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8.5: Mental Health and Culture-Bound Syndromes

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    Culture Bound Syndromes are those in which changes in behavior and experiences have substantial effects on peoples lives. These are identified as syndromes not sicknesses. A syndrome is a group of symptoms when present together are characteristics of a specific disorder, disease, etc.[6] The patterns of the symptoms that characterize or indicate can be of a particular social condition like heavy pollution. Syndromes can be a culture bound syndrome like Anorexia Nervosa or they can be a biological syndromes like Down’s Syndrome. The word syndrome comes from the Greek meaning “run together”. Medical anthropology describes culture-bound syndrome as a combination of psychiatric and somatic symptoms that are considered to be an identifiable disease that is only discovered within a specific society or culture. There are no changes in the biochemical or structural of body organs or functions, and the disease is not recognized in other cultures. A substantial portion of mental disorders are at least partially if not completely conditioned by the culture in which they are found. Some disorders however are more culture-specific than others. The concept of culture-bound syndromes is a controversial subject to which many psychologists, medical doctors and anthropologists reject the concept.


    Addiction is a serious mental health issue that is present in cultures worldwide. Addiction is the condition of being mentally or physically reliant to a chemical substance, action, or item. Addiction is often sprouted from an early age. Factors that can effect an individual's likelihood of becoming a substance abuser can range from their upbringing and environment in their youth, to the people they chose to surround themselves with later on in life. Many substances are highly addictive upon first use such as heroin. Heroin has become one of the largest health concerns in many countries with alarming rates of growth. According to 90,000 people in the United States reported trying heroin for the first time in 2006, compared to the alarming 156,000 people who tried it just 6 years later in 2012. Addiction often originates as a mental disorder through the cravings and desires of addicts, but can soon develop into a physical dependence which can lead to many negative health effects. Addiction to many different drugs including heroin almost always quickly deteriorates the addict's body and is very often fatal.

    Addiction can also occur due to cultural factors such as being addicted to a certain activity or a certain hobby a great deal to the point that it interferes with other activities that are necessary in everyday life for wellbeing.[11]


    Figure \(\PageIndex{1}\): High-fructose corn syrup, found in most soda beverages, is public enemy number one in the war against obesity.

    Obesity is a condition affecting more than 300 million people.[12] Obesity is most common in first world countries and it affects millions of people. Obesity the term used to describe a person who is overweight to the point that it becomes the cause of many other afflictions that could potentially threaten their life. A person is obese when their body mass index (BMI) exceeds 30 kg/m2 [12]The World Health Organization (WHO) considers obesity to be one of the top 10 causes of preventable death worldwide. Overweight individuals in developing countries are considered attractive and desirable due to connotations such as excess wealth, the ability to live lavishly and abundantly, etc. Interestingly, this is the opposite to the view of body weight in developed countries, where thinness implies beauty, wealth, and good health. One who is wealthy can eat a balanced and healthy (and often more expensive) diet and has the luxury, time and money to exercise in either a gym or with the help of a personal trainer.

    Ataque de Nervios

    Term used among Caribbean Latinos used to describe a culture-bound syndrome, or state of mind, characterized by uncontrollable shouting, crying, aggressiveness, shaking or trembling, fainting, and suicidal gestures. Ataque de nervios typically follows a stressful event - death of a loved one, divorce or other domestic conflicts. This affliction is shares features of a panic attack defined by the DSM-IV, an ataque, usually following a precipitating event, occurs in the absence of acute fear or apprehension, and is accompanied by amnesia for the ataque.

    Mal de Ojo

    Medical problems, such as vomiting, fever, diarrhea, and mental problems (e.g., anxiety, depression) could result from the mal de Ojo (evil eye) that an individual has experienced from another person. Mal de Ojo is initiated when a person of higher strength gazes upon the weaker counterpart out of envy or admiration.[13] The condition is common among infants and children; adults might also experience similar symptoms resulting from this mal de Ojo. There are many different ways in curing mal de Ojo. In Latin America the most common way is to have the parent rub an egg on the child while saying a prayer over the child then put the egg in a bowl and put it under the child's pillow. In the morning if the bowl has this white fog then you can tell the child was affected by the mal de Ojo. This process also cures it.[14]

    Eating Disorders

    Figure \(\PageIndex{2}\): Pop icons suffering from Anorexia have raised popular awareness to this disease.

