Culture-specific syndrome
Encyclopedia
In medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

 and medical anthropology
Medical anthropology
Medical anthropology is an interdisciplinary field which studies "human health and disease, health care systems, and biocultural adaptation". It views humans from multidimensional and ecological perspectives...

, 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
Culture
Culture is a term that has many different inter-related meanings. For example, in 1952, Alfred Kroeber and Clyde Kluckhohn compiled a list of 164 definitions of "culture" in Culture: A Critical Review of Concepts and Definitions...

. There are no objective biochemical or structural alterations of body organs
Organ (anatomy)
In biology, an organ is a collection of tissues joined in structural unit to serve a common function. Usually there is a main tissue and sporadic tissues . The main tissue is the one that is unique for the specific organ. For example, main tissue in the heart is the myocardium, while sporadic are...

 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.

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
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

(American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

, 1994) which also includes a list of the most common culture-bound conditions (DSM-IV: Appendix I). American psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...

 and medical anthropologist
Medical anthropology
Medical anthropology is an interdisciplinary field which studies "human health and disease, health care systems, and biocultural adaptation". It views humans from multidimensional and ecological perspectives...

 Arthur Kleinman
Arthur Kleinman
Arthur Kleinman is a prominent American psychiatrist and is the Esther and Sidney Rabb Professor of medical anthropology and cross-cultural psychiatry at Harvard University, USA. He is well known for his work on mental illness in Chinese culture, was the chair of the Harvard Department of...

 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
    Disease
    A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

     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
    Folk medicine
    -Description:Refers to healing practices and ideas of body physiology and health preservation known to a limited segment of the population in a culture, transmitted informally as general knowledge, and practiced or applied by anyone in the culture having prior experience.All cultures and societies...

     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 panic
Penis panic
Koro is a culture-specific syndrome from Southeast Asia in which the patient has an overpowering belief that his penis is shrinking and will shortly disappear. Also known as shrinking penis, the syndrome is listed in the Diagnostic and Statistical Manual of Mental Disorders...

s.

A culture-specific syndrome is not the same as a geographically localized disease with specific, identifiable, causal tissue abnormalities, such as kuru
Kuru (disease)
Kuru is an incurable degenerative neurological disorder that is a type of transmissible spongiform encephalopathy, caused by a prion found in humans...

 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
Malingering
Malingering is a medical term that refers to fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, which may include financial compensation ; avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences;...

”. Culture-specific syndromes shed light on how our mind
Mind
The concept of mind is understood in many different ways by many different traditions, ranging from panpsychism and animism to traditional and organized religious views, as well as secular and materialist philosophies. Most agree that minds are constituted by conscious experience and intelligent...

 decides that symptoms are connected and how a society defines a known “disease”. The American Psychiatric Association states the following:

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
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...

 that fits the way of looking at the body and its diseases of both parties. The physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 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
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

 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
Western culture
Western culture, sometimes equated with Western civilization or European civilization, refers to cultures of European origin and is used very broadly to refer to a heritage of social norms, ethical values, traditional customs, religious beliefs, political systems, and specific artifacts and...

 this is considered one of the most unethical
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...

 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.”).

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). 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.
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. 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.

The definition of such conditions logically leads to the conclusion that they are viewed within their culture as "normal"
Norm (sociology)
Social norms are the accepted behaviors within a society or group. This sociological and social psychological term has been defined as "the rules that a group uses for appropriate and inappropriate values, beliefs, attitudes and behaviors. These rules may be explicit or implicit...

 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.

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
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...

 sufferers he concluded that the condition can be misdiagnosed by the layperson 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.

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:
Name Geographical localization/populations
Running amok
Running amok
Running amok, sometimes referred to as simply amok is a term for a killing spree perpetrated by an individual out of rage or resentment over perceived mistreatment....

Malaysia, Indonesia
Indonesia
Indonesia , officially the Republic of Indonesia , is a country in Southeast Asia and Oceania. Indonesia is an archipelago comprising approximately 13,000 islands. It has 33 provinces with over 238 million people, and is the world's fourth most populous country. Indonesia is a republic, with an...

, Philippines
Philippines
The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...

