This essay is focused on the examination of civilization bound syndrome (CBS), including its definition, categorization, and the arguments for or against its existence.
Most mental health disorders follow the Western scientific model of medicine, which assumes a universal biological basis for these disorders across cultures.
The societal impact on emotional well-being and the resulting misdiagnosis and limited understanding of mental health as a whole are overlooked by the notion that mental health issues are universal.
In clinical settings involving different groups like inmates, outpatients, and community populations, psychologists utilize classification systems such as the DSM IV (Diagnostic and Statistical Manual of Mental Disorders) to diagnose mental disorders.
The current edition of the DSM has made limited attempts to incorporate mental wellness disorders from various cultures to address cultural issues. These disorders, referred...
to as culture-bound syndromes, exhibit distinctive symptoms that are exclusive to a particular culture. They encompass recurrent patterns of abnormal behavior and distressing experiences that may or may not align with a specific diagnostic category in the DSM-IV.
These patterns are typically considered "illnesses" or afflictions within the indigenous culture and are commonly identified by local names. The term "culture" pertains to the beliefs, norms, and values governing interactions among individuals in a defined group, such as a society or nation. Each new member of the society must learn and follow these beliefs and understandings because they are relevant to culture-bound syndromes—meaning their symptoms can only be observed and experienced within that specific culture.
An example of civilization edge syndrome is Amok, which is found in Malaysia. It is characterized by a dissociative episode followed by aggressive and violent behavior towards people and objects. This syndrome mainly affects
males and is often triