Chapter 2
DISCUSSION
In what
way do diseases affect specific societies and cultures?
I.
Defining Culture-Bound Syndrome
Culture-bound
syndrome --also called culture-specific disease or folk illness-- is a generic
term for a series of symptoms that may be regarded by most of the populace in a
specific country or culture as a disease, many of which cannot be linked to a
particular category in the diagnostic and statistical manual for mental
disorders - IV (DSM IV).(Medical Dictionary, 2012)
In the past, medical anthropologists have categorized
that this disease is only found in the East and called "exotic psychotic
syndrome, as said by McLean and Ringe.
To
elaborate further, according to Carrie McLean and Alexanra Ringe:
"These
days, Western science takes it as a given that mental illness is rooted in
biology. But this approach ignores culture's role in shaping health: simply
put, different social environments create different mental health problems.
Psychiatrists used to call ailments limited to particular environs "exotic
psychotic syndromes" until it dawned on them that Western culture has its
syndromes, too--namely, anorexia and bulimia nervosa."
As the
name implies, it is an illness which is defined as such by those within the
culture or society. Dr. Yatan Pal Singh Balhara defines the term in his article.
“Culture-bound
syndrome is a broad rubric that encompasses certain behavioral, affective and
cognitive manifestations seen in specific cultures. These manifestations are
deviant from the usual behavior of the individuals of that culture and are a
reason for distress/discomfort.”
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271505/)
With that
in mind, it can be safely assumed that culture-bound syndrome is mostly a
psychological manifestation unique only to those in a particular culture. As
the name implies, the illness is “bound” to a certain culture only, and found
nowhere else. But an argument by Ronald Simons (Psychiatric Times, 2001) stated,
“Since
many of the culture-bound syndromes are not really syndromes, another term is
needed to signify what we are talking about. Furthermore, not only are many of
these conditions not syndromes, but some are not bound to a single culture.”
He also states:
“To
date, no one has come up with a really good name for this group of conditions.
Thus the name culture-bound syndrome persists simply for lack of a better term”
The term,
just like “disease”, is still broad, with no solid foundation in and of itself.
Culture-bound syndrome implies that the illness in question can be found in
only one particular area of the world.
To drive
the point further, Carrie McLean and Alexanra Ringe states:
"Culture-bound
syndromes are not linked to a particular culture in a particular time and place
so much as to a prominent cultural emphasis. Cultures that place high
importance on fertility, for example, may fuel fears of semen loss."
Elaborating
on this quote, a country's culture is influenced by a number of other countries
throughout history. Thus, if one keeps this in mind, it can be safely assumed
that it cannot be said that a country has a unique history that is entirely
different than those around it.
With
these in mind, the researcher would like to propose that, although culture-bound
syndrome itself is a common and widely accepted phenomenon that happens throughout
the world, the definition and term these groups of mental inflictions are still
vague and broad. It would be better if the definition and categorization would
be rather specific, or at least give the diseases specific sub-categories as to
not mix up their types.
II.
Types of Culture-Bound Syndrome
As
stated from previously, culture-bound syndrome has a broad definition, as the
disease under the category cannot be placed in a single and specific group.
Thus, many diseases put under culture-bound syndrome may not be recognized by
professionals as a legitimate. Some examples of these are:
Kuru
–
Also known as the laughing sickness, Kuru is a culture-specific disease that is
also closely related to Creutzfeld-Jakob. According to an article
by David O’ Neill, “the symptoms
include palsy, contracted face muscles, and the loss of motor control resulting
in the inability to walk and eventually even eat. Kuru victims become
progressively emaciated. The South Foré called this disease
"trembling sickness" and "laughing sickness."”
(http://anthro.palomar.edu/medical/med_4.htm)
As with
any disease affecting the nervous system and brain, the disease causes losing
control of one’s own body, progressively getting worse. And in the same article
by the author, there has been no known cure for this disease.
It was
found only in South Fore, New Guinea that spread due to the consumption of the
deceased’s flesh. According to the same author, at the beginning
of the 20th Century, the disease started to progress, and became
more common throughout the 1950’s. Because of this, it caused a social problem
among the tribe, as the women –who usually takes care of the children- are
bedridden, and the men are forced to take care of their offspring as a result.
