Culture-bound Syndrome - Medical Perspectives

Medical Perspectives

An interesting aspect of culture-specific syndromes is the extent to which they are "real". Characterizing them as "imaginary" is as inaccurate as characterizing them as "malingering". Culture-specific syndromes shed light on how our mind decides that symptoms are connected and how a society defines a known "disease". The American Psychiatric Association states the following:

The term culture-bound syndrome denotes recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. Many of these patterns are indigenously considered to be “illnesses,” or at least afflictions, and most have local names. Although presentations conforming to the major DSM-IV categories can be found throughout the world, the particular symptoms, course, and social response are very often influenced by local cultural factors. In contrast, culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations.

Medical care of the condition is challenging and illustrates a truly fundamental but rarely discussed aspect of the physician-patient relationship: the need to negotiate a diagnosis that fits the way of looking at the body and its diseases of both parties. The physician may do any of the following:

1. Share the way the patient sees the disorder, and offer the folk medicine treatment
2. Recognize it as a culture-bound syndrome, but pretend to share the patient’s perspectives and offer the folk medicine treatment or a new improvised treatment
3. Recognize it as a culture-bound syndrome but try to educate the patient into seeing the condition as the physician sees it

The problem with choice 1 is that physicians who pride themselves on their knowledge of disease may like to think they know the difference between culture-specific disorders and "organic" diseases. While choice 2 may be the quickest and most comfortable choice, the physician must deliberately deceive the patient. Currently in Western culture this is considered one of the most unethical things a physician can do, whereas in other times and cultures deception with benevolent intent has been an accepted tool of treatment. Choice 3 is the most difficult and time-consuming to do without leaving the patient disappointed, insulted, or lacking confidence in the physician, and may leave both physician and patient haunted by doubts ("Maybe the condition is real." or "Maybe this doctor doesn’t know what s/he is talking about.").

The term culture-bound syndrome has, in many ways, been a controversial topic since it has reflected the different opinions of anthropologists and psychiatrists. Anthropologists have a tendency to emphasize the relativistic and culture-specific dimensions of the syndromes, while physicians tend to emphasize the universal and neuropsychological dimensions (Prince, 2000; Jilek, 2001). Guarnaccia & Rogler (1999) have argued in favor of investigating culture-bound syndromes on their own terms, and believe that the syndromes have enough cultural integrity to be treated as independent objects of research. Some studies suggest that culture-bound syndromes represent an acceptable way within a specific culture (and cultural context) among certain vulnerable individuals (i.e. an ataque de nervios at a funeral in Puerto Rico) to express distress in the wake of a traumatic experience. A similar manifestation of distress when displaced into a North American medical culture may lead to a very different, even adverse outcome for a given individual and her family.

The definition of such conditions logically leads to the conclusion that they are viewed within their culture as "normal" in the limited sense of a readily possible, if not necessarily common or beneficial, manner of behavior. This probably accounts for the scarcity of English-language work on Western culture-bound syndromes, though these conditions are existent and some researchers have attempted to treat with the phenomena in their own parent cultures.

In 1980, social anthropologist and physician Dan Blumhagen put forward the theory that folk illnesses and formal medical illnesses are not mutually exclusive. Based upon his research with hypertension sufferers he concluded that the condition can be misdiagnosed by the layperson by associating the plain English name of illness with its literal meaning; in this case all pressure or "tension" in the extremities could be self-diagnosed as hyper-tension.