World View of Disorders and Culture Bound Syndromes


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A lecture by Dr Imran Waheed, Consultant Psychiatrist, delivered in Birmingham, UK on February 7th 2012. The audience was medical students in Birmingham.

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World View of Disorders and Culture Bound Syndromes

  1. 1. World view of disorders and culture bound syndromes Dr Imran Waheed Consultant Psychiatrist Birmingham Central Home Treatment Team
  2. 2. Influence of culture on psychiatry <ul><li>Culture also influences mental illness in many ways — assessment and diagnosis, illness behaviour and help-seeking, the expectations of patients and health professionals and the acceptance of appropriate therapies. </li></ul><ul><li>Concepts of illness vary between cultures and people from different cultures express their symptoms differently. </li></ul><ul><li>What may be abnormal and psychopathological in one culture may be culturally acceptable in another. </li></ul><ul><li>Thus, an understanding of the patient ’ s culture is important in assessing the clinical significance of specific symptoms and behaviours and in the treatment of mental disorders. </li></ul>
  3. 3. Culture bound syndromes <ul><li>‘ episodic and dramatic reactions specific to a particular community - locally defined as discrete patterns of behaviour ’ </li></ul><ul><li>Syndrome: from the Greek “ to run together ” i.e. a collection of signs and symptoms that tend to occur together </li></ul><ul><li>Used to describe the uniqueness of some syndromes in specific cultures </li></ul><ul><li>Usually get a combination of psychiatric and somatic symptoms – these are a recognisable disease only within a specific society or culture </li></ul><ul><li>The term was included in DSM-IV. </li></ul>
  4. 4. Features of a culture bound syndrome <ul><li>“ CBS is a collection of signs and symptoms which is restricted to a limited number of cultures primarily by reasons of certain of their psychosocial features.” [Prince 1985] </li></ul><ul><li>Categorisation as a disease in the culture (i.e., not a voluntary behaviour or false claim); </li></ul><ul><li>Widespread familiarity in the culture; </li></ul><ul><li>Complete lack of familiarity of the condition to people in other cultures; </li></ul><ul><li>No objectively demonstrable biochemical or tissue abnormalities; </li></ul><ul><li>The condition is usually recognised and treated by the folk medicine of the culture. </li></ul>
  5. 5. Amok (Indonesia/Malaysia) <ul><li>The victim, known as a pengamok , suddenly withdraws from family and friends, then bursts into a murderous rage, attacking the people around him with whatever weapon is available. </li></ul><ul><li>He does not stop until he is overpowered or killed; if the former, he falls into a sleep or stupor, often awakening with no knowledge of his violent acts. </li></ul><ul><li>Usually precipitated by perceived slight. </li></ul><ul><li>Dissociative episode usually accompanied by paranoid ideas, automatism, amnesia, exhaustion & return to normality </li></ul>
  6. 6. Dhat, Shen K ’ ui (India/China) <ul><li>Dhat derives from the Sanskrit word dhatu meaning ‘ metal ’ , and also ‘ elixir ’ or ‘ constituent part of the body ’ . </li></ul><ul><li>First described in Western psychiatric texts by Wig (1960) </li></ul><ul><li>Comprises vague somatic symptoms of fatigue, weakness, anxiety, loss of appetite, guilt and sexual dysfunction </li></ul><ul><li>Attributed by the patient to loss of semen in nocturnal emissions, through urine and masturbation. </li></ul><ul><li>Wen & Wang (1980) define shen k ’ ui as vital or kidney deficiency. In classical Chinese medicine shen (kidney) is the reservoir of vital essence in semen (ching) and k ’ ui signifies deficiency. </li></ul><ul><li>Some contend that with industrialisation and urbanisation, the anxiety about semen loss in the West diminished, and the same is likely to happen in southern Asia as well. </li></ul>
  7. 7. Koro (Southeast Asia) <ul><li>First described in 300 BC in the Yellow Emperor ’ s Classic of Internal Medicine </li></ul><ul><li>Genital retraction syndrome - acute pain or anxiety reaction involving fear of genital retraction. </li></ul><ul><li>In severe cases, men become convinced that the penis will suddenly withdraw into the abdomen; women sense that their breasts, labia or vulva will retract. </li></ul><ul><li>Victims expect the consequences to be fatal. </li></ul><ul><li>Studies cite factors such as illness, exposure to cold or excess coitus as precursors. </li></ul><ul><li>Onset is rapid, intense and unexpected. </li></ul><ul><li>Can sometimes present as a mass hysteria event or panic in which males in a population suddenly exhibit symptoms of genital retraction syndrome (1967 Singapore epidemic) </li></ul>