According
to Francesca Fiore, whose article has already been removed due to unknown
reasons,
They
weren't, for the most part, what we have come to think of as cannibals in
Western culture. They didn't contract the disease from so-called headhunting.
They became afflicted with Kuru from their bizarre funeral customs
Anorexia
nervosa
–
An eating disorder prevalent in Western society, wherein the sufferer restricts
himself or herself from eating to the point of unhealthiness, along with it is
the fear of gaining weight, and a distorted self-image. As stated by Elizabeth
Hopton, “the relationship between how an individual evaluates
himself (self-image) and his body (body image) can at best be defined within
loose term.”
An individual’s
self-worth is related to how he perceives he is physically and mentally. But as
most can attest, it is mostly through physical means, as it is normally what
one judges on another person. Not only is the individual’s own self-esteem can
cause this disorder, but also environmental effects as well. As from the
researcher above stated,
“The
secularist conceptualization of AN points to trends in modern Western society
as being responsible for motivating extreme dieting and weight-concern. In
particular, the media has been popularly cited as promoting an unrealistic
aesthetic ideal of the young female body, resulting in an unhealthy
preoccupation with body size.”
Since Western society’s
standard of beauty is high, and is very influential throughout the culture, it
causes stress on its populace, mostly women, to achieve the same standard to be
accepted by their peers, resulting in extreme dieting and distorted self-image
that results to this.
Although the practice
is, according to the same researcher above, “[self-starvation] date back to the
Hellenistic era, the first medical description of AN was not published until
the mid-19th century, and it has been argued that the diagnostic
classifications in use today (DSM-IV and ICD-10) represent a modern
reconceptualization of the pathology underlying the disorder (Habermas, 2005;
Pearce, 2004, 2006).”
Another eating disorder due to similar reasons is
called Bulimia nervosa, although both Anorexia and Bulimia are mixed up with
each other more often than not.
Wendigo
psychosis
- Also
known as “Windigo Psychosis”, it is a culture-bound syndrome wherein the person
inflicted has --as with the legend-- an insatiable craving for human flesh
despite the fact that the person in question is not in a sort of famine. The
origin is that of the Wendigo, a feared mythological creature that was once
human, but turned into a malicious spirit because the human in question
consumed human flesh.
There
have been reports that this occurred within the Algonquian native tribes, to
which the myth of the Wendigo originated.
According
to Chris Hibbard, “The initial symptoms (thought to be psychosomatic) of the
Windigo Psychosis were depression, distaste for most ordinary foods and a
subsequent poor appetite, nausea, and vomiting, followed by periods of
semi-stupor. Gradually, the victim becomes obsessed with paranoid ideas of
being bewitched and is subject to homicidal and sometimes suicidal thoughts. He
feels that he has been possessed by the Windigo spirit or monster and it is
controlling him, it is this delusion that gives the psychosis its name.”
(http://articles.latimes.com/1990-03-24/news/mn-721_1_sudden-unexplained-nocturnal-death-syndrome)
He also
adds that “An affected person may see the people around him or her turning into
beavers or other edible animals, leading the victim to become violent,
homicidal, and cannibalistic. It is commonly thought that once this stage is
reached and the victim has tasted human flesh, he or she must be killed.”
A famous example of this is the account of a
man named Swift Runner, who killed his wife and five children despite living 25
miles away from the nearest resource center.
According
to Chris Hibbard:
“During
the winter of 1878, Swift Runner and his family were starving, and his eldest
son had died. Within just 25 miles of emergency food supplies at a Hudson Bay
Company trading post, Swift Runner acted out on his delusions, butchering and
eating his wife and five remaining children. He eventually confessed, and was
executed by authorities at Fort Saskatchewan. That he resorted to cannibalism
so near to food supplies, and that he killed all those present
indiscriminately, reveal that Swift Runner’s was not a case of pure cannibalism
(a last resort to avoid starvation) but rather a man suffering from Windigo
Psychosis and becoming a homicidal cannibal.”
