Culture Bound Syndrome - an Unprecedented Inclusion
Total Page：16
File Type：pdf, Size：1020Kb
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Review Article Culture Bound Syndrome - An Unprecedented Inclusion Mrs. Xavier Belsiyal C1, Mrs. Sasirekha2 1Assistant Professor, College of Nursing, AIIMS, Rishikesh. 2Tutor/Clinical Instructor, College of Nursing, AIIMS, Rishikesh. Corresponding Author: Mrs. Xavier Belsiyal. C ABSTRACT Delivery of mental health services to a large population is really a challenging task especially country like India. Many people agree that culture, beliefs and norms of society put forth a stabilizing, positive influence on mental health, however individual expectations vary from acceptable social norms. It is not uncommon to find culture bound syndromes within primary care in India and other Asian countries. Nevertheless, the understanding of culture bound syndromes among mental health professionals is scarce. Therefore, this review will give a clear picture about the common culture bound syndromes in South East Asia in particular India. Key words: culture bound syndrome, mental health. INTRODUCTION individual‟s social situation in providing Culture is the way of life and social treatment. behaviour of a particular group of people What is culture bound syndrome? which is the deposit of knowledge, Culture-bound syndrome is also experience, beliefs, values, attitudes, called culture-specific syndrome in the meanings, hierarchies, religion, roles and patient is presented with combination of concepts that are possessed and acquired by psychiatric and somatic symptoms which a group of people. (1) are prevalent only within a specific society The word “syndrome” implies or culture. There is no evident of any specific disease entities and the term biochemical or structural alterations of body “bound” implies that the entities described organs or functions. Moreover, the disease are restricted to a single culture. is not recognized in other culture. (2) Collectively the culture bound syndromes Is culture bound syndrome, a psychiatric are the illnesses that are present only within illness? a specific group of people. The term culture-bound syndrome The term culture bound syndrome was included in the fourth version of the was intended not only to describe specific Diagnostic and Statistical Manual of Mental syndromes, but also meanings of illness and disorders (American Psychiatric the cultural notions of disease causation. Association, 1994). Culture-bound The study of culture bound syndrome syndrome denotes recurrent, locality- emphasis on the necessity of considering not specific patterns of aberrant behaviour and only the physiology, but also culturally troubling experience that may or may not be significant beliefs, practices and the linked to a particular DSM-IV diagnostic category. Many of these patterns of International Journal of Health Sciences & Research (www.ijhsr.org) 256 Vol.7; Issue: 10; October 2017 Xavier Belsiyal C et al. Culture Bound Syndrome –An Unprecedented Inclusion symptoms are considered to be illnesses and The person with Dhat syndrome they also have their own local names in the usually has a varied somatic, psychological community. (3) and sexual symptom. Person complaints of How culture has an impact on mental passing of whitish discharge in urine and he health? also report of premature ejaculation or Culture plays a vital role in impotence. The other symptoms include, determining the psychiatric disorders. The weakness, aches, anorexia, feelings of guilt attitudes towards the mental illness vary and panic attacks. (7,8) Initially it was thought from person to person. The cultural and that this syndrome is prevalent only among religious teachings always have an influence men, but later it was found in women too. on the beliefs and attitude of an individual Treatment mainly consists of towards the origins and the nature of mental alleviating the misconception about the illness. However, some psychiatric illness through psychoeducation, syndromes are limited to certain specific reassurance and treating the underlying cultures and hence those disorders are called psychiatric disorder by the use of anti- as the culture bound syndrome. anxiety and anti-depressant drugs. It is also Culture-bound syndromes are the suggested that, emphatic listening, a non- folk illnesses in which there are the confrontational approach along with the use alterations of behaviour and experience of placebo is also helpful. Many studies figure prominently. Actually many of these have proven that the management of Dhat are not syndromes at all but they are local syndrome involves sex education, relaxation ways of explaining some wide assortment of therapy and medications. (9,10) misfortunes. (4) Is the Possession syndrome has publicly The common culture bound recognized as apparently superhuman feats syndromes are Dhat Syndrome, Possession of strength? Syndrome, Koro, Gilhari syndrome etc. A person who is often having a What are the cultural variations in horrible impulse to do