THE CULTURE·BOUND SYNDROMES CUL TURE, ILLNESS, AND HEALING
Studies in Comparative Cross-Cultural Research
Editor-in-Chief:
ARTHUR KLEINMAN Harvard University and Medical School, Cambridge, Massachusetts, U.S.A.
Editorial Board:
ATWOOD D. GAINES Departments of Anthropology and Psychiatry, Case Western Reserve University and Medical School, Cleveland, Ohio, U.S.A.
MARGARET LOCK Departments of Anthropology and Humanities and Social Studies in Medicine, McGill University, Montreal, Canada
NUR YALMAN Harvard University, Cambridge, Massachusetts, U.S.A.
ALLAN YOUNG Department of Anthropology, Case Western Reserve University, Cleveland, Ohio, U.S.A. THE CULTURE-BOUND SYNDROMES Folk Illnesses of Psychiatric and Anthropological Interest
Edited by
RONALD C. SIMONS Depts. of Psychiatry and Anthropology, Michigan State University, East Lansing, Michigan, U.S.A.
and
CHARLES C. HUGHES Dept. of Family and Community Medicine, Medical Center, The University of Utah, Salt Lake City, Utah, U.S.A.
D. REIDEL PUBLISHING COMPANY
A MEMBER OF THE KLUWER ACADEMIC PUBLISHERS GROUP
DORDRECHT I BOSTON I LANCASTER /TOKYO Library of Congress Cataloging-in-Publication Data Main entry under title: The Culture-bound syndromes. (Culture, illness, and healing) Bibliography: p. Indudes indexes. I. Medical anthropology-Addresses, essays, lectures. 2. Ethno• psychology-Addresses, essays, lectures. 3. Mental illness-Social aspects• Addresses, essays, lectures. 4. Psychiatry, Transcultural-Addresses, essays, lectures. I. Simons, Ronald C. II. Hughes, Charles C. (Charles Campbell) III. Series. [DNLM: 1. Culture. 2. Ethnic Groups-psychology. 3. Mental Disorders-etiology. 4. Social Environment. WM 31 C9685] GN296.C835 1985 362.1'042 85-14613 ISBN-13: 978-90-277-1859-4 e-ISBN-13: 978-94-009-5251-5 DOl: 10.1007/978-94-009-5251-5
Published by D. Reidel Publishing Company. P.O. Box 17, 3300 AA Dordrecht, Holland.
Sold and distributed in the U.S.A. and Canada by Kluwer Academic Publishers, 190 Old Derby Street, Hingham, MA 02043, U.S.A.
In all other countries, sold and distributed by Kluwer Academic Publishers Group, P.O. Box 322, 3300 AH Dordrecht, Holland.
All Rights Reserved © 1985 by D. Reidel Publishing Company and copyrightholders as specified on appropriate pages within. Softcover reprint of the hardcover I st edition 1985 No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, induding photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner With Appreciation to: Clyde Kluckhohn Alexander H. Leighton Eng-Seong Tan Nathaniel N. Wagner T ABLE OF CONTENTS
SOURCES AND ACKNOWLEDGEMENTS xi
PREFACE xiii
INTRODUCTION
CHARLES C. HUGHES / Culture-Bound or Construct-Bound? The Syndromes and DSM-III 3 RONALD C. SIMONS / Sorting the Culture-Bound Syndromes 25
PART I: FOLK ILLNESSES OF PSYCHIATRIC INTEREST IN WHICH SOME EVIDENCE SUPPORTS THE HYPOTHESIS OF A NEUROPHYSIOLOGICAL SHAPING FACTOR
A. The Startle Matching Taxon
RONALD C. SIMONS / Introduction 41
RONALD C. SIMONS / The Resolution of the Latah Paradox 43
MICHAEL G. KENNY / Paradox Lost: The Latah Problem Revisited 63
RONALD C. SIMONS / Latah II - Problems with a Purely Symbolic Interpretation: A Reply to Michael G. Kenny 77
EMIKO OHNUKI-TIERNEY I Shamans and Imu: Among Two Ainu Groups - Toward a Cross-CulturaI Model of Interpretation 91
CHARLES C. HUGHES / Commentary 111
B. The Sleep Paralysis Taxon
RONALD C. SIMONS / Introduction 115
JOSEPH D. BLOOM and RICHARD D. GELARDIN / Uqamairineq and Uqumanigianiq: Eskimo Sleep Paralysis 117 ROBERT C. NESS / The Old Hag Phenomenon as Sleep Paralysis: A Biocultural Interpretation 123 CHARLES C. HUGHES / Commentary 147 vii viii T ABLE OF CONTENTS
PART II: FOLK ILLNESSES OF PSYCHIATRIC INTEREST IN WHICH A NEUROPHYSIOLOGICAL SHAPING FACTOR IS ONLY SUSPECTED
A. The Genital Retraction Taxon
RONALD C. SIMONS / Introduction 151
GWEE AH LENG / Koro - A Cultural Disease 155 o. I. IFABUMUYI and G. G. C. RWEGELLERA / Koro in a Nigerian Male Patient: A Case Report 161
J. GUY EDWARDS / The Koro Pattern of Depersonalization in an American Schizophrenic Patient 165
JAMES W. EDWARDS / Indigenous Koro, A Genital Retraction Syndrome of Insular Southeast Asia: A Critical Review 169
CHARLES C. HUGHES / Commentary 193
