15 culture-bound syndromes
Hello! Today is the World Mental Health Day and this year’s theme is ‘mental health for all’. As a Psychiatrist, I am passionate about mental health and wellbeing. At the same time, as a travel enthusiast, I love not just visiting different places around the world, but also discussing and learning about these places and their culture. Today, I will put both these hats on, and talk about 15 culture-bound syndromes.
The term ‘culture-bound syndromes’ was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), but in 2013, it was replaced by the term ‘cultural concepts of distress’ in the fifth edition of the DSM (DSM-V). The 10th revision of the International Statistical Classification of Diseases (ICD-10) prefers the term ‘culture-specific disorders’. Nonetheless, the term ‘culture-bound syndromes’ remains the most widely used.
What are the culture-bound syndromes?
According to the Oxford Handbook of Psychiatry, “culture-bound syndromes comprise of a wide range of disorders occurring in particular localities or ethnic groups. The behavioural manifestations or subjective experiences particular to these disorders may or may not correspond to diagnostic categories in DSM-IV or ICD-10. They are usually considered to be illnesses and generally have local names.”
In my opinion, culture-bound syndromes exemplify the social dimension of mental illness. I have previously written about the ‘biopsychosocial’ approach or model that I use in the assessment and management of the people that seek my help. According to this model, mental illnesses are rarely due to a single cause; mental illness usually develops through the complex interaction of biological (i.e. genes and chemical imbalances), psychological (i.e. personality and coping skills) and social (or even sociocultural) factors. In the case of the culture-bound syndromes, society and culture affect the way that mental illness manifests in a psychologically vulnerable individual (usually in the absence of any primary biological factors).
Let’s now discuss some of these culture-bound syndromes recognised in the DSM and ICD-10.
Amok
Most of us are familiar with the term ‘amok’ or the phrase ‘running amok’, but only a few are aware that amok is classified as a psychiatric condition. In this context, it refers to “sudden, unprovoked, random acts of violence, for which the subject is amnesic, and after which the may commit suicide” (according to the Oxford Handbook of Psychiatry).
Amok has been described in Southeast Asian populations (mostly in Malaysia, Indonesia and the Philippines), but appears to resemble the Scandinavian berserker, the Puerto-Rican mal de pelea, the South-American colerina and the Navajo Native American iich’aa.
Brain fag syndrome
Brain fag syndrome has been described among West African students complaining of a combination of cognitive symptoms (reduced concentration and poor memory) with somatic ones (blurred vision, head/neck pain, fatigue, sleep disturbance). It has been attributed to excessive pressure to succeed academically.
Dhat
Dhat has been described among males from the Indian subcontinent complaining of passing semen in their urine. This belief is usually associated with somatic and emotional symptoms, such as fatigue, sexual dysfunction, anxiety and dysphoria.
Dhat resembles the Chinese shenkui.
Ghost sickness
This culture-bound syndrome has been described among Native Americans complaining of multiple psychosomatic symptoms that they attribute to ghosts or witches. Symptoms include anxiety, nightmares, fatigue, appetite loss, and a feeling of suffocation.
Hwabyung
This is another culture-bound psychosomatic syndrome, seen in Korea. Subjects internalise their anger and manifest psychosomatic symptoms, such as epigastric pain, muscular aches and pains, loss of appetite, sleep disturbance, palpitations, breathlessness, dysphoria, anxiety and panic.
Koro
A medical student favourite, Koro has been described in Southeast Asian male populations. Subjects have the delusional belief that their penis is retracting into their abdomen; they may even fear that this is fatal and will lead to their death.
Latah
Latah is another culture-bound syndrome described in Southeast Asian populations, usually women. It refers to an abnormal behavioural response to sudden trauma or shock; this behavioural response may consist of echopraxia and echolalia (the involuntary repetition of other people’s actions and sounds respectively), dissociation and trance-like behaviour.
Pa-leng
Pa-leng (or frigophobia) is characterised by an irrational fear of becoming too cold. It has been described among Chinese populations.
Piblokto
Also known as pibloktoq and Arctic hysteria, this is a culture-bound syndrome described among Inuit (Polar Eskimo) women. It is a dissociative reaction with four phases: withdrawal, impulsive or dangerous behaviour (i.e. screaming or shouting, destroying property, running out into the snow), convulsions and/or stupor, and recovery. Once recovered, subjects have amnesia of the whole episode.
Qigong psychotic reaction
Also known as zou huo ru mo, qigong psychotic reaction is believed to result during or after qigong practice. Qigong has been popular in China for millennia; like yoga and sophrology, it comprises a set of practices that include coordinated body posture and movement, breathing exercises, and meditation. Qigong psychotic reaction refers to undesirable somatic or psychological symptoms (such as dissociation and paranoia) experienced during or after qigong.
Sinbyeong
Sinbyeong is linked to the Korean shamanic tradition and presents with somatic and psychotic symptoms attributed to spirit possession.
Taijin kyofusho
Taijin kyofusho has been described amongst the Japanese, and appears similar to social phobia. Subjects are embarrassed about themselves and/or fearful of embarrassing others with their appearance and behaviour.
Ufufunyane
Ufufunyane (or saka) has been described among African populations, and has been attributed to the effects of magical potions (given by rejected lovers), demons, or spiritual possession. Symptoms include sobbing, paralysis, temporary blindness, trance-like states, loss of consciousness and nightmares with sexual themes.
Wendigo psychosis
Wendigo psychosis (or fear of wendigo) is named after wendigo (also spelt windigo), a mythical monster from the folklore of Native Americans. Subjects develop an obsession with becoming a wendigo; this obsession may range from a fear to a delusional belief, and can be associated with suicidal and homicidal thoughts.
Zār
Zār is another culture-bound syndrome attributed to demonic or spirit possession. It has been described in North and East Africa.
Further reading
If you want to read more about the culture-bound syndromes and/or other psychiatric disorders, I would recommend the Oxford Handbook of Psychiatry.
You may also want to read my previous posts:
10 tips for better mental health & wellbeing (part 1) published on the World Mental Health Day 2018
Keep Calm & Carry On!
Alex
(the Traveling Psychiatrist)