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).

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The ‘baby bump’ as public property

What is it about a pregnant woman’s belly that inspires strangers to stare at it, touch it (sometimes without asking permission), and comment upon it? On Slate today, Jessica Grose is creeped out by our obsession with celebrity pregnancies, pointing to a recent New York Times article about pregnant celebrity fashion entitled Pregnancy Takes a Turn on the Red Carpet. Her views are doubtlessly shaped by her own experience:

People I passed on the street wouldn’t meet my eye, they’d stare right at my stomach. Once, a man leered at me, which felt much more invasive than cat calls did before I was with child. I suppose it’s because I had no control over the way my body looked, and I felt much more vulnerable than usual because I had a helpless baby I was supposed to be protecting.

Grose finds the flaunting of bellies — or at least the media’s treatment of it — to be extremely objectifying.  The NYT article relates the history of celebrity demi-moorepregnancies, mentioning Demi Moore’s famous Vanity Fair cover from 1991 as a turning point that brought bellies into the open. It talks about a “revolution” that empowered celebrity women to appear at award shows when they were visibly pregnant and seems to take the position that this is universally liberating, especially now that there are more fashionable options. Grose points out that an essay by Renee Ann Cramer cited in the article draws a very different conclusion. In that essay, “The Baby Bump is the New Birkin“, Cramer writes:

Tabloids and glossy magazines watch and judge these pregnant bodies. Given that celebrities provide models of fashion that everyday women try to emulate, the sexy new baby bump establishes standards of pregnant and post-baby female beauty that are unattainable — perhaps even undesirable — to most. What’s more, press coverage of celebrity moms predictably replicates tired tropes and existing power gaps in class, race, and gender.

Looking at a media culture that reeks of TMI and TMZ, I’m inclined to say, “Who cares?”, but the answer seems to be “almost everybody but me”. Baby bump speculation sells magazines and raises hit counts, encouraging us to evaluate the celeb as a mother-to-be, not as woman, a person, or on the basis of whatever qualities brought her to the public eye. Let me throw in a plug for a professor at my alma mater, Erin Meyers of Oakland University, whose recent book Dishing Dirt in the Digital Age: Celebrity Gossip Blogs and Participatory Media Culture analyzes the digital obsession with celebrity gossip and who has looked at the “bump watch” in particular.

Celebrities aside, some of the comments on Grose’s article suggest this is part of an oversharing trend that extends to posting photos of urine-sensitive pregnancy tests with positive results on one’s Facebook page. Think of Janelle Taylor’s The Public Life of the Fetal Sonogram: Technology, Consumption, and the Politics of Reproduction. It’s not uncommon to get a first glimpse of a friend or relative’s child long before birth as a shared sonogram image. When I researched the social construction of pregnancy in the virtual world Second Life, among the phenomena I considered were products that give the fetus a more active role. These include transparent belly or uterus add-ons that show the growing baby (giving the pregnancy a whole new level of visibility) and some known as “tummy talkers” that simulate monologues by the fetus reminding the mother to eat properly and rest, expressing love, or warning others nearby to be careful not to push into Mommy. Though these are not universally used, they’re common enough that dozens of brands exist.

Celebrities set trends but they also follow them; if they reveal their pregnancies in ways that ordinary women might, the scrutiny and judgment they receive is magnified. Grose felt that she garnered unwanted attention when she was visibly expecting. I can’t guess whether she shares that feeling with the majority of today’s American  mothers, though signs point to women inviting others to bear witness to their pregnancies earlier and earlier in their progression. The female body remains a battleground for agency, no matter how famous one happens to be.

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?

The forgotten victims of Breast Cancer Awareness Month

Health on Today: ‘Pinktober’ ignores breast cancer patients who can’t be cured, some say  From the article:

“I can’t celebrate because I’m not a survivor,” said Clark, who was diagnosed in 2010 with an aggressive Stage III cancer that quickly advanced. “There’s not a cure.”

“The message has really been skewed,” says Knackmuhs, 61, of Wyckoff, N.J., who was diagnosed with Stage IV disease in 2009. “It’s so associated with selling products and shopping and dubious product endorsement.”

