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In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. There are no known objective biochemical or structural alterations of body organs or functions, and the disease is not recognized in other cultures. The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) which also includes a list of the most common culture-bound conditions (DSM-IV: Appendix I). Its counterpart in the framework of ICD-10 (Chapter V) is the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research. [1]
More broadly, an endemic that can be attributed to certain behavior patterns within a specific culture by suggestion may be referred to as a potential behavioral epidemic. As in the cases of drug use, or alcohol and smoking abuses, transmission can be determined by communal reinforcement and person-to-person interactions. On etiological grounds, it can be difficult to distinguish the causal contribution of culture upon disease from other environmental factors such as toxicity. [2]
A culture-specific syndrome is characterized by:[ citation needed ]
Some culture-specific syndromes involve somatic symptoms (pain or disturbed function of a body part), while others are purely behavioral. Some culture-bound syndromes appear with similar features in several cultures, but with locally specific traits, such as penis panics.
A culture-specific syndrome is not the same as a geographically localized disease with specific, identifiable, causal tissue abnormalities, such as kuru or sleeping sickness, or genetic conditions limited to certain populations. It is possible that a condition originally assumed to be a culture-bound behavioral syndrome is found to have a biological cause; from a medical perspective it would then be redefined into another nosological category.
The American Psychiatric Association states the following: [3]
The term culture-bound syndrome denotes recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. Many of these patterns are indigenously considered to be "illnesses," or at least afflictions, and most have local names. Although presentations conforming to the major DSM-IV categories can be found throughout the world, the particular symptoms, course, and social response are very often influenced by local cultural factors. In contrast, culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations.
The term culture-bound syndrome is controversial since it reflects the different opinions of anthropologists and psychiatrists. [4] Anthropologists have a tendency to emphasize the relativistic and culture-specific dimensions of the syndromes, while physicians tend to emphasize the universal and neuropsychological dimensions. [5] [6] Guarnaccia & Rogler (1999) have argued in favor of investigating culture-bound syndromes on their own terms, and believe that the syndromes have enough cultural integrity to be treated as independent objects of research. [7]
Guarnaccia and Rogler demonstrate the issues that occur when diagnosing cultural bound disorders using the DSM-IV. One of the key problems that arise is the "subsumption of culture bound syndromes into psychiatric categories", [7] which ultimately creates a medical hegemony and places the western perspective above that of other cultural and epistemological explanations of disease. The urgency for further investigation or reconsideration of the DSM-IV's authoritative power is emphasized, as the DSM becomes an international document for research and medical systems abroad. Guarnaccia and Rogler provide two research questions that must be considered, "firstly, how much do we know about the culture-bound syndromes for us to be able to fit them into standard classification; and secondly, whether such a standard and exhaustive classification in fact exists". [7]
It is suggested that the problematic nature of the DSM becomes evident when viewed as definitively conclusive. Questions are raised to whether culture-bound syndromes can be treated as discrete entities, or whether their symptoms are generalized and perceived as an amalgamation of previously diagnosed illnesses. If this is the case, then the DSM may be what Bruno Latour would define as "particular universalism". In that the Western medical system views itself to have a privileged insight into the true intelligence of nature, in contrast to the model provided by other cultural perspectives. [8]
Some studies suggest that culture-bound syndromes represent an acceptable way within a specific culture (and cultural context) among certain vulnerable individuals (i.e. an ataque de nervios at a funeral in Puerto Rico) to express distress in the wake of a traumatic experience. [9] A similar manifestation of distress when displaced into a North American medical culture may lead to a very different, even adverse outcome for a given individual and the individual's family. [10] The history and etymology of some syndromes such as brain-fog syndrome, have also been reattributed to 19th century Victorian Britain rather than West Africa. [11]
In 2013, the DSM 5 dropped the term culture-bound syndrome, preferring the new name "cultural concepts of distress". [12]