  8. 8. Latah (Malaysia/Indonesia) <ul><li>tends to occur in Malayan women </li></ul><ul><li>highly exaggerated startle response to a fright or trauma, followed by: </li></ul><ul><li>involuntary echolalia </li></ul><ul><li>echopraxia </li></ul><ul><li>trance-like states </li></ul><ul><li>automatic obedience </li></ul><ul><li>coprolalia </li></ul><ul><li>may be one form of the ‘ hyperstartle reaction ’ and is therefore universally found </li></ul>
  9. 9. Brain Fag (West Africa) <ul><li>a low grade stress symptom, commonly encountered among students </li></ul><ul><li>five symptom types have been described: </li></ul><ul><li>head symptoms – aching, burning, crawling sensations </li></ul><ul><li>eye symptoms – blurring, watering, aching </li></ul><ul><li>difficulty grasping the meaning of spoken or written words </li></ul><ul><li>poor retentivity </li></ul><ul><li>sleepiness on studying </li></ul><ul><li>rates highest in rural areas </li></ul><ul><li>sufferers are resistant to psychological interpretation of their condition </li></ul><ul><li>may be a form of depression in which depressive features are not articulated in Western psychological terms </li></ul>
  10. 10. Windigo (North American Indians) <ul><li>Rare, historic accounts of cannibalistic obsession. </li></ul><ul><li>Symptoms include depression, homicidal or suicidal thoughts, and a delusional compulsive wish to eat human flesh. </li></ul><ul><li>In the late nineteenth century, numerous cases of windigo murders were reported in court trial transcripts and newspapers, often depicting gruesome details of the killings, either by the so-called 'windigos' themselves, or by those who executed the windigos in order to preserve the safety of the community. </li></ul>
  11. 11. Susto (Mexico, Central/South America) <ul><li>Susto comes from the Spanish word for “ fright ” </li></ul><ul><li>People believe that if a person is suffering from susto, his or her soul is separated from the body. </li></ul><ul><li>Highly diverse, chronic complaints attributed to ‘ soul loss ’ induced by a severe, often supernatural, fright. </li></ul><ul><li>In some cases, individuals may be stricken when others suffer a fright. </li></ul><ul><li>Symptoms often include agitation, anorexia, insomnia, fever, diarrhoea, mental confusion and apathy, depression and introversion. </li></ul>
  12. 12. Piblokto (Arctic Circle) <ul><li>Abrupt dissociative episode accompanied by extreme excitement for 30 minutes and followed by seizure and coma lasting for 12 hours. </li></ul><ul><li>Prodromal fatigue, depression or confusion followed by a ‘ seizure ’ of disruptive behaviour, including stripping or tearing off clothes, frenzied running, rolling in snow, glossolalia or echolalia, echopraxia, property destruction and coprophagia. </li></ul><ul><li>Most episodes last only minutes and are followed by loss of consciousness, amnesia and complete remission </li></ul><ul><li>Some suggestion of link to Vitamin A toxicity </li></ul>
  13. 13. Taijin kyofusho (Japan) <ul><li>Literally means the disorder (sho) of fear (kyofu) of interpersonal relations (taijin). </li></ul><ul><li>Anxiety or phobia more common among men and young adults. </li></ul><ul><li>Cases are marked by a fear of social contact, extreme self-consciousness and a fear of contracting disease. </li></ul><ul><li>Intense fear that one ’ s body, its part or functions, displease or embarrass, or are offensive to others because of appearance, odour, facial expression or movement. </li></ul><ul><li>Somatic symptoms include head, body and stomach aches, fatigue and insomnia. </li></ul>
  14. 14. Culture-bound syndromes Ataque de nervios Symptoms include uncontrollable shouting, attacks of crying, trembling, heat in the head, verbal or physical aggression. Note seizure-like attacks of fainting and suicidal episodes are frequent. Usually precipitated by stressful event. Bilis & colera Headache, trembling, stomach disturbances, loss of consciousness. Usually associated with underlying feelings of anger and rage Bouffee delirante Sudden outburst of aggression and agitation, confusion and psychomotor excitement. There may be visual and auditory hallucinations. Hwa-byung Anger syndrome presenting with insomnia, panic, fear of impending death, indigestion, anorexia, dyspnoea, palpitations, generalised aches and pains, etc. Shenjing shuariuo Fatigue, dizziness, headaches, poor concentration, sleep disturbance, and memory loss. Note irritability, sexual dysfunction.