Culture-Bound Syndromes

Culture-bound syndromes (CBSs) comprise a heterogeneous set of illness phenomena

of particular interest to medical anthropologists and to psychiatrists. The eclectic nature
of the category makes it hard to define precisely, and has invited much dispute over the
best name and definition for it.

DSM-IV (844) defines a

culture-bound syndrome:
recurrent, locality-specific patterns of aberrant behavior and troubling experience
that may or may not be linked to a particular DSM-IV diagnostic category. Many
of these patterns are indigenously considered to be "illnesses", or at least
afflictions, and most have local names.

More generally, culture-bound syndromes comprise several kinds of illness or affliction,

all of which are defined as culture-bound (and therefore have been of interest to medical
anthropologists and ethnopsychiatrists) in that they do not have a one-to-one
correspondence with a disorder recognized by Western, allopathic nosologies. Most
CBSs were initially reported as confined to a particular culture or set of related or
geographically proximal cultures.

At least seven broad categories can be differentiated among phenomena often

described as culture-bound syndromes:

1. an apparent psychiatric illness, not attributable to an identifiable organic cause,

which is locally recognized as an illness and which does not correspond to a
recognized Western disease category, e.g. amok.

2. an apparent psychiatric illness, not attributable to an identifiable organic cause,

which is locally recognized as an illness and which resembles a Western disease
category, but which has locally salient features different from the Western
disease, and which may be lacking some symptoms seen as salient in the West.
One example is shenjing shaijo or neurasthenia in China, which resembles
major depressive disorder but has more salient somatic features and often
lacks thedepressed mood which defines depression in the West. Another is taijin
kyufusho which is widely regarded as being a peculiarly Japanese form of
social phobia.

3. a discrete disease entity not yet recognized by Western medicine. The most
famous example of this is kuru, a progressive psychosis and dementia
indigenous to cannibalistic tribes in New Guinea. Kuru was eventually classified
as a "slow-virus" disease, and is now believed to result from an aberrant protein
or "prion" which is capable of replicating itself by deforming other proteins in the
brain. (A 1997 Nobel prize was awarded for the elucidation of prions.) Kuru has
been identified with a form of Creuzfeldt-Jakob disease, and may be equivalent
or related to scrapie, a disease of sheep, and bovine spongiform encephalopathy
(BSE) or "mad cow disease".
 4. an illness which may or may not have an organic cause, and may correspond to
a subset of a Western disease category or may elaborate symptoms not
recognized as constituting a Western disease into an illness category. In other
words, this is a phenomenon which occurs in many cultural settings, but which is
only elaborated as an illness in one or a few. A possible example is koro, the
fear of retracting genitalia, which may sometimes have a physiological-
anatomical reality, and which appears to occur independently in a non-culturally-
elaborated way as a delusion or phobia in numerous cultural settings.

5. culturally accepted explanatory mechanisms or idioms of illness which do not

match allopathic mechanisms or Western idioms, and which, in a Western
setting, might indicate culturally inappropriate thinking and perhaps delusions or
hallucinations. Examples of this include witchcraft, rootwork (Caribbean) or the
evil eye (Mediterranean and Latin America).

6. a state or set of behaviors, often including trance or possession states; hearing,

seeing, and/or communicating with the dead or spirits; or feeling that one has
"lost one's soul" from grief or fright; which may or may not be seen as
pathological within their native cultural framework, but which if not recognized as
culturally appropriate could indicate psychosis, delusions, or hallucinations in a
Western setting.

7. a syndrome allegedly occuring in a given cultural setting which does not in fact
exist, but which may be reported to the anthropologist or psychiatrist. A possible
example is windigo (Algonkian Indians), a syndrome of cannibal obsessions
whose reality has been challenged (Marano, in Simons & Hughes, 1985) but may
in fact be used to justify the expulsion or execution of an outcast in a manner
similar to witchcraft allegations.

Debates over culture-bound syndromes often revolve around confusions or conflations

among these different categories. Many so-called culture-bound syndromes actually
occur in many unrelated cultures, or appear to be merely locally flavored varieties of
illnesses found elsewhere. Some are not so much actual illnesses as explanatory
mechanisms, like witchcraft or humoral imbalances. Beliefs in witchcraft and humoral
imbalances can lead to behaviors which would seem to indicate disordered thought
processes outside their cultural context, such as avoidance of cold and drafts in Chinese
pa-feng and pa-leng, but which actually make sense in context.

