Culture Bound Syndromes
by Brittany Tusing
Culture-bound syndromes, also known as culture-specific syndromes or folk illnesses, refer to a set of symptoms found in a specific ethnic or geographical group (1). These symptoms can be psychiatric, behavioral and/or physical. The population that experiences the set of symptoms attributes them to culture-specific causes, many of which are tied to spirituality or superstition (1). Understanding of culture-bound syndromes can be used to inform intervention or treatment design for a particular set of symptoms, such as loss of libido and fatigue, irrational thinking and homicidal rampage, or inability to concentrate and neck pain.
For example, dhat has been identified as a culture-bound syndrome common in adolescent males in India. In Indian culture, semen is regarded as a “soul substance” (1), giving a man his vitality and virility. Loss of semen during masturbation, nocturnal emission, or urination is presumed to be the cause of weakness, fatigue, and loss of libido in men (1). Symptoms manifest as a type of depression (1).
Running amok is a culture-bound syndrome found most commonly in tribal communities of Malaysia, the Philippines, Laos, Papua New Guinea, and Puerto Rico. Symptoms include sudden irrational behavior that typically causes great harm to self or others, such as homicide and subsequent suicide (2).
Nigerian students experiencing inability to concentrate or retain information, visual impairment, and burning sensations in the neck and head attribute these symptoms to a culture-bound syndrome called brain fag (3). Brain fag is most commonly found in young adult males pursuing higher education, and often occurs during high stress periods when the brain may be fatigued.
Figure 1 was developed on the thinking of Arthur Kleinman (4) and Yatan Balhara (1), as none were readily available in the existing literature.
It interprets the contributing factors of a culture bound syndrome. A model such as this may help researchers and practitioners frame findings of studies and inform decisions about ways to treat symptoms of culture-bound syndromes.
Descriptions of ailments are shaped by a multitude of factors, such as limitations imposed by language, physiological understanding, cultural acceptance, validation by others, and cause-effect associations one makes based on his or her own experience (1). These factors appear to strongly reinforce belief models that underlie self-diagnosis. Physical symptoms may be objective, but an individual may associate them with their psychological symptoms based on their understanding of those symptoms and/or the social acceptability of those symptoms. Expression of symptoms to others is limited by the constraints of the vocabulary available to the individual. Validation occurs when other members of a population can empathize with the symptoms and causes expressed by the affected individual. It is ultimately this widespread validation that leads to a generalized understanding of the syndrome among members of a population, thus making it culture-bound.
Psychological, anthropological, and medical literature dating to the 1970s demonstrates an increasing interest in the cultural ties to illness, with particular focus on those with strong psychological components. Arthur Kleinman, considered a leader in the field, has written extensively on the topic. Since then, awareness of the importance of culture in diagnosing patients has increased. The current Diagnostic and Statistical Manual of Mental Disorders (DSM-V) recognizes culture bound syndromes, and the term has been in use for several decades. However, researchers continue to question the validity of the concept and its relevance to diagnoses such as anorexia nervosa, schizophrenia and depression in Western society (5). In addition, new research that identifies symptoms of culture-bound syndromes in varying populations calls into question the idea that culture-bound syndromes are not pervasive (1,5).
In-depth knowledge of culture bound syndromes commonly found in a particular ethnic group could be useful in informing public health interventions or medical treatment. For example, the CDC has published a document targeted at providers of health care and social work to Hmong populations in the United States that outlines key cultural norms and beliefs (6). Considering the importance of culture in working with non-Westernized populations should be a vital first step in designing any public health intervention.
In his 1977 book Rethinking Psychiatry, Arthur Kleinman discusses the limitations of diagnosis based on a list of symptoms, citing the example of depression, which can manifest itself purely as lumbar pain or as a more complex psycho-physical impairment (4). Furthermore, evidence suggests that non-Western populations are more likely to somaticize, in which an individual describes psychological symptoms as physical (1,5). Rethinking Psychiatry illustrates the intricacy of the concept, another limitation to clear understanding and applying culture-bound syndromes in public health practice (4).
(1) Balhara YPS. Culture-bound Syndrome: Has it Found its Right Niche? Indian J Psychol Med [Internet]. 2011 Jul [cited 2015 Apr 27];33(2):210–5. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3271505&tool=pmcentrez&rendertype=abstract
(2) Saint Martin ML. Running Amok: A Modern Perspective on a Culture-Bound Syndrome. Prim Care Companion J Clin Psychiatry. 1999;1(3):66–70.
(3) Prince R. The “Brain Fag” Syndrome in Nigerian Students. Br J Psychiatry [Internet]. 1960;(106):559–70. Available from: http://bjp.rcpsych.org.ezproxy.bu.edu/content/bjprcpsych/106/443/559.full.pdf
(4) Kleinman A. Rethinking Psychiatry: From Cultural Category to Personal Experience. New York City: The Free Press; 1988.
(5) Keshavan MS. Culture bound syndromes: Disease entities or simply concepts of distress? Asian J Psychiatr [Internet]. Elsevier B.V.; 2014;12:1–2. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1876201814002524
(6) CDC. Chapter 2 . Overview of Lao Hmong Culture. Culture. 2004;13–23.