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 known 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, which also includes a list of the most common culture-bound conditions. Its counterpart in the framework of ICD-10 is the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.
More broadly, an endemic that can be attributed to certain behavior patterns within a specific culture by suggestion may be referred to as a potential behavioral epidemic. As in the cases of drug use, or alcohol and smoking abuses, transmission can be determined by communal reinforcement and person-to-person interactions. On etiological grounds, it can be difficult to distinguish the causal contribution of culture upon disease from other environmental factors such as toxicity.

Identification

A culture-specific syndrome is characterized by:

categorization as a disease in the culture
widespread familiarity in the culture
complete lack of familiarity or misunderstanding of the condition to people in other cultures
no objectively demonstrable biochemical or tissue abnormalities
recognition and treatment by the folk medicine of the culture

Some culture-specific syndromes involve somatic symptoms, 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:
The term culture-bound syndrome is controversial since it reflects the different opinions of anthropologists and psychiatrists. 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. Guarnaccia & Rogler 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.
Guarnaccia and Rogler demonstrate the issues that occur when diagnosing cultural bound disorders using the DSM-IV. One of the key problems that arise is the "subsumption of culture bound syndromes into psychiatric categories", which ultimately creates a medical hegemony and places the Western perspective above that of other cultural and epistemological explanations of disease. The urgency for further investigation or reconsideration of the DSM-IV's authoritative power is emphasized, as the DSM becomes an international document for research and medical systems abroad. Guarnaccia and Rogler provide two research questions that must be considered: "firstly, how much do we know about the culture-bound syndromes for us to be able to fit them into standard classification; and secondly, whether such a standard and exhaustive classification in fact exists".
It is suggested that the problematic nature of the DSM becomes evident when viewed as definitively conclusive. Questions are raised to whether culture-bound syndromes can be treated as discrete entities, or whether their symptoms are generalized and perceived as an amalgamation of previously diagnosed illnesses. If this is the case, then the DSM may be what Bruno Latour would define as "particular universalism", in that the Western medical system views itself to have a privileged insight into the true intelligence of nature, in contrast to the model provided by other cultural perspectives.
Some studies suggest that culture-bound syndromes represent an acceptable way within a specific culture among certain vulnerable individuals to express distress in the wake of a traumatic experience. 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 the individual's family. The history and etymology of some syndromes such as brain fag syndrome, restricted to West Africa by the DSM-IV, have also been reattributed to 19th century Victorian Britain.
In 2013, the DSM 5 dropped the term culture-bound syndrome, preferring the new name "cultural concepts of distress".

Cultural collision between medical perspectives

Within the traditional Hmong culture, epilepsy directly translates to "the spirit catches you and you fall down" and is said to be an evil spirit called a dab that captures one's soul and makes one ill. In this culture, individuals with seizures are seen to be blessed with a gift: an access point into the spiritual realm which no one else has been given. In Westernised society, epilepsy is recognized as a serious long-term brain condition that can have a major impairment on an individual's life. The way the illness is dealt with in Hmong culture is vastly different due to the high status epilepsy has in the culture, compared to individuals who have the condition in Westernised societies. Individuals with epilepsy within the Hmong culture are a source of pride for their family.
Another culture-bound illness is neurasthenia, which is a vaguely described medical ailment in Chinese culture that presents as lassitude, weariness, headaches, and irritability and is mostly linked to emotional disturbance. A report done in 1942 showed that 87% of patients diagnosed by Chinese psychiatrists as having neurasthenia could be reclassified as having major depression according to the DSM-3 criteria. Another study conducted in Hong Kong showed that most patients selectively presented their symptoms according to what they perceived as appropriate and tended to only focus on somatic suffering, rather than the emotional problems they were facing.

Globalisation

Globalisation is a process whereby information, cultures, jobs, goods, and services are spread across national borders. This has had a powerful impact on the 21st century in many ways, including enriching cultural awareness across the globe. Greater level of cultural integration is occurring due to rapid industrialisation and globalisation, with cultures absorbing more influences from each other. As cultural awareness begins to increase between countries, there is a consideration into whether cultural-bound syndromes will slowly lose their geographically bound nature and become commonly known syndromes that will then become internationally recognised.
Anthropologist and psychiatrist Roland Littlewood makes the observation that these diseases are likely to vanish in an increasingly homogenous global culture in the face of globalisation and industrialisation. Depression, for example, was once only accepted in Western societies; it is now recognised as a mental disorder in all parts of the world. In contrast to Eastern civilizations such as Taiwan, depression is still much more common in Western cultures like the United States. This could indicate that globalisation may have an impact on allowing disorders to be spread across borders, but these disorders may remain predominant in certain cultures.

''DSM-IV-TR'' list

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

Name	Geographical localization/populations
Running amok	Brunei, Singapore, Malaysia, Indonesia, Philippines, Timor-Leste
Ataque de nervios	Latinos in the United States and Latin America
Bilis, cólera	Latinos in the United States and Latin America
Bouffée délirante	France and French-speaking countries
Brain fag syndrome	West African students
Dhat syndrome	India
Falling-out, blacking out	Southern United States and Caribbean
Ghost sickness	Native American
Hwabyeong	Korean
Koro	Chinese, Malaysian and Indonesian populations in Southeast Asia; Assam; occasionally in the West
Latah	Malaysia and Indonesia, as well as the Philippines
Locura	Latinos in the United States and Latin America
Mal de pelea	Puerto Rico
Piblokto	Arctic and subarctic Inuit populations
Zou huo ru mo	Han Chinese
Sangue dormido	Cape Verde
Shenjing shuairuo	Han Chinese
Shenkui, shen-k'uei	Han Chinese
Shinbyeong	Koreans
Spell	African American, White populations in the Southern United States and Ethiopia
Susto	Latinos in the United States; Mexico, Central America and South America
Taijin kyofusho	Japanese

''DSM-5'' list

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders classifies the below syndromes as cultural concepts of distress, a closely related concept:

Name	Geographical localization/populations
Ataque de nervios	Latin America
Dhat syndrome	India
Khyâl cap	Cambodian
Ghost sickness	Native American
Kufungisisa	Zimbabwe
Maladi moun	Haiti
Shenjing shuairuo	Han Chinese
Susto	Latinos in the United States; Mexico, Central and South America
Taijin kyofusho	Japanese