Within the traditional Hmong culture, epilepsy (qaug dab peg) directly translates to "the spirit catches you and you fall down" which is said to be an evil spirit called a dab that captures one's soul and makes one ill. In this culture, individuals with seizures are seen to be blessed with a gift: an access point into the spiritual realm which no one else has been given. [13] In westernised society, epilepsy is recognized as a serious long-term brain condition that can have a major impairment on an individual's life. The way the illness is dealt with in Hmong culture is vastly different due to the high status epilepsy has in the culture, compared to individuals who have the condition in westernised societies. Individuals with epilepsy within the Hmong culture are a source of pride for their family. [14]
Another culture-bound illness is neurasthenia, which is a vaguely described medical ailment in Chinese culture that presents as lassitude, weariness, headaches, and irritability and is mostly linked to emotional disturbance. A report done in 1942 showed that 87% of patients diagnosed by Chinese psychiatrists as having neurasthenia could be reclassified as having major depression according to the DSM-3 criteria. [15] Another study conducted in Hong Kong showed that most patients selectively presented their symptoms according to what they perceived as appropriate and tended to only focus on somatic suffering, rather than the emotional problems they were facing. [16] [17]
Globalisation is a process whereby information, cultures, jobs, goods, and services are spread across national borders. [18] This has had a powerful impact on the 21st century in many ways including through enriching cultural awareness across the globe. Greater level of cultural integration is occurring due to rapid industrialisation and globalisation, with cultures absorbing more influences from each other. As cultural awareness begins to increase between countries, there is a consideration into whether cultural bound syndromes will slowly lose their geographically bound nature and become commonly known syndromes that will then become internationally recognised. [19]
Anthropologist and psychiatrist Roland Littlewood makes the observation that these diseases are likely to vanish in an increasingly homogenous global culture in the face of globalisation and industrialisation. [20] Depression, for example, was once only accepted in western societies; it is now recognised as a mental disorder in all parts of the world. In contrast to Eastern civilizations such as Taiwan, depression is still much more common in Western cultures like the United States. This could indicate that globalisation may have an impact on allowing disorders to be spread across borders, but these disorders may remain predominant in certain cultures.
The fourth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as culture-bound syndromes: [21]
| Name | Geographical localization/populations |
|---|---|
| Running amok | Brunei, Singapore, Malaysia, Indonesia, Philippines, Timor-Leste |
| Ataque de nervios | Latinos in the United States and Latin America |
| Bilis, cólera | |
| Bouffée délirante | France and French-speaking countries |
| Brain fag syndrome | West African students |
| Dhat syndrome | India |
| Falling-out, blacking out | Southern United States and Caribbean |
| Ghost sickness | Native American (Navajo, Muscogee/Creek) |
| Hwabyeong | Korean |
| Koro | Chinese, Malaysian and Indonesian populations in Southeast Asia; Assam; occasionally in the West |
| Latah | Malaysia and Indonesia, as well as the Philippines (as mali-mali , particularly among Tagalogs) |
| Locura | Latinos in the United States and Latin America |
| Mal de pelea | Puerto Rico |
| Evil eye | Mediterranean; Hispanic populations and Ethiopia |
| Piblokto | Arctic and subarctic Inuit populations |
| Zou huo ru mo (Qigong psychotic reaction) | Han Chinese |
| Rootwork | Southern United States, Caribbean nations |
| Sangue dormido | Cape Verde |
| Shenjing shuairuo | Han Chinese |
| Shenkui , shen-k'uei | Han Chinese |
| Shinbyeong | Koreans |
| Spell | African American, White populations in the Southern United States and Ethiopia |
| Susto | Latinos in the United States; Mexico, Central America and South America |
| Taijin kyofusho | Japanese |
| Zār | Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies |
The fifth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as cultural concepts of distress, a closely related concept: [22]
| Name | Geographical localization/populations |
|---|---|
| Ataque de nervios | Latin America |
| Dhat syndrome | India |
| Khyâl cap | Cambodian |
| Ghost sickness | Native American |
| Kufungisisa | Zimbabwe |
| Maladi moun | Haiti |
| Shenjing shuairuo | Han Chinese |
| Susto | Latinos in the United States; Mexico, Central and South America |
| Taijin kyofusho | Japanese |
The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) classifies the below syndromes as culture-specific disorders: [1]
| Name | Geographical localization/populations |
|---|---|
| Amok | Southeast Asian Austronesians |
| Dhat syndrome (dhātu), shen-k'uei , jiryan | India; Taiwan |
| Koro , suk yeong, jinjin bemar | Southeast Asia, India, China |
| Latah | Malaysia and Indonesia |
| Ataque de nervios | Mexico, Central and South America |
| Pa-leng (frigophobia) | Taiwan; Southeast Asia |
| Pibloktoq (Arctic hysteria) | Inuit living within the Arctic Circle |
| Susto , espanto | Mexico, Central and South America |
| Taijin kyofusho , shinkeishitsu (anthropophobia) | Japan |
| Ufufuyane , saka | Kenya; southern Africa (among Bantu, Zulu, and affiliated groups) |
| Uqamairineq | Inuit living within the Arctic Circle |
| Fear of Windigo | Indigenous people of north-east America |
