Power point presentation on culture bound syndrome. Literature reference taken from Robert A. Hann's work

1. Presentation on :Culture Bound Syndrome
“Sickness and Healing”
Robert A. Hahn
Presented by
Doodle Basumatary
MPH, Hyderabad Central University

2. INTRODUCTION
• Also known as culture related specific disorders, culture
specific disorders/ syndromes.
• In the American handbook of psychiatry, Exotic psychiatric
syndromes or Rare atypical unclassifiable disorders.
• They all refer to certain illnesses or disorders which occur
exclusively in certain cultures and not found in others.
• If particular cultural conditions are necessary for the
occurrence of a syndrome, then it is called CBS.

3. • Various definitions for CBS have been proposed :
* Cassidy 1962
* Tseng & McDermont 1981
* Littlewood & Lipsedge 1986. (others)
• However, the most widely accepted is that proposed by
Prince 1985 which states that
“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.”
Definition

4. HISTORY
• Conditions now been referred to as CBS was first
described in Kraepelin textbook of psychiatry, the
8th edition (1909)
• It was Yap, a Chinese psychiatrist in 1962 that
introduced it (although they were described as folk
names) into the psychiatric literature first made an
attempt to put into a diagnostic classification
scheme.
• CBS were first described outside the west and so
were thought to be only non-western conditions

5. Meaning of CBS
• Behavioral syndromes unique / strange fitting to
local cultural setting
• Cultural alone doesn’t exhaustively determine all
conditions of sickness
“I claim that the idea of CBS is a
conceptual mistake, confusing our
understanding of the role of culture
in sickness and fostering a false
dichotomy of events and the
disciplines in which they are studied.”

6. • Simon and Hughes (1985) : Though they
provided a survey and classification of CBS,
Hughes argues that the label “CBS” is misleading
and should be abandoned to develop a universal
theory of sickness and its classification.
• Hahn points out that the term itself is a form of
“Reductionism” and so, other explanatory models
are denied relevance.
• Anthropological explanation is “excessive and too
modest” i.e. too much for CBS and too little for
the disease stalked out by Biomedicine.

7. • Hahn argues that full explanation of CBS
requires an opening of the inner sanctum of
Biomedicine to Anthropological review and a
concomitant recognition of pervasive
physiological constraint in the workings of
culture.
• Humans are culturally bound-but not rigidly,
nor is culture the only binding principle.

8. For the assessment of CBS, a breif definition of , Hahn
gives brief definitions of :
• Syndrome
• Culture
• Binds

9. Syndrome :
Syndrome : A group of conditions, generally pathological, that may be physical
and/or mental, signs and/or symptoms, and that is thought to constitute a discrete
entity.
Distinguished from other events that co-occur in that their co-occurrence is thought
to be not simply coincidental.
Latin "things that run together"

10. Culture :
• Culture refers to a way of life of a group of people.
• Culture in this context refers to the ideas, values,
habits and other patterns of behavior which a
human group transmits from one generation to
another.

11. Culture Bound Syndrome
• A syndrome may be regarded as culture-
bound if particular cultural conditions are
necessary for the occurrence of that
syndrome.
• The more of the surrounding context that is
included in the definition of a syndrome, the
more restricted its distribution is likely to be.

12. 4. Observer set apart the new syndrome as an
oddity from another culture, rather than
questioning the completeness or validity of
western nosology.
5. Now the challenge is showing how this CBS fits
into their own explanatory paradigm.
Explanatory gain may be culture specific loss.
6. Now, having established a new condition, the
discoverer may find similar conditions in
different settings. Eg. Amok, Koro and suoyang

13. A Hypothetical Ethnography of the Diagnosis of
CBS
1. Observers visit foreign setting or an ethnic
setting at home.
2. Observers notice behaviors that are strange
(unusual by their standards of normality) to
them and take them to be as pathological but
may not know to diagnose them.
3. Presence of Ethno-medicine in that setting.
Observers may take it as relevant, if not
definitive, others may just ignore.

14. Understanding Culture Bound
Syndrome
• Three alternate understanding of CBS are
possible, viz.
(i) Exclusionist
(ii) Inclusionist
(a) Nature-Culture Continuum
(b) Multiple Aspect

15. • Exclusionist :
Some conditions are culture
bound and some are not. Conditions not bound
by culture are said to be culture-free, culture-
blind, physiology, or materiality-bound.
Eg. Latah and Amok are culture bound syndrome
Measles and lung cancer are not (Kenny,1978,83)
• Using the notion of disease and developed by
Kleinman, John Carr associates CBS with illness
behavior, which, “as distinct from the disease
process, is always culturally determined. ”

16. Explanatory Principle
Culture Nature
Condition CBS Culture Free Syndrome
Illness Disease
Discipline Psychology Physiology
Anthropology Medicine
Psychiatry

17. Inclusionist
• All human events, including the supposed
culture-bound ones, have cultural and
biological and cognitive and psychodynamic
aspects, though some events are more
profoundly shaped by one of these aspects
than by others.
• No conditions are exclusively culture-bound or
culture-free.
Eg. Leighton and Murphy – development of
psychiatric disorder.
Nature-Culture Continuum
Multi-Aspect

18. • The inclusionist multiple-aspect position takes a
stance distinct from the nature-continuum
position, asserting that all human conditions are
equally biologic and cultural and social, cognitive,
psychologic, and psychodynamic, and so on.
• Each deals with different and distinct aspect of a
common phenomenon.
• All syndromes are regarded as equally culture-
bound, so that the concept of CBS is itself not a
useful distinction.

