An article in The Atlantic Monthly (Elliott, 2000) on apotemnophilia (compulsion to amputate one's healthy limbs) discussed two books on dissociative disorders by Ian Hacking, Ph.D. The article contained a wonderfully succinct restatement of Hacking's main thesis, applicable to a great many human conditions, including culture-bound syndromes:
Unlike objects, people are conscious of the way they are classified, and they alter their behavior and self-conceptions in response to their classification.
That is, in a cultural setting in which there is a particular folk illness, both the experience and the behaviors of the ill person will be shaped by that patient's understanding of that illness. Hacking considers multiple personality disorder (dissociative identity disorder) to be a prime example of just such a condition, and his argument is well worth considering (Elliott, 2000). His observation is especially apt with regard to the culture-bound syndromes.
Since many of the culture-bound syndromes are not really syndromes, another term is needed to signify what we are talking about. Furthermore, not only are many of these conditions not syndromes, but some are not bound to a single culture. Alert readers will have noted the awkward phrase "diagnostic entities," which has been used in this article for lack of a better alternative.
There have been many suggestions of more descriptive terms, some of which include atypical psychoses (Manschreck and Petri, 1978), but these entities are not usually psychoses; syndromes not seen in Western culture (Favazza, 1985), but this is a definition by exclusion and ignores conditions such as jumping and old hag that do occur in the West; culture-related specific syndromes (Tseng, 2001), but what syndromes aren't culturally related and specific?
To date, no one has come up with a really good name for this group of conditions. Thus the name culture-bound syndrome persists simply for lack of a better term.
Because the culture-bound syndromes are so varied, there can be no single type of diagnostic or therapeutic approach. For some patients, even the idea of therapy seems ill-considered. In some cases, their behaviors are eccentricities that do not need treatment, and, for some people, a therapeutic approach that has nothing to do with any medical system may be most helpful and least disruptive.
When dealing with a patient from another culture who presents with an assortment of symptoms that seem unfamiliar, it is always useful to find out what they and other concerned individuals believe is going on. What prior efforts for help or cure have been tried? What were the results? What have culture-relevant authorities advised and concluded? Since there is no one-to-one correspondence between culture-bound syndromes and DSM diagnoses, what is the DSM diagnosis, if any, for this particular patient? Particularly with regard to issues of compliance, a therapeutic approach that includes both culture-specific and Western biomedical ways of understanding the world is likely to be most successful.
