Culture-Bound Syndromes

Culture-bound syndromes (CBSs) comprise a heterogeneous set of illness phenomena of particular interest to medical anthropologists and to psychiatrists. The eclectic nature of the category makes it hard to define precisely, and has invited much dispute over the best name and definition for it.

DSM-IV (844) defines a culture-bound syndrome:

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.

More generally, culture-bound syndromes comprise several kinds of illness or affliction, all of which are defined as culture-bound (and therefore have been of interest to medical anthropologists and ethnopsychiatrists) in that they do not have a one-to-one correspondence with a disorder recognized by Western, allopathic nosologies. Most CBSs were initially reported as confined to a particular culture or set of related or geographically proximal cultures.

At least seven broad categories can be differentiated among phenomena often described as culture-bound syndromes:

1. an apparent psychiatric illness, not attributable to an identifiable organic cause, which is locally recognized as an illness and which does not correspond to a recognized Western disease category, e.g. amok.

2. an apparent psychiatric illness, not attributable to an identifiable organic cause, which is locally recognized as an illness and which resembles a Western disease category, but which has locally salient features different from the Western disease, and which may be lacking some symptoms seen as salient in the West. One example is shenjing shaijo or neurasthenia in China, which resembles major depressive disorder but has more salient somatic features and often lacks thedepressed mood which defines depression in the West. Another is taijin kyufusho which is widely regarded as being a peculiarly Japanese form of social phobia.

3. a discrete disease entity not yet recognized by Western medicine. The most famous example of this is kuru, a progressive psychosis and dementia indigenous to cannibalistic tribes in New Guinea. Kuru was eventually classified as a "slow-virus" disease, and is now believed to result from an aberrant protein or "prion" which is capable of replicating itself by deforming other proteins in the brain. (A 1997 Nobel prize was awarded for the elucidation of prions.) Kuru has been identified with a form of Creuzfeldt-Jakob disease, and may be equivalent or related to scrapie, a disease of sheep, and bovine spongiform encephalopathy (BSE) or "mad cow disease".

4. an illness which may or may not have an organic cause, and may correspond to a subset of a Western disease category or may elaborate symptoms not recognized as constituting a Western disease into an illness category. In other words, this is a phenomenon which occurs in many cultural settings, but which is only elaborated as an illness in one or a few. A possible example is koro, the fear of retracting genitalia, which may sometimes have a physiological-anatomical reality, and which appears to occur independently in a non-culturally-elaborated way as a delusion or phobia in numerous cultural settings.

5. culturally accepted explanatory mechanisms or idioms of illness which do not match allopathic mechanisms or Western idioms, and which, in a Western setting, might indicate culturally inappropriate thinking and perhaps delusions or hallucinations. Examples of this include witchcraft, rootwork (Caribbean) or the evil eye (Mediterranean and Latin America).

6. a state or set of behaviors, often including trance or possession states; hearing, seeing, and/or communicating with the dead or spirits; or feeling that one has "lost one's soul" from grief or fright; which may or may not be seen as pathological within their native cultural framework, but which if not recognized as culturally appropriate could indicate psychosis, delusions, or hallucinations in a Western setting.

7. a syndrome allegedly occuring in a given cultural setting which does not in fact exist, but which may be reported to the anthropologist or psychiatrist. A possible example is windigo (Algonkian Indians), a syndrome of cannibal obsessions whose reality has been challenged (Marano, in Simons & Hughes, 1985) but may in fact be used to justify the expulsion or execution of an outcast in a manner similar to witchcraft allegations.

Debates over culture-bound syndromes often revolve around confusions or conflations among these different categories. Many so-called culture-bound syndromes actually occur in many unrelated cultures, or appear to be merely locally flavored varieties of illnesses found elsewhere. Some are not so much actual illnesses as explanatory mechanisms, like witchcraft or humoral imbalances. Beliefs in witchcraft and humoral imbalances can lead to behaviors which would seem to indicate disordered thought processes outside their cultural context, such as avoidance of cold and drafts in Chinese pa-feng and pa-leng, but which actually make sense in context.

The concept of culture-bound syndromes is therefore useful insofar as it brings culture to the attention of psychiatrists trained in a different cultural tradition. Awareness of CBSs allow psychiatrists and physicians to make culturally appropriate diagnoses. The concept is also interesting to medical and psychiatric anthropologists, in that culture-bound syndromes provide examples of how culturally salient symptoms can be elaborated into illness experiences. The concept is problematic, however, in that it is not a homogeneous category, and the designation of "culture-bound" can imply that the illness is somehow "not real", or that a patient's experience can be dismissed as merely exotic.

One of the best available compilations on culture-bound syndromes is:

Simons, Ronald C.; and Hughes, Charles C. (eds.) (1985) The Culture-Bound Syndromes: folk illnesses of psychiatric and anthropological interest. Dordrecht, The Netherlands: D. Reidel Publishing Company.

Useful information is also found commonly in the journals Culture, Medicine, and Psychiatry, and Transcultural Psychiatry. Several references are given in the bibliography.