Culture-Bound Syndromes

Mental health functioning is important regarding a person’s well-being, being able to interact with others in a healthy manner, and contributes many things to individual’s through communities and society. Culture-bound syndromes are conditions that are specific to particular cultures. The cultures that experience, express, and deal with culture-bound syndromes in different ways is extremely common. LaVeist and Thomas (2005) state that “culture-bound syndromes are clusters of symptoms more common in some cultures than others” (p. 01).

There are symptoms that are found in all nations, cultures, and similarly recognizable worldwide but yet are different at the same time. Culture-Bound Syndromes Culture-bound syndromes, also known as culture-specific syndromes, have been defined as “clusters of symptoms more common in some cultures than in other cultural groups” (LaVeist & Thomas, 2005, p. 101). Although many mental disorders are well known in specific cultures, these disorders are at least somewhat conditioned by the culture in which they are found.More importantly, the topic of culture-bound syndromes has “been a controversial topic since they have reflected the different opinions of anthropologists and psychiatrists” (WHO, 1992). Consequently, researchers have had some difficulty emphasizing culture specific dimensions of certain syndromes. Some studies have suggested that the most beneficial aspect of defining culture-bound syndromes is that they represent an acceptable way to define specific cultural responses to certain situations.

According to Guarnaccia and Rogler (1999), “researchers have referred to culture bound research on culture-bound syndromes serves strategically to tighten the integration between cultural and clinical knowledge, while providing insights into issues of diagnostic universality and culturally specificity” (p. 1326). The role of biology in the development of culture-bound syndromes, therefore, has proved to be of debate. Interest in culture-bound syndromes has increased over the last few decades.Similarly the treatment in a diagnostic classification treatment of these disorders has over the last several years gained attention (Guarnaccia & Rogler, 1999). Clinicians are presented with plenty of challenges when dealing with culture-bound syndromes such as how to diagnose them. Several questions clinicians present include the stability of culture-bound syndromes, the common nature of these disorders across cultures, and the similarity of symptoms between syndromes (APA, 1994).

Similarly, the question of whether culture-bound syndromes should be included in the diagnostic criteria of current psychological illnesses or as individual entities themselves is also debatable (APA, 1994). Another issue concerns the relationship between culture bound syndromes and standard diagnostic systems such as the DSM. Of specific concern is that they do not easily conform to the categories within the DSM due to significant differences across cultures.These differences are due to differing views of self and reality as well as the different ways cultures express certain disorders (APA, 1994). Guarnaccia and Rogler (1999) referring to the DSM classification system in that it addresses certain concerns about differing cultural boundaries, and in dealing with the classification methods certainly deal with the reliability and validity of the non-universality of cultural experiences in relation to mental illnesses.The fact that each culture-bound syndrome is individually associated with particular sets of illness responses, it is difficult to define precisely the definition of the culture-bound syndromes as a unit. Culture-bound syndromes as therefore comprised as several different illnesses and afflictions.

LaVeist and Thomas (2005) thoroughly expresses the dynamic nature of culture-bound syndromes when they state: The symptoms of mental disorders are found in all nations and in all cultures; there are recognizable symptoms that are common worldwide.Mental health researchers have not yet been able to determine whether culture bound syndromes are indicative of one or more possibilities that include distinct disorders that exist only in specific cultures, and reflect different ways in which individuals from different cultures express mental illness, as well as reflecting different ways in which the social and cultural environment interact with genes to produce disorders, or any combination of these. (pp. 01) With the following information in mind, it should be noted that not all disorders are considered pathological; some behaviors are seen as ways of expressing and communicating distress to members of a certain culture and are seen as culturally accepted responses (APA, 1994). In fact, cultures experience, express, and cope with feelings of distress in various ways that may counter what Western societies see as common. Furthermore, at times these cultural differences are referred to as idioms of distress.Understanding the expression of these idioms (for example somatization, which is a physical representation of distress that is typically accompanied by symptoms such as abdominal or chest pain, heart palpitations, dizziness or vertigo, and blurred vision) allows clinicians to be more aware of the diagnoses they give (LaVeist & Thomas, 2005).

