Culture-Bound Syndromes

1904

Emil Kraepelin (1856–1926), Arthur Kleinman (b. 1941)

Are psychiatric disorders best understood within a particular cultural context? That is, are they culture-bound? A growing body of evidence indicates that we cannot assume that human beings experience mental and emotional distress in the same ways or that treatment of such distress is easily exportable from one culture to another. While cultural differences in mentality have been noted for centuries, it was psychiatrist Emil Kraepelin who wrote about the necessity of taking cultural considerations into account in 1904:

The characteristics of a people should find expression in the frequency as well as the shaping of the manifestations of mental illness … so that comparative psychiatry shall make it possible to contribute to the understanding of pathological psychic processes.

It was initially the fieldwork of medical anthropologists that raised questions about the role of culture in health and disease, including mental health. Psychiatrist Arthur Kleinman’s Patients and Healers in the Context of Culture (1980) helped set off the contemporary debate on culture-bound syndromes. Psychologist Anthony Marsella has written extensively about culture and depression, pointing out that in many cultures, depression is often expressed through the body, with such symptoms as back pain or stomach distress.

In recent years, there has finally been recognition by American psychiatrists that some behaviors are culturally prescribed ways of describing distress that may or may not have psychopathological significance. Two culture-bound syndromes will serve as examples:

Koro (East and Southeast Asia): an episode of sudden and intense anxiety in which the penis (or in the rare female cases, the vulva and nipples) will recede into the body and possibly cause death

Anorexia nervosa (North America, western Europe): severe restriction of food intake, associated with morbid fear of obesity

These syndromes indicate the important role that cultural beliefs and mores play in determining mental health and illness.

SEE ALSO Torres Straits Expedition (1898), American Classification of Mental Disorders (1918), The Golden Cage (1978)

Voodoo altar with several fetishes in Abomey, Benin, 2008. West African followers of the Vodun religion believe that such objects possess divine powers of rejuvenation.