, Brunei
Brunei
Brunei , officially the State of Brunei Darussalam or the Nation of Brunei, the Abode of Peace , is a sovereign state located on the north coast of the island of Borneo, in Southeast Asia...

, Singapore
Singapore
Singapore , officially the Republic of Singapore, is a Southeast Asian city-state off the southern tip of the Malay Peninsula, north of the equator. An island country made up of 63 islands, it is separated from Malaysia by the Straits of Johor to its north and from Indonesia's Riau Islands by the...

ataque de nervios Latinos
bilis, cólera Latinos
bouffée délirante West Africa
West Africa
West Africa or Western Africa is the westernmost region of the African continent. Geopolitically, the UN definition of Western Africa includes the following 16 countries and an area of approximately 5 million square km:-Flags of West Africa:...

 and Haiti
Haiti
Haiti , officially the Republic of Haiti , is a Caribbean country. It occupies the western, smaller portion of the island of Hispaniola, in the Greater Antillean archipelago, which it shares with the Dominican Republic. Ayiti was the indigenous Taíno or Amerindian name for the island...

brain fag
Brain fag
Brain fag is an example of a culture-bound syndrome. Once a common term for mental exhaustion, it is now encountered almost exclusively in West Africa. Seen predominantly in male students, it generally manifests as vague somatic symptoms, depression, and difficulty concentrating...

West African students
dhat syndrome
Dhat syndrome
Dhat syndrome is a condition found in the cultures of the Indian subcontinent in which male patients report that they suffer from premature ejaculation or impotence, and believe that they are passing semen in their urine....

India
Indian subcontinent
The Indian subcontinent, also Indian Subcontinent, Indo-Pak Subcontinent or South Asian Subcontinent is a region of the Asian continent on the Indian tectonic plate from the Hindu Kush or Hindu Koh, Himalayas and including the Kuen Lun and Karakoram ranges, forming a land mass which extends...

falling-out
Falling-out
Falling-out is a culture-bound syndrome seen in the southern United States and the Caribbean. It is characterized by a dizzy, "spinning" sensation that eventually results in the sufferer collapsing unconscious. While unconscious, sufferers report being unable to see, even if their eyes are open,...

, blacking out
Southern United States
Southern United States
The Southern United States—commonly referred to as the American South, Dixie, or simply the South—constitutes a large distinctive area in the southeastern and south-central United States...

 and Caribbean
Caribbean
The Caribbean is a crescent-shaped group of islands more than 2,000 miles long separating the Gulf of Mexico and the Caribbean Sea, to the west and south, from the Atlantic Ocean, to the east and north...

ghost sickness
Ghost sickness
Ghost sickness is a culture-bound syndrome which some Native American tribes believe to be caused by association with the dead or dying. It is considered to be a psychotic disorder of Navajo origin. Its symptoms include general weakness, loss of appetite, a feeling of suffocation, recurring...

American Indian
Indigenous peoples of the Americas
The indigenous peoples of the Americas are the pre-Columbian inhabitants of North and South America, their descendants and other ethnic groups who are identified with those peoples. Indigenous peoples are known in Canada as Aboriginal peoples, and in the United States as Native Americans...

Hwabyeong Korean
Korean people
The Korean people are an ethnic group originating in the Korean peninsula and Manchuria. Koreans are one of the most ethnically and linguistically homogeneous groups in the world.-Names:...

koro Chinese
Chinese people
The term Chinese people may refer to any of the following:*People with Han Chinese ethnicity ....

 and Malaysian populations in southeast Asia
Southeast Asia
Southeast Asia, South-East Asia, South East Asia or Southeastern Asia is a subregion of Asia, consisting of the countries that are geographically south of China, east of India, west of New Guinea and north of Australia. The region lies on the intersection of geological plates, with heavy seismic...

; Assam
Assam
Assam , also, rarely, Assam Valley and formerly the Assam Province , is a northeastern state of India and is one of the most culturally and geographically distinct regions of the country...

; occasionally in West
Western world
The Western world, also known as the West and the Occident , is a term referring to the countries of Western Europe , the countries of the Americas, as well all countries of Northern and Central Europe, Australia and New Zealand...

latah
Latah
Latah is a condition where, triggered by the startle reflex, victims fall into a trance in which they engage in repetitive speech or movements. Often these take the form of echopraxic and/or echolaliac automatisms...

