Indian Journal of , April 1985, 27(2), pp 119-122

DHAT SYNDROME REVISITED GURMEET SINGH

SUMMARY

Fifty consequetive patients of male potency disorders were examined and classified as Dhat Syndrome, Impotence or Premature depending on definition laid down for these. Dhat syndrome has been found predominantly in young adults. Thirty one patients (62 %) complained of Dhat as a major symptom. Associated diagnosis was depression (48%) and neurosis (16%). No psychiatric disorder was noticed in 16 (32%) cases. The socio-demographic relationships are given and difficulty in handling such patients has been discussed.

The so-called 'Dhat syndrome' is a com­ their excessive indulgence in monly recognized clinical entity in our cul­ and/or sexual intercourse. It is commonly ture both by lay people as well as clinicians believed that 40 drops of butter produce 1 in their general practice. However, very drop of blood and 40 drops of blood pro­ little scientific study has been made of the duce 1 drop of semen, hence the loss of se­ extent and manifestations of this semen- men leads to physical and mental weakness. complex in the Indian society but it must be We commonly refer to this as the 'Dhat extremely common judging from the nu­ syndrome' a term first used by Wig in 1960 merous sex therapists at street corners and (Dhat-semen). This belief is extremely wi­ advertisements in the newspapers. despread especially among the youth and whitish discharge with the urine is des­ In a survey conducted at Patiala (unpub­ cribed as 'Dhat' by them. Over 2/3 of pa­ lished data) 48 per cent of rural and 23 per tients inquired, in the clinic viewed seminal cent of college sample viewed masturba­ loss as positively harmful and the percen­ tion and/or excessive sex as positively tage rose to 80 per cent among patients of harmful and that it could lead to mental ill­ Dhat syndrome. ness. Another 21 per cent of rural sample and 45 per cent of college sample agreed 'Dhat' is a word which literally that it was physically debilitating but were can be translated as 'Dhatu' and refers to the not sure whether it could cause mental ill­ basic or essential elements either of the ness or not, only 32 per cent were positive body or of the universe considered to com­ that it was not harmful. prise of five elements-earth, water, air, fire Nakra (1977) in a review of 150 conse­ and ether. At a differential level of concep­ cutive patients of cons­ tualization 'Dhat' is often used in the sense tituting 9.2 per cent of all patients seen at of 'to sustain'-or 'to retain' and at times ref­ Chandigarh clinic reported that whereas 25 ers to the supreme spirit of soul. Semen is per cent complained of premature ejacula­ referred in ancient Indian medical treatise tion and 35 per cent of impotence, the lar­ as 'Virya'-which has been derived from the gest number 40 per cent complained of va- Sanskrit word meaning bravery, valour, £ue somatic symptoms (at times associated strength, power or that which generates with impotence or P.M.E.) attributed to the power and greatness. 'Shukra' is a term belief that it was a direct consequence of which more specifically refers to the sperm

