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The controversy over ‘culture-bound’ mental illnesses

The Boston Globe ran a fascinating and provocative article last Sunday on the controversial topic of “culture-bound syndromes.”

Pibloktoq, or 'arctic hysteria' is an illness 'in which Greenlandic Inuit strip off all their clothes and run out into the subzero Arctic tundra.'
Pibloktoq, or “arctic hysteria,” is an Greenlandic Inuit.

The Boston Globe ran a fascinating and provocative article last Sunday on the controversial topic of “culture-bound syndromes,” mental illnesses that have been identified by the psychiatric community as occurring only within a particular society or culture.

The article’s author, Latif Nasser, a doctoral candidate in the history of science department at Harvard University, cites several examples of these illnesses, including

  • susto (“a distinctly Latin American fear that one’s soul has panicked and left one’s body”),
  • pibloktoq, or “arctic hysteria” (“in which Greenlandic Inuit strip off all their clothes and run out into the subzero Arctic tundra”),
  • koro (“the fear [in Malaysia] that one’s genital organs are retracting into one’s body, and that this will eventually lead to death”),
  • dhat (a syndrome “particular to the Indian subcontinent [in which] Indian men report a vast array of symptoms — among them headaches, forgetfulness, and constipation — that they attribute to a lack of vital fluid, namely, semen”),
  • and brain fag, a West African syndrome in which university students spontaneously lose the ability to read and also complain of such symptoms as burning scalp, blurred vision and sexual dysfunction. (Fag is slang for fatigue.)

Some 25 culture-bound syndromes are listed in a seven-page appendix in the current (1994) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is in the midst of being updated (itself a highly controversial undertaking). As Nasser reports, the question of what to do with this appendix “is proving a thorny problem to solve”:

It’s not because no one is sure whether pibloktoq is a real thing, although that’s an open question. It’s because the whole debate turns on an issue that psychiatry itself has yet to agree on: how much mental illnesses are a manifestation of the cultures in which they arise. And whether, when it comes to how culture and human psychology intersect, it’s time to start seeing the West as a culture too. [There are no British or American syndromes listed in the appendix.]

In fact, as critics of the DSM appendix have pointed out to Nasser, “many of those supposedly exotic disorders appear strangely familiar, if you look hard enough”:

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[Nineteenth-century] Americans had their own version of dhat—a semen loss anxiety that led, in part to the development of health foods like Kellogg’s corn flakes and Graham’s crackers, whose inventors created their products as panacea for ills caused by, among other things, masturbation. … [And there was] an American wave of brain fag — the phrase was such a household term between 1890 and 1920 that the Chicago Tribune called it “the disease of the century.” Quack cures proliferated around the country: thermal baths, a “brain fag pillow,” even an electric hairbrush invented at Stanford University.

So, asks Nasser, “what’s really going on here? Is brain fag a universal phenomenon draped in West African garb, or is it a unique condition that only appears when the right cultural circumstances align?”

That question, he adds, “gets to the heart of a debate in psychiatry about what mental illness really is. … If underlying mental illness is universal, then what looks like a ‘culture-bound syndrome’ is likely to be a common problem that happens to show up differently in different settings. In this way of thinking, susto, or ‘soul loss,’ could be seen as just a Hispanic way of describing what Americans know as plain old depression.”

On the other hand, Nasser writes, “if it’s culture that decides what’s ‘crazy’ and what’s reasonable behavior, then there may be no such thing as an illness that isn’t culture-bound. It’s not that a handful of disorders no longer belong in a cultural appendix; it’s that perhaps they all do.”

“Far more mental illnesses might be cultural than we currently think,” he adds.

You can read Nasser’s article in full on the Boston Globe website.