January 18, 2018

By Angela Borders

Culture Bound Syndromes

Here at SacWellness, one of our goals (aside from helping people find therapists and therapists find clients) is to be an educational resource, and recently a topic came up in discussion that we wanted to spend some more time thinking, talking, and sharing about: culture bound syndromes.

Many people might not have even heard of culture bound syndromes, but the idea of certain illnesses being unique to specific areas is certainly something that sparks discussion. Why is this or that illness more common/unique in that area? What factors are at play? What can we learn about ourselves from these differences? Talking about culture bound syndromes can open the door to all sorts of interesting conversations about culture, diversity, and mental health around the world.

What are culture bound syndromes (or “folk illnesses”)?

The Psychiatric Times defines culture bound syndromes as being “local ways of explaining any of a wide assortment of misfortunes” and by saying “in a cultural setting in which there is a particular folk illness, both the experience and the behaviors of the ill person will be shaped by that patient’s understanding of that illness“. What this means is that due to specific cultural norms, behaviors, and dominant views, the experiences and yes even mental health issues of the people living in any given place, are shaped by their surroundings. This may seem obvious when we consider that our day to day surroundings shape our mood and overall health all the time, but many find it surprising and interesting that entire regions have mental health issues unique to that area.

But before we get into what exactly that all means/how that can affect treatment and attitudes about those illnesses, lets first take a look at what mental illness means generally. The following video gives a brief history and explanation of how disorders and mental health issues are diagnosed, classified, and discussed in the field of psychology.

Ok, so now that we know about all that, how do culture bound syndromes fit into all this?

Well, for one thing, they don’t always fit so neatly into the diagnoses and criteria for mental illnesses that we find in areas outside of the cultures they are unique to. For another, they also sometimes involve physical symptoms that most mental illnesses don’t.

What are some examples of culture bound syndromes?

There are quite a few culture bound illnesses, many of which are clearly outlined, researched, and defined in medical diagnostic tools. Just for the sake of brevity, we are just going to talk about a few, purely for the sake of being examples: Ghost Sickness, Koro, and Taijin kyofusho.

Ghost Sickness

Ghost sickness is a culture bound syndrome that links mental and physical problems with visitations/other connections to a death or deceased person.

The article “Ghost Illness: A Cross-Cultureal Experience with the Expression of a non-western Tradition in Clinical Practice”, by Robert W. Putsch MD, details several case studies of ghost illness. One of them discusses a patient who experienced arthritis after participating in a healing ceremony and a supposed visitation from her deceased father.

“The patient’s history was unusual. She dated the onset of her illness to a specific date in the preceding fall, the morning after she experienced a visit by her deceased father. ‘I… opened my eyes and my father was standing there. He had on his tie, and looked the same as when we buried him…’ The patient insisted that she was awake at the time, and stated that her father spoke and made her the special gift of a Salish spirit song.”

A later part of the interview included an account of an associated episode which she felt may have contributed to her illness. She stated that her arthritis may have been caused by her failure to be properly

“‘brushed off’ after participating in a healing ceremony. This incident had occurred about three months prior to her admission, and the ceremony was being done for an individual who had multiple arthritic complaints. The patient hypothesized that the spirit that was causing the arthritic individual’s illness had ‘come off’ and somehow had been transferred to herself. (Brushing off healers and participants in healing practices is a common practice used by Salish groups. It is aimed at preventing dangerous spirits from sticking to others during and after the healing process.)”

As the article continues, Dr. Putsch talks about how treatment for this woman, and the other patients, involved healing ceremonies, spiritual guidance, and a level of cultural awareness that was needed for such treatment.

“The mother’s denial of her husband’s death made her reluctant to participate in the memorial service. The service would be an irrevocable sign and recognition that many decades of marriage had come to an end, and that her husband was indeed gone. The therapeutic suggestions were specifically designed to meet the circumstances. The patient was encouraged to sing her father’s spirit song, to give something up, and to help with the ceremonial process. The mother was encouraged to participate in the memorial service. The service was successfully held two months later, and the patient participated with vigor in spite of severe problems with active rheumatoid arthritis.”

Recommending singing at a service is not something most would probably consider typical treatment for arthritis, but it is a perfect example of how culture bound illness requires a special attention to cultural expectations and factors.

Koro

Koro is a culture bound syndrome that is a very specific form of Obsessive Compulsive Disorder (OCD), (though it makes us think of our recent post on “pure O” OCD as it doesn’t necessarily involve compulsions). Patients experiencing koro have a strange obsession with their genitalia. European Psychiatry defines it as:

“a culturally related disorder characterized by intense anxiety that the penis (vulva or nipples in females) is shrinking or retracting and will recede into the body. Usually it occurs in epidemics in Southeastern Asia, being extremely rare in western countries. The condition is more common in males and is classified within Obsessive Compulsive and Related Disorders.”

This culture bound illness seems especially striking because it is so specific and unique to that area. While many may feel self conscious about their reproductive organs, few have real fears about them shrinking or disappearing completely. The European Psychiatry article goes on to talk about how people with this syndrome fear their worth being taken away, due to reproductive ability being prized.

Taijin kyofusho

Taijin kyofusho is a form of anxiety that is focused on someone feeling like they will be a burden to others because of embarrassing themselves. This can be because of physical reasons like blushing or just having awkward physical interactions, or just by acting or feeling foolish. In Unusual and Rare Psychological Disorders: A Handbook for Clinical Practice and Research, the authors state that “In contrast to egocentric fears found in social anxiety disorder (e.g., ‘I will embarrass myself’), prototypical taijin kyofusho symptoms are more other directed (e.g., ‘I will offend others or make them uncomfortable’)”. The blog tofugu calls this a “very Japanese” form of anxiety, which raises the question of why it may be culture bound to Japan. We don’t want to generalize about any culture ever, but it is fairly common knowledge that decorum and formality are strong in traditional Japanese culture, so we can’t help but wonder if that is a factor.

In any case, generalizing about Japanese culture may be beside the point as newer findings are discovering cases of Taijin kyofusho in places outside Japan.

How do attitudes and treatment differ?

As you can imagine, cultural sensitivity and awareness are key in diagnosing and treating these syndromes and others like it. Also, there may be a need for addressing physical, rather than just psychological, symptoms. All of this means that culture bound syndromes, or “folk illnesses” need special attention and understanding.

Here is a great Ted Talk video that gets at how, not just with culture bound syndromes, but in all aspects of mental health, cultural awareness and attention is needed:

Why talk about this now?

At a time when our world is becoming more and more connected, and we are gaining an ever greater understanding of each other, it’s good to step back and remember that we still have so much to learn about each other’s experiences. Whether it be language, history, culture, or  even something like culture bound syndromes, there is a lot of diversity on the big blue marble we call Earth. Remembering that perspective and that there is always more to learn and understand can feel overwhelming, but we hope instead that it inspires us to remain humble and to seek out more to learn. It’s often said that the more you learn, the more you learn what you don’t know, and by looking to other cultures we can often expand our perspective and learn more about our own culture as well.

Are you or someone you know struggling with a specific issue or looking for a therapist who speaks a language other than English? Check out our therapist directory for Sacramento area therapists who may be able to help!