February 02, 2012
Culture-bound Symptom Repertoire
Latif Nasser in the Boston Globe, on the Diagnostic and Statistical Manual of Mental Disorders:
If you turn to page 898 of the current edition — past the glossary and the alphabetical index of diagnoses — you’ll find a list of 25 little-known illnesses. These are the “culture-bound syndromes”: mental illnesses that psychiatrists officially acknowledge occur only within a particular society. Take, for instance, susto — a distinctly Latin American fear that one’s soul has panicked and left one’s body. Or pibloktoq, also known as “arctic hysteria,” in which Greenlandic Inuit strip off all their clothes and run out into the subzero Arctic tundra.See also, from a while ago:
Depending on whom you ask, the notion that some cultures have their own ways of going crazy is either the ultimate in cultural sensitivity or the ultimate in Western condescension. And although these syndromes haven’t attracted nearly as much attention as Asperger’s or binge eating disorder, they are starting to come under fire from critics who don’t think that the appendix belongs in the book at all. Since the last edition of the DSM, in lectures and research journal articles around the world, a cluster of psychiatrists, anthropologists, and historians has attacked the validity of specific disorders on the list. To these critics, the very notion of a “culture-bound illness” is an outdated relic from the days of European empires.
What is not on the table yet — and considering that the DSM is ultimately published by American psychiatrists, may never be — is a deeper acknowledgment that far more mental illnesses might be cultural than we currently think. After all, commonly cited Western syndromes like chronic fatigue syndrome or multiple personality disorder are unknown in many countries, and yet the 1994 manual includes no British or American syndromes in its “culture-bound” category.
To put them there now, Lewis-Fernández says, would be “politically unfeasible.”
“We might think of the culture as possessing a ‘symptom repertoire’ — a range of physical symptoms available to the unconscious mind for the physical expression of psychological conflict,” Edward Shorter, a medical historian at the University of Toronto, wrote in his book “Paralysis: The Rise and Fall of a ‘Hysterical’ Symptom.” “In some epochs, convulsions, the sudden inability to speak or terrible leg pain may loom prominently in the repertoire. In other epochs patients may draw chiefly upon such symptoms as abdominal pain, false estimates of body weight and enervating weakness as metaphors for conveying psychic stress.”
In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.
That is until recently.
For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.