19. CLASSIFICATION
• Cultural emphasis on fertility and procreation
-genital shrinking (koro /suo-yang),
-semen loss (dhat) syndromes
• Cultural emphasis on learnt dissociation
-latah type and
-amok type reactions
• Syndromes related to acculturative stress
-Brain fag,
-Bouffee-delirante type reactions

20. • Idioms of distress –
-susto/ espanto,
-nervios,
-hwa-byung,
-ataque de nervios
• Syndromes related to physical appearance
-(taijin-kyofu reactions)
• Reactions to extreme environmental conditions
(arctic hysteria)
-pibloktoq,
-Windigo psychosis

22. The Jumping Frenchman of Maine were first discovered in a medical journal article
written by Dr. George Beard in 1880. He described people in an isolated community of
lumberjacks of French Canadian decent who were unable to keep from startling. After
being startled, the men would utter weird phrases and obey ridiculous commands.

23. “KORO”
Koro is typically defined as a culture bound
syndrome involving:
– delusions of genitalia shrinkage
– acute anxiety
– psychosomatic complaints
– The conviction among some
individuals that death will occur once
the genitalia fully retract
The individual feels an acute state of anxiety from a subjective
experience of shrinking of their penis / breasts/ labia. They anticipate
not only impotence /sterility but also death! They are also able to
convince people in their immediate environment and so “life saving”
measures are taken!

24. • Latah is an exaggerated startle
response, typically found
among women. Being
surprised may result in
screaming, cursing, dancing
and hysterical laughter that
might last a half hour or more.
• They may imitate the people
around them or things they
see or hear in the media
• Latah often occurs following a
traumatic episode. There are
many cultures which have
similar syndromes, but it is
unclear how or if they relate to
each other.

25. Among the Saora tribe of Orissa State in India, young men and women sometimes
exhibit abnormal behavior patterns that western trained mental health specialists
would likely define as a mental disorder. They cry and laugh at inappropriate times,
have memory loss, pass out, and claim to experience the sensation of being repeatedly
bitten by ants when no ants are present. These individuals are usually teenagers or
young adults who are not attracted to the ordinary life of a subsistence farmer. They
are under considerable psychological stress from social pressure placed on them by
their relatives and friends. The Saora explain the odd behavior of these people as
being due to the actions of supernatural beings who want to marry them.

26. • Amok (Malaysia)
• Cafard or Cathard (Laos, Polynesia, the Phillipines)
• Mal de pelea (Puerto Rico)
• Iich'aa (Navajo)
*This is a dissociative episode featuring a period of brooding followed
by an outburst of aggressive, violent or homicidal behavior aimed at
people and objects.
*It seems to occur only among males, and is often precipitated by a
perceived slight or insult.
*It is often accompanied by persecutory ideas, automatism, amnesia or
exhaustion, following which the individual returns to their premorbid
state.
*The victim, has often experienced a loss of social status or a major life
change.

27. Brain fag or brain fog (West Africa)
Studiation Madness (Trinidad)
• This disorder typically begins after an
intensive period of intellectual activity,
and is usually associated with college
or high school students.
Symptoms may include
-watering or dry eyes, dizziness, blurring of vision,
-difficulty concentrating or remembering,
-pain or feelings of pressure in the head or neck,
fatigue and difficulty sleeping, shaking hands,
rapid heartbeat,
-crawling sensations under the skin, feelings of
weakness and depression.

28. A sufferer of shenkui (a Chinese culture-bound syndrome) shows marked anxiety or
panic symptoms with accompanying somatic complaints for which no physical cause
can be demonstrated. Symptoms include dizziness, backache, fatiguability, general
weakness, insomnia, frequent dreams, and complaints of sexual dysfunction (such as
premature ejaculation and impotence). Symptoms are attributed to excessive semen
loss from frequent intercourse, masturbation, nocturnal emission, or passing of
“white turbid urine” believed to contain semen. Excessive semen loss is feared
because it represents the loss of one’s vital essence and can thereby be life
threatening.

29. Grisi siknis (“crazy sickness”) is a contagious, culture-bound syndrome that occurs
predominantly among the Miskito People of eastern Central America and affects mainly young
women. Most of the victims are young girls from 15 to 18 years old. The attacks are prefaced
by headaches, dizziness, anxiety, nausea, irrational anger and/or fear. During the attack, the
“victim loses consciousness” and falls to the ground, subsequently running away. The victim
may view other people as devils, feel no pain for bodily injuries and have absolute amnesia
regarding their physical circumstances. Some grab machetes or broken bottles to wave off
unseen assailants. Other victims are reported to have performed superhuman feats, vomited
strange objects such as spiders, hair and coins and spoken in tongues. In some cases the semi-
conscious victim will speak the names of the next to be infected, although it is not always
accurate. Grisi siknis is highly contagious.
Grisi Siknis

30. Paris Syndrome
In its purest form, Paris Syndrome is culture shock to the max. This super-specific
syndrome affects Japanese tourists who visit Paris and are devastated by the
discrepancy between reality and their idealized image of the city of love.
In Japanese media, Paris is portrayed as a quaint, friendly city filled with kindness and
love. In reality, Paris is just as full of unfriendly locals, crime, and filth as other major
tourist stops, though unlike cities such as New York that embrace the good and bad,
Paris has written off the bad and given Japan an unattainable, idealized vision.

31. Summary
• What is CBS ?
• Construct of CBS
• Some examples
• Views of Robert A. Hahn
• Exclusionist
• Inclusionist

32. Thank You