Culture-bound syndromes can also appear to be similar within several cultures. Furthermore, a culture specific syndrome can be categorized by various things.The APA (1994) characterizes culture specific syndromes as the following: categorization as a disease in the culture, familiarity within a widespread culture, people with lack of familiarity of specific conditions from other cultures, and the use of folk medicines that particular cultures use as a conditioned sense of usage within a specific culture. More specifically, culture-bound syndromes are not the same as geographically localized diseases with specific biological causes, such as kuru or sleeping sickness, or genetic conditions limited to certain populations, like sickle cell anemia (APA, 1994).Discussions of culture-bound syndromes have often concerned the amount of different categories of syndromes present in the world today. Many culture-bound syndromes are actually specific cultural representations of illnesses found elsewhere in the world. Some of these responses are not necessarily psychological illnesses but rather are explanatory mechanisms like witchcraft (Simons & Hughes, 1985).

Beliefs in witchcraft could seem to be a little farfetched as a type of culture-bound illness; however, it is supposed that witchcraft can lead to behaviors that can be seen as disordered.This concept is of particular concern to medical and psychiatric anthropologists because culture-bound syndromes provide examples of how cultural specific symptoms can evolve into psychological illnesses. Just because these responses may not begin as disorders, however, does not devalue the fact that they are illnesses and should be taken seriously (Simons & Hughes, 1985). The American Psychiatric Association (1994), states that the Western scientific perspective characterizes culture specific syndromes as imaginary and has no way of clearly being able to show why someone cannot understand that perspective.According to the APA (1994), physicians will share many things about a disorder with the patients and help them try to understand how they see their particular disorder; they also use folk medicine treatment if the patient asks for that if it is a culture-bound syndrome. Another thing is that a physician may falsify a patients perspective to offer folk medicine treatments that are available or maybe for a new and improved treatment strategy. Lastly, the clinician should educate the patient on being able to recognize their condition as a culture-bound syndrome so that the clinician may treat them as they see fit.

Guarnaccia and Rogler (1994) said that specific conditions are very challenging within medical care and illustrate rarely discussed aspects of fundamental aspects of physician to patient relationships, a diagnosis that is the best fit for the way of looking at the body and its diseases are easily negotiated if both parties can be found. Restrictions of the diagnostic classification systems of culture-bound syndromes have complications with certain additions within the iagnostic classification systems and have raised many questions. It is not quite clear on whether culture-bound syndromes are actually different from conventional syndromes or if they are just categorically different. Some people like to argue that some culture-bound syndromes are not just limited to specific cultures but are widely experienced throughout the world. Many of the syndromes that have been labeled as culture- bound are compromised by many mixtures of indicators that have been witnessed collectively.Culture-bound syndromes are lacking in diagnostic regularity and legitimacy making it extremely difficult to reach widespread straightforward criteria to describe these illnesses because of problems in language. “In the development of the DSM, its designers tried to create a diagnostic system that was well-suited with a broader and more worldwide medical organization system that is, the International Classification of Diseases, Injuries, and Causes of Death (ICD) developed by the World Health Organization” (WHO, 1992).

Therefore, the DSM implements a medical model of diagnosis for which many mental disorders, regardless of whether their background is biological or psychological, is viewed as mental illnesses and requires treatment. Furthermore, this model is implicit and assuming that mental disorders are under the compromise of behavioral or psychological symptoms that can form definable patterns or distinct forms of a particular syndrome (Guarnaccia & Rogler, 1994).The authors of the DSM definitely made a careful choice to accept a clear-cut categorization of mental illnesses. It is important to notice, however, that the DSM does not make the assumption that all mental disorders are discreet entities with absolutely no boundaries. Finally, before methodology is discussed, examples of what culture-bound syndromes actually are is important to include. The case of Koro “provides an example of shifting diagnostic classifications because of changing decisions about which symptoms are predominant.For example, Koro was first categorized as a somatoform disorder on the basis of the perception of the afflicted person’s intense preoccupation with a somatic concern, the retraction of the penis” (Bernstein & Gaw, 1990).