    Eating disorders are defined as any of a range of psychological disorders characterized by abnormal or disturbed eating habits. The most common eating disorder is anorexia nervosa.

    Anorexia Nervosa

    Anorexia Nervosa is a eating disorder and is commonly shortened to anorexia. Anorexia Nervosa is a psychiatric illness which is specifically defined as the "obsessive fear of gaining weight". This fear causes the individual to avoid food consumption. This disorder most commonly affects young teenage girls. In total, males account for only 10% of the reported cases. Bulimia Nervosa is a similar culture-bound syndrome to Anorexia Nervosa in which purging is the method of losing weight. Many times people who have these eating disorders though do not have one strict eating disorder. It tends to be a combination of anorexia, bulimia and binge eating. For example, a person may restrict themselves to not eating, but if they do they may go and work out excessively and then binge eat after [15] In some cases however, these eating disorders are developed as a coping mechanism for problems other than the common fear of weight gain. Providing its victims with a sense of control, anorexia and bulimia can help ease the mind even if the goal is to find stability in areas other than weight loss.

    The process used to initially lose and prevent weight gain is voluntary starvation, but other methods such as purging, excessive exercise and the use of dietary pills are used also to control body image. One of the proposed reasons for the cause of this disease is the effect of images portrayed by the media on young women and men, demanding a necessity to be slim, because that is the only socially acceptable way to look

    Symptoms include:

    • Refusing, avoiding, or not wanting to eat in public
    • Anxiety
    • Weakness
    • Brittle skin
    • Shortness of breath
    • Obsessiveness about calorie intake
    • muscle loss/degeneration
    • Additionally, anorexic people have a tendency to create a distorted, negative view of themselves "Anorexia". [16]
    Figure \(\PageIndex{3}\)

    Body Image and Fitness

    Eating disorders such as anorexia nervosa are often caused by body image issues. Every culture around the world has varying ideas of what the “ideal body” should look like. These standards are especially high in the in United States. With an increasingly high exposure to social media, fashion magazines and beauty advertisements, adolescents in the US (especially young women) are feeling an increased pressure to obtain these “perfect bodies.” In recent years there have been cases of some people going to the extremes to be “perfect,” which are more often than not unhealthy and potentially life-threatening. For example eating disorders such as Anorexia nervosa or Bulimia nervosa.

    Avoidant/Restrictive Food Intake Disorder

    Avoidant/Restrictive Food Intake Disorder, or ARFID, is an eating disorder that was recently made independent from EDNOS (Eating Disorder Not Otherwise Specified) when the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) was released in 2013. Originally, there was a disorder labeled as "Feeding Disorder of Infancy or Early Childhood" which listed similar diagnoses, but this was removed in the DSM-V, as it was decided that ARFID was a disorder that also occurred in adults.

    The disorder itself can be described similarly to a phobic fear, and usually stems from anxiety around new and unfamiliar foods, rather than with body image and self-esteem issues that are associated with eating disorders such as anorexia or bulimia.

    To be diagnosed with ARFID, the DSM-V gives these criteria:

    • Disturbance in eating or feeding, as evidenced by one or more of:
    • Substantial weight loss (or, in children, absence of expected weight gain)
    • Nutritional deficiency
    • Dependence on a feeding tube or dietary supplements
    • Significant psychosocial interference
    • Disturbance not due to unavailability of food, or to observation of cultural norms
    • Disturbance not due to anorexia nervosa or bulimia nervosa, and no evidence of disturbance in experience of body shape or weight
    • Disturbance not better explained by another medical condition or mental disorder, or when occurring concurrently with another condition, the disturbance exceeds what is normally caused by that condition

    A person with ARFID acts similarly to a child who is a "picky eater." They typically have a small number of "safe foods" that they eat normally and do not have any trouble with for the most part, but most new or unfamiliar foods outside of their safe ones cause seemingly irrational and extreme (sometimes phobic-level) fear and anxiety, often leading to a full-on anxiety/panic attack or breakdown. This may be caused by a food's appearance, smell, texture, or any other number of reasons.