Bangungot
– Also known as Sudden Unexpected Death Syndrome.
The sufferers are mostly young men; and as the name implies, this is a
culture-bound syndrome wherein the sufferer sleeps and never wakes up.
An example
of the case is in a written article by Charles P. Wallace, where “a decade-old medical mystery that has confounded investigators in the United States and Southeast Asia by killing young, apparently healthy Asian men in their sleep has taken a new turn with the deaths in a single day of two Thai construction workers in the island republic of Singapore.”
(http://articles.latimes.com/1990-03-24/news/mn-721_1_sudden-unexplained-nocturnal-death-syndrome)
The
phenomenon is also prevalent in the Philippines, as the researcher herself can
attest. Parents in the country would always warn their children to never eat
before sleeping, as the illness may happen to them.
Taijin
Kyofusho
-
In Japan, this is a social phobia wherein the individual shows fear of social
events which may cause embarrassment for them.
According
to Dustin Saunders, “Taijin kyofusho, centers on concerns about embarrassing
others with one's presence, rather than embarrassing one's self in the presence
of others. TKS is believed to emerge out of a childhood history of social
inhibition and shyness. The disorder may abruptly follow a stressful or
humiliating experience or its onset could be more subtle in nature with the
lifetime course of the disorder usually existing on a continuum.”
(http://www.brainphysics.com/taijin-kyofusho.php)
It is a culture-specific syndrome that's unique in
Eastern society. In Western societies, this disease is mostly foreign, and
unheard of.
According to the same researcher above, Taijin
Kyofusho is divided into sub-categories.
·
Sekimen-kyofu: the
phobia of blushing
·
Shubo-kyofu: the
phobia of a deformed body (similar to body dysmorphic disorder)
·
Jikoshisen-kyofu: the
phobia of eye-to-eye contact
·
Jikoshu-kyofu: the
phobia of having foul body odor (similar to olfactory reference syndrome)
As Japan
is possibly the only country where this is found, it is not surprising to see
that the prevalence is high. As Dustin
Saunders states, “taijin kyofusho affects 10-20% of the Japanese population.” He
also says that majority of those inflicted are male, despite the fact that
their female counterparts are more prone to be embarrassed than males, and even
scoring high on the social phobia scale.
The
Jumping Frenchmen of Maine
-
As the name implies, it is a culture-bound syndrome found exclusively in Maine.
According to Alasdair Wilkins, the symptoms of those inflicted are “when
startled, the men would display exaggerated, and apparently reflexive,
reactions that included jumping, yelling, hitting, obeying commands, repeating
back phrases even if they didn't understand the language used (a phenomenon
known as echolalia), and imitating how other people moved (echopraxia). The men
were also said to be shy and very ticklish.”
(http://io9.com/5893214/the-jumping-frenchmen-of-maine-is-historys-most-startling-mental-disorder)
To quote,
the phenomenon was first investigated by neurologist George Miller Beard in
1878.
“He
argued for several psychiatric reforms meant to protect the mentally ill, and
he risked widespread public denouncement when he argued Charles Guiteau, the
assassin of Present James Garfield, should be found not guilty by reason of
insanity.” Alasdair Wilkins says.
Though
not the most significant in his research, the illness in question did have the
strangest. The cause of the illness “may have had some genetic component,
considering most of the sufferers were closely related and came from one of
four families, but that may just speak to the insular nature of the
French-Canadian lumberjack community in 19th century Maine.” The same author
states.
III.
Influence of Culture-bound Syndromes in Societies and Cultures
One
positive influence of culture-bound syndrome is the fact it gives way for
researchers and modern anthropologists a chance to discover more about the
disease, and find a way to help those in their countries. In an article about
Taijin Kyofusho, an illness which is foreign in the Western world, Dustin
Saunders state that,
“Understanding
this disorder is clearly important to the many whom suffer from it, but this
cultural-bound syndrome is also an important aid in understanding the
differences between Western society and other areas of the globe.”
