Culture-bound syndromes
Culture-bound syndromes are psychological disorders that are specific to particular cultural groups, demonstrating how cultural context can shape the expression and understanding of mental health issues. First recognized in the late 1960s, these syndromes highlight differences in prevalence and manifestation of mental disorders across diverse cultures, challenging the idea of universal psychological conditions. Two primary models exist: the pathogenic-pathoplastic model, which suggests that while the underlying causes of mental disorders are the same globally, their expressions vary due to cultural factors, and the cross-cultural psychiatry model, which posits that certain culture-bound syndromes are distinct conditions with no direct equivalents in Western psychiatry.
Examples of culture-bound syndromes include kayak angst, prevalent among Greenland seal hunters, and taijin-kyofusho, common in Japan, reflecting collective social anxieties. Other conditions, like koro, which involves the fear of genital retraction, and amok, characterized by violent outbursts following perceived insults, may not align neatly with Western diagnostic categories. The American Psychiatric Association has recognized several culture-bound syndromes in its diagnostic manuals, emphasizing the need for culturally sensitive approaches in mental health assessments. Ongoing debate surrounds the classification and understanding of these conditions, as researchers advocate for broader recognition of cultural influences on mental health.
Culture-bound syndromes
- DATE: 1960s onward
- TYPE OF PSYCHOLOGY: Psychopathology
- Culture-bound conditions are psychological disorders that are limited to certain cultures. Some may be culturally specific expressions of largely universal psychological disorders, whereas others may be distinct disorders in their own right. Debate persists on how best to integrate culture-bound syndromes into diagnostic practices.
Introduction
In the late 1960s, the fields of psychology and psychiatry developed a particular interest in how cultural factors shape the manifestation of mental disorders. Before that time, some believed that mental disorders were largely universal in their underlying causes and expression. Several decades of cross-cultural research highlighted the limitations of this view by uncovering potentially important differences in the prevalence and expression of certain psychological conditions across the world.
Models
There are two major models of psychological disorders that are limited to certain cultures. The first, a pathogenic-pathoplastic model, presumes that mental disorders across the world are identical in their underlying causes (pathogenic effects) but are expressed differently depending on cultural factors (pathoplastic effects). According to this model, cultural influences do not create distinctly different disorders but merely shape the outward expression of existing disorders in culturally specific ways.
Harvard University’s Arthur Kleinman and some other cultural anthropologists contended that this model underestimates the cultural relativity of mental disorders. In its place, Kleinman proposed the new cross-cultural psychiatry model, which maintains that many culture-bound syndromes are causally distinct conditions that bear no underlying commonalities to those in Western culture. According to this alternative model, non-Western disorders are not merely culturally specific variations of Western disorders.
In some ways, these competing models parallel the etic-emic distinction in cross-cultural psychology. As noted by University of Minnesota psychiatrist Joseph Westermeyer and others, the term “etic” refers to universal, cross-cultural phenomena that can occur in any cultural group. Conversely, the term “emic” refers to socially unique, intracultural perspectives that occur only within certain cultural groups. There is probably some validity to both perspectives. Some culture-bound syndromes may be similar to conditions in Western culture, whereas others may be largely or entirely distinct from these conditions.
Examples
Some culture-bound conditions appear to fit a pathogenic-pathoplastic model. For example, seal hunters in Greenland sometimes experience kayak angst, a condition marked by feelings of panic while alone at sea, along with an intense desire to return to land. Kayak angst appears to bear many similarities to the Western condition of panic disorder with and may be a culturally specific variant of this condition.
A culture-bound syndrome widespread among the Japanese is taijin-kyofusho, an anxiety disorder characterized by a fear of offending others, typically by one’s appearance or body odor. Some authors have suggested that taijin-kyofusho is a culturally specific variant of the Western disorder of , a condition marked by a fear of placing oneself in situations that are potentially embarrassing or humiliating, such as speaking or performing in public. Interestingly, Japan tends to be more collectivist than most Western countries, meaning its citizens view themselves more as group members than individuals. In contrast, most Western countries tend to be more individualistic than Japan, meaning their citizens view themselves more as individuals than as group members. As a consequence, taijin-kyofusho may reflect the manifestation of social phobia in a culture that is highly sensitive to the feelings of others.
In contrast, other culture-bound conditions may be largely distinct from Western disorders and therefore difficult to accommodate within a pathogenic-pathoplastic model. In koro (genital retraction syndrome), a condition found primarily in southeast Asia and Africa, individuals believe their sexual organs (for example, the penis in men and breasts in women) are retracting, shrinking, or disappearing. Koro is associated with extreme anxiety and occasionally spreads in contagious epidemics marked by mass societal panic. Although koro bears some superficial similarities to the Western diagnosis of hypochondriasis, it is sufficiently different from any Western condition that it may be a distinctive disorder in its own right.
Another potential example is the Malaysian condition of amok. In amok, individuals, almost always men, react to a perceived insult by engaging in social withdrawal and intense brooding, followed by frenzied and uncontrolled violent behavior. Afflicted individuals, known as "pengamoks," often fall into a stupor after the episode and report memory loss for their aggressive actions. Although amok may be comparable in some ways to the sudden mass shootings observed in Western countries, such shootings are rarely triggered by only one perceived insult or associated with stupor following the episode. Amok, incidentally, is the origin of the colloquial phrase “running amok.”