Though "the ethnocentric bias of Euro-American psychiatrists has led to the idea that culture-bound syndromes are confined to non-Western cultures", [23] within the contiguous United States, the consumption of kaolin, a type of clay, has been proposed as a culture-bound syndrome observed in African Americans in the rural South, particularly in areas in which the mining of kaolin is common. [24]
In South Africa, among the Xhosa people, the syndrome of amafufunyana is commonly used to describe those believed to be possessed by demons or other malevolent spirits. Traditional healers in the culture usually perform exorcisms in order to drive off these spirits. Upon investigating the phenomenon, researchers found that many of the people claimed to be affected by the syndrome exhibited the traits and characteristics of schizophrenia. [25] [26]
Some researchers have suggested that both premenstrual syndrome (PMS) and the more severe premenstrual dysphoric disorder (PMDD), which have currently unknown physical mechanisms, [27] [28] [29] are Western culture-bound syndromes. [30] [31] However, this is controversial. [30]
Tarantism is an expression of mass psychogenic illness documented in Southern Italy since the 11th century. [32]
Morgellons is a rare self-diagnosed skin condition that has been described as "a socially transmitted disease over the Internet". [33]
Vegetative-vascular dystonia can be considered an example of somatic condition formally recognised by local medical communities in former Soviet Union countries, but not in Western classification systems. Its umbrella term nature as neurological condition also results in diagnosing neurotic patients as neurological ones, [34] [35] in effect substituting possible psychiatric stigma with culture-bound syndrome disguised as a neurological condition.
Refugee children in Sweden have been known to fall into coma-like states on learning their families will be deported. The condition, known in Swedish as uppgivenhetssyndrom, or resignation syndrome, is believed to only exist among the refugee population in Sweden, where it has been prevalent since the early part of the 21st century. In a 130-page report on the condition commissioned by the government and published in 2006, a team of psychologists, political scientists, and sociologists hypothesized that it was a culture-bound syndrome. [36]
A startle disorder similar to latah, called imu (sometimes spelled imu:), is found among Ainu people, both Sakhalin Ainu and Hokkaido Ainu. [37] [38]
A condition similar to piblokto, called menerik (sometimes meryachenie), is found among Yakuts, Yukaghirs, and Evenks living in Siberia. [39]
The trance-like violent behavior of the Viking age berserkers – behavior that disappeared with the arrival of Christianity – has been described as a culture-bound syndrome. [40]
The Diagnostic and Statistical Manual of Mental Disorders is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria. It is an internationally accepted manual on the diagnosis and treatment of mental disorders, though it may be used in conjunction with other documents. Other commonly used principal guides of psychiatry include the International Classification of Diseases (ICD), Chinese Classification of Mental Disorders (CCMD), and the Psychodynamic Diagnostic Manual. However, not all providers rely on the DSM-5 as a guide, since the ICD's mental disorder diagnoses are used around the world, and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions.
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.
Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.
Koro is a culture bound delusional disorder in which individuals have an overpowering belief that their sex organs are retracting and will disappear, despite the lack of any true longstanding changes to the genitals. Koro is also known as shrinking penis, and was listed in the Diagnostic and Statistical Manual of Mental Disorders.
Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized by emotional, cognitive, and physical symptoms. PMDD causes significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symptoms occur in the luteal phase, improve within a few days after the onset of menses, and are minimal or absent in the week after menses. PMDD has a profound impact on a woman’s quality of life and dramatically increases the risk of suicidal ideation and even suicide attempts. Many women of reproductive age experience discomfort or mild mood changes prior to menstruation. However, 5–8% experience severe premenstrual syndrome causing significant distress or functional impairment. Within this population of reproductive age, some will meet the criteria for PMDD.
Latah is a condition in which abnormal behaviors result from a person experiencing a sudden shock or other external stressor almost exclusively having been observed in persons from Southeast Asia. When induced, the affected person typically engages in such behaviors as screaming, cursing, dance movements, uncontrollable laughter, mimicry and command obedience. Physical symptoms include an increased heart rate and profuse sweating, but no clear physiological causality beyond the apparent relationship between sudden shock and/or severe emotional stress have been identified. Since no research has emerged indicating whether the behavior is caused by a genetic disorder unique to those of Southeast Asian ancestry, a set of psychosomatic symptoms triggered by Southwest Asian cultural anthropological factors, or another cause not yet hypothesized, the cause has remained undetermined.