The concept of culture-bound syndromes is therefore useful insofar as it brings culture to

the attention of psychiatrists trained in a different cultural tradition. Awareness of CBSs
allow psychiatrists and physicians to make culturally appropriate diagnoses. The concept
is also interesting to medical and psychiatric anthropologists, in that culture-bound
syndromes provide examples of how culturally salient symptoms can be elaborated into
illness experiences.

The concept is problematic, however, in that it is not a homogeneous category, and the
designation of "culture-bound" can imply that the illness is somehow "not real", or that a
patient's experience can be dismissed as merely exotic.

One of the best available compilations on culture-bound syndromes is:

Simons, Ronald C.; and Hughes, Charles C. (eds.) (1985) The Culture-Bound
Syndromes: folk illnesses of psychiatric and anthropological interest. Dordrecht, The
Netherlands: D. Reidel Publishing Company.
Useful information is also found commonly in the journals Culture, Medicine, and
Psychiatry, and Transcultural Psychiatry. Several references are given in the
bibliography.

Glossary of Culture-Bound Syndromes:

This glossary lists most of the culture-bound syndromes found in the literature, although
it is by no means exhaustive. Syndromes are listed alphabetically in two sections: actual
culture-bound syndromes vs. culture-specific idioms of disease (see the introductory
essay for a brief description of the differences.) The major geographical or cultural locale
for each syndrome is given, along with a brief description and a listing of synonyms or
similar syndromes in other cultural regions. For syndromes (e.g., koro) which have a
similar presentation in many cultures, only one or two of the best-documented variants
have a description.

The following list is adapted in part from lists of culture-bound syndromes given in DSM-
IV (pp. 845-849) and in Kaplan and Sadock's Synopsis of Psychiatry (pp. 190-191, 493-
494). Simons & Hughes (1985: 475-505) give a much more extensive listing of culture-
bound syndromes; however, their descriptors are not always specific enough for
inclusion here.

The author of the glossary list added several syndromes, expanded or condensed
descriptors, and divided the categories into actual culture-bound syndromes vs. culture-
specific idioms of disease.

At present, descriptions in this list are more complete for syndromes of East Asia,
Southeast Asia, and South Asia, which are my areas of interest.

Psychiatric syndromes which are endemic to particular cultures:

amok or mata elap: (Malaysia) a dissociative episode characterized by a period

of brooding followed by an outburst of violent, aggressive, or homicidal behavior
directed at people and objects. The episode tends to be precipitated by a
perceived insult or slight and seems to be prevalent only among males. The
episode is often accompanied by persecutory ideas, automatism, amnesia for the
period of the episode, exhaustion, and a return to premorbid state following the
episode. Some instances of amok may occur during a brief psychotic episode or
constitute the onset or exacerbation of a chronic psychotic process.
Similar to cafard or cathard (Polynesia), mal de pelea (Puerto Rico), iich'aa
(Navaho), and syndromes found in Laos, Papua New Guinea, and the
Philippines. Similar also to the nascent American folk-category of going postal.

anorexia mirabilis or holy anorexia: (medieval Europe): severe restriction of

food intake, associated with experience of religious devotion. Often not
 considered pathological within the culture. The terms are used by historians, and
are not emic.

anorexia nervosa (North America, Western Europe): severe restriction of food

intake, associated with morbid fear of obesity. Other methods may also be used
to lose weight, including excessive exercise. May overlap with symptoms of
bulimia nervosa.

boufe deliriante: (West Africa and Haiti) sudden outburst of agitated and
aggressive behavior, marked confusion, and psychomotor excitement. It may
sometimes be accompanied by visual and auditory hallucinations or paranoid
ideation. Similar to DSM-IV brief psychotic disorder.

brain fag or brain fog: (West Africa) a condition experience by primarily male
high school or university students. Symptoms include difficulties in concentrating,
remembering, and thinking. Students often state that their brains are "fatigued".
Additional symptoms center around the head and neck and include pain,
pressure, tightness, blurring of vision, heat, or burning. "Brain tiredness" or
fatigue from "too much thinking" is an idiom of distress in many cultures.
May resemble anxiety, depressive, or somatoform disorders in DSM-IV.

bulimia nervosa (North America, Western Europe): binge eating followed by

purging through self-induced vomiting, laxatives, or diuretics; and morbid fear of
obesity. May overlap with symptoms of anorexia nervosa.

dhat: (India) semen-loss syndrome, characterized by severe anxiety and

hypochondriacal concerns with the discharge of semen, whitish discoloration of
the urine, and feelings of weakness and exhaustion.
Similar to jiryan (India), sukra prameha (Sri Lanka), and shenkui (China).