B. The Sudden Mass Assault Taxon
RONALD C. SIMONS / Introduction 197
JOHN E. CARR / Ethno-Behaviorism and the Culture-Bound Syndromes: The Case of Amok 199
JOSEPH WESTERMEYER / Sudden Mass Assault with Grenade: An Epidemic Amok Form from Laos 225
B. G. BURTON-BRADLEY / The Amok Syndrome in Papua and New Guinea 237
J. ARBOLEDA-FLOREZ / Amok 251
CHARLES C. HUGHES / Commentary 263
C. The Running Taxon
RONALD C. SIMONS / Introduction 267
ZACHAR Y GUSSOW / Pibloktoq (Hysteria) Among the Polar Eskimo: An Ethnopsychiatric Study 271
PHILIP A. DENNIS / Grisi Siknis in Miskito Culture 289
EDWARD F. FOULKS / The Transformation of Arctic Hysteria 307
CHARLES C. HUGHES / Commentary 325 TABLE OF CONTENTS ix
PART III: FOLK ILLNESSES USUALLY LISTED AS CULTURE-BOUND PSYCHIATRIC SYNDROMES WHICH SHOULD PROBABLY NO LONGER BE SO CONSIDERED
A. The Fright fllness Taxon RONALD C. SIMONS I Introduction 329
ARTHUR 1. RUBEL, CARL W. O'NELL, and ROLANDO COLLADO I The Folk Illness Called Susto 333 MARLENE DOBKIN DE RIOS I Saladera - A Culture-Bound Misfortune Syndrome in the Peruvian Amazon 351 DONN V. HART I Lanti, Illness by Fright Among Bisayan Filipinos 371 STEPHEN FRANKEL I Mogo Laya, A New Guinea Fright Illness 399 CHARLES C. HUGHES I Commentary 405
B. The Cannibal Compulsion Taxon
RONALD C. SIMONS I Introduction 409 LOU MARANO I Windigo Psychosis: The Anatomy of an Emic-Etic Confusion 411
H. B. M. MURPHY, HAZEL H. WEIDMAN, ROBERT A. BRIGHTMAN, and LOU MARANO I Commentaries and Replies 449 CHARLES C. HUGHES I Commentary 463
APPENDIX
CHARLES C. HUGHES I Glossary of 'Culture-Bound' or Folk Psychiatric Syndromes 469
LIST OF CONTRIBUTORS 507
INTRODUCTION TO THE INDEX 509
INDEX 512 SOURCES AND ACKNOWLEDGEMENTS
Ronald C. Simons, 'The Resolution of the Latah Paradox' originally appeared in the Journal of Nervous and Mental Disease 168 (1980),195-206. It is reprinted here by permission of the Williams & Wilkins Co., Baltimore. Michael G. Kenny, 'Paradox Lost: The Latah Problem Revisited', and Ronald C. Simons' rejoinder, 'Latah II - Problems with a Purely Symbolic Interpretation', fIrst appeared in the Journal ofNervous and Mental Disease 171 (1983), 159-67 and 168-75 and are both reprinted here by permission of The Williams & Wilkins Co., Baltimore. Emiko Ohnuki-Tierney, 'Shamans and Imu: Among Two Ainu Groups - Toward a Cross-Cultural Model of Interpretation', fIrst appeared in Ethos 8 (1980), 204-28 and is reproduced here by permission of the Society for Psychological Anthropology . Joseph D. Bloom and Richard D. Gelardin, 'Uqamairineq and Uqumanigianiq: Eskimo Sleep Paralysis' originally appeared in Arctic 29(1) (1967), and is re• printed here by permission of the Arctic Institute of North America_ Gwee Ah Leng, 'Koro - A Cultural Disease' first appeared in the Singapore Medical Journal 4(3) (1963) and is reprinted here by permission of the Singapore Medical Association. O. I. Ifabumuyi and G. G. C. Rwegellera, 'Koro in a Nigerian Male Patient: A Case Report' fIrst appeared in the African Journal of Psychiatry 5 (1979) and is re• printed here by permission of Literamed Publications Nigeria Ltd. J. Guy Edwards, 'The Koro Pattern of Depersonalization in an American Schizo• phrenic Patient' originally appeared in The American Journal ofPsychiatry 126 (1970),1171-73 and is reprinted here by permission of the American Psychiatric Association. Burton G. Burton-Bradley, 'The Amok Syndrome in Papua and New Guinea' originally appeared in The Medical Journal of Australia 1 (1968), 252-56 and is reprinted here by permission of The Medical Journal of Australia. J. Arboleda-Florez, 'Amok', first appeared in the Bulletin of the American Academy of Psychiatry and Law 7 (1979), 286-95 and is reprinted here by permission of the American Academy of Psychiatry & the Law. Z. Gussow, 'Pibloktoq (Hysteria) Among the Polar Eskimo' first appeared in The Psychoanalytic Study of Society 1 (1960), 218-36 and is reprinted here by permission of the International Universities Press, Inc., New York. Philip A. Dennis, 'Grisi Siknis in Miskito Culture' is a shorter version of the article entitled: 'Grisi Siknis Among the Miskito', which appeared in Medical Anthro• pology 5, 445-505 and is reprinted here by permission of Redgrave Publishing Co. xi xii SOURCES AND ACKNOWLEDGEMENTS