Psychiatric Classification
The American Psychiatric Association’s 1994 Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) included twenty-five culture-bound syndromes in its appendix, marking the mental health community's first attempt to recognize them as worthy of research and clinical attention. The 2000 text revision of the DSM-IV (the DSM-IV-TR) added an outline of issues and factors clinicians should consider when diagnosing culturally diverse patients. Nevertheless, some researchers criticized the DSM-IV’s list of culture-bound syndromes, such as taijin-kyofusho, koro, and amok.
Some, like McGill University psychiatrists Lawrence J. Kirmayer and Eric Jarvis, argued that some of these “syndromes” were not genuine mental disorders but rather culturally specific explanations for psychological problems familiar to Western society. They cited the example of dhat—a culture-bound condition in the DSM-IV appendix prevalent in India, Pakistan, and neighboring countries. Dhat is commonly associated with anxiety, fatigue, and hypochondriacal worries about loss of semen. As Kirmayer and Jarvis observe, many or most individuals with dhat appeard to suffer from depression, so dhat may merely be a culturally specific interpretation of depressive feelings.
Other critics charged that DSM-IV’s list of culture-bound syndromes was marked by Western bias and that some well-established psychological conditions in Western culture are, in fact, culture-bound conditions. For example, based on a comprehensive literature review, Harvard University psychologist PamelaKeel and Michigan State University psychologist Kelly Klump persuasively argued that bulimia nervosa (often known as bulimia), an eating disorder characterized by repeated cycles of binging and purging, is a culture-bound syndrome limited largely to Western culture. Indeed, the few non-Western countries in which bulimia has emerged, such as Japan, have been exposed widely to Western ideals of thinness. In contrast, as Keel and Klump noted, anorexia nervosa (often known as anorexia) appears to be about equally prevalent in Western and non-Western countries.
For the fifth edition of the DSM (DSM-V), published in 2013, and the fifth text revision edition (DSM-V-TR), published in 2022, the American Psychiatric Association sought to address some of these concerns. The DSM-V-TR lists several culture-bound syndromes as cultural concepts of distress, including amok, amurakh, bangungut, hsieh-ping, imu, jumping Frenchmen of Maine syndrome, koro, latah, mal de pelea, myriachit, piblokto, susto, voodoo death, and windigo psychosis. While the DSM-V-TR retains the list of culture-bound syndromes, along with their "idioms of distress" and explanations, in an appendix, it also integrates their symptoms throughout the manual as additions to existing classifications. For example, "offending others," a symptom of taijin-kyofusho, was listed under the diagnostic criteria for social anxiety disorder. Another modification was adding an interview guide with questions about the patient's cultural, racial, ethnic, and religious heritage, which allows patients to describe their condition on their own terms and helps clinicians better interpret this information.
Mental health professionals are increasingly recognizing that psychological conditions are sometimes influenced by sociocultural contexts, which must be considered in diagnoses. More research is needed to ascertain how best to classify culture-bound syndromes and integrate cultural influences into diagnostic practices.
Bibliography
Aneshensel, Carol S., et al. Handbook of the Sociology of Mental Health. Springer, 2013.
"Culture-Bound Syndromes." APA Dictionary of Psychology, 15 Nov. 2023, dictionary.apa.org/culture-bound-syndrome. Accessed 10 Dec. 2024.
Kirmayer, Laurence J., and Eric Jarvis. “Cultural Psychiatry: From Museums of Exotica to the Global Agora.” Current Opinion in Psychiatry, vol. 11, no. 2, 1998, p. 183.
Mezzich, J. E., et al. “The Place of Culture in DSM-IV.” Journal of Nervous and Mental Disease, vol. 187, no. 8, 1999, pp. 457–64.
Murphy, Jane M. “Psychiatric Labeling in Cross-Cultural Perspective.” Science, vol. 191, no. 4231, 1976, pp. 1019–28.
Paniagua, Freddy A. "Assessment and Diagnosis in a Cultural Context." Culture and Therapeutic Process, edited by Mark M. Leach and Jamie D. Aten, Routledge, 2010.
Paniagua, Freddy A., and Ann-Marie Yamada, editors. Handbook of Multicultural Mental Health: Assessment and Treatment of Diverse Populations. 2nd ed., Elsevier, 2013.
Simons, Ronald C., and Charles C. Hughes, editors. The Culture-Bound Syndromes: Folk Illnesses of Psychiatric and Anthropological Interest. Reidel, 1986.
Sue, Derald Wing, and David Sue. Counseling the Culturally Diverse: Theory and Practice. Wiley, 2012.
Tseng, Wen-Shing. “From Peculiar Psychiatric Disorders through Culture-Bound Syndromes to Culture-Related Specific Syndromes.” Transcultural Psychiatry, vol. 43, no. 4, 2006, pp. 554–76.
Ventriglio, Antonio, et al. “Relevance of Culture-Bound Syndromes in the 21st Century.” Psychiatry and Clinical Neurosciences, vol. 70, no. 1, 2016, pp. 3–6, doi.org/10.1111/pcn.12359. Accessed 28 Dec. 2024.
Westermeyer, J. “Psychiatric Diagnosis across Cultural Boundaries.” American Journal of Psychiatry, vol. 142, no. 7, 1985, pp. 798–805.
Yatan Pal, Singh Balhara. “Culture-Bound Syndrome: Has It Found Its Right Niche?” Indian Journal of Psychological Medicine, vol. 33, no. 2, 2011, pp. 210–15, doi.org/10.4103/0253-7176.92055. Accessed 28 Dec. 2024.