Culturally Determined Syndromes: Amok, PMS, Depression?

Some diseases only seem to occur in certain places, or is it that different cultures develop different symptom definitions based on the local culture? For example, I remember hearing that menopausal hot flashes are only described in Western countries.

The phenomenon of culturally determined syndromes has been around for a long time and it has become established in psychiatric terminology. For example, the term “running amok”, of Indonesian origin, first described in the 1800’s, was included in the psychiatric diagnostic index that was just replaced, DSM IV-TR.

In Swedish newspapers and magazines, I often read about people who suffer from electromagnetic hypersensitivity syndrome. This spring, the Swedish medical journal “Dagens Medicin” published an article suggesting that many such patients meet diagnostic criteria for depression, but the stigma of mental illness causes many patients to seek an explanation for their symptoms in their environment instead of within themselves.

Recently, The Guardian ran a piece on this topic, reviewing some classic examples of culture-bound syndromes and suggesting some new ones:

Culture-bound syndromes are most often the preoccupation of anthropologists. Typically, the patient displays symptoms that are recognised as indicating a particular illness only by other members of that patient’s cultural group. The dhat syndrome observed in parts of India, characterised by fatigue, anxiety and guilt and usually experienced by men, is a well-documented example of a psychological culture-bound syndrome, as is the susto, or fright sickness, of Latin America.

In a recent editorial in the British Journal of General Practice, Professor Christopher Dowrick argues that depression could be a western culture-bound syndrome, rather than a universal disorder. In support of his case, Prof Dowrick notes the lack of consensus in psychiatry over what even constitutes depression: the endless shifting of diagnostic goalposts….

Others have argued that pre-menstrual syndrome, too, is a Western culture-bound syndrome. In 1987, Thomas S Johnson claimed that the symptoms were an expression of “conflicting societal expectations” on women. In 2012, a meta-analysis of published research failed to find evidence that negative mood correlates to the pre-menstrual phase of the menstrual cycle. And earlier this year, a qualitative study found that a “cognitive reframing” of the symptoms could reduce self-reported pre-menstrual distress.

There is new criticism that psychiatric diagnosis is too much based on symptoms instead of the emerging biomarkers for some psychiatric diseases. The Guardian continues:

A DSM-style categorisation of illness based on symptoms could still be useful, provided we bear in mind that our local diagnostic categories are no more universal than our local language. We may also need to accept that treatments for mental disorder are not universally applicable. Culture-bound syndromes need culture-bound treatments: interventions recognised as “medicine” by both patient and practitioner.

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