falling out or blacking out: (Southern U.S. and Caribbean) episodes

characterized by sudden collapse, either without warning or preceded by feelings
of dizziness or "swimming" in the head. The individual's eyes are usually open,
but the person claims inability to see. The person usually hears and understands
what is occurring around him or her, but feels powerless to move.
May correspond to DSM-IV conversion disorder or dissociative disorder

ghost sickness: (American Indian groups) preoccupation with death and the
deceased, sometimes associated with witchcraft. Symptoms may include bad
dreams, weakness, feelings of danger, loss of appetite, fainting, dizziness, fear,
anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, amd
a sense of suffocation.

grisi siknis: (Miskito Indians, Nicaragua) symptoms include headache, anxiety,

anger, aimless running. Some similarities to pibloktoq.

Hi-Wa itck: (Mohave American Indians) insomnia, depression, loss of appetite,

and sometimes suicide associated with unwanted separation from a loved one.

hsieh-ping: (Taiwan) a brief trance state during which one is possessed by an

ancestral ghost, who often attempts to communicate to other family members.
 Symptoms include tremor, disorientation and delirium, and visual or auditory
hallucinations.

hwa-byung or wool-hwa-bung: (Korea) "anger syndrome". Symptoms are

attributed to suppression of anger and include insomnia, fatigue, panic, fear of
impending death, dysphoric affect, indigestion, anorexia, dyspnea, palpitations,
generalized aches and pains, and a feeling of a mass in the epigastrium.
See also bilis and colera, below.

involutional paraphrenia: (Spain, Germany) paranoid disorder occurring in

midlife.

koro: (Malaysia) an episode of sudden and intense anxiety that the penis (or in
the rare female cases, the vulva and nipples) will recede into the body and
possibly cause death. The syndrome occasionally occurs in local epidemics.
This syndrome occurs throughout south and east Asia under different names:
suo yang (China); jinjinia bemar (Assam); and rok-joo (Thailand). It has been
identified in isolated cases in the United States and Europe, as well as among
diasporic ethnic Chinese or Southeast Asians.

latah: (Malaysia and Indonesia) hypersensitivity to sudden fright, often with

echopraxia, echolalia, command obedience, and dissociative or trancelike
behavior. The Malaysian syndrome is more frequent in middle-aged women.
Similar syndromes include: amurakh, irkunii, ikota, olan, myriachit, and
menkeiti (Siberian groups); bah-tschi, bah-tsi, and baah-ji (Thailand); imu
(Ainu & Sakhalin, Japan); and mali-mali and silok (Philippines).

locura: (Latin America) a severe form of chronic psychosis, attributed to an

inherited vulnerability, the effect of multiple life difficulties, or a combination of the
two. Symptoms include incoherence, agitation, auditory and visual hallucinations,
inability to follow rules of social interaction, unpredictability, and possible
violence.

pibloktoq or Arctic hysteria: (Greenland Eskimos) an abrupt dissociative

episode accompanied by extreme excitement of up to 30 minutes' duration and
frequently followed by convulsive seizures and coma lasting up to 12 hours. The
individual may be withdrawn or mildly irritable for a period of hours or days before
the attack and will typically report complete amnesia for the attack. During the
attack, the individual may tear off his or her clothing, break furniture, shout
obscenities, eat feces, flee from protective shelters, or perform other irrational or
dangerous acts. The syndrome is found throughout the arctic with local names.

qi-gong psychotic reaction: (China) an acute, time-limited episode

characterized by dissociative, paranoid, or other psychotic or nonpsychotic
symptoms that occur after participating in the Chinese folk health-enhancing
practice of qi-gong. Especially vulnerable are individuals who become overly
involved in the practice.

sangue dormido: (Portuguese Cape Verdeans) Literally "sleeping blood".

Symptoms include pain, numbness, tremor, paralysis, convulsions, stroke,
blindness, heart attack, infection, and miscarriage.
 shenjian shuairuo: (Chinese) equivalent to now-defunct diagnosis of
"neurasthenia". Symptoms include physical and mental fatigue, dizziness,
headaches and other pains, difficulty concentrating, sleep disturbance, and
memory loss. Other symptoms include gastrointestinal problems, sexual
dysfunction, irritability, excitability, and various signs suggesting disturbances of
the autonomic nervous system. Many cases would be DSM-IV criteria for major
depressive disorder or an anxiety disorder.