Dhat syndrome is a condition found in the cultures of South Asia in which male patients report that they suffer from premature ejaculation or impotence, and believe that they are passing semen in their urine. The condition has no known organic cause.
Intermittent explosive disorder is a behavioral disorder characterized by explosive outbursts of anger and/or violence, often to the point of rage, that are disproportionate to the situation at hand. Impulsive aggression is not premeditated, and is defined by a disproportionate reaction to any provocation, real or perceived. Some individuals have reported affective changes prior to an outburst, such as tension, mood changes, energy changes, etc.
Psychogenic non-epileptic seizures (PNES), also referred to as pseudoseizures, non-epileptic attack disorder (NEAD), functional seizures, or dissociative seizures, are episodes resembling an epileptic seizure but without the characteristic electrical discharges associated with epilepsy. PNES fall under the category of disorders known as functional neurological disorders (FND) and are typically treated by psychologists or psychiatrists.
Piblokto, also known as pibloktoq and Arctic hysteria, is a condition most commonly appearing in Inughuit societies living within the Arctic Circle. Piblokto is a culture-specific hysterical reaction in Inuit, especially women, who may perform irrational or dangerous acts, followed by amnesia for the event. Piblokto may be linked to repression of the personality of Inuit women. The condition appears most commonly in winter. It is considered to be a form of a culture-bound syndrome, although more recent studies question whether it exists at all. Piblokto is also part of the glossary of cultural bound syndromes found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Cross-cultural psychiatry is a branch of psychiatry concerned with the cultural context of mental disorders and the challenges of addressing ethnic diversity in psychiatric services. It emerged as a coherent field from several strands of work, including surveys of the prevalence and form of disorders in different cultures or countries; the study of migrant populations and ethnic diversity within countries; and analysis of psychiatry itself as a cultural product.
The classification of mental disorders, also known as psychiatric nosology or psychiatric taxonomy, is central to the practice of psychiatry and other mental health professions.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In 2022, a revised version (DSM-5-TR) was published. In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has practical importance. However, some providers instead rely on the International Statistical Classification of Diseases and Related Health Problems (ICD), and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions. The DSM-5 is the only DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the only living document version of a DSM.
Grisi siknis is a contagious, culture-bound syndrome that occurs predominantly among the Miskito people of eastern Central America, and affects mainly young women. It is also known as "grisi munaia", "Chipil siknis", and "Nil siknis". More recently, cases occurring amongst people of Spanish descent have also been reported.
Brief psychotic disorder—according to the classifications of mental disorders DSM-IV-TR and DSM-5—is a psychotic condition involving the sudden onset of at least one psychotic symptom lasting 1 day to 1 month, often accompanied by emotional turmoil. Remission of all symptoms is complete with patients returning to the previous level of functioning. It may follow a period of extreme stress including the loss of a loved one. Most patients with this condition under DSM-5 would be classified as having acute and transient psychotic disorders under ICD-10. Prior to DSM-IV, this condition was called "brief reactive psychosis." This condition may or may not be recurrent, and it should not be caused by another condition.
Spiritual crisis is a form of identity crisis where an individual experiences drastic changes to their meaning system typically because of a spontaneous spiritual experience. A spiritual crisis may cause significant disruption in psychological, social, and occupational functioning. Among the spiritual experiences thought to lead to episodes of spiritual crisis or spiritual emergency are psychiatric complications related to existential crisis, mystical experience, near-death experiences, Kundalini syndrome, paranormal experiences, religious ecstasy, or other spiritual practices.
Iich'aa is a culture-bound syndrome found in the Navajo Native American culture. Symptoms include epileptic behaviour, loss of self-control, self-destructive behaviour and fits of violence and rage.
Somatic symptom disorder, also known as somatoform disorder, or somatization disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.
Ataque de nervios, also known as nervous tension) is a psychological syndrome mostly associated, in the United States, with Spanish-speaking people from the Caribbean, although commonly identified among all Iberian-descended cultures. Ataque de nervios translates into English as "attack of nerves". It is used in its common cultural form to refer to a specific pattern of symptoms, rather than being a general term for feeling nervous.
Locura, which translates to "insanity" in Spanish, is a mental disorder characterized as severe chronic psychosis. The term refers to a culture-bound syndrome, found mostly in Latin America and Latin Americans in the United States. Also referred to as ataques de locura, it is categorized as a more severe form of nerviosataque de nervios with symptoms appearing similar to those of schizophrenia.