Lou Marano, 'Windigo Psychosis: The Anatomy of an Emic-Etic Confusion' and the 'Commentaries and Replies' following this article originally appeared in Current Anthropology 23 (1982), 385-412 and 24 (1983), 120-25 and are both reprinted here by permission of The University of Chicago Press.
We also wish to acknowledge quotations from the following publications:
Alexander H. Leighton, T. Adeoye Lambo, Charles C. Hughes, Dorothea C. Leighton, Jane M. Murphy, and David B. Macklin, Psychiatric Disorder Among the Yoruba: A Report from the Cornell-Aro Mental Health Research Project in the Western Region, Nigeria. © 1963 by Cornell University. Reprinted by permission of the publisher, Cornell University Press. A large quotation from P. M. Yap in M. P. Lau and A. B. Stokes (eds.), Comparative Psychiatry: A Theoretical Framework, 1974. Reprinted by permission of the University of Toronto Press. Parts from the Diagnostic and Statistical Manual ofMental Disorders, Third Edition, American Psychiatric Association, Washington, D.C., APA, 1980. Reprinted by permission. Z. Gussow, 'Some Responses of West Greenland Eskimo to a Naturalistic Situation of Perceptual Deprivation', INTER-NORD: International Journal of Arctic and Nordic Studies (December 1970),227-62. Reprinted with permission. Joseph P. Reser and Harry D. Eastwell, 'Labelling and Cultural Expectations: The Shaping of a Sorcery Syndrome in Aboriginal Australia', The Journal of Nervous and Mental Disease 169 (1981), 303-10. Reprinted by permission of The Williams & Wilkins Co., Baltimore. PREFACE
In the last few years there has been a great revival of interest in culture-bound psychiatric syndromes. A spate of new papers has been published on well known and less familiar syndromes, and there have been a number of attempts to put some order into the field of inquiry. In a review of the literature on culture-bound syndromes up to 1969 Yap made certain suggestions for organizing thinking about them which for the most part have not received general acceptance (see Carr, this volume, p. 199). Through the seventies new descriptive and conceptual work was scarce, but in the last few years books and papers discussing the field were authored or edited by Tseng and McDermott (1981), AI-Issa (1982), Friedman and Faguet (1982) and Murphy (1982). In 1983 Favazza summarized his understanding of the state of current thinking for the fourth edition of the Comprehensive Textbook of Psychiatry, and a symposium on culture-bound syndromes was organized by Kenny for the Eighth International Congress of Anthropology and Ethnology. The strong• est impression to emerge from all this recent work is that there is no substantive consensus, and that the very concept, "culture-bound syndrome" could well use some serious reconsideration. As the role of culture-specific beliefs and prac• tices in all affliction has come to be increasingly recognized it has become less and less clear what sets the culture-bound syndromes apart. Does the concept of culture-bound syndromes still retain any utility or is it merely the anachronistic legacy of an ethnocentric and imperial past? There are many other questions as well, e.g.: how are the individual syndromes best thought of: what concepts derived from which disciplines are the most reason• able and the most useful with which to consider each syndrome? Can they be encompassed in a meaningful collective category? Does biology, especially neuro• physiology, have a role in explaining the manifestations of any of the syndromes? Are multi-disciplinary explanations possible, are they necessary, and for which syndromes? How do the syndromes relate to current psychiatric nosology; are they variants of ubiquitous psychiatric syndromes or is each locally unique? What is the role of culture; does it cause something locally unique to happen or is it merely the symbol system for elaborating ubiquitous pathological processes? And in one noteworthy instance, does a syndrome which has been repeatedly described and variously explained even exist, or does it have no actual incidence whatsoever?