Shenkui (Chinese): marked anxiety or panic symptoms with accompanying

somatic complaints for which no physical cause can be demonstrated. Symptoms
include dizziness, backache, fatiguability, general weakness, insomnia, frequent
dreams, and complaints of sexual dysfunction (such as premature ejaculation
and impotence). Symptoms are attributed to excessive semen loss from frequent
intercourse, masturbation, nocturnal emission, or passing of "white turbid urine"
believed to contain semen. Excessive semen loss is feared because it represents
the loss of one's vital essence and can thereby be life threatening.
Similar to dhat and jiryan (India); and sukra prameha (Sri Lanka).

shin-byung: (Korea) syndrome characterized by anxiety and somatic complaints

(general weakness, dizziness, fear, loss of appetite, insomnia, and
gastrointestinal problems), followed by dissociation and possession by ancestral
spirits.

shinkeishitsu: (Japan) syndrome marked by obsessions, perfectionism,

ambivalence, social withdrawal, neurasthenia, and hypochondriasis.

spell: (southern U.S.) a trance state in which individuals "communicate" with

deceased relatives or with spirits. At times this is associated with brief periods of
personality change. Spells are not considered medical events in the folk tradition,
but may be misconstrued as psychotic episodes in a clinical setting.

tabanka: (Trinidad) depression associated with a high rate of suicide; seen in

men abandoned by their wives.

taijin kyofusho: (Japan) a syndrome of intense fear that one's body, body parts,
or bodily functions are displeasing, embarrassing, or offensive to other people in
appearance, odor, facial expressions, or movements. Similar in some respects to
DSM-IV social phobia, and included in the official Japanese classification of
mental disorders.

windigo or witiko: (Algonkian Indians, NE US and Eastern Canada) Not in DSM-

IV. Famous syndrome of obsessive cannibalism, now somewhat discredited.
Wendigo was supposedly brought about by consuming human flesh in famine
situations. Afterwards, the cannibal was supposed to be haunted by cravings for
human flesh and thoughts of killing and eating humans. Excellent review of the
windigo literature in Lou Marano. "Windigo psychosis: the anatomy of an emic-
etic confusion." In The Culture-Bound Syndromes. Ronald Simons and Charles
Hughes. (eds.) Boston, MA: D. Reidel Publishing Company. 1985.
 zar: (Ethiopia, Somalia, Egypt, Sudan, Iran, and elsewhere in North Africa and
the Middle East) experience of spirit possession. Symptoms may include
dissociative episodes with laughing, shouting, hitting the head against a wall,
singing, or weeping. Individuals may show apathy and withdrawal, refusing to eat
or carry out daily tasks, or may develop a long-term relationship with the
possessing spirit. Such behavior is not necessarily considered pathological
locally. For an ethnographic description of similar possession, see Vincent
Crapanzano, Tuhami: portrait of a Moroccan.

Culture-specific idioms of distress and disease:

ataque de nervios: an idiom of distress principally reported among Latinos from

the Caribbean, but also among many Latin American and Latin Mediterranean
groups. Symptoms include uncontrollable shouting, attacks of crying, trembling,
heat in the chest rising to the head, and verbal or physical aggression. Ataques
de nervios frequently occur as a result of a stressful family event, especially the
death of a relative, but also a divorce or fight with a family member.

bilis and colera: part of a general Latin American idiom of distress and
explanation of physical or mental illness as a result of extreme emotion, which
upsets the humors (described in terms of hot and cold.) Bilis and colera
specifically implicate anger in the cause of illness.

mal de ojo: (Spain and Latin America) the Spanish term for the evil eye. Evil eye
occurs as a common idiom of disease, misfortune, and social disruption
throughout the Mediterranean, Latin American, and Muslim worlds.

nervios: (Latin America) Idiom of distress, refers to a general state of

vulnerability to stressful life experiences and to a syndrome brought on by such
stresses. Symptoms may be very broad, but commonly include emotional
distress, headaches, irritability, stomach disturbances, sleep disturbances,
nervousness, easy tearfulness, inability to concentrate, tingling sensations, and
dizziness. Similar to nevra (Greece).
rootwork: (Southern U.S. and Caribbean) a set of cultural interpretations that
explain illness as the result of hexing, witchcraft, voodoo, or the influence of an
evil person. Similar to mal puesto or brujeria (Latin America).

susto: an idiom of distress principally reported among Latinos in the U.S. and
Latin America. Susto is an illness attributed to a frightening event that causes the
soul to leave the body, leading to symptoms of unhappiness and sickness.
Symptoms are extremely variable and may occur months or years after the
supposedly precipitating event. Alternate names include espanto, pasmo, tripa
ida, perdida del alma, and chibih.
 Index of Culture-Bound Syndromes
By Culture