    Many teenagers and adults with ARFID have gone and continue to go undiagnosed and untreated for most of their lives, due to the disorder only being classified in recent years. It can also be assumed that the majority of people who have ARFID are completely unaware that their strange eating problems are likely a legitimate disorder, and not just "picky eating" that they never grew out of in childhood. ARFID can get in the way of not only a person's health, but also their social life: people with ARFID may tend to avoid social gatherings involving food, holidays that involve eating may become more anxiety-inducing than enjoyable, etc.

    While there has not been much research done on the treatment of ARFID, many people choose Cognitive Behavioral Therapy or hypnotism as ways to work towards a normal food palette and healthy diet.


    Malaysian sudden mood change/aggression.

    Amok is the psychological disorder where males who typically have never acted out before experience a sudden mood change and become violent and angry. Deep shame experienced by the male often seems to be the cause of the sudden mood changes, these changes can be caused by situations and feelings such as jealousy or gambling losses. People suffering from a mood change will often attempt to hurt or kill anyone they run into. Often people who have these mood shifts will end up being killed by a bystander out of self-defense or other reasons, or the person suffering from Amok will commit suicide. The word was derived from the Malay, Indonesian and Filipino word "amuk" which means "mad with rage." The term has been changed into slang in the United States and the phrase "Running Amok" is used to describe someone who is acting crazy or can't control themselves.

    Dhat Syndrome

    The patient is preoccupied with the excessive loss of semen by nocturnal emissions. There is a fear that semen is being lost and mixed in urine. In the Hindu culture and religion, it is believed that "40 meals create one drop of blood, 40 drops of blood create one drop of bone marrow and 40 drops of marrow create one drop of semen." It is thought in the Hindu culture in India, although not isolated there, that the loss of semen can deteriorate your health and create health problems. Symptoms of Dhat Symdrome are depression, preoccupation, trouble sleeping, inability to perform sexually, exhaustion and headaches, and others. In order to treat these symptoms of depression and anxiety, counseling or anti-anxiety or anti-depression medications have been found to be of use. [7]

    Genital Retraction Syndrome (Koro)

    Retraction into body. (Malay Koro, Sudan melting penis/cell phone phenomenon)

    Genital Retraction syndrome is a culture-bound syndrome occurring mostly in African and Asian men. This syndrome causes the men to think that their penis is going to shrivel into their stomach and that they will die. In South East Asia this syndrome has become known as “Koro”, which means “head of the turtle”. It can also be referred to as penis panic. In this case a large group of men can become panicked about their genitalia disappearing. Often these fears come about in cultures where witchcraft is used, or where biological education isn’t available. In 1997 lynch mobs in Ghana attacked foreigners they accused of being sorcerers capable of shrinking men’s penises.


    Latah is a culture-bound syndrome that exist in Malaysian and Indonesian cultures. People showing signs of this syndrome respond to minimal stimuli with exaggerated startles. Sometimes, after becoming started, people suffering from this syndrome will obey the commands or imitate the actions of the people around them. Most occurrences of Latah are intentionally provoked to act as entertainment for those surrounding. Latah is very closely tied to specific factors in the cultural systems of the Southeast Asian societies in which it is found. The Latah syndrome exemplifies the very dynamic and complex ways in which neurophysiological, experiential, and cultural variables coincide with each other to produce a strongly marked phenomenon in these cultures. It is most widely known as a hyperstartling condition which mainly occurs in Malayan cultures. Latah is also the name for those who have the condition, which consists mainly of adult women. During episodes of this behavior, Latah's are usually not held responsible for their actions. It is also closely related to another condition called Hyperexplexia. (SE Asia women, obey, not responsible for acts)


    File:Inuit-Kleidung 1.jpg
    Figure \(\PageIndex{4}\): Two Inuit women and child. (Origin: Taken by Angsar Walk [8])

    Piblokto, pronounced (pee-block-toh) and loosely translated from Inuit to English means "running crazy" is a hysterical/dissociative state. It occurs mostly in the winter season and typically shown in Inuit or Eskimo women and is characterized by short attacks of disturbed behavior that are not remembered by the individual afterward.

