Culture-bound syndrome

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 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). Counterpart within the framework of ICD-10 (Chapter V) are the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.^[1]

More broadly, an epidemic that can be attributed to cultural behavior patterns or suggestion is sometimes referred to as a behavioral epidemic. As in the cases of drug or alcohol abuse or smoking, transmission can be determined by communal reinforcement as well as by person-to-person interactions. On etiological grounds, it can be difficult to distinguish the causal contribution of culture in disease from other environmental factors such as toxicity.^[2]

Identification

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.

Medical perspectives

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]

DSM-IV-TR list

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

DSM-5 list

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as culture-bound syndromes:^[12]

ICD-10 list

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

Other examples

Within the contiguous United States, the consumption of kaolin 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.^[13] In South Africa, among the Xhosa people, the syndrome 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.^[14]

Vegetative-vascular dystonia can be considered an example of somatic condition formally recognised by local medical community 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,^[15][16] in effect sybstituting possible psychiatric stigma with culture-bound syndrome disguised as a neurological condition.

See also

• Cross-cultural psychiatry
• Cross-cultural psychology
• Hikikomori
• Hi-wa itck
• Medical anthropology
• Neurasthenia
• Zen sickness

References

Further reading

• Kleinman, Arthur (1991), Rethinking psychiatry: from cultural category to personal experience, New York: Free Press, ISBN 0-02-917441-4, 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 
• John Launer (2003), "Folk illness and medical models", Q J Med, 96 (11): 875–876, doi:10.1093/qjmed/hcg136 
• Simons, Rondald C; Hughes, Charles C, eds. (1985), The Culture-Bound Syndromes: Folk Illnesses and Anthropological Interest, Dordrecht, Holland: D. Reidel Publishing Co, ISBN 90-277-1858-X, retrieved 9 September 2010  Paperback ISBN 90-277-1859-8
• Rebhun, L.A (2004), "Culture-Bound Syndromes", in Ember, Carol R.; Ember, Melvin, Encyclopedia of Medical Anthropology: Health and Illness in the World's Cultures, New York: Klower Academic/Plenum Publishers, pp. 319–327, ISBN 0-306-47754-8, 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 

External links

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