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 . 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 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 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. to avoid it retracting fibre rich diets. The symptoms are usually back. (14) treated by applying sesame or castor oil in The syndrome occurs worldwide, the umbilicus or on the head to reduce the and mass hysteria of genital-shrinkage body temperature. Few people get relief anxiety has a history in Africa, Asia from having oil massage and warm water and . It is seen in North-eastern states bath. Having Fenugreek seeds in empty like Assam which may occur as stomach is found to be useful and also been epidemics. In the United States and Europe, suggested by many. (2) the syndrome is commonly known Is a lizard syndrome being a new culture as genital retraction syndrome. (15,16) bound syndrome?

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Gilhari syndrome is also known as beliefs of lizards and being under the more the “squirrel or Lizard syndrome” which of physical, biological and mental stresses. is highly prevalent among the regions of The physical examination and investigations west Rajasthan in India. reveals no physical illness in the particular According to the individual, a small blood individual. They simply call these filled swelling on the body changing its symptoms as tactile hallucinations with position from time to time as if squirrel or delusions. The patients can be categorized lizard is climbing in the body from back and as having somatoform disorders associated reaches the neck leading to obstruction of with maladaptive behaviours. (18,16) airways followed by death if it is not The treatment of this syndrome is crushed. The person strongly believes that mainly focused on reassuring the patient and the condition is very serious and fatal. The providing supportive psychotherapy. Anti- treatment of this syndrome is usually sought anxiety drugs are found to be useful in from the local faith healers in the reducing the symptoms in few patients. (3) community. (12,17) Are there new psychiatric illness found in The medical practitioners explain folk cultures? that the Gilhari syndrome is nothing but the There is other few culture bound muscular contraction or movements of the syndromes across the world on which light specific group of muscles that is caused by has to be thrown for the betterment of the the severe anxiety and stress in an mental health of the people. Some of the individual. It affects mostly the young culture specific syndromes and its adults who are having the false cultural descriptions are as follows:

Table1. Different Categories of Culture Bound Syndrome with Description Nomenclature Country Description Culture Bound India : It is the self-immolation by a widow on her husband‟s pyre. It was seen mostly in upper Suicide castes notably Brahmins and Kshatriyas. Santhara/Sallekhana: It is voluntarily giving up life by fasting unto death over a period of time for religious reasons to attain God/ Moksha. It is commonly seen in Jain Community. (4) Mass Hysteria India Mass hysteria is also known as collective hysteria, group hysteria, or collective obsessional behaviour where hundreds to thousands of people were seen to be believing and behaving in a manner in which ordinarily they will not. (4) Japan most common among the adolescents who withdraw from social life, often seeking extreme Hikikomori degrees of isolation and confinement in their room, for prolonged periods, sometimes measured in years. (20) Ataque De Western Countries The individual is presented with uncontrollable screaming or shouting, crying, trembling, Nervios sensations of heat rising in the chest and head, and verbal or physical aggression. It is usually associated with a stressful event. (20) Brain Fag A person suffering from Brain Fag is usually a high school or university student with syndromes such as difficulties in concentrating, remembering, and thinking, as well as head, neck, and eye pain. It is caused by excessive external pressure to become successful among the peer groups. (20) Amok Malaysia When a person suddenly withdraws from family and friends, then bursts into a murderous rage, attacking the people or objects around him with whatever weapon is available. (19) Taijin Kyofusho Japan A person suffering from this syndrome is likely to be extremely embarrassed of themselves or displeasing to others when it comes to the functions of their bodies or appearances. This culture- bound syndrome is a social phobia dealing with social anxiety. (21) Ghost Sickness Native American A person suffering from Ghost Sickness is said to be preoccupied and/or consumed by the red or Indian Tribes dying. It is sometimes associated with and its symptoms include weakness, loss of appetite, nightmares and suffocation. (22) Bhanmati South India It is believed to be due to psychiatric illness i.e. conversion disorders, somatization disorders, Sorcery anxiety disorder, dysthymia, schizophrenia etc. (4) Jhin Jhinia India It is characterised by bizarre and seemingly involuntary contractions and spasms despite underlying pathology. (4) Eye Mediterranean and The Evil Eye is a malevolent look which is believed to be able to cause injury or misfortune for Hispanic the person at whom it is directed for reasons of or dislike. The term also refers to the power populations attributed to certain persons of inflicting injury or bad by such envious or ill-wishing look. The Evil Eye is usually given to others who remain unaware. (20) Falling Out Southern United Falling out is described as a constricted consciousness as a psychological response to anxiety States and and specific stressors. It is sometimes characterized by sudden collapse and preceded dizziness Caribbean and spinning sensation. The person suffering from Falling Out can usually hear and understand why this is going on around them. (23) Ascetic This syndrome, mostly appears in adolescents and young adults which is characterised by social Syndrome withdrawal, severe sexual abstinence, practice of religious austerities, lack of concern with physical appearance and considerable loss of weight. (4)

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How to cite this article: Belsiyal CX, Sasirekha. Culture bound syndrome - an unprecedented inclusion. Int J Health Sci Res. 2017; 7(10):256-261.

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