“More recently, Koro was categorized as an anxiety disorder and noted that others have associated Koro with panic disorders” (Levine & Gaw, 1995, p. 1323). Second, the debate of the relationship between culture-bound syndromes and psychiatric disorders according to symptoms is evident in the case of Latah Levine & Gaw, 1995). More specifically, “a debate about Latah focuses on which theoretical perspective should prevail; Simons and Hughes argued that the predominant feature of Latah is the neurophysiological startle reflex, culturally elaborated into Latah in Malaysia” (Simons & Hughes, 1985, p. 1323). Therefore, each disorder represents responses specific to certain cultures while also explaining the different ways cultures respond to events. MethodUnderstanding culture-bound syndromes requires looking at multiple sources that give a broad range of information regarding the topic.

For this paper I felt that it was necessary to use the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders because it gives plenty of information regarding culture-bound syndromes. The Diagnostic and Statistical Manual of Mental Disorders is extremely useful in the fact that it allows a health educator to become more acquainted with culture-bound syndromes that are unique and unusual to our specific field of study.Guarnaccia and Rogler and their research on culture-bound syndromes is informational in that they give a comprehensive look at culture-bound syndromes through the classification system and allow one to focus more on specific syndromes, such as Koro and Latah. LaVeist and Thomas from Chapter 5 in Minority Populations and Health are really informational along the lines of mental health, mental illness, and mental health problems.They give a more thorough explanation of basic background information on the previously stated information and topics and yet still remain in-depth when looking at specific aspects of mental health. They describe mental health, mental health problems, and mental illness in more detail and allow for the interpretation of others reading their work to help fuel one’s own judgments on those topics. I also used various sources to address other topics relevant to culture-bound syndromes.

For example, Bernstein and Gaw specifically addressed Koro, which I used as an example of a culture-bound syndrome.Another example, Simon and Hughes addressed Latah, I felt it was necessary to use examples of both Koro and Latah to help show what culture-bound syndromes were exactly and what they meant to cultures that were not American and how the cultures that were affected by these syndromes. The method I used for identifying and locating sources mainly dealt with trying to find a broad aspect of culture-bound syndromes and basic information on this particular subject. The rationale for choosing the specific sources was along the lines of being able to find enough useable information that could allow me to get my points across.When searching the electronic databases and the library at Central Arkansas University I was mainly looking for a broad range of topics that could fulfill the various information needs I had for this paper. I wanted to look at the topic on multiple levels, including cross-cultural, the way culture-bound syndromes affect others, and the ways in which these disorders are specifically associated with mental illness. Analysis & Discussion The grouping of culture-bound syndromes into qualified diagnostic categories usually is based on a perception of their principal indicators.

But the bigger issue itself of classifying a majority of symptoms is definitely challenging, as exemplified in the cases of Koro and Latah. Problems most definitely arose when conclusions were built on general, typical descriptions of the syndrome that are then linked with the textbook criteria of psychiatric diagnoses. The present method of studying the same set of readings and engaging in the classification process with them does not, from my viewpoint, promote the consideration of culture-bound syndromes.The approach of trying to find the right classificatory organization by basing it on the similarity between certain symptoms that include maybe one or two of the same grouping within the syndrome as well as the DSM groupings as the main organizing arrangement of significance to the culture-bound syndromes is not expected to produce new answers to the questions about the classification system. There are many syndromes that have different names that are seen from a variety of cultures that are basically the same set of behaviors, but culturally are explained in slightly different ways.Occasionally, on certain remote instances the arrangement of the behavior that is recognized as a culture-bound syndrome occurs in an area that is far from individuals where the termed and elaborated syndrome is an endemic. Conclusion & Recommendations Some major challenges that can help the classification system out is that the same distress responses may be stated differently as a result of cultural cues, language variances, and changes in experience.

