Culture Specific Syndrome

ultural Bound Syndromes

Culture-bound syndrome

The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) which also includes a list of the most common culture-bound conditions (DSM-IV: Appendix I). Included in DSM-IV-TR (4th.ed) the term cultural-bound syndrome denotes recurrent, locality-specific patterns of abnormal behavior and troubling experience that may or may not be linked to a particular DSM-IV-TR diagnostic category. Many of these patterns are naturally considered to be illnesses, or at least afflictions, and most have local names. Although presentations conforming to the major DSM-IV-TR categories can be found throughout the world, the particular symptoms, course, and social response are very often influenced by local cultural factors. In contrast, cultural-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.

In medicine, a culture-specific syndrome or culture-bound syndrome 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. While a substantial portion of mental disorders, in the way they are manifested and experienced, are at least partially conditioned by the culture in which they are found, some disorders are more culture-specific than others. The concept of culture-bound syndromes is very controversial and many psychologists, medical doctors, and anthropologists reject the concept.

The identification of culture-specific syndromes:

A culture-specific syndrome is characterized by: categorization as a disease in the culture (i.e., not a voluntary behavior or false claim); widespread familiarity in the culture; complete lack of familiarity of the condition to people in other cultures; no objectively demonstrable biochemical or tissue abnormalities (symptoms); 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.

Western medical perspectives:

An interesting aspect of culture-specific syndromes is the extent to which they are “real”. Characterizing them as “imaginary” is as inaccurate as characterizing them as “malingering”, but there is no clear way to understand them from a Western scientific perspective. Culture-specific syndromes shed light on how our mind decides that symptoms are connected and how a society defines a known “disease”. In contrast, culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic [comma sic] categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations.

Medical care of the condition is challenging and illustrates a truly fundamental but rarely discussed aspect of the physician-patient relationship: the need to negotiate a diagnosis that fits the way of looking at the body and its diseases of both parties. The physician may do any of the following: Share the way the patient sees the disorder, and offer the folk medicine treatment, recognize it as a culture-bound syndrome, but pretend to share the patient’s perspectives and offer the folk medicine treatment or a new improvised treatment, recognize it as a culture-bound syndrome but try to educate the patient into seeing the condition as the physician sees it.

The problem with the first choice is that physicians who pride themselves on their knowledge of disease like to think they know the difference between culture-specific disorders and “organic” diseases. While the second choice may be the quickest and most comfortable choice, the physician must deliberately deceive the patient. Currently in Western culture this is considered one of the most unethical things a physician can do, whereas in other times and cultures deception with benevolent intent has been an accepted tool of treatment. The third choice is the most difficult and time-consuming to do without leaving the patient disappointed, insulted, or lacking confidence in the physician, and may leave both physician and patient haunted by doubts (“Maybe the condition is real.” or “Maybe this doctor doesn’t know what s/he is talking about.”).

Root-work/Obeah:

DSM IV-TR (2000), states that a set of cultural interpretations that ascribe illness to hexing, witchcraft, sorcery, or the evil influence of another person. Symptoms may include generalized anxiety and gastrointestinal complaints (e.g., nausea, vomiting, and diarrhea), weakness, dizziness, the fear of being poisoned, and sometimes fear of being killed (voodoo death). DSM IV-TR site roots, spells, or hexes can be put or placed on other persons, causing a variety of emotional and psychological problems. The hexed person may even fear death until the root has been taken off, or eliminated usually through the work of the root doctor (a healer in this tradition), who can also be called on to bewitch an enemy. Roots is found in the southern United States among both African-American and European American populations and in the Caribbean societies. Obeah (sometimes spelled "Obi") is a term used in the West Indies to refer to folk magic, sorcery, and religious practices derived from Central African and West African origins. Obeah can either be a form of 'dark' magic or 'good' magic. As such, Obeah is similar to Palo, Voodoo, Santeria, root-work, and hoodoo. Obeah (another name used in the Caribbean society) is practiced in Suriname, Jamaica, Haiti, the Virgin Islands, Trinidad and Tobago, Guyana, and Belize, the Bahamas, St. Vincent and the Grenadines, Barbados and many other Caribbean countries. Obeah is associated with both benign and malign magic, charms, luck, and with mysticism in general. In some Caribbean nations Obeah refers to African diasporic folk religions; in other areas, Christians may include elements of Obeah in their religion. Obeah is often associated with the Spiritual Baptist church.

Origins:

In Jamaica, slaves from different areas of Africa were brought into contact, creating some conflicts between those who practiced varying African religions. Those of West African Ashanti descent, who called their priests "Myal men" (also spelled Mial men), used the Ashanti term "Obi" or "Obeah" -- meaning "sorcery" -- to describe the practices of slaves of Central African descent. Thus those who worked in a Congo form of folk religion were called "Obeah men" or "sorcerers.” Obeah also came to mean any physical object, such as a talisman or charm that was used for evil magical purposes. However, despite its fearsome reputation, Obeah, like any other form of folk religion and folk magic, contains many traditions for healing, helping, and bringing about luck in love and money.

Elements (key features/symptoms)

According to Hughes, Simons &Wintrob, 1997 study, knowledge about a culture-bound syndrome, can address the relationship between the culture-bound syndrome and the more familiar psychiatric disorders, such as those in DSM-IV. These researchers call this the comorbidity question on the assumption that studying the culture-bound syndrome's patterned relationship to psychiatric diagnoses is a more fruitful approach than attempting prematurely to subsume it into the DSM diagnostic categories. Systematic research has identified strong correlations between culture-bound syndromes and criteria for psychiatric disorder, but there is rarely a one-to-one relationship between culture-bound syndrome and psychiatric disorder. The culture-bound syndromes often coexist with a range of psychiatric disorders, as many psychiatric disorders do with each other. The comorbidity question brings culture-bound syndrome research in line with current approaches in psychiatric research. Differences in the symptomatic, emotional, and contextual aspects of cultural syndromes, in turn, may signal different comorbid relationships with psychiatric diagnosis or even the lack of such a relationship.

Opinion

The extra ordinary addition of culture-bound syndromes in DSM-IV provides the opportunity for improving the need to study such syndromes and the chance for developing a research to study them. The growing ethnic and cultural diversity of the U.S. population presents a challenge to the mental health field to develop truly cross-cultural approaches to mental health research and services. This addition will give researchers the chance to study the relationship between culture-bound syndromes and psychiatric diagnoses. In my opinion a research program based on key questions is still unanswered, which is understanding culture-bound syndromes within their cultural context and to analyze the relationship between these syndromes and psychiatric disorders.

Reference

DSM -IV-TR Diagnostic and Statistical Manual of Mental Disorders (2000). Publication manual of the American Psychological Association (4th ed.). Washington, DC: Author.

Hughes CC, Simons RC, Wintrob RM: The "Culture-Bound Syndromes" and DSM-IV, in DSM-IV

Sourcebook, vol 3. Edited by Widiger TA, Frances AJ, Pincus HA, Ross R, First MB, Davis W.

Washington, DC, American Psychiatric Association, 1997, pp 991–1000

Retrieved July 29, 2009 from American Journal of Psychiatry.