Culture-bound syndromes

Since its inception, scholars have struggled with the concept of CBSs. This struggle is reflected in the continuing use of a term that is confusing and inaccurate. Most authors would agree that the term 'culture-bound syndrome' was intended to describe forms of otherwise common mental illness that are rendered unusual because of the pathoplastic influence of culture. It was intended not only to describe specific syndromes, but also meanings of illness and non-Western notions of disease causation. The term has become an anachronism, for the word, 'syndrome,' implies specific disease entities, not illnesses of attribution or idioms of distress. Furthermore, the word 'bound' implies that the entities described are restricted to a single culture. Close examination reveals that many of the so-called 'culture-bound' syndromes are found in multiple cultures that have in common only that they are 'non- Western.' It may be unreasonable to expect one term to describe these different concepts. The most accurate of the designations offered might be 'folk diagnostic categories.' Perhaps the most difficult question remaining is 'How can we understand (and classify) these phenomena in such a way that highlights their uniqueness but does not dismiss them as too rare and exotic to warrant attention?' The first step is to recognize that the CBSs are a heterogeneous group of conditions. We must next acknowledge that the concepts represented may be difficult for the average Western clinician to recognize but, in their respective cultures, are neither rare nor unusual. With 80% of our increasingly shrinking world coming from 'non-Western' cultures, a familiarity with non-Western notions of disease causation is particularly important for modern clinicians. Many authors have recommended that those CBSs that are 'true' syndromes be classified together with their Western counterparts. In order to do this, the folk labels need to be put aside and the fundamental components of each disorder examined. Each entity would have to be placed in the body of the classificatory manual, and defined by its symptoms, not by the fact that its form is highly influenced by culture. An acknowledgment of the influence of culture would be appropriate, perhaps by means of a 'culture-specific' label with criteria outlined, such as the ones we mentioned earlier in this article. Until these entities are placed in the body of the text, many clinicians will have difficulty recognizing their importance. There is much we can learn from examination of the culture-bound syndromes. Because they are eloquent examples of the influence of culture on psychopathology, they are superb models for examining the interplay between psychosocial and biologic contributions to mental illness. By elucidating the 'bio-psycho-social' mechanisms of those afflicted with these syndromes, we may better recognize this interplay for all other kinds of psychopathology.