Malaysia and Indonesia
Indonesia
Indonesia , officially the Republic of Indonesia , is a country in Southeast Asia and Oceania. Indonesia is an archipelago comprising approximately 13,000 islands. It has 33 provinces with over 238 million people, and is the world's fourth most populous country. Indonesia is a republic, with an...

locura Latinos in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 and Latin America
Latin America
Latin America is a region of the Americas where Romance languages  – particularly Spanish and Portuguese, and variably French – are primarily spoken. Latin America has an area of approximately 21,069,500 km² , almost 3.9% of the Earth's surface or 14.1% of its land surface area...

evil eye
Evil eye
The evil eye is a look that is believed by many cultures to be able to cause injury or bad luck for the person at whom it is directed for reasons of envy or dislike...

Mediterranean; Hispanic
Hispanic
Hispanic is a term that originally denoted a relationship to Hispania, which is to say the Iberian Peninsula: Andorra, Gibraltar, Portugal and Spain. During the Modern Era, Hispanic sometimes takes on a more limited meaning, particularly in the United States, where the term means a person of ...

 populations
nervios Latinos in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 and Latin America
Latin America
Latin America is a region of the Americas where Romance languages  – particularly Spanish and Portuguese, and variably French – are primarily spoken. Latin America has an area of approximately 21,069,500 km² , almost 3.9% of the Earth's surface or 14.1% of its land surface area...

Piblokto
Piblokto
Piblokto, Pibloktoq or Arctic hysteria is a condition exclusively appearing in Inughuit societies living within the Arctic Circle. Appearing most prevalently in winter, it is considered to be a form of a culture-bound syndrome, although more recent studies question whether it exists at...

Arctic and subarctic Eskimo
Eskimo
Eskimos or Inuit–Yupik peoples are indigenous peoples who have traditionally inhabited the circumpolar region from eastern Siberia , across Alaska , Canada, and Greenland....

 populations
Qigong psychotic reaction Chinese
Chinese people
The term Chinese people may refer to any of the following:*People with Han Chinese ethnicity ....

rootwork African American
African American
African Americans are citizens or residents of the United States who have at least partial ancestry from any of the native populations of Sub-Saharan Africa and are the direct descendants of enslaved Africans within the boundaries of the present United States...

 and White
White people
White people is a term which usually refers to human beings characterized, at least in part, by the light pigmentation of their skin...

 populations in southern United States; Caribbean
Caribbean
The Caribbean is a crescent-shaped group of islands more than 2,000 miles long separating the Gulf of Mexico and the Caribbean Sea, to the west and south, from the Atlantic Ocean, to the east and north...

sangue dormido Portuguese
Portuguese people
The Portuguese are a nation and ethnic group native to the country of Portugal, in the west of the Iberian peninsula of south-west Europe. Their language is Portuguese, and Roman Catholicism is the predominant religion....

 populations in Cape Verde
Cape Verde
The Republic of Cape Verde is an island country, spanning an archipelago of 10 islands located in the central Atlantic Ocean, 570 kilometres off the coast of Western Africa...

shenjing shuairuo
Neurasthenia
Neurasthenia is a psycho-pathological term first used by George Miller Beard in 1869 to denote a condition with symptoms of fatigue, anxiety, headache, neuralgia and depressed mood...

Chinese
Chinese people
The term Chinese people may refer to any of the following:*People with Han Chinese ethnicity ....

shenkui Chinese
Chinese people
The term Chinese people may refer to any of the following:*People with Han Chinese ethnicity ....

shinbyeong Korean
Korean people
The Korean people are an ethnic group originating in the Korean peninsula and Manchuria. Koreans are one of the most ethnically and linguistically homogeneous groups in the world.-Names:...

spell African American
African American
African Americans are citizens or residents of the United States who have at least partial ancestry from any of the native populations of Sub-Saharan Africa and are the direct descendants of enslaved Africans within the boundaries of the present United States...

 and White
White people
White people is a term which usually refers to human beings characterized, at least in part, by the light pigmentation of their skin...

 populations in the southern United States
Southern United States
The Southern United States—commonly referred to as the American South, Dixie, or simply the South—constitutes a large distinctive area in the southeastern and south-central United States...

susto
Susto
Susto is a cultural illness, specifically a "fright sickness" with strong psychological overtones. Susto comes from the Portuguese, and Spanish word for "fright" . A more severe and potentially fatal form of susto is called espanto...

