Stay Free! magazine


Curious Mental Illnesses Around the World

By Carrie McLaren and Alexanra Ringe | Issue #21

These days, Western science takes it as a given that mental illness is rooted in biology. But this approach ignores culture's role in shaping health: simply put, different social environments create different mental health problems. Psychiatrists used to call ailments limited to particular environs "exotic psychotic syndromes" until it dawned on them that Western culture has its syndromes, too--namely, anorexia and bulimia nervosa. Now they refer to "culture-bound syndromes," though this name, too, is a bit misleading. Culture-bound syndromes are not linked to a particular culture in a particular time and place so much as to a prominent cultural emphasis. Cultures that place high importance on fertility, for example, may fuel fears of semen loss.

Though slow on the draw, the American Psychiatric Association began acknowledging the importance of culture in the fourth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) by adding an appendix on culture-bound syndromes. Granted, the main body of the DSM-IV is filled with syndromes you can only imagine happening in the West--disruptive behavior disorder, for instance, or medication induced mathematics disorder. But, hey, it's a start.

Here are a few examples of culture-bound syndromes.

Origins: China, Malaysia, Indonesia

A man who suffers from koro, or genital retraction syndrome, is gripped by the fear that his penis is shrinking and gradually being absorbed by his body. (Women suffer from koro, too--afraid for their nipples or vulva--but this is much rarer.) A typical case of koro goes like this: A man goes to urinate and notices that his penis is becoming smaller. Usually this happens because he's in a cold place or because he's upset about something--his sex life, for example. Both anxiety and exposure to cold cause male genitals to shrink temporarily.

But rather than shrugging the incident off, the man--who has heard about koro attacks in his community--only grows more anxious, particularly since koro is considered deadly. As panic mounts, the man grabs his genitals before they can retract into his body and calls for help. According to one scholar: "If no one is around to help hold onto his penis, he may even use mechanical devices--including cords, chopsticks, clamps, or small weights--to keep the penis from retracting." Koro attacks usually occur in epidemics rather than striking on an individual basis, further proof of their social nature.

Although some scholars trace koro to the Chinese concept of yin and yang, the syndrome and similar problems have also been found in places without any Chinese tradition. Ultimately, koro may have less to do with Chinese culture itself than with its strong cultural emphasis on fertility and procreation. Source: Timothy McCajor Hall, "Culture-Bound Syndromes in China,"

Origins: Malaysia and Indonesia

Many people, when startled, gasp or swear. But after a few seconds most of us return to whatever we were doing before. For those who suffer from latah, however, that jolt of surprise turns into a 30-minute orgy of screaming, dancing, and hysterical laughter, punctuated by shouted obscenities.

Though often unpleasant for the latah herself (latahs are usually middle-aged women), family and friends find the outbursts entertaining and slyly provoke them in order to see a show. Startled women tend to mimic those around them, aping relatives or imitating things they see on TV. When a woman goes latah in public, this can be a real problem: One woman told a New York Times reporter about a hunchbacked man who lives in her neighborhood. If something sets her off when she's out shopping, she'll start walking like him for no apparent reason.

Any number of things can cause the onset of latah. Sufferers often cite a traumatic experience--the death of a child, for instance--as the source of the problem. But, according to psychiatrist Ronald C. Simons, the author of Boo! Culture, Exper-ience and the Startle Reflex, "Some cultures are more fascinated (and amused) by the startle response than others, making people who are easily frightened objects of attention."

Source: New York Times Magazine, May 6, 2001

Brain fag, or brain fog
Origin: West Africa

"Brain fag" is one of those phrases you would expect to see in 1930s advertisements along with housework fag and smoker's fag. (Fag is short for fatigue.) But in this case, the fag is primarily experienced by stressed-out students in Nigeria and other parts of Africa--a reaction, it is said, to the alien pressures of Western-style book learning. Symptoms include difficulties in concentrating, remembering, and thinking, as well as burning or crawling sensations under the skin and visual disturbances. Studiation madness is a term used in Trinidad for a similar syndrome.

Source: Pulse, June 3, 2002

Anorexia nervosa, bulimia nervosa
Origin: North America, Western Europe

Yeah, we already know about anorexia and bulimia, though we may confuse the two (bulimia is the one where people binge and vomit; anorexics simply starve themselves). That's because modern eating disorders are a response to that tall, skinny woman who appears everywhere on magazine covers, billboards, and television, beckoning young women to look like her. Anorexia and bulimia occur overwhelmingly in countries with advertising-driven mass media: the U.S., Canada, Europe, Australia, Japan, New Zealand, and South Africa. For those unconvinced of the media's impact, the example of the Fiji Islands provides a case in point. Prior to 1995, there was no television in the South Pacific nation, and the beauty ideal was curvy: to insult someone, you called her "skinny legs." But a few years after the introduction of television, girls in Fiji started dieting and showing signs of eating disorders.


Amok, or mata galap
Origin: Malaysia

The phrase "running amok" comes from this syndrome. The victim, known as a pengamok, suddenly withdraws from family and friends, then bursts into a murderous rage, attacking the people around him with whatever weapon is available. He does not stop until he is overpowered or killed; if the former, he falls into a sleep or stupor, often awakening with no knowledge of his violent acts. The pengamok is almost always a man between the ages of 20 and 45; there is only one female pengamok on record.

Some psychiatrists attribute amok to Malaysian culture's combination of extreme indulgence of young children and extreme restrictiveness for adolescents. As a result, the young men might stifle their feelings of hostility and also might blame others for their difficulties, leading them to lash out. According to social psychologists, a victim might suffer from amok after a loss of social status or another major life change.

Since the 1930s, amok has occurred rarely in Malaysia, and the few contemporary cases have been in rural areas far from modern influences. But the disorder, or something similar, has cropped up more recently in the Philippines, Thailand, Laos, and, one might argue, the United States.

Source: Manias and Delusions, Time/Life Books, 1992