    The symptoms can include running naked through the snow, an insensitivity to extreme cold, coprophagia (the consumption of feces), echolalia (the repetition of words), depression, screaming, crying, and violence towards other people and animals. Piblokto is most often seen in women of the Inuit tribe. These people inhabit the areas of northern Canada,Greenland, the coastal regions of Alaska and north eastern Asia/Russia. They are able to inhabit very harsh conditions and tolerate the snow and ice of the Arctic tundra for most of the year. There has never been a recorded case of Piblotko in children, although women in tribal groups have been recorded as having as many as 5 attacks of hysteria a day. The Inuit people's diet mainly consists wild game, whale and seal meat. A diet high in protein, selenium, and fats may help these people escape the risks of cancer but not the biological/psychological malady of Piblokto. Although commonly thought of as a psychological ailment, Piblotko may be linked to vitamin A toxicity, or hypervitaminosis A. Vitamin A toxicity is caused by an overconsumption of pre-formed Vitamin A, which is the result of high amounts of vitamin A in the diet at one time. This can lead to altered mental state, confusion, headache,and irritability, as well as many symptoms that are common to Piblotko. Piblotko has also been recorded in Inuit dogs and while these dogs are not considered infectious, they are shot when symptoms first occur and then eaten by the tribe. SAD- seasonal affective disease; loosely linked to this syndrome, as the weather and light are factors that play straight into symptoms like depression. [17]


    Susto is a Folk Illness that is most commonly found in Latin America. The term "susto" comes from the Portuguese and Spanish word for fright. In this way, the illness is called “fright sickness”. It is also referred to as "spirit attacks," most common among Native Americans. The disease is usually generated from a traumatic experience like the death of a loved one, an accident, or anything else that might cause physiological pain. It is most common in women but can also be found in men and children. The illness in not recognized by Western Traditional Medicine, but is commonly compared to anxiety disorders.

    Symptoms of susto can be nervousness, anorexia, insomnia, listlessness, despondency, involuntary muscle tics, and diarrhea. Treatments for this illness are mostly natural and herbal, such as consuming marijuana teas, Brazil wood, and orange blossom. The most effective treatments are done by what is called a healer and can include different sort of rituals. The closer these rituals are practiced to when the traumatic experience occurred, the better. It is also very important to recognize the event and not suppress it.

    Susto is often compared to other biomedical illnesses. In 2002 studies about susto were conducted in; Latin communities, the United States, Mexico and Guatemala. First they defined susto in the different communities. Although the definition differed from region to region, the main idea was that susto was an illness caused by fright, and not necessarily loss of soul. It was seen as a serious illness that could even lead to death. But to better understand this folk illness, in biomedical culture and culture I am familiar with in United States, susto is best related to depressive disorders, post traumatic stress disorder, and somatoform disorders.[18]


    Opsophagos was an ancient Greek label given to anyone who had an extreme and irrepressible desire for eating fish.

    The term is a definition one’s character, not literally their general palate for fish. Charging someone with the term is directed in a very negative manner- it parallels being indicted with having over-indulgent behavior, a taboo in Greek society. Opsophagos is synonymous with words like unsophisticated and barbaric- words opposite of rationality. The fish is simply a symbol for overindulgence.

    Greek tall tales describe an opsophagos as a gluttonous and greedy man who would consume all prepared fish, sharing none with anyone. The painted image of an opsophagos was the opposite of an ideal human- a man with a heat-resistant throat to handle fish too hot for anyone else to eat, thus keeping the fish for only themselves.

