Culture-bound syndrome

A culture-specific syndrome is characterized by:

1. categorization as a disease in the culture (i.e., not a voluntary behaviour or false claim);
2. widespread familiarity in the culture;
3. complete lack of familiarity or misunderstanding of the condition to people in other cultures;
4. no objectively demonstrable biochemical or tissue abnormalities (signs);
5. the condition is usually recognized and treated by the folk medicine of the culture.

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]

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.[8] 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 his or her family.[9]

The fourth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as culture-bound syndromes:[10]

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as cultural concepts of distress, a closely related concept:[11]

The 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) classifies the below syndromes as culture-specific disorders:[1]

Though "the ethnocentric bias of Euro-American psychiatrists has led to the idea that culture-bound syndromes are confined to non-Western cultures,"[12] a prominent example of a Western culture-bound syndrome is anorexia nervosa.[13]

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.[14] 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.[15]

Some researchers have suggested that both premenstrual syndrome (PMS) and the more severe premenstrual dysphoric disorder (PMDD), which have currently unknown physical mechanisms,[16][17][18] are Western culture-bound syndromes.[19][20] However, this is controversial.[19]

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,[21][22] 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 the Scandinavian country, 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.[23]

A startle disorder similar to latah, called imu (sometimes spelled imu:), is found among Ainu people, both Sakhalin Ainu and Hokkaido Ainu.[24][25]

A condition similar to piblokto, called menerik (sometimes meryachenie), is found among Yakuts, Yukaghirs, and Evenks living in Siberia.[26]

• Kleinman, Arthur (1991), Rethinking psychiatry: from cultural category to personal experience, New York: Free Press, ISBN 978-0-02-917441-8, retrieved 8 January 2011
• Landy, David, ed. (1977), Culture, Disease, and Healing: Studies in Medical Anthropology, New York: Macmillan, ISBN 978-0-02-367390-0
• Launer, John (November 2003). "Folk illness and medical models". QJM. 96 (11): 875–876. doi:10.1093/qjmed/hcg136. PMID 14566046.
• Simons, Rondald C; Hughes, Charles C, eds. (1985), The Culture-Bound Syndromes: Folk Illnesses and Anthropological Interest, Dordrecht, Holland: D. Reidel Publishing Co, ISBN 978-90-277-1858-7, retrieved 9 September 2010 Paperback ISBN 90-277-1859-8
• Rebhun, L.A (2004), "Culture-Bound Syndromes", in Ember, Carol R.; Ember, Melvin (eds.), Encyclopedia of Medical Anthropology: Health and Illness in the World's Cultures, New York: Klower Academic/Plenum Publishers, pp. 319–327, ISBN 978-0-306-47754-6, retrieved 9 September 2010 (Note: Different preview pages result in the full chapter being viewable from the title link).
• Kirmayer, L. J. (2001), "Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment.", Journal of Clinical Psychiatry, 62: 22–30, PMID 11434415
• Bures, Frank (2016). The Geography of Madness: Penis Thieves, Voodoo Death, and the Search for the Meaning of the World's Strangest Syndromes Hardcover. Melville House. ISBN 978-1612193724.

• Psychiatric Times – Introduction to Culture-Bound Syndromes(registration required)
• Skeptical Inquirer – Culture-bound syndromes as fakery