Introduction to Culture-Bound Syndromes

In the glossary of our book The Culture-Bound Syndromes, Charles C. Hughes, Ph.D., listed almost 200 folk illnesses that have, at one time or another, been considered culture-bound syndromes (Simons and Hughes, 1986). Many have wonderfully exotic and evocative names: Arctic hysteria, amok, brain fag, windigo. Some of the more common syndromes are described in the Table. These diagnostic entities, both individually and collectively, have been the subject of a large and contentious body of literature. Are they best explained within the conceptual framework of Western psychiatry, or are they best explained anthropologically as manifestations of structural and functional elements operating in the societies in which they are found?

In the introductory comments to the glossary, Hughes pointed out that it is impossible to produce a definitive list of this group of diagnostic entities (Simons and Hughes, 1986). It is unclear exactly what sort of things should be included. How about reports of possession and trance states, which often had local names? Should descriptively similar patterns of behavior or experience from different cultures be lumped together or split apart? What can reasonably be called an illness, and what is better considered a set of customary beliefs and practices of an entirely different order? Hughes concluded that the term culture-bound syndrome "still has currency but little discriminable [i.e., operationally definable] content" (Simons and Hughes, 1986).

In theory, culture-bound syndromes are those folk illnesses in which alterations of behavior and experience figure prominently. In actuality, however, many are not syndromes at all. Instead, they are local ways of explaining any of a wide assortment of misfortunes.

In certain parts of the Philippines, for example, when a person becomes ill in a number of very different ways (fever, stomachache, shouting during sleep, incessant crying, various skin ailments), it may be said that the individual is suffering from lanti. This is a way of saying that the presumed etiology of all of these complaints is having been shocked or startled some time before. There is no discrete lanti syndrome with either a specific experience of altered reality or any specific altered behavior. Instead, the illness label is used as an explanation for a variety of troubles. Saladera, from the Peruvian Amazon, is also a way of explaining any of a host of misfortunes such as a persistent run of bad luck. In addition to suffering misfortunes of many kinds, patients with saladera may exhibit signs of great anxiety, but this is because they believe that they have been bewitched.

People with bipolar disorder, major depression, schizophrenia or intellectual handicap may also be considered to be suffering from a locally prevalent culture-bound syndrome. This can be the case even when the majority of people classified locally as suffering from that particular diagnostic entity do not suffer from an illness meeting any DSM-IV diagnosis.

However, some culture-bound syndromes are indeed syndromes. Latah, described from Malaysia and Indonesia, is a good example (Simons, 1996, 1983). Although everyone can be startled, in all populations some people startle more readily and strongly than others. In Malaysia and Indonesia, these people are repetitively startled by others until they become extremely flustered whenever they are startled. In the highly flustered state that follows being startled, these people may say things that are normally considered obscene or irreverent, imitate the actions of others around them (Photograph), and obey commands that are forcefully directed at them. These hyperstartling people are called latahs, and this condition of being latah is a well-defined role in Malay and Indonesian society with its own set of rules and understandings.

This same physiology has been elaborated in a variety of societies that are unrelated either historically or culturally. Among the Ainu in Japan, the syndrome is called imu, and in a French-Canadian population in Maine it is called jumping. Thus, these syndromes are similar, but not identical, from society to society. This, of course, is true of the diagnostic entities described in DSM-IV as well. Like hyperstartling, sleep paralysis (a feeling of paralysis when either just falling asleep or waking up, sometimes accompanied by visual or audio hallucinations) has been elaborated into a culture-bound syndrome in a number of unrelated geographic locations. It is known as uqamairineq among the Yupik Eskimos and as old hag in parts of Newfoundland, Canada.