East Asia

China and Taiwan

hsieh-ping: (Taiwan) a brief trance state during which one is possessed by an
ancestral ghost, who often attempts to communicate to other family members.
Symptoms include tremor, disorientation and delirium, and visual or auditory
hallucinations. Similar to shin-byung (Korea).

pa-feng and pa-leng: (China) phobic fear of wind and cold, respectively. Patients
fear an excess of yin (negative/femal energy) from exposure to wind and cold.
Afflicted individuals bundle up in warm clothing, eat symbolically "hot" food, and
avoid wind or drafts. Symptoms of both often co-occur.

shenkui (China); also shen k'ui (WG): marked anxiety or panic symptoms with
accompanying somatic complaints for which no physical cause can be
demonstrated. Symptoms include dizziness, backache, fatiguability, general
weakness, insomnia, frequent dreams, and complaints of sexual dysfunction
(such as premature ejaculation and impotence). Symptoms are attributed to
excessive semen loss from frequent intercourse, masturbation, nocturnal
emission, or passing of "white turbid urine" believed to contain semen. Excessive
semen loss is feared because it represents the loss of one's vital essence and
can thereby be life threatening.

suo yang (China): See koro (Malaysia). Dialectal variants include: suo1 yang2,
(Mandarin), suk7 joeng4 (Cantonese), siok4 iong5 (Hokkien), shuk yang
(Shanghai). Many other dialectal or idiosyncratic spellings are used in the
literature.

qi-gong psychotic reaction: (China) an acute, time-limited episode

characterized by dissociative, paranoid, or other psychotic or nonpsychotic
symptoms that occur after participating in the Chinese folk health-enhancing
practice of qi-gong.

shenjian shuairuo (Chinese); shen2jing1 shuai1ruo4 (pinyin with tones) shen-

ching shuai-jo (WG): "neurasthenia". Symptoms include physical and mental
fatigue, dizziness, headaches and other pains, difficulty concentrating, sleep
disturbance, and memory loss.

Japan
imu (Ainu & Sakhalin, Japan): See latah (Malaysia)

taijin kyofusho: (Japan) a syndrome of intense fear that one's body, body parts,
or bodily functions are displeasing, embarrassing, or offensive to other people in
appearance, odor, facial expressions, or movements.
Korea
hwa-byung or wool-hwa-bung: (Korea) "anger syndrome".
 shin-byung: (Korea) syndrome characterized by anxiety and somatic complaints
(general weakness, dizziness, fear, loss of appetite, insomnia, and
gastrointestinal problems), followed by dissociation and possession by ancestral
spirits.

Other East Asia

amurakh, irkunii, ikota, olan, myriachit, and menkeiti (Siberian groups): See
latah (Malaysia).

South and Southeast Asia

India, Sri Lanka, Pakistan, Assam, Bhutan, Nepal.

dhat and jiryan: (India) semen-loss syndrome.

sukra prameha (Sri Lanka): semen-loss syndrome.

jinjinia bemar (Assam): See koro (Malaysia).

Malaysia and Indonesia

amok: (Malaysia) a dissociative episode characterized by a period of brooding
followed by an outburst of violent, aggressive, destructive, or homicidal behavior.

koro: (Malaysia) an episode of sudden and intense anxiety that the penis (or in
the rare female cases, the vulva and nipples) will recede into the body and
possibly cause death.

latah: (Malaysia and Indonesia) hypersensitivity to sudden fright, often with

echopraxia, echoLalia, command obedience, and dissociative or trancelike
behavior. The Malaysian syndrome is more frequent in middle-aged women.

Other Southeast Asia

rok-joo (Thailand): See koro (Malaysia).

bah-tschi, bah-tsi, and baah-ji (Thailand): See latah (Malaysia).

mali-mali and silok (Philippines): See latah (Malaysia).

Africa

North Africa
zar: (Ethiopia, Somalia, Egypt, Sudan, Iran, and elsewhere in North Africa and
the Middle East) experience of spirit possession. Symptoms may include
dissociative episodes with laughing, shouting, hitting the head against a wall,
singing, or weeping. Individuals may show apathy and withdrawal, refusing to eat
or carry out daily tasks, or may develop a long-term relationship with the
possessing spirit.