(http://www.brainphysics.com/taijin-kyofusho.php)
If one
were to think about it, culture-bound syndrome may help bridge an understanding
between differing cultures, and possibly bring cooperation in understanding
these symptoms and how it affects a certain society.
For
example, before this study has been conducted, the researcher has already known
that Japan is a country where courtesy and politeness is held in high regard.
One example is the many suffixes (i.e. –san,
-kun, -sama, etc.) that are added at the end of an individual’s name, and
calling someone without these –especially if it’s their first name-- it is
considered rude. Another example would be the various first person pronouns
that are used for specific individuals. In Japan, a woman who uses that
primarily male-oriented ‘boku’ is
frowned upon, and the rougher ‘ore’
is mostly scandalous to hear. On formal occasions, the gender-neutral ‘watashi’ is used, such as interviews,
etc.
If one
gains this knowledge and make a connection, then Taijin Kyofusho’s prevalence
would make sense in Japan. Thus, an understanding of a culture is established.
Another
positive influence is that the disease itself is a part of the culture’s
identity. Just like the example earlier, Taijin Kyofusho is a part of Japan’s
modern culture and developed as such. Another example would be an illness in
the Philippine’s called lanti. According
to Ronald Simons,
“In
certain parts of the Philippines, for example, when a person becomes ill in a
number of very different ways (fever, stomachache, shouting during sleep,
incessant crying, various skin ailments), it may be said that the individual is
suffering from lanti. This is a way
of saying that the presumed etiology of all of these complaints is having been
shocked or startled some time before.” (Psychiatric Times, 2001)
Another
disease found in the Philippines would something called pasma. This phenomenon is said to be caused by the interaction of
heat and coldness. A firsthand account of the researcher herself would be doing
laundry then ironing clothes. The sensation felt by the researcher as she did
the laundry then immediately ironing clothes gave her –such as numbness and
tremors—is a common sign of pasma.
Although it is not recognized by professional medicine, medical anthropologists
such as Micheal Tan do state that the phenomenon is legitimate.
To quote,
“I've been lecturing in several medical schools for several years now and I
keep urging health professionals to be more inquisitive about these illnesses
because even if these are not recognized by mainstream medicine, the ailments
are very real as far as people are concerned, causing suffering and may even be
cited as the cause of death, as in the case of "bangungot."” (The
Daily Inquirer, 2007)
This
illness has been a part of Filipino culture, and there is possibly no citizen
in the Philippines who has not heard of it, justifying that it does have a
major influence on a culture and its populace, shaping it to what the
traditional beliefs are today.
But as
everything else, there is also a downside to culture-bound syndrome’s
influence. A negative aspect of the disease, other than the signs and symptoms
leading to death, is the mass hysteria that could prove fatal to those
affected.
An
example would be the effect of Koro, which is, according to Caren McLean and
Alexanra Ringe,
“koro, or
genital retraction syndrome, is gripped by the fear that his penis is shrinking
and gradually being absorbed by his body. (Women suffer from koro, too--afraid
for their nipples or vulva--but this is much rarer.) A typical case of koro
goes like this: A man goes to urinate and notices that his penis is becoming
smaller. Usually this happens because he's in a cold place or because he's
upset about something--his sex life, for example. Both anxiety and exposure to
cold cause male genitals to shrink temporarily.”
And to
further elaborate, they state that “rather than shrugging the incident off, the
man--who has heard about koro attacks in his community--only grows more
anxious, particularly since koro is considered deadly. As panic mounts, the man
grabs his genitals before they can retract into his body and calls for help.”
This
culture-bound syndrome is found in cultures where one’s fertility is an
important aspect, such as China, Malaysia and India. It is purely
psychological, but the extent the sufferer would do to avert the so-called
retraction ranges from mild to severe. The physical effect is just as bad as the
psychological, as one’s fear can drive the individual to go through extreme
measures to alleviate the problem.
Thus, the
researcher then concludes that culture-bound syndrome is something that may not
only have a foundation for medical anthropologists, but also something that may
help different cultures to understand another that is entirely different from
their own. Its influence on the society it is found in is important, and gives
many people a gateway to understanding their cultures, and how it works.
