences and Canadian Perspectives". The Canadian Journal of Psychiatry. 45 (5): 431–437. doi:10.1177/070674370004500502. ISSN 0706-7437. PMID 10900522.
  6. Jilek, W.G. (2001), "Psychiatric Disorders: Culture-specific", International Encyclopedia of the Social & Behavioral Sciences, Elsevier, pp. 12272–12277, doi:10.1016/b0-08-043076-7/03679-2, ISBN 9780080430768
  7. Guarnaccia, Peter J.; Rogler, Lloyd H. (September 1999). "Research on Culture-Bound Syndromes: New Directions". American Journal of Psychiatry. 156 (9): 1322–1327. doi:10.1176/ajp.156.9.1322 (inactive 27 March 2020). PMID 10484940.
  8. 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. doi:10.1023/a:1007797611148. ISSN 0894-9867. PMID 10948492.
  9. 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. doi:10.1002/imhj.10070. ISSN 0163-9641. PMC 2078527. PMID 18007961.
  10. Ayonrinde, Oyedeji A. (26 June 2020). "'Brain fag': a syndrome associated with 'overstudy' and mental exhaustion in 19th century Britain". International Review of Psychiatry. 0 (0): 1–16. doi:10.1080/09540261.2020.1775428. ISSN 0954-0261. PMID 32589474.
  11. American Psychiatric Association (22 May 2013). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. doi:10.1176/appi.books.9780890425596. ISBN 0-89042-555-8.
  12. American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision, American Psychiatric Pub, pp. 898–901, ISBN 978-0-89042-025-6
  13. American Psychiatric Association (2013), Diagnostic and statistical manual of mental disorders, 5th ed., pp. 833–837, ISBN 978-0-89042-554-1
  14. Prince, R.; Thebaud, E.F. (3 September 2016). "Is Anorexia Nervosa a Culture-Bound Syndrome?". Transcultural Psychiatric Research Review. 20 (4): 299–302. doi:10.1177/136346158302000419.
  15. Banks, Caroline Giles (April 1992). "'Culture' in culture-bound syndromes: The case of anorexia nervosa". Social Science & Medicine. 34 (8): 867–884. doi:10.1016/0277-9536(92)90256-P. PMID 1376499.
  16. South Med J. 1999;Feb 92 (2): 190-192. Chalk Eating in Middle Georgia: A Culture-Bound Syndrome of Pica? Grigsby, RK, Thyer, BA, Waller, RJ, Johnston, GA Jr
  17. 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". Psychopathology. Karger Publishers. 37 (2): 59–63. doi:10.1159/000077579. PMID 15057028.
  18. Hunter, Melissa H.; Mazyck, Pamela J.; Dickerson, Lori M. (15 April 2003). "Premenstrual Syndrome". American Family Physician. 67 (8): 1743–1752. ISSN 0002-838X. PMID 12725453.
  19. Richardson, J. T. (September 1995). "The premenstrual syndrome: a brief history". Social Science & Medicine. 41 (6): 761–767. doi:10.1016/0277-9536(95)00042-6. ISSN 0277-9536. PMID 8571146.
  20. Rapkin, Andrea J.; Akopians, Alin L. (June 2012). "Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder". Menopause International. 18 (2): 52–59. doi:10.1258/mi.2012.012014. ISSN 1754-0461. PMID 22611222.
  21. Does PMDD Belong in the DSM? Challenging the Medicalization of Women's Bodies Archived 2011-06-28 at the Wayback Machine Journal article by Alia Offman, Peggy J. Kleinplatz; The Canadian Journal of Human Sexuality, Vol. 13, 2004
  22. Johnson, T. M. (September 1987). "Premenstrual syndrome as a western culture-specific disorder". Culture, Medicine and Psychiatry. 11 (3): 337–356. doi:10.1007/BF00048518. ISSN 0165-005X. PMID 3677777.
  23. Savely, Virginia R; Stricker, Raphael B (13 May 2010). "Morgellons disease: Analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology". Clinical, cosmetic and investigational dermatology : CCID. 3: 67–78. ISSN 1178-7015. PMC 3047951. PMID 21437061.
  24. "Pathogens & People:Internet helps spread delusion that Morgellons a disease • Columnists (www.HometownAnnapolis.com - The Capital)". web.archive.org. 9 July 2011. Retrieved 8 August 2020.
  25. Mikhaylov, B (2010). "P02-34 -Statistical issues of the psychiatric care in Ukraine". European Psychiatry. 25: 652. doi:10.1016/S0924-9338(10)70647-7. Retrieved 2 October 2016.
  26. Kudinova, O.; Mykhaylov, B. (2014). "EPA-1025 - Integrative psychotherapy model of anxiety disorders". European Psychiatry. 29 (1): 1–10. doi:10.1016/S0924-9338(14)78319-1. ISSN 0924-9338. PMID 24119631.
  27. Rachel Aviv (3 April 2017). "The Trauma of Facing Deportation". The New Yorker. Retrieved 1 July 2017.
  28. Tseng, Wen-Shing (6 June 2001). Handbook of Cultural Psychiatry. Academic Press. p. 250. ISBN 9780127016320.
  29. Ohnuki-Tierney, Emiko (8 May 2014). Illness and Healing among the Sakhalin Ainu. Cambridge University Press. p. 198. ISBN 9781107634787.
  30. Sidorov, P. I.; Davydov, A. N. (1992). "Ethnopsychiatric research in the national minorities of Northern Russia and Siberia". Bekhterev Review of Psychiatry and Medical Psychology. Washington. ISBN 0-88048-667-8. ISSN 1064-6930.

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