Subsaharan Africa
brain fag or brain fog: (West Africa) a condition experience by high school or
university students. Symtoms include difficulties in concentrating, remembering,
 and thinking. Additional symptoms center around the head and neck and include
pain, pressure, tightness, blurring of vision, heat, or burning.

boufe deliriante: (West Africa and Haiti) sudden outburst of agitated and
aggressive behavior, marked confusion, and psychomotor excitement. It may
sometimes be accompanied by visual and auditory hallucinations or paranoid
ideation.

Mediterranean and Middle East

nevra (Greece): See nervios (Latin America).

mal de ojo: (Spain and Latin America) the "evil eye".

sangue dormido: (Portuguese Cape Verdeans) Literally "sleeping blood".

Symptoms include pain, numbness, tremor, paralysis, convulsions, stroke,
blindness, heart attack, infection, and miscarriage.

Latin America and the Caribbean

Caribbean
falling out or blacking out: (Southern U.S. and Caribbean) episodes
characterized by sudden collapse and fainting, often with hysterical blindness.

Latin America
mal de pelea (Puerto Rico): see amok (Malaysia).

locura: (Latin America) a severe, chronic psychosis.

ataque de nervios: an idiom of distress principally reported among Latinos from

the Caribbean, but also among many Latin American and Latin Mediterranean
groups. Symptoms include uncontrULlable shouting, attacks of crying, trembling,
heat in the chest rising to the head, and verbal or physical aggression. Ataques
de nervios frequently occur as a result of a stressful family event, especially the
death of a relative, but also a divorce or fight with a family member.

bilis and colera: part of a general Latin American idiom of distress and
explanation of physical or mental illness as a result of extreme emotion, which
upsets the humors (described in terms of hot and cold.) Bilis and colera
specifically implicate anger in the cause of illness.

mal de ojo: (Spain and Latin America) the "evil eye".

nervios: (Latin America) Idiom of distress, refers to a general state of

vulnerability to stressful life experiences and to a syndrome brought on by such
stresses. Symptoms may be very broad, but commonly include emotional
distress, headaches, irritability, stomach disturbances, sleep disturbances,
nervousness, easy tearfulness, inability to concentrate, tingling sensations, and
dizziness.

susto: an idiom of distress principally reported among Latinos in the U.S. and
Latin America. Susto is an illness attributed to a frightening event that causes the
 soul to leave the body, leading to symptoms of unhappiness and sickness.
Symptoms are extremely variable and may occur months or years after the
supposedly precipitating event. Alternate names include espanto, pasmo, tripa
ida, perdida del alma, and chibih.

mal puesto or brujeria (Latin America): illness caused by witchcraft.

United States, Canada, and Western Europe

Western Europe
anorexia mirabilis or holy anorexia: (medieval Europe): severe restriction of
food intake, associated with experience of religious devotion. Often not
considered pathological within the culture. The terms are used by historians, and
are not emic.

anorexia nervosa (North America, Western Europe): severe restriction of food

intake, associated with morbid fear of obesity. Other methods may also be used
to lose weight, including excessive exercise. May overlap with symptoms of
bulimia nervosa.

bulimia nervosa (North America, Western Europe): binge eating followed by

purging through self-induced vomiting, laxatives, or diuretics; and morbid fear of
obesity. May overlap with symptoms of anorexia nervosa.

United States and Canada

anorexia nervosa (North America, Western Europe): severe restriction of food
intake, associated with morbid fear of obesity. Other methods may also be used
to lose weight, including excessive exercise. May overlap with symptoms of
bulimia nervosa.

bulimia nervosa (North America, Western Europe): binge eating followed by

purging through self-induced vomiting, laxatives, or diuretics; and morbid fear of
obesity. May overlap with symptoms of anorexia nervosa.

Southern United States

falling out or blacking out: (Southern U.S. and Caribbean) episodes
characterized by sudden collapse and fainting, often with hysterical blindness.

spell: (southern U.S.) a trance state in which individuals "communicate" with

deceased relatives or with spirits.

rootwork: (Southern U.S. and Caribbean) illness as the result of hexing,

witchcraft, voodoo, or the influence of an evil person.

Native Americans, Arctic, and Polynesia

Native Americans
ghost sickness: (American Indian groups) preoccupation with death and the
deceased, sometimes associated with witchcraft. Symptoms may include bad
dreams, weakness, feelings of danger, loss of appetite, fainting, dizziness, fear,
 anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, amd
a sense of suffocation.

iich'aa (Navaho): see amok (Malaysia).

windigo or witiko: (Algonkian Indians, NE US and Eastern Canada) syndrome

of obsessive cannibalism, now somewhat discredited. Windigo was supposedly
brought about by consuming human flesh in famine situations. Afterwards, the
cannibal was supposed to be haunted by cravings for human flesh and thoughts
of killing and eating humans.

