FEATURE ARTICLE REETINDER KAUR Culture-bound Syndromes: where culture meets psychiatry Certain psychological and psychiatric disorders need to be looked at in the socio-cultural context characterised by anxiety, aggression, of the deaths. The cause of the disease fear, so-called spirit possession, evil was attributed to ecological conditions, eye or sexuality. social structure of the community ULTURE is often an important (as the disease was more in women factor in diagnosis of mental Social Environment and and children, and less in men due to Chealth conditions. These Aggressive Behaviour marked physical and social separation), culture-specifi c mental health conditions Individual behaviour is shaped by nutrition and toxicity. are referred to as ‘Culture-bound environment and culture. The factors Research by anthropologists Syndromes’ (CBS). Other terms like underlying anxiety and aggressive Robert Glasse and Shirley Lindenbaum folk illness, culture-reactive syndromes, behaviours may include ecological from 1961 to 1963 revealed that the exotic psychoses, atypical psychoses, conditions, social structure of the kuru disease emerged in 1920 and esoteric disorders, hysterical disorders, community, nutrition, social practice might have been transmitted by ritual exotic, rare, uncommon, extraordinary of cannibalism (as in the case of kuru consumption of infected portions of the and unclassifi able mental disorders are among the Fore of New Guinea), brain of the deceased relative. After the also used in literature. family problems, sex role stress, abandonment of cannibalism in 1950s, These syndromes are classifi ed economic problems, general life stress the incidence of kuru began to decline. based on cultural assumptions: sorcery, (as in case of nervios), child rearing However, since this disease has a breach of taboo, intrusion of a disease- practices or social dependency (as in long period of incubation, new cases causing spirit, or loss of soul. The case of hysteria among the Eskimos). continued to appear for many years. understanding of CBS is important for Kuru is an acute, progressive and The child rearing practices among two reasons: (a) to treat and manage degenerative disease of the central the Eskimo have been related to the mental health conditions among nervous system. The prevalence of appearance of convulsive hysterical culturally varied people, and (b) to the disease was found to be quite high attacks (exaggerated or uncontrolled understand the socio-cultural factors among the Fore during early 20th emotions) in adult life. The roots that underlie the CBS. CBS may be century and it accounted for almost half of adult hysteria are found in three 27 SCIENCE REPORTER April 2017 social situations: (a) a child rearing process that does not prepare them for crisis situations, (b) socially approved outlets for hostility and role models for hysteria-like behaviour, and (c) social dependency. Similarly, nervios, a psychosocial discomfort and anxiety is widespread in Costa Rica. The roots of nervios lie in family problems, sex role stress, economic problems and general life stress. Among Mexican-American families, the concept of nervios serves as a culturally meaningful illness category for a wide range of conditions including schizophrenia disorders diagnosed according to psychiatric criteria. CBS Characterised by Anxiety and Aggressive Behaviours Syndrome Region/Populations Description affected Amok Malaysia Period of deep thinking followed by violent, aggressive or suicidal behaviour Arctic hysteria Alaska natives Extreme excitement frequently followed by convulsive seizures and coma Boufee delirante Haitians Sudden outburst of aggression, agitation associated with confusion and symptom resembling brief psychotic disorder Brain fag West Africa Symptoms include diffi culty in concentrating, remembering and thinking Chakore Ngawbera of Panama Wandering or fl eeing aimlessly Colera Hispanics Anger and rage disturbing body balances leading to headache, screaming, stomach pain, loss of consciousness and fatigue Empacho Mexican populations Stomach distress as a result of wrong food eaten at a wrong time Gila babi Rural Malaysia Sudden outburst of anger Grisi siknis Miskito of Nicaragua Wandering or fl eeing aimlessly Hikikimori Japan Acute social withdrawal Hwabyung Korea Anger syndrome as a result of long-standing suppressed anger Hysteria Eskimos Convulsive hysterical attacks in adult life due to child rearing practices Kuru The Fore of New Guinea An acute, progressive and degenerative disease of central nervous system due to Highlands social practice of cannibalism Locura Latin America Chronic psychosis Nervios Costa Rica Psychosocial discomfort and anxiety Neurasthenia Europeans especially Dutch Depressive disorder