Appendix Charles C

APPENDIX CHARLES C. HUGHES GLOSSARY OF 'CULTURE-BOUND' OR FOLK PSYCHIATRIC SYNDROMES INTRODUCTION As suggested by Hughes in his Introduction to this volume, the term "culure bound syndromes" has an elusive meaning; in fact, the several conceptual elements that might imply a focused and exclusive reference for the phrase vanish upon examination, leaving a phrase that still has currency but little discriminable content. What remains appears to be more a feeling tone about certain patterns of behavior so unusual and bizarre from a Western point of view that, regardless of defmitional ambiguities, they have continued to be accorded by some writers a reified status as a different "class" sui generis of psychiatric or putatively psychiatric phenomena. Even if such a unique class were defensible, the topic is beset with sheer nota tional confusion. A reader may wonder, for example, whether terms resembling each other in spelling (e.g., bah tschi, bah-tsi) are reporting different disorders or simply reflecting differences in the authors' phonetic and orthographic tran scription styles for the same disorder. Or perhaps the various renderings are ac curately transcribed but represent dialectical differences in names used for a given syndrome by various groups having the same basic cultural orientation (e.g., win diga, witika, wihtigo, whitigo, wiitika)? In addition, of course, there may be entirely different terms for what is claimed to be essentially the same condition in diverse cultural groups (e.g., karo and shook yang). Dr. Simons noted in the foreword to this book that, as colleagues at Michigan State University over ten years ago, we began to think about such a volume. Out of those early discussions came recognition of several important conceptual and format problems that had to be resolved. One was the question of the most useful type of framework for grouping and sorting the phenomena that receive the label of "culture-bound syndrome"; others were the issue of appropriate terminology for such syndromes, as well as the boundaries of this purported special class of disorders. More recently he suggested that a "glossary" of the folk terms used for the syndromes would be a useful addition to the substantive chapters in the book. We agreed that at this stage of knowledge it would be most useful to sort the syndromes listed in the glossary on the basis of gross descriptive features. I agreed to take on the task and for some time wrestled with formulating terms of reference and a succinct method of indexing the material. What eventually emerged as this appendix may be seen as a preliminary way of sorting other "culture-bound syn dromes" consistent with the concept of "taxon" which Dr. Simons has used as a fIrst-order sorting device applied to the syndromes specifically dealt with in the book. 469 RontJld C. Simons and Charles C. Hughes (eds.), The Culture-Bound Syndromes, 469-505. © 1985 by D. Reidel Publishing Company. 470 CHARLES C. HUGHES This glossary is, in the first instance, an attempt (obviously only a beginning) to systematize and bring some cross-referenced order to the names used for the various conventional "culture-bound syndromes". Actually, although called a "glossary", it is intended to function at the same time as a brief synonymy, gaze teer, and index to the various names. But systematizing the names for these syndromes is only part - and the most easily handled part - of ordering the content and integrating the concept of "cul ture-bound syndromes" into other conceptual schemes. An even more Significant issue is whether what have heretofore been called the "culture-bound" syndromes are not, in fact, simply a sub-set of a broader domain, that of folk psychiatric disorders. There is one difference, however: namely, that, though generically the same, these particular disorders have become better publicized than other disorders in that group; but, as demonstrated in the material following in this glossary, when examined synoptically and with symptomatic behavioral detail, the phenomena of what have traditionally been delimited as the "culture-bound" syndromes resolve imperceptibly into the general array of folk-conceptualized disorders of psychiatric interest. I began assembling data for this glossary using only those "conventional" cul ture-bound disorders for which there was a distinctive non-English name (e.g., amok). But it soon became apparent that to remain with so circumscribed a format would be to lose the chance to undergird discussions of 'what are culture-bound syndromes?' with substantive, comparable data. For this reason I began, for ex ample, to include instances of reputedly witchcraft-caused types of disorders, such as among the Shona reported by Gelfand (1964), the reason for inclusion being the character of the behavioral symptoms displayed in the syndrome, not the reputed cause. In fact, throughout the glossary any reference to cause (whether "folk" or scientific) is irrelevant for this cataloguing; the essential point is cluster ings of observable data conceptualized as a disorder by the group itself. In the same light, I have also included syndromes which authors themselves may not have explicitly called "culture-bound" and some for which there may be no specific native term but which seem comparable to the essential spirit of the idea (e.g., significant cultural influence in the genesis and expression of a patterned disorder). An example is brain fag as seen among Nigerian students (prince 1960); others are the crazy sickness among the Navajo (Kaplan and Johnson 1964: 216- 220) and ghost sickness among the Kiowa Apache (Freeman et al. 1976). Of course, an indigenous word may well exist to describe such behavior, and a author with interests lying in the psychodynamic and not the linguistic aspects of the phenomena may simply have chosen not to include it for English reader. But, again, as with notions of cause, it is not existence or non-existence of the word that is important, but rather it is the patterned, observable data. In some instances a non-Western name has become widely adopted into English ( and other) usage to designate an obviously similar condition appearing in a dif ferent cultural context (as with amok). And the reverse holds as well- an English or other term used in referring to disorders in other societies; Arctic hysteria GLOSSARY OF 'CULTURE-BOUND' OR PSYCHIATRIC SYNDROMES 471 is an example, or kayak angst (in this case, of course, neither word being of English derivation). When such a term is used the reader is referred to the cognate indige nous term (if one exists) for fuller details of synonyms, location, symptomatology, and bibliography. If the disorder occurs in an English-speaking folk tradition and is named, the English term is used, e.g., falling out among American blacks (Weid man 1979). Several articles have recently appeared in the literature that demonstrate the plasticity of a taxonomic idea such as "culture-bound", as well as the appeal of the phrase. It has been suggested, for instance, that obesity is a "culture-bound disorder" in American society (Ritenbaugh 1982); that the post-partum blues constitute another such syndrome in the same group (Stern and Kruckman 1983); that protein-energy malnutrition represents the influence of "culture-binding" on the process of biomedical scientific conceptualizing itself (Cassidy 1982); and that the disease hypertension is a good illustration of the intersection of two different domains of disease labelling, the folk or popular and the scientific/bio medical (Blumhagen 1980). Although I have not included any of these in the glossary, given the interactive nature of disease as well as disease nosology with a given cultural context, the omission may well be arguable. Citation of these examples occurring in a modern society does, however, underscore the point that while every society has its folk or "popular" concepts of disorder, super imposed over those ideas in some groups is another (and contending) system, the conceptual scheme of modern medicine and psychiatry, and such a juxta position is what much of the presumed controversy concerning that status of the "culture-bound syndromes" is about. The sheer abundance and variety of cross-cultural data pertaining to mental disorders or apparent mental disorders obviously disallows a complete inventory in this glossary, and some exclusions are necessary for limiting what otherwise could become unmanageable. For example, a term is excluded if it is simply a generic term for "crazy" without any further specification, e.g., were among the Yoruba (Leighton et al. 1963) or caduca on Guam (penningroth and Pen ningroth 1977). In some instances, however, where it has been an author's pre ference to list specific disorders following the generic term for mental illness, that practice has been followed here, e.g., gila mengamok ("crazy") ("random running and violence toward other people") The phenomena of possession and trance pose major challenges in regard to this glossary. For one thing, the behaviors and experiences are so Ubiquitous that there could be no end to the listing of relevant published materials. There is already a substantial literature dealing with such matters as formal, ritualized healing cults and periods of "out of awareness" phenomena prescribed by various social and ceremonial occasions (e.g., Bourguignon 1976; Langness 1976; Prince 1968; Crapanzano and Garrison 1977, and many more). Sometimes, of course, behavior of persons in such situations is of psychiatric relevance (Le., demonstrates patho logy at the behavioral level), but often it is simply the playing of a publically viewed and socially-prescribed role. 472 CHARLES C. HUGHES What is included in this glossary from such a vast array of descriptive data are those behavioral episodes labelled disorder by the folk tradition itself when the explanation for the behavior is that the person is "possessed", i.e., as described by the author, the behavior fits the other general criteria for culturally-structured pathology in that it has psychopathologic features and is not simply a pro-forma, ritually-prescribed public performance.

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