something bad, the response to Dhat syndrome? emotions that cannot be controlled and it “Dhat Syndrome (rog)” is not also seems to be not of their own, exhibits something new to the culture, which has the symptoms that the person is possessed recently come up. It is a very old term by a demon, for the eyes of the public. (11,12) which was described by Dr.N.N. Wig in the Many religious shrines hold special year 1960. This syndrome is recognized annual festivals where hundreds of people both by the people as well as the medical get possessed simultaneously. These people practitioners in the society. In china it is are looked as a special by their family known in the name of “shenkui” members and villages which itself reinforce Dhat is a Sanskrit word which means the secondary gains. The individual, who is „Dhatu‟- semen. Some of the related terms possessed by a „spirit/soul‟ of deceased to this, are „Veerya‟ which is also known as relative or a local deity, speaks in changed bravery, strength, courage and valour. It is tone. (13) also believed that 40 meals make 1 drop of The medical practitioners explain blood, 40 drops of blood make 1 drop of that, the person who has an uncharacteristic bone marrow and 40 drops of bone marrow mood and demonstrates the destructive makes 1 drop of semen and hence it is behaviour is suffering with Possession considered as “a precious fluid”. People Syndrome which is included in ICD-10 believe that, the preservation of Dhatu leads under Dissociative disorders. It is seen in all to healthy and long life whereas the loss of parts of India usually in rural areas or in semen is very harmful to health. Hence the migrants from rural areas. The most life preserving properties of semen is deeply important thing about this syndrome is that, ingrained in Indian culture. (5,6) the individual is often getting relief from International Journal of Health Sciences & Research (www.ijhsr.org) 257 Vol.7; Issue: 10; October 2017 Xavier Belsiyal C et al. Culture Bound Syndrome –An Unprecedented Inclusion their symptoms when an exorcism has been The condition can be diagnosed performed on them. Majority of these through psychological assessment along patients are females as they don‟t have any with physical examination to rule out the outlet to express their emotions. (11) genuine cause that causing true retraction. It is very important to explore the Treatment is mainly focussed on the precipitating factors of the underlying stress reassurance of the patient and talks which caused the possession attack. on sexual anatomy. Psychotherapy is found Treatment is also aimed to decrease any to be more useful in these patients. secondary gains that the patient may be In china, traditional treatment is getting from this behaviour. Antidepressants given to the individual suffering with this and anxiolytics are helpful in certain cases. syndrome. Praying to gods, performing (13) exorcism, beating the person if a fox spirit is Is “Koro” - an overpowering belief of the believed to be involved. Some are treated individual in the community? with herbs, pepper and ginger soup, liquor, Koro is a culture-specific syndrome stag of deer or deer tail, tiger penis, deer which is also knows as shrinking penis in penis, or fur seal penis. (14) which the individual has a strong belief that An increase in the inner heat of the body one's genitalia are retracting and will attributes to culture bound syndrome? disappear but there are no any true Suddu is a culture specific longstanding changes to the genitals. syndrome. People in some culture believe Koro is described as a syndrome in that, increase in the inner heat of the body ICD-10 and DSM-IV. In DSM-IV-TR, koro will result in pelvic heat and painful is listed as one of the entries in the Glossary urination. It is very familiar in south India, of Culture-Bound Syndromes of Appendix especially prevalent among the people in I. The manual gives koro's definition as "a Tamilnadu. It occurs in both males and term, probably of Malaysian origin, that females. (4) refers to an episode of sudden and intense People believe that it is often caused anxiety that the penis (or, in females, by high temperature during summers, lack the vulva and nipples) will recede into the of healthy foods and fluids, long travel, body”. (3) improper sleep patterns etc., The individual The medical practitioners explain, presents with the complaints of severe lower that the Koro is the false belief of an abdominal pain, dark yellow coloured urine, individual that the genitalia is retracting into painful and burning micturition, abdomen which will ultimately lead to constipation, head ache, fatigue and dry death. This syndrome is seen in both the mouth. sexes. The individual, who is suffering with Medical persons explain suddu, this syndrome, is mostly seen that they simply as “dehydration” which can be involve in abnormal practices of applying corrected by the intake of adequate fluids external retractors to the genitalia in form of like fresh juice and butter milk along with clamps, chains etc.