CultureBound Syndromes
The term folk illness has been used to refer to many conditions not recognized in biomed-icine, such as soul loss, bewitchment, and possession. Because of negative connotations of "folk," other terms have been introduced to refer to these maladies found in ethnomedical traditions around the world. Culture-bound syndromes refer to culturally recognized illnesses such as witchcraft or soul loss that are not included in biomedical or psychiatric diagnostic systems. Besides soul loss, these include "penis shrinkage" (in Chinese, koro), magical fright (in Spanish, susto), and "nightmare deaths." Culture-bound syndromes are conventionally understood as culturally specific systems of behavioral, psychological, cognitive, and emotional disorders that derive from the psychological, interpersonal, and social dynamics specific to a culture. Most conceptualizations of these syndromes have assumed that they are cultural illnesses without a biological basis. Yet, there are similarities, perhaps even universal manifestations, of some ethnomedical syndromes. Are these diverse illnesses derived from biology, from culture, or both?
Culture-bound syndromes are generally viewed in standard biomedical or psychiatric diagnostic schemes as not being real. This perspective has ethnocentric biases, reflecting cultural assumptions regarding what is real. Should only conditions with a biological cause be considered real? Even if not a physical disease, an illness may have consequences for mortality, as illustrated in Rubel's long-term study of susto (Rubel, O'Nell, and Collado, 1985).
The assumption that culture-bound syndromes are derived from a single set of cultural circumstances undermines any effort at scientific comparison and explanation. The classic notion of "culture bound" implies its presence in a single culture and, by extension, that the condition is a consequence of cultural and social causes, not biological factors. There are similarities in this syndrome in distinct regions of the world, implying that some have a biological basis (Simons and Hughes, 1985). Some ethnomedical syndromes
Some characteristic features of their nightmares are not unique to the Hmong, but parallel the "old hag" syndrome, a form of sleep paralysis reported in Newfoundland (Ness, 1985). This is an immobilizing dream in which one typically experiences an "old hag," a person or large animal, seated on one's chest while one struggles violently to free one's self. The individual normally leaves the paralyzed state and comes to full consciousness when touched or spoken to but feels exhausted. A well-recognized medical syndrome known as sleep paralysis exemplifies the physiological characteristics of being awake but unable to move, clarity of consciousness, and awareness of surroundings, often coupled with high levels of anxiety. This condition is recognized in the medical literature but not in psychiatrists' diagnostic categories (DSM). If it were more prevalent in our culture, it might become a clinical and diagnostic concern.
involve recognized biological conditions not yet formally categorized in the DSM, as illustrated in the cross-cultural manifestations of a sleep paralysis syndrome.
The parallels between the Hmong and Newfoundland cases illustrate why there are questions about the validity of the assumptions of culture-bound, implying unique cultural conditions that cannot be compared cross-culturally. Anthropologist Hahn (1995) has criticized the concept of a culture-bound syndrome as obscuring the interactive roles of culture and biology in illness, giving the false impression that some illnesses are culture-specific and independent of biology. This implication distracts from the multidis-ciplinary approaches necessary to understand the manifestations of illness in the interaction of one's physiology with mind, self-concept, and social relations.
An alternative to the term culture-bound syndrome is culture-reactive syndrome (Hughes, 1985). Rather than viewing these illnesses as specific and exclusive to a single culture, culture-reactive syndrome includes the possibility that a variety of cultures may produce similar psychological disorders. The concept of culture-reactive syndrome emphasizes that local cultural conditions or social relations predispose members of a population toward particular kinds of disorders. For instance, cultures that induce a lot of sexual anxiety produce the psychological generation of anxiety, illustrated in the genital retraction syndrome.
The perspective of a culture-reactive syndrome emphasizes the importance of considering the sociocultural factors disposing particular kinds of illness disorders. For instance, cultural factors in complex industrial societies may predispose our own culture-bound syndromes in conditions such as premenstrual syndrome, type A personality, agoraphobia (fear of leaving the house), obesity, anorexia nervosa, and road rage. The concept of "culture-reactive" nonetheless has problematic assumptions in implicitly suggesting that some ailments are not "cultural reactive." As discussed in Chapter Two, even physical diseases have cultural dynamics, a reaction to the cultural and social milieu, rather than
Post a comment