I'rofessor and Head, Department of Psychiatry, Government Medical College, Patiala. 120 DHAT SYNDROME content of seminal fluid and is derived from Patiala, formed the basis of this stud'. the Sanskrit word 'Shuch'-the word 'Shu- These excluded the patients whose con - cha' literally means the 'essence' or fire or plaint of potency disorder was secondary to shine or glow. severe depression, schizophrenia, organic or sexual perversion. Patients oi­ The dislike and fear of the loss of semen ly with complaint of 'Dhat' were also im - is far more vocal and intense in India than luded. For classificatory purpose the fol­ the west. The Shiva Samhita says "the fal­ lowing definitions were used: ling of seed leads towards death, the keep­ ing of ones seed is life. Hence with all his Dhat syndrome: A condition where a patient power should a man hold his seed." (quoted presents with primary complaint of loss cl by Volin and Phelan, 1967). The idea of loss semen. Various physical and mental symp­ of semen and with it physical and mental toms usually accompany the chief com­ power is often described as a fear-somew­ plaint. This includes loss of semen through hat like the castration complex, but it is in night discharges and^ masturbation or fact, not a fear of attack by aother person in­ through sexual intercourse. At times, pa­ volving aggressive feelings towards the tients complain of whitish discharge alon^ subject but primarily a loss of semen and a with or preceding passage of urine. This is desire to retain the loved object. The belief usually related to presence of oxalates that the semen is drawn from all parts and/or phosphates in the urine but is be­ of body and is the recreator of the self lieved to be semen by the subject. suggests an unusually strong cathexis on the semen which is practically identified with It was further classified into: (a) Dhar the ego. syndrome with no other sexual complaints, (b) Dhat syndrome with impotency and /or It is thus evident that in our culture there is an intense libidinal cathexis of the P.M.E. semen as evident in Indian mythology. In Impotence: A persistent inability to obtain view of this the 'loss' of semen like the loss an erection sufficient to allow of any other valued possession should theo­ and ejaculation to be satisfactorily conclud­ retically produce a sense of grief and clini­ ed during hetrosexual coitus (Hastings cal depression. It was hypothesised that (a) 1963). the symptoms of the so-called Dhat synd­ rome should be similar to the symp­ (P.M.E.) : A condition toms of Depressive Neurosis rather than wherein orgasm and ejaculation persistent­ anxiety neurosis, and (b) that the patients ly occur before or immediately after pene­ would have high scores on the Amritsar tration of the female introitus during hete­ Depressive Inverntory (A.D.I.) (Singh et al rosexual coitus (Schapiro, 1943). 1974)-falling within the depressive range. The patients were subjected to routine psychiatric and medical check up. Detailed Material and Methods psychiatric history and mental state exami­ Fifty consecutive patients of male pot­ nation was done. Special emphasis was ency disorders coming to the psychiatric given on taking in detail the sexual his­ outdoor department of Rajendra Hospital, tory. GURMEET SINGH 121