Eskimos and Arctic

pibloktoq: (Greenland Eskimos) an abrupt dissociative episode.

Polynesia
cafard or cathard: see amok (Malaysia).

Index of Culture-Bound Syndromes

By Symptoms

This index groups the major culture-bound syndromes by symptoms. I borrow the term
taxon from Ronald Simons. A taxon is a set of similar syndromes which share symptoms
and are presumably related, but the term taxon does not specify whether the syndromes
are merely variant manifestations of the same disease (as pneumonic and bubonic
forms of plague, Yersinia pestis infection), or are different diseases with similar
mechanisms (as Type I and Type II diabetes), or are related in some more complicated
way. I also borrow Ronald Simons' terms for several of the taxa: "startle matching",
"genital retraction", "sudden mass assault", and "running". To these, I add the "semen
loss", "food restriction", "spirit possession", "obsession with the deceased", "exhaustion",
and "suppressed rage" taxa.

Startle Matching Taxon

latah: (Malaysia and Indonesia) hypersensitivity to sudden fright, often with
echopraxia, echolalia, command obedience, and dissociative or trancelike
behavior. The Malaysian syndrome is more frequent in middle-aged women.
amurakh, irkunii, ikota, olan myriachit, and menkeiti (Siberian groups)
bah-tschi, bah-tsi, and baah-ji (Thailand)
imu (Ainu & Sakhalin, Japan)
mali-mali and silok (Philippines).

Genital Retraction Taxon

koro: (Malaysia) an episode of sudden and intense anxiety that the penis (or in
the rare female cases, the vulva and nipples) will recede into the body and
possibly cause death. The syndrome occasionally occurs in local epidemics.
suo yang (China)
jinjinia bemar (Assam)
rok-joo (Thailand)
Also, idiopathic cases throughout the world.
Sudden Mass Assault Taxon
amok: (Malaysia) syndrome characterized by a period of brooding followed by an
outburst of violent, aggressive, or homicidal behavior, often followed by a claim of
amnesia.
cafard or cathard (Polynesia)
mal de pelea (Puerto Rico)
iich'aa (Navaho)
going postal (United States) nascent folk-category.

Running Taxon
pibloktoq or Arctic hysteria: (Greenland Eskimos) an abrupt dissociative
episode accompanied by extreme excitement of up to 30 minutes' duration and
frequently followed by convulsive seizures and coma lasting up to 12 hours. The
individual may be withdrawn or mildly irritable for a period of hours or days before
the attack and will typically report complete amnesia for the attack. During the
attack, the individual may tear off his or her clothing, break furniture, shout
obscenities, eat feces, flee from protective shelters, or perform other irrational or
dangerous acts.
grisi siknis: (Miskito Indians, Nicaragua) symptoms include headache, anxiety,
anger, aimless running. Similar to pibloktoq.

Semen Loss Taxon

dhat and jiryan: (India) semen-loss syndromes, characterized by severe anxiety
and hypochondriacal concerns with the discharge of semen, whitish discoloration
of the urine, and feelings of weakness and exhaustion.
sukra prameha (Sri Lanka).
shenkui (Chinese): marked anxiety or panic symptoms with accompanying
somatic complaints for which no physical cause can be demonstrated. Symptoms
include dizziness, backache, fatiguability, general weakness, insomnia, frequent
dreams, and complaints of sexual dysfunction (such as premature ejaculation
and impotence). Symptoms are attributed to excessive semen loss from frequent
intercourse, masturbation, nocturnal emission, or passing of "white turbid urine"
believed to contain semen. Excessive semen loss is feared because it represents
the loss of one's vital essence and can thereby be life threatening.

Food Restriction Taxon

anorexia nervosa: (North America, Western Europe, Australia) syndrome of
food restriction, morbid fear of obesity, and extreme weight loss. May be fatal.
Especially common among adolescent girls and young women.
Also, idiopathic cases throughout the world.
bulimia nervosa: (North America, Western Europe, Australia) syndrome of binge
eating and subsequent purging through self-induced vomiting, laxatives, or
diuretics. Also includes morbid fear of obesity, and may overlap in course or
symptoms with anorexia nervosa.
anorexia mirabilis or holy anorexia: (medieval Europe) syndrome of extreme
fasting motivated by religious devotion. Terms are modern, not medieval, and the
syndrome was often not perceived as pathological.

