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.^[1]

Even though the concept is controversial, 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). American psychiatrist and medical anthropologist Arthur Kleinman has contributed much to the understanding of these 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 another nosological category.

Western medical perspectives

An interesting aspect of culture-specific syndromes is the extent to which they are “real”. Characterizing them as “imaginary” is as inaccurate as characterizing them as “malingering”. Culture-specific syndromes shed light on how our mind decides that symptoms are connected and how a society defines a known “disease”. The American Psychiatric Association states the following:^[2]

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 [comma sic] categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations.

Medical care of the condition is challenging and illustrates a truly fundamental but rarely discussed aspect of the physician-patient relationship: the need to negotiate a diagnosis that fits the way of looking at the body and its diseases of both parties. The physician may do any of the following:

1. Share the way the patient sees the disorder, and offer the folk medicine treatment
2. Recognize it as a culture-bound syndrome, but pretend to share the patient’s perspectives and offer the folk medicine treatment or a new improvised treatment
3. Recognize it as a culture-bound syndrome but try to educate the patient into seeing the condition as the physician sees it

The problem with choice 1 is that physicians who pride themselves on their knowledge of disease may like to think they know the difference between culture-specific disorders and “organic” diseases. While choice 2 may be the quickest and most comfortable choice, the physician must deliberately deceive the patient. Currently in Western culture this is considered one of the most unethical things a physician can do, whereas in other times and cultures deception with benevolent intent has been an accepted tool of treatment. Choice 3 is the most difficult and time-consuming to do without leaving the patient disappointed, insulted, or lacking confidence in the physician, and may leave both physician and patient haunted by doubts (“Maybe the condition is real.” or “Maybe this doctor doesn’t know what s/he is talking about.”).^{[improper synthesis?]}

The term culture-bound syndrome has, in many ways, been a controversial topic since it has reflected the different opinions of anthropologists and psychiatrists. 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 (Prince, 2000; Jilek, 2001).^[3][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] 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.^[6] 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.^[7]

The definition of such conditions logically leads to the conclusion that they are viewed within their culture as "normal" in the limited sense of a readily possible, if not necessarily common or beneficial, manner of behavior. This probably accounts for the scarcity of English-language work on Western culture-bound syndromes, though these conditions are existent and some researchers have attempted to treat with the phenomena in their own parent cultures.^{[clarification needed][8]}

In 1980, social anthropologist and physician Dan Blumhagen put forward the theory that folk illnesses and formal medical illnesses are not mutually exclusive. Based upon his research with hypertension sufferers he concluded that the condition can be misdiagnosed by the layment by associating the plain English name of illness with its literal meaning; in this case all pressure or "tension" in the extremities could be self-diagnosed as hyper-tension.^[9]

DSM-IV list of culture-bound syndromes

The fourth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as culture-bound syndromes^[10]:

Name	Geographical localization/populations
Running amok	Malaysia, Indonesia, Philippines, Brunei, Singapore
ataque de nervios	Latinos
bilis, cólera	Latinos
bouffée délirante	West Africa and Haiti
brain fag	West African students
dhat syndrome	India
falling-out, blacking out	Southern United States and Caribbean
ghost sickness	American Indian
Hwabyeong	Korean
koro	Chinese and Malaysian populations in southeast Asia; Assam; occasionally in West
latah	Malaysia and Indonesia
locura	Latinos in the United States and Latin America
evil eye	Mediterranean; Hispanic populations
nervios	Latinos in the United States and Latin America
Piblokto	Arctic and subarctic Eskimo populations
Qigong psychotic reaction	Chinese
rootwork	African American and White populations in southern United States; Caribbean
sangue dormido	Portuguese populations in Cape Verde
shenjing shuairuo	Chinese
shenkui	Chinese
shinbyeong	Korean
spell	African American and White populations in the southern United States
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

Others

• Caída de Mollera
• Cólico
• Embrujamiento^[11]
• Empacho - food forms clumps during digestion, causing pain^[12]
• Hysteria
• Mal Puesto
• Mal de Latido
• Mal Aire
• Melancholia
• Pasma
• Tristeza
• Wendigo psychosis

