This paper reflects the research and thoughts of a student at the time the paper was written for a course at Bryn Mawr College. Like other materials on Serendip, it is not intended to be "authoritative" but rather to help others further develop their own explorations. Web links were active as of the time the paper was posted but are not updated.
2006 Third Web Paper
One's understanding of the outside world comes from a combination of what actually exists and what the brain tells us exists. One sees colors and hears sounds. Part of this perception is truth, the actual movement of electrons to make color and the vibrations in the air to make sound; and part of it is the fantasy our brain uses to make sense of the world; blue instead of red and high pitch instead of low pitch. This same need for sense in the world can be seen within the cultures of the world. The many cultures that exist contain beliefs that help those within it make better sense of the world. Especially with regards to remedies for health, treatment can come through spirituality, herbal remedies, and sacred rituals.
With these many views on the treatment of health disorders, also comes the occurrence of illnesses that vary from culture to culture. That is to say, syndromes that are found in some societies, but not within others. This is the basis of the definition given to culture-bound syndromes. The Diagnostic and Statistical Manual of Mental Disorders (DSM) "defines a culture bound-syndrome (CBS) [as] 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." A CBS, then, is an illness that is particular to a certain grouping of people and may or may not be identifiable using the methods of Western medicine. More interestingly, they often do not have a biological basis (1).
At the heart of CBS is culture. Culture is the shared beliefs, norms, and values of a particular group (2). Culture is also a creation of peoples, and of their brains, to make order, bring unity, and understand the world around them. In terms of CBS, culture is an example of how the brain, along with other brains, works to justify what is inexplicable in its surrounding environment. But, this justification is not equally seen by all the brains of the world. The same characteristics can even be seen differently by different brains.
The existence of CBS is something that is disputed among members of different disciplines. Currently, there are two main beliefs; on that CBS is rooted in biology and the other that it is rooted in culture. Robert Hahn and Ivan Karp have written about their opposing views with regards to CBS. In "Culture-bound Syndromes Unbound," Robert A. Hahn expresses his belief that biology, as well as culture, are important in disease, but that humans are too closely attached to their culture. One of his main beliefs is that the diagnosis of an illness as being culture-bound is flawed. For example, if one was to take a person trained in Western medicine and place them in another country with a different culture, they would find behaviors that seem abnormal to them. That observer would then return home after some time with a "new syndrome." This "new syndrome" is only found in that one place he visited, and is considered to be culture-bound. Hahn believes that during this evaluation process the biological basis of the "new syndrome" is being ignored. He believes that the condition must have a biological source, but due to the way it is represented in that different environment as well as it not fitting in with other known Western disorders, its origin is put in the culture; it is a culture-bound syndrome (3).
Ivan Karp shares a slightly different view. In "Deconstructing Culture-Bound Syndromes" he agrees with Hahn in that culture-culture comparison is to blame for the diagnosis of culture-bound syndrome. In the prior example, had the Westerner not compared the new culture with Western culture in such a negative light, he would not have believed the behavior to be a CBS. However, he also states that culture plays the most important role in the emergence of CBS. He believes that culture-bound syndromes do exist. Unlike Hahn who believes that there is only a biological basis to them, Karp thinks that there are different behaviors in cultures that point to the same overall behavioral sickness. He believes CBS is a real medical syndrome rooted in ones culture (3).
The difference in these two view points lies in what they view is the origin of CBS. Hahn believes it is biology, and that culture changes the ways one sees the symptoms. Karp believes that the foundation lies within the culture and that different cultures can have different ways of expressing the symptoms for the same behavioral illness.
The role of culture in CBS is in establishing what is acceptable and what is not within that culture and what should then be taken for illness based on those factors. An example of this is with anorexia nervosa. The behavior seen within anorexia which is considered non-adaptive in Western cultures may be seen as something entirely different in other cultures. But, in the Western world because of this view it is treated as a disease. This thought process is consistent with Karp's theory (3).
The existence of anorexia in the Western world is based within Western culture. Appearance, especially in women, is an ideal that is stressed in the Western world. Women must be slim and youthful to be considered beautiful and healthy. The opposite of these characteristics is viewed as ugly and lacking self-discipline. For some, anorexia is a way to obtain a desired body, while for others it is a means of self-discipline or control. These cultural values are what lead to the destructive behaviors that are associated with anorexia. In societies that are becoming more and more Western, such as Japan, anorexia is also becoming more and more common. This leads to the conclusion that the demands of Western culture on women are part of the prevalence of the illness within that society, and this makes anorexia nervosa a CBS (3).
Apart from recognizing that a CBS must be categorized as a disease within that culture itself, such as with anorexia, there are four more ways in which CBS is recognized. A CBS must have at least one of the following characteristics: be seen as a disease within the culture, familiarity within the culture, lack of familiarity to outside cultures, no demonstrable biological basis, and/or can be treated with folk medicine of the culture (4). Anorexia nervosa fits at least the first three descriptions from the list. It is seen as a disease within Western culture, it is familiar in Western culture, and it is not familiar to non-Western cultures. Another disorder to be noted is amok or mata elap that is known in Malaysia. It is an aggression disorder characterized by violent, aggressive, or homicidal behavior towards other people or objects. Amok is also similar to other disorders found in Polynesia, Puerto Rico and the Navaho Native-Americans. It can be seen as a CBS in that it does not have a biological cause, nor does it correspond to any illness within Western culture. Another example is shenjing shaijo, a depressive disorder in China. Shenjing shaijo is very similar to the Western diagnosis of major depressive disorder, but it only has the physical symptoms of depression and none of the emotional features (1).
Culture-bound syndromes are indeed something that is there. They are not imaginary with respect to cultural views, nor should they be undermined. They are real disorders that are greatly influenced by their cultural surroundings. As stated previously, culture is a way of creating order and unity within a society of people through the workings of the brain. The brain is working to change its environment, with culture, but the culture can rebound and then affect the brain. This is the case in CBS and explains why some syndromes are only seen in certain cultures and not others.
The environment the brain is found in differs for all of the cultures of the world. A different environment means slightly different brains among cultures of the world. And, within those cultures, individuals will also have slightly different brains from one another. This explains how boufée deliriante, a panic disorder, can be found among West African and Haitian populations, but not among others (1). The environment constructed by the African and Haitian culture demands different characteristics to be expressed by the brain. If these characteristics, or tasks, go astray, a disorder common only to that population will arise.
Culture-bound syndromes are an interesting phenomenon that results from the way groups of brains construct their environment. These constructions vary from place to place. With the acceptance of different values, norms, and customs, illnesses of the body and mind will be accepted and treated within varying degrees in different locations. Culture-bound syndromes could, as Hahn believes just be rooted in biology, but since many do not have any biological source it is hard to come to this conclusion for all disorders. Karp's views on the syndromes being rooted in the various cultural beliefs of the world, is an easier belief to follow. Although the actual origin of these syndromes can only be seen within the particular culture they affect, it is still important to realize that they are factors to consider when looking at health; especially in Western society which is often used as the standard for comparison.
1)Glossary of Culture-Bound Syndromes, This website contains a good list of the most common CBS found in Asia and other parts of the world. It give information on what criteria a CBS must have
2)Mental Health: Culture, Race, and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General, Although this report was not very relevant to the paper. The second chapter, Culture counts: The influence of culture and society on mental health, takes a look at cultural differences in mental health treatment in the United States. It can give a good idea of how CBS can make things difficult for both doctors and patients.
3)Culture-Bound Syndromes, This thesis on ADHD contains a section that looks at how it may be a CBS. It also looks at anorexia nervosa and the two main theories that surround the origin of CBS.
4)Culture-Specific Syndrome, This article from Wikipedia gives general information about CBS. It also has good links for further research at the bottom of the page.
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