Sangue dormido Portuguese Cape verde Pain, numbness, paralysis and convulsive stroke islanders Saora India Memory loss, fainting and inappropriate crying or laughing Shenjing shuairuo China Physical and mental fatigue, dizziness, headache, concentration diffi culty, sleep disturbance and memory loss Suudu South India Painful urination often described as pelvic heat due to increase in inner heat of the body Wacinko Oglala Sioux Anger, withdrawal, immobility which may lead to suicide 28 SCIENCE REPORTER April 2017 CBS Characterised by Fear or Sudden Fright Syndrome Region/Populations Description From a diagnostic point affected of view, it is necessary Bah-tschi Thailand Sudden fright to be careful in labelling Frigophobia China Excessive fear of catching cold ‘peculiar behaviour’ as a Imu Ainu of Japan Psychosis due to spirit possession ‘disorder’ simply because Latah Malaysia and Indonesia Startling behaviour, sudden fright, obscenity and mimicry/imitation it is unfamiliar. Lycanthropy Babylon, Iraq Fear of being transformed into an animal Culture, Fear and CBS Malgri Aboriginals in Australia Territorial anxiety There is a convincingly strong Mali-mali Philippines Mimic psychosis interrelationship between fear and the occurrence of certain CBS. Fright Miryachit Siberia Sudden fright refers to sudden fear or shock. Latah P’a-leng Chinese populations Wind illness with fear of cold and wind is the most common example. It is Taijinkyofusho Japan Fear of human beings a disorder found in Malaysia and Windigo Native Americans, Central Morbid state of anxiety with fear of Indonesia since the 19th century. It is and North East Canada becoming a cannibal a well-known hyperstartling (abusive) behaviour that represents marginality. Yaun Myanmar Sudden fright It occurs largely among women in a socially and psychologically marginal CBS Characterised by Spirit Possession and situation. Evil Eye A phenomenon similar to latah is Syndrome Region/Populations Description mali-mali found in the Philippines and affected imu found among the Ainu of Japan. Although a hyperstartle response may Anfechtung Hutterites of Canada Intense guilt because of spiritual confl ict or be viewed as part of human nature, insuffi cient faith cultural patterns and social infl uences. Bhanmati Sorcery South India Long-term chronic illness with psycho- social stress Spirit Possession and Evil Eye Ghost illness India Range of alternate states, possession of Spirit possession and evil eye are individual by ghost conditions unrecognised by biomedicine Ghost sickness American Indians Weakness, dizziness, fainting, anxiety, but remarkably widespread throughout hallucination and confusion many societies. Possession is the belief Ifufunyane Xhosa Zionist community Spirit possession that an individual has been entered by of South Africa an alien spirit or supernatural force, which then controls the person or alters Jinn possession Saudi Arabia Long-term illness with unclear medical that person’s actions and identity. diagnosis The most important causes of Kamidaari Japan Deity curse, possession and spirit possession include confl icts, psychosomatic disorder contradictions and tensed social ties Mal de ojo Spain and Latin America A common idiom to describe disease, (as in case of grisi siknis), impairment misfortune and social disruption caused by of social functioning (as in case of the evil eye zar among the women, immigrants Ode-ori Nigerians Sensation of parasites crawling in the and marginalised individuals) and jinn head, feeling of heat in the head, paranoid possession. The other reasons include fear of violent attacks by evil spirits deity curse (as in case of kamidaari) and spirit attack (as in case of susto). Phii pob Rural Thailand Spirit possession The understanding of spirit Saladerra Peruvian Amazon Form of constant and continuing possession and evil eye within a culture misfortune is crucial as some of their symptoms are Susto Latin America Lack of appetite and sleep disturbance similar to psychotic illnesses. In such caused by the spirit attack cases, psychiatrists take into account Zar Ethiopia, Somalia, Egypt, Spirit possession leads to shouting, the cultural beliefs as they infl uence the Sudan, Iran laughing, hitting head against wall or way illnesses are interpreted, reported weeping found especially among women and treated. 29 SCIENCE REPORTER April 2017 CBS Characterised by Sexuality The relatives and neighbours of the Syndrome Region/Populations Description same sex often help to rescue the organ affected in question, especially by applying Ascetic syndrome Indian sub-continent Psycho-social withdrawal, sexual anchoring devices. abstinence and practices of Koro in China is best described as religious sternness a social sickness supported by cultural