This book was originally intended to follow a conference considering these ques• tions which Professor John Carr of the University of Washington and I had planned to arrange. As old friends who views differ almost diametrically on several of the central issues, our plan was to assemble a group of fieldworkers from various xiii
Ronald C. Simons and Charles C. Hughes (eds.), The Culture·Bound Syndromes, xiii-xv. © 1985 by D. Reidel Publishing Company. xiv PREFACE disciplines who had done primary work on the syndromes and to publish both their original descriptive papers and a summary of our deliberations and debates. For a number of practical reasons, the conference could not be held, and though Jack and I for a long time still cherished the plan of publishing a collection of papers representing our two viewpoints, ultimately the press of his duties as acting chairman of the University of Washington'S psychiatry department forced him to withdraw from that plan as well. As we had by that time collected the papers that form the nucleus of this volume, I offered a seminar based on this compila· tion as part of the Medical Anthropology core curriculum at Michigan State Uni• versity. The more we considered the controversies, the more useful it seemed to publish some compilation such as that which Professor Carr and I had originally envisaged. Desiring some assistance with the editorial chores and even more importantly some view of the field complementing mine, I thought first of Charles Hughes, from whom I had taken my first course in anthropology a dozen years earlier. I had once discussed a similar project with him, but it had been abandoned when he left Michigan State for a professorship at the University of Utah. Much to my pleasure and relief, Charles was interested; he had also been keeping up his interest in the syndromes and had been puzzling out how they might be related to standard psychiatric nomenclature. We did not fully agree on the most useful way to classify and analyze the syndromes, but we did agree that the time was ripe for a book laying out some of the controversies. Further, we agreed that many of the major conceptual problems had to do with the levels of abstraction in which divergent analyses were couched. All of this history is offered as a way of explaining the somewhat unusual nature of the present collaboration and more importantly, the organization of the pressent volume. From the vast literature on culture-bound syndromes, this volume contains an illustrative sampling chosen to reflect a wide diversity of viewpoints and analytic conceptualizations. The papers' authors include anthropologists, sociologists, psychologists, psychiatrists, and non-psychiatric physicians. Some of the papers are classic accounts from the literature; many are adapted from more recent journal publications; several were written expressly for this volume; and one is an excerpt from a PhD dissertation. Each of the papers deals with a single syndrome, and the papers have been grouped into subsections based on gross behavioral re• semblances within syndrome sets, groupings which I have called "taxa". There are two explicit debates; my debate with Michael Kenny on how latah might best be understood and a debate between Lou Marano and his critics on the existence or non-existence of windigo as a set of actual behaviors. The book also contains as many implicit debates as we could cram in; contrasting viewpoints with the contrast emphasized by the juxtaposition of papers. This is a volume of controversy, and to that extent at least, a true reflection of the present state of thinking in this field. Charles Hughes' introductory chapter relates the syndromes to current psychiatric nosologic and taxonomic thinking and suggests a new way of consider• ing single instances of any of the syndromes discussed. My introductory chapter PREFACE xv suggests a way in which biological, psychological, social, and cultural factors can be considered jointly, and it proposes a taxonomic scheme which I believe could be helpful in bringing some order to the field and in suggesting avenues for future research. The present volume, organized according to this scheme, is intended as a demonstration of its potential utility. Both Dr. Hughes and I stress the need to collect descriptive data bearing on specific unanswered questions, al• though the data we solicit and the questions we seek to answer differ somewhat. The last section of the volume is a preliminary, partially sorted listing of culture• bound syndromes, prepared by Dr. Hughes. It is presented in the hope that it will be useful to future researchers and that some may even be tempted by this volume to undertake additional sorting. We also hope that this volume will acquaint readers with the main currents of thought on culture-bound syndromes and will expose them to a wide enough range of sets of data, analytic perspectives and styles of reasoning to make possible preliminary conclusions as to which approaches to future research are likely to prove most useful.
RONALD C. SIMONS East Lansing, Ml January, 1985