See also

• Cross-cultural psychiatry
• Cross-cultural psychology
• Medical anthropology

Further reading

• Kleinman, Arthur (1991), Rethinking psychiatry: from cultural category to personal experience, New York: Free Press, ISBN 0-02-917441-4, http://books.google.com/?id=bY6f7ebzTvYC&printsec=frontcover&dq=%22Rethinking+psychiatry%22#v=onepage&q&f=false, retrieved 08 January 2011 
• Landy, David (editor) (1977), Culture, Disease, and Healing: Studies in Medical Anthropology, New York: Macmillan, ISBN 978-0023673900 
• John Launer (2003), "Folk illness and medical models", Q J Med 96 (11): 875–876, doi:10.1093/qjmed/hcg136, http://qjmed.oxfordjournals.org/cgi/content/full/96/11/875 
• Simons, Rondald C & Hughes, Charles C, ed. (1985), The Culture-Bound Syndromes: Folk Illnesses and Anthropological Interest, Dordrecht, Holland: D. Reidel Publishing Co, ISBN 90-277-1858-X, http://books.google.com/?id=nMQQ7-AR1dYC&printsec=frontcover&dq=culture-bound#v=onepage&q&f=false, retrieved 09 September 2010  Paperback ISBN 90-277-1859-8
• Rebhun, L.A (2004), "Culture-Bound Syndromes", in Ember, Carol R. & Ember, Melvin, Encyclopedia of Medical Anthropology: Health and Illness in the World's Cultures, New York: Klower Academic/Plenum Publishers, pp. 319–327, ISBN 0-306-47754-8, http://books.google.com/books?id=JI9IsHAbsnsC&pg=PA319&dq=culture-bound&hl=en&ei=1GSITMfnGpTSuwPDwJ0B&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDcQ6AEwAg#v=onepage&q=culture-bound&f=false, retrieved 09 September 2010  (Note: Different preview pages result in the full chapter being viewable from the title link).

References

1. ^ Folk Medicine in Hispanics in the Southwestern United States, Nancy Neff, M.D., Assistant Professor, Department of Community Medicine, Baylor College of Medicine
2. ^ American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision, American Psychiatric Pub, p. 898, ISBN 9780890420256 
3. ^ Prince, Raymond H. (2000) In Review. Transcultural Psychiatry: Personal Experiences and Canadian Perspectives. Canadian Journal of Psychiatry, 45: 431–437
4. ^ Jilek W.G (2001) Psychiatric Disorders: Culture-specific. International Encyclopedia of the Social and Behavioral Sciences. Elsevier Science Ltd.
5. ^ Guarnaccia, Peter J. & Rogler, Lloyd H. (1999) Research on Culture-Bound Syndromes: New Directions. American Journal of Psychiatry 156:1322–1327, September
6. ^ Schechter DS, Marshall RD, Salman E, Goetz D, Davies SO, Liebowitz MR (2000). Ataque de nervios and childhood trauma history: An association? Journal of Traumatic Stress, 13:3, 529-534.
7. ^ Schechter DS, Kaminer, T, Grienenberger JF, Amat J (2003). Fits and starts: A mother-infant case study involving pseudoseizures across three generations in the context of violent trauma history (with Commentaries by RD Marshall, CH Zeanah, T Gaensbauer). Infant Mental Health Journal. 24(5), 510-28.
8. ^ http://www.springerlink.com/content/gx6821m8ul37781v/
9. ^ Blumhagen D. Hyper-Tension: a folk illness with a medical name. Culture, Medicine and Psychiatry 1980; 4:197–227
10. ^ American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision, American Psychiatric Pub, pp. 898–901, ISBN 9780890420256 
11. ^ Common Latino/Hispanic Folk Illnesses
12. ^ Snyder, Julie S.; Jarvis, Carolyn (2004), Physical examination & health assessment, Philadelphia: Saunders, p. 47, ISBN 0-7216-9773-9 

External links

• Culture-Bound Syndromes
• Psychiatric Times – Introduction to Culture-Bound Syndromes
• Skeptical Inquirer – Culture-bound syndromes as fakery^{[dead link]}