Latinos in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

; Mexico
Mexico
The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...

, Central America
Central America
Central America is the central geographic region of the Americas. It is the southernmost, isthmian portion of the North American continent, which connects with South America on the southeast. When considered part of the unified continental model, it is considered a subcontinent...

 and South America
South America
South America is a continent situated in the Western Hemisphere, mostly in the Southern Hemisphere, with a relatively small portion in the Northern Hemisphere. The continent is also considered a subcontinent of the Americas. It is bordered on the west by the Pacific Ocean and on the north and east...

taijin kyofusho
Taijin kyofusho
Taijin kyofusho , is a Japanese culture-specific syndrome. The term taijin kyofusho literally means the disorder of fear of interpersonal relations . Dr...

Japanese
Japanese people
The are an ethnic group originating in the Japanese archipelago and are the predominant ethnic group of Japan. Worldwide, approximately 130 million people are of Japanese descent; of these, approximately 127 million are residents of Japan. People of Japanese ancestry who live in other countries...

zār
Zar
- Places :* Zar, Armenia, a town in the Kotayk Province* Zar, Azerbaijan, a village in the Kalbajar Rayon currently controlled by the Nagorno-Karabakh Republic* Žár , a village in the Czech Republic* Żar, Łódź Voivodeship, Poland...

Ethiopia
Ethiopia
Ethiopia , officially known as the Federal Democratic Republic of Ethiopia, is a country located in the Horn of Africa. It is the second-most populous nation in Africa, with over 82 million inhabitants, and the tenth-largest by area, occupying 1,100,000 km2...

, Somalia
Somalia
Somalia , officially the Somali Republic and formerly known as the Somali Democratic Republic under Socialist rule, is a country located in the Horn of Africa. Since the outbreak of the Somali Civil War in 1991 there has been no central government control over most of the country's territory...

, Egypt
Egypt
Egypt , officially the Arab Republic of Egypt, Arabic: , is a country mainly in North Africa, with the Sinai Peninsula forming a land bridge in Southwest Asia. Egypt is thus a transcontinental country, and a major power in Africa, the Mediterranean Basin, the Middle East and the Muslim world...

, Sudan
Sudan
Sudan , officially the Republic of the Sudan , is a country in North Africa, sometimes considered part of the Middle East politically. It is bordered by Egypt to the north, the Red Sea to the northeast, Eritrea and Ethiopia to the east, South Sudan to the south, the Central African Republic to the...

, Iran
Iran
Iran , officially the Islamic Republic of Iran , is a country in Southern and Western Asia. The name "Iran" has been in use natively since the Sassanian era and came into use internationally in 1935, before which the country was known to the Western world as Persia...

, and other North African and Middle Eastern societies

Others

  • Caída de Mollera
  • Cólico
  • Embrujamiento
  • Empacho - food forms clumps during digestion, causing pain
  • Hysteria
    Hysteria
    Hysteria, in its colloquial use, describes unmanageable emotional excesses. People who are "hysterical" often lose self-control due to an overwhelming fear that may be caused by multiple events in one's past that involved some sort of severe conflict; the fear can be centered on a body part, or,...

  • Mal Puesto
  • Mal de Latido
  • Mal Aire
  • Melancholia
    Melancholia
    Melancholia , also lugubriousness, from the Latin lugere, to mourn; moroseness, from the Latin morosus, self-willed, fastidious habit; wistfulness, from old English wist: intent, or saturnine, , in contemporary usage, is a mood disorder of non-specific depression,...

  • Pasma
    Pasma
    Pasma refers to a "folk illness" unique to the Filipino culture. As such, it has distinct signs, symptoms, perceived causes and treatments which are recognized in the folk medicine of the Philippines, but these are not described in medical textbooks, discussed in medical schools, or generally...

  • Tristeza
  • Wendigo psychosis

Further reading

Paperback ISBN 90-277-1859-8 (Note: Different preview pages result in the full chapter being viewable from the title link).

External links

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