Results Table 3 shows the symptoms, most The age range, marital status and litera- commonly presented by patients of Dhat cv of the patients is given below Table 1. Table 3 1. Age (in yrs.): Range 18-45 Mean 25.9 ± 5.8 Symptoms in patients of Dhat Syndromes 2. Age at on set Range 16-25 Mean 21.8 ±4.0 N = 31 Jin yrs.) Percentage 3. Marital Status of patients Married 35 70% complaining Single 15 30% 1. Somatic symptoms 73.8% -I. Literacy (fatigue, weakness) Illiterate 3 6% below 5th 4 8% 2. Headache 68.0 % 5-10th Class 20 40% 3. Depressed mood 62.5 % Above High school 18 36% 4. Anxiety 51.6% Postgraduate/Professional 5 10% 5. Loss of appetite 43.8% Diagnosis wise, twelve patients (24 per 6. i) Insomnia cent) suffered from impotence alone, seven ii) Cardiovascular symptoms 31.3% (14 per cent) from premature ejaculation, (palpitation, tachycardia) eleven (22 per cent) from Dhat and impot­ 7. Death wish/suicidal feelings 26.2 % ence and twenty (40 per cent) complained 8. i) Pessimistic thinking of Dhat in urine (Dhat syndrome) with no ii) Tension complaint of either P.M.E. or impotence. In in) GIT symptoms 18.8% iv) Forgetfulness/ all, thirty-one patients (62 per cent) com­ Loss of concentration plained of Dhat as a major symptom. 9. i) Guilt feelings ii) Constipation 12.5% Associated psychiatric diagnosis is given iii) Reduced work and interest in Table 2. 10. Frequency of micturition 6.3% Table 2 Associated diagnosis syndrome. Somatic symptoms (fatigue, Anxiety neurosis 8 16% muscular aches and pains, feelings of weak­ Depressive reaction 24 48% ness) were present in 73.8 per cent of these 1'sychotic depressive reaction 2 4% patients. Tension headache was com­ N.P.D. 16 32% plained of by another 68.8 per cent. De­ \'.P.D. = No other psychiatric disorder. pressed mood and anxiety were shown by another 62.5 per cent and 51.6 per cent of Scoring was done on A.D.I, which is a these patients. Thus, from the above table self report instrument and has been found coupled with findings of A.D.I, scores of ro correlate well with clinical diagnosis of 18.8 ±4.6, it is evident that majority of depression and the Hamilton Rating Scale these patients suffer from underlying de­ (Singh et al, 1951) to elicit the degree of de­ pression. pression. The scores ranged from 12-27 with a mean of 18.8 ± 4.6 which confirmed Discussion the presence of clinical depression in al­ The findings of the present study sug­ most majority of cases. gest that patients of Dhat syndrome are 122 DHAT SYNDROME generally young adults, and the onset of patient that he is not suffering from the ill­ symptoms in most cases is in late teens or ness for which he has come, we should ex­ early adulthood—mean age being 21.8 pect him to take our treatment for an illnes-, years. A majority were married (70 per which he does not believe even exists. cent) while only fifteen (20 per cent) were However, that is exactly what most of us unmarried, this contrasts with findings of have been doing and our results have been a Nakra in whose series almost half were still dismal failure as compared to the roaring unmarried. An important finding was that success of the so-called sex clinics. Dhat syndrome was more common among the literates e.g. 40% were educated bet­ References ween 5-10th class and another 36% with DANIELOU, A. (1949), Yoga: The method of education level above high school. It is inte­ reintegration, London. resting to note that patients with low litera­ EL1ADE, M. (1958), Yoga, Immortality and cy levels constitute only 14 per cent of the freedom : Translated from French by Wil- total. These figures compare well with lard R. Trask, London. Nakra (1977). HASTINGS, D. M. (1963), Impotence and Fri­ A total of thirty-one out of 50 patients gidity, London: Churchil. (62 per cent) came with the primary com­ NAKRA, B., WIG, N. N. & VARMA, V. K. plaint of Dhat syndrome and of these ele­ (1977), A study of Male Potency Disorders, ven patients also complained of impotence Indian Journal of Psychiatry, 19 :13. and/or P.M.E. An additonal psychiatric SCHAPIRA, B. (1943), Pre-mature ejaculation, diagnosis was made in 68% of the total Review of 1130 cases, Journal of , sample and in 50 per cent of these cases it 50:374. was of depression and in fact two patients SINGH, G., VERMA, H. C, VERMA, R. S. & had psychotic depressive reaction. A.D.I, KAUR, H. (1974), A new depressive inven­ scores also show that these persons score tory. Indian Journal of Psychiatry, 22:376. high on depressive scale (mean of 18.8) SINGH, G. (1981), Correlation between the (The recommended cut off point for de­ ADI self rating scale, the Hamilton rating pression on the scale is 14.0). Follow up of scale and clinical assessment of depression, these patients is very poor, majority (64 per Indian Journal of Psychiatry, 23 :142. cent) did not come again after the first visit SHIVA SAMHITA (1967), Quoted by Michael and hence the response to anti-depressant Volin and Nancy Phelan in Sex and Yoga treatment could not be assessed. It is pro­ 1.63, London: Pelham books. bably that these patients were not satisfied SRI SWAMI SIVANANDA (1971), Vajroli with our explanation that seminal loss was Mudra P. 141 in Kundalini Yoga. The Divine not harmful but that their symptoms were Life Society, P.O. Sivanandanogar, Garhwal, due to their excessive worrying about this U.P. for which we would prescribe them the WIG, N. N. (1960), Problems of Mental health treatment. On the contrary it seems extre­ in India, Journal of Clinical Society, Medical mely naive to believe that after telling a College, Lucknow, 17:48.