In addition, the American Psychiatric Association (1994) notes that some examples of cultural structuring and or human behavior knowledge regarding illnesses are stated in Western classification systems more commonly known as the DSM. Thus, the challenge to categorize culture bound syndromes, whether as diverse syndromes or as part of an already categorized illness, is an activity that is inseparably tied to a certain culture. Also it has been suggested the ways that cultures and their social methods can limit the expansion of an internationally valid system of identification.Guarnaccia and Rogler (1999) suggests that classification of culture-bound syndromes are better than recording symptoms due to the fact that examining the context and symbolic structure of cultural reactions yield a better turnout. The main themes of most discussions over culture-bound syndromes is that such illnesses personalize symptom patterns that are somewhat linked in some significant way to the specific cultural setting in which they have occurred within.Because most of the syndromes are separate from the theoretical outlook of the Western medicine systems, they are quite often disregarded in serious analyses and therefore are carelessly overlooked for helpful mediations. These disorders appear to reside in a figurative twilight zone of psychiatric diagnosis and are viewed as highly mysterious.

To nearly everyone, the behavior and outlooks common to one’s own culture seem natural and/or rational in most parts, while those derived from other cultures appear abnormal, culture-specific, or arising from irregular conditions.Most clinicians are more than likely to think through the justification of culture when presenting a patient’s problem, especially when he or she is from a cultural setting other than the clinician’s own. However, cultural factors are a considerable part of every disorder and expressive in the outlook of specific components. Nonetheless, all psychiatric illnesses are culture bound to a certain degree. The divisions of psychiatric illnesses of culture-bound syndromes are those found only in inadequate cultural areas.Though culture does shape all illness behavior, it is always hypothetically informative to ask why any given syndrome appears to be present or not in a given culture. In recent years, the mindfulness of cultural diversity and of the role of culture in all illnesses has greatly been improved.

Because of the interpretations into the relationships between individual psychopathology and culturally firm practices and beliefs that the study of culture-bound syndromes offers, an interest in these syndromes has grown greatly over the past several years.Health educators in dealing with culture-bound syndromes would be able to help Center for Disease Control officials in many aspects. Since culture-bound syndromes are very common among many cultures around the world, health educators who deal with particular syndromes could help assess and implement many programs that can help with assessing many syndromes that afflict many cultures throughout the world. In a classroom setting, health educators can teach students how to spot syndromes and treat them to an extent in which helps their particular culture, community or society.Health education programs that are implemented within colleges and universities can stress that culture-bound syndromes are very serious and need to be treated like any other mental health disease that we as educators deal with and try to diagnose every day. I believe that policies and procedures that are already implemented within our culture are doing a good job in trying to handle culture-bound syndromes. Educationally, I believe that there are definitely some great programs that try to help with identifying and dealing with culture-bound syndromes.

References American Psychiatric Association (APA). 1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: DSM-IV. Washington, DC. Bernstein, R. L. , & Gaw, A.

C. (1990). Koro: proposed classification for DSM-IV. American Journal of Psychiatry, 147, 1670-1674. Guarnaccia, P. J. , & Rogler, L.

H. (1999). Research on culture-bound syndromes: New directions. American Journal of Psychiatry, 156(9), 1322-1327. Hall, T. M. (2008).

Culture-bound syndromes in China. Retrieved from http://homepage. mac. com/mccajor/cbs. html LaVeist, T. A. , & Thomas, D.

(2005). Mental health. In T. A. LaVeist (Ed. Minority populations and health: An introduction to health disparities in the United States (pp. 83-107).

San Francisco, CA: Jossey-Bass. Levine, R. E. , & Gaw, A. C. (1995). Culture-bound syndromes.

Psychiatry Clinic North America, 18, 523-536. World Health Organization (WHO). (1992). International Classification of Diseases, 10th Edition (ICD-10): Classification of mental and behavioral disorders. Geneva, Switzerland. Simons, R. C.

, & Hughes, C. C. (1985). The culture-bound syndromes: Folk illnesses of psychiatric and anthropological interest. Dordrecht, Netherlands.

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