Spirit Possession Taxon

spell: (southern U.S.) a trance state in which individuals "communicate" with
deceased relatives or with spirits. At times this is associated with brief periods of
 personality change. Spells are not considered medical events in the folk tradition,
but may be misconstrued as psychotic episodes in a clinical setting.

zar: (Ethiopia, Somalia, Egypt, Sudan, Iran, and elsewhere in North Africa and
the Middle East) experience of spirit possession. Symptoms may include
dissociative episodes with laughing, shouting, hitting the head against a wall,
singing, or weeping. Individuals may show apathy and withdrawal, refusing to eat
or carry out daily tasks, or may develop a long-term relationship with the
possessing spirit. Such behavior is not necessarily considered pathological
locally.

Obsession with the Deceased Taxon

ghost sickness: (American Indian groups) preoccupation with death and the
deceased, sometimes associated with witchcraft. Symptoms may include bad
dreams, weakness, feelings of danger, loss of appetite, fainting, dizziness, fear,
anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, amd
a sense of suffocation.
hsieh-ping: (Taiwan) a brief trance state during which one is possessed by an
ancestral ghost, who often attempts to communicate to other family members.
Symptoms include tremor, disorientation and delirium, and visual or auditory
hallucinations.
shin-byung: (Korea) syndrome characterized by anxiety and somatic complaints
(general weakness, dizziness, fear, loss of appetite, insomnia, and
gastrointestinal problems), followed by dissociation and possession by ancestral
spirits.

Exhaustion Taxon
neurasthenia: (19th-century U.S.)
brain fag or brain fog: (West Africa) a condition experience by high school or
university students. Symtoms include difficulties in concentrating, remembering,
and thinking. Students often state that their brains are "fatigued". Additional
symptoms center around the head and neck and include pain, pressure,
tightness, blurring of vision, heat, or burning.
shenjian shuairuo: (China) Symptoms include physical and mental fatigue,
dizziness, headaches and other pains, difficulty concentrating, sleep disturbance,
and memory loss. Other symptoms include gastrointestinal problems, sexual
dysfunction, irritability, excitability, and various signs suggesting disturbances of
the autonomic nervous system.

Suppressed Rage Taxon

hwa-byung or wool-hwa-bung: (Korea) "anger syndrome". Symptoms are
attributed to suppression of anger and include insomnia, fatigue, panic, fear of
impending death, dysphoric affect, indigestion, anorexia, dyspnea, palpitations,
generalized aches and pains, and a feeling of a mass in the epigastrium.
bilis and colera: part of a general Latin American idiom of distress and
explanation of physical or mental illness as a result of extreme emotion, which
upsets the humors (described in terms of hot and cold.) Bilis and colera
specifically implicate anger in the cause of illness.
 Culture-Bound Syndromes in China
By: Timothy McCajor Hall

China is one of the world's oldest continuous cultural bodies, and has one of the most
extensively developed traditional medical systems. It presents a challenge to the
Western anthropologist of medicine in a number of ways, not the least of which are the
mysterious practices of acupuncture, acupressure, and moxibustion, or the unique
pharmacopia of classical Chinese medicine.

Beyond these, however, Chinese values in general and theories of medicine and the
body in particular continue to shape the experience of illness differently in China than in
the West. This is true to some degree anywhere: the experience of illness is always
subjective, and varies from person to person and from group to group. Among the
myriad societies of the world, however, the Chinese situation is of particular interest to
the Western scholar. Chinese society is one of the most different from Western
societies, and the Chinese situation is better documented than almost any other.

The focus of these pages is upon a set of illnesses often called "culture-bound
syndromes". These are illnesses or illness categories with a strong psychosocial
component which are typically found in only one or a few cultural groups. In the current
American nosology, they are classified as psychiatric syndromes. Some of the most
famous of these come from China, including shen kui, suo yang (a.k.a. koro), and qi-
gong psychotic reaction.

In addition, some Chinese illnesses have sufficient differences from their apparent
Western equivalents that the Chinese variant has merited special treatment.
Neurasthenia or shenjing shuairuo is the most famous example.
The pages linked below attempt to answer some of the questions about the way in which
"mental illness" (from a Western nosology) is experienced in China, and about illnesses
or variants of illnesses which seem particularly Chinese.

A note on romanization: I do not speak or read Chinese, and the sources available have
a combination of Wade-Giles romanization (WG), pinyin romanization, and various
ideosyncratic representations of dialectal pronunciations. Many thanks are due to David
Jordan for corrections and provision of tone markings. I have attempted to standardize
most Chinese words to pinyin spellings. Any remaining errors are entirely my own.