What it means to have a culture-bound syndrome

If you tell a distressed woman that her suffering is a culture-bound syndrome, perhaps citing examples that she would find bizarre, you shouldn’t expect a pleasant and understanding response. It sounds dismissive, like saying it’s “all in her head” or a manipulative tactic to garner sympathy.

There have been a flutter of articles about culture-bound syndromes in the wake of the DSM-5 publication, and a piece on the The Guardian (Are mental illnesses such as PMS and depression culturally determined?) seems to have inspired this one on Jezebel and then this one on Slate.  There are many good links in the articles and I recommend clicking if you’re interested in the topic.  But what comes through to me in some sections of the writing and definitely in the comments is the attitude that if an illness is culture-bound, it’s not real.  Many of the comments are defensive, daring others to say that what they’re experiencing is a lie.  This can be complicated by a mainstream understanding that something “cultural” is something shared, yet (to use the main example from the articles) not every woman in Western cultures has PMS or experiences it in the same way. Does this mean that those who do are exaggerating for effect or making it up?

No.  However, we start to wade into the swamp of the “really real” where I so often find myself lost. I know I’m not alone in struggling to understand what it means for someone to have a culture-bound syndrome and I’d make a mess if I tried to unpack a lot of theory.  However, I think it’s a common mistake to see these syndromes as only a way of expressing emotions that don’t have another path of release. I’m more inclined toward the notion of local biologies, where societal and cultural expectations play a role, but so can genetics and epigenetics, diet, and environment.

We do a disservice by pointing out the culture-bound syndromes of others without inclusively evaluating those that might be our own (not at higher levels of study, but certainly in lower levels and mainstream articles). It wrongly puts Western culture in a position of rationality and superiority, smiling at the quaint confusion of others, rather than questioning our own socially accepted conditions that are proving to be non-universal and WEIRD (Western, Educated, Industrial, Rich, and Democratic).

Munchausen by Internet

While following a trail of links from an article about Manti Te’o’s imaginary girlfriend, I rediscovered this excellent article from The Stranger (a weekly newspaper in Seattle) about people — mostly women — who lie about illnesses online. It’s a terribly interesting read.

“Munchausen by Internet” is not considered a unique illness, though that was debated for the DSM-V, but is a form of Munchausen Syndrome in which a person fakes his/her own illnesses.  (There is also Munchausen by proxy, the most common example of which is a mother who exploits exaggerated or imaginary illnesses in her child.)

It’s easy to say that these illness fabricators are pathetic or predatory, emotional vampires who feed on the sympathy of others.  However, I find myself thinking about Ong’s work with Malaysian factory workers, Nichter’s “Idioms of Distress”, or accounts of spirit possessions (mostly of women) in various cultures.  Should we consider this an individual psychiatric disorder when the condition centers around relationships with others?  Why is it largely a female phenomenon?  Is this a culture bound syndrome?

Culture bound syndromes in girls

Two occasions of mysterious illnesses among girls: culture bound syndromes?  The first is a Radiolab podcast about an 1962 outbreak of contagious laughter in Tanzania and the second is a  New York Times Magazine article about a group of girls from Le Roy, New York (near Rochester).

Contagious Laughter Radiolab Podcast

The Mystery of 18 Twitching Teenagers in Le Roy

Lydia Parker, foreground, at home with her sister. She got one of the bruises on her face when an uncontrollable tic caused her to hit herself with her cellphone.
(c) Gillian Laub/The New York Times

Matt K. shared this article during the Winter 2012 semester class, wondering if this is an example of a culture-bound syndrome: Mysterious nodding disease debilitates children

“A sufferer of Nodding Disease is put in a child’s crib at Antanga Health Center, Uganda, so that he doesn’t injure himself. The affliction is associated with violent epilepsy-like convulsions that can lead to permanent disabilities.” – CNN