I’m always skeptical of something that is treated like a universal good — “I was going to spend the money/go to the event anyway and now some of that money goes to breast cancer awareness!” — especially when large corporations enthusiastically jump on board. After doing some research into this for a presentation I did for class last semester, I’m collecting examples of pink co-branding this October with hopes of doing a full study on the topic in the future.

For now, I’m going to skip my rant and let others speak. Read the article linked above, and from my presentation, these quotes:

  • “My disease has become a marketable commodity and nothing more.  The sad irony in all of this is that I believe Komen’s approach to cause-marketing has only served to undermine the seriousness of this disease in the public’s perception.” – Rachel, who shared her story of metastatic breast cancer at cancerculturenow.blogspot.com, until she died this February  (If you can stand the heartbreak, read her husband’s post about enduring a “Paint The Town Pink” campaign less than 3 months after Rachel’s death.  It’s agonizing.)
  • “Telling an authentic story about an illness that is heavily laden with cultural expectations about femininity, normalcy, and triumphant survivorship requires a new way of thinking and speaking. Falling on the margins of the cultural framework, these kinds of stories can be threatening and hard to hear.“ – Gayle Sulik in Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health
  • “Fashion statements aside, once I became a person with breast cancer, it didn’t take long at all for me to develop a very low tolerance for all things pink. The sheer ubiquity of pink as the symbol of the fight against breast cancer is overwhelming. And one of the things that you discover… is that everyone … seems to assume that you are now the local poster chick…everyone assumes that you have the interest, time, energy, inclination and funds to contribute to or participate in every bleeping event, cause, or group that is even remotely associated with helping everyone else not end up like you.“ – A breast cancer patient named Kathi

Lecture on concepts of embodiment in Appalachian women

Mark your calendars for this lecture! (via News at OU)

Friday, Oct. 12
Noon to 1 p.m. in Oakland Center Gold Room C

Between the River and the Railroad Tracks: Speaking Marginal Bodies to Central Spaces in Appalachian Ohio

Using life history research, Dr. Rebecca Mercado-Thornton, assistant professor of communication, will examine the scarcely told experiences of Appalachian women living in Appalachia, Ohio. Focused on the life histories of three women, the talk will trace the ways in which these women resist and undermine traditional conceptions of embodiment.

Here and abroad, two articles on prevention

Two articles caught my eye today.  The first is on some of the experimental programs coming out of the Affordable Care Act to design effective community prevention.  But since we don’t see a lot of evidence that awareness-raising campaigns can work in and of themselves, new approaches are being tried out.  The article points to distrust of the government, the short-term thinking that results from living in poverty, and easy access to less healthy food as some of the reasons why preventable disease continues to be the leading cause of death in America.

It’s instructive to compare this article to a recent study on the factors leading to maternal mortality in India.  Summarized nicely here, researchers from the Public Health Foundation of India (PHFI), the London School of Hygiene and Tropical Medicine, and the University of Aberdeen looked at the success of a recent government program (JSY), a conditional cash-transfer program meant to create incentives for women to go to hospitals to give birth.  What looks like thoughtful qualitative work revealed that “good care” looks different to Indian women than it does in many other cultural contexts.  Moreover, the structural constraints women face are so great that cash incentives are not likely to change maternal mortality rates dramatically: many women don’t have the right to choose when they want to get pregnant and where they will deliver, and one in three women said they couldn’t go to hospitals because there was no one to look after other children at home.

Breastfeeding in Public: A Feminist Anthropologist Speaks Out

Adrienne Pine is always brilliant, and this post on CounterPunch, in which she details her correspondence with a school newspaper over breastfeeding in class, is no exception.

“To be honest, if there were an easy way I could feed my child without calling attention to my biological condition as a mother, which inevitably assumes primacy over my preferred public status as anthropologist, writer, professor, and solidarity worker, I would do so. But there is not.”

Micah posted this in March, with the comment, “Do hair relaxers cause uterine fibroids in African-American women? Sounds like ice cream and murder to me.”

This author agrees: Chemical relaxers linked to high uterine fibroid risk in African-American women? I doubt it.