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Chapter 5 Sociocultural Influences 131 Influences of Culture on Health dark and light, hot and cold, hard and soft, or male and fe- male. An excess or shortage of elements in either direction causes discomfort and illness. CONCEPTS OF ILLNESS Many cultures explain the cause of and treatment for illness in one or Because every culture is complex, it can be difficult to deter- several of the following categories (2, 14, 37, 112): mine whether health and illness are the result of cultural or other elements, such as physiologic or psychological factors. Yet there are 1. Natural: Weather changes, bad food, or contaminated water numerous accounts of the presence or absence of certain diseases cause illness. in certain cultural groups and reactions to illness that are cultur- 2. Supernatural: The gods, demons, or spirits cause illness as pun- ally determined. ishment for faulty behavior, violation of the religious or ethi- Culture-bound illness or syndrome refers to disorders re- cal code, or an act of omission to a deity; or as a result of black stricted to a particular culture because of certain psychosocial charac- magic, voodoo, or evil incantation of an enemy or sorcerer. teristics of the people in the group or because of cultural reactions to the 3. Metaphysical: Health is maintained when nature and the body malfunctioning biological or psychological processes (2, 37, 112). See operate within a delicate balance between two opposites, such Table 5-8 for examples (2, 14, 37, 112). Culture and climate in- as Am and Duong (Vietnamese), yin and yang (Chinese), fluence food availability, dietary taboos, and methods of hygiene, which in turn affect health, as do cultural folkways. TABLE 5-8 Culture-Bound Illness or Behaviors

1. Amok. Asian and Southeast Asian males, Puerto Ricans, 10. Latah. Southeast Asian women. Minimal stimuli elicit an Navajos. Period of brooding followed by violent outbursts at exaggerated startle response, often with swearing. This is people or objects, precipitated by insult, with persecutory also reported among the Ainu of Japan, the Bantu of Africa, ideas, amnesia, exhaustion, and return to premorbid state. and French-Canadians. 2. Ataque de nervios. Latinos. Uncontrollable shouting, 11. Locura. Latinos in U.S., Latin Americans. Caused by crying, trembling, feeling heat, verbal or physical aggres- inherited vulnerability and multiple life difficulties. Agitation, sion, sense of being out of control precipitated by stressful hallucinations, unpredictable or violent behavior. Severe family events. Resembles adjustment, anxiety, depressive, form of chronic psychosis. dissociative, or psychotic disorders. 12. Maldicion, Voodoo, Hex. Spanish-speaking, American 3. Belis, Colera, Muina. Latinos. Acute nervous tension, Indians, , Jamaicans, Haitians, and Cajuns, headache, screaming, stomach disorder, fatique caused by as well as various Caucasian groups. Cause of illness or death anger or rage. Resembles brief psychotic disorder. Chronic is pronounced or cast upon the person. Victim develops fatigue syndrome may result. symptoms accordingly with great sense of helplessness. 4. Bouffee delirantes. French, West Africans, Haitians. Sudden Death may result from stimulation of sympathetic and outburst of aggressive behavior; confusion; suspicion; dream parasympathetic nervous system response. state; hallucinations. Resembles brief psychosis disorder with 13. Qi gong psychotic reaction. Chinese or persons who are elements of trance state. overparticipating in qi gong (exercise of vital energy). Acute, 5. Bulimia. North American European-Americans, mostly time-limited dissociative, paranoid, psychotic or nonpsy- females. Food binging is followed by self-induced vomiting. chotic symptoms. Sometimes associated with other conditions, such as depres- 14. Shinkeisbitsu. Japanese. A syndrome marked by obsessions, sion, anorexia, and substance abuse. perfectionism, ambivalence, social withdrawal, , 6. “Falling out.” African Americans and Blacks in the and hypochondriasis. Caribbean, Sudden collapse and paralysis and inability to see 15. Susto (soul loss). Spanish-speaking societies. An expression or speak; hearing and understanding intact. of emotional stress, helplessness, and role conflict; caused by 7. Ghost sickness. American Indian. Preoccupation with death a frightening experience; consists of anorexia, listlessness, and deceased, bad dreams, feelings of danger, fainting, apathy, depression, and withdrawal. dizziness, anxiety, confusion, hallucinations, sense of suffoca- 16. Zar. North African and Middle Eastern countries. Spirits tion, loss of consciousness. possess person, who experiences dissociative episodes, 8. Grisi siknis. Miskito Indians of . Headache, shouting, laughing, hitting head, weeping, refusing to eat or anxiety, irrational anger toward people nearby, aimless do daily tasks. May develop long-term relationship with running, and falling down. spirit. Not considered pathological locally. 9. Involutional paraphrenia. Spanish and Germans. A midlife condition with paranoid features; “paraphrenia” distinct from and depression but contains elements of both.