    Opposite of America’s Judeo-Christian tradition, Greek thought and morality is more flexible than the orthodox, black and white view of simple rights or wrongs. For example, instead of ruling out women or wine, Greeks believe in “nothing in excess”-enjoy life’s pleasure but under control. This is contrary to the American idea of suppressing vices and how negative habits should be cut out completely “cold turkey”.

    Ghost Sickness

    Figure \(\PageIndex{5}\): A Dust Devil is an example of a manifestation of Ghost Sickness

    Ghost Sickness originates from the Navajo Nation and is believed to be a psychotic disorder associated with death. Common symptoms include fatigue, recurring nightmares, hallucinations, and a constant feeling of terror. The people of the Navajo Nation believe that a Chindi causes Ghost Sickness. A Chindi is the ghost of the Navajo Tribe and many believe that this ghost is released during a person’s dying breath, and it is also believed to nearly always be an evil force. A common manifestation of a Chindi is believed to be a Dust Devil, and the direction they spin signifies whether it is a ‘good’ Chindi or a ‘bad’ one; a clockwise spin is considered good – a counter-clockwise is considered bad. Other Native American tribes have modified beliefs of Ghost Sickness and have attempted to prevent or avoid passing it on. For example, the Lakota Tribe attempted a ban on mourning rituals in order to avoid the illness in the 1800's, but many still practice modified rituals.


    Windigo (or Witiko) A culturally bound syndrome found among the Algonkian Indians, NE United States and Eastern Canada. Windigo is the famous syndrome of obsessive cannibalism or the consumption of another’s flesh. Windigo has fallen under skeptical eyes and to many is now somewhat discredited. A modern medical diagnosis of this condition would probably label it as paranoia, due to the irrational perceptions of being persecuted for suffering from Windingo. Fear of prosecution is prevalent among victims of Windingo because of the cultural universal that eating humans is wrong. Windigo was supposed to have been brought about by consuming human flesh in desperate circumstances such as famines. Afterwards, the individual who consumed flesh was supposed to be haunted by cravings for human flesh and thoughts of killing and eating humans. In other words, Windigo is the unwanted transformation into a cannibal.

    In the Great Lakes of Canada and the United States where climate was harsh, Windingo would develop among families who, isolated in their homes due to heavy snow storms, had inadequate food and supplies. Symptoms of Windigo include vomiting and lack of appetite. The individual would then begin to develop delusions of him or herself believing they are becoming a Windigo Monster. People suffering from Windigo psychosis claim to see others as edible, which only increases with time. As the individual becomes aware of the transformation they begin to deeply fear becoming a cannibal. Victims of Windigo psychosis often experience severe panic and anxiety. Suicide is common in order to prevent themselves from becoming Windigo monsters. [9]


    Zar[10] is experienced in Ethiopia, Somalia, Egypt, Sudan, Iran, and other places in the Middle East and North Africa. The feeling you get when you have zar is spirit possession. Some symptoms that could occur are dissociation episodes including shouting, laughing, singing, weeping, or hitting the head against some sort of surface. Individuals may refuse to do simple tasks such as eat or go about their daily tasks in life; they may also show withdrawal and apathy. In some cases the person might develop a long-term relationship with the possessing spirit, but this is the rarest symptom. Zar can also be used as part of the training and practice of shamanistic healers. [11] This is usually practiced in Africa and is unfamiliar in Europe. Since this is a trance that is induced voluntarily as part of a shamanistic ritual, it is not considered a disorder.

    Zar was experienced in many cases when immigrants would move from Ethiopia to Israel. This is when zar was known to happen the most. Zar as a voluntarily induced spirit would occur the most in Northern African countries. One of the most common possession phenomena in Africa and in other continents is the belief in possession by spirits, known as zar.

    This page titled 8.5: Mental Health and Culture-Bound Syndromes is shared under a CC BY-SA 4.0 license and was authored, remixed, and/or curated by Wikibooks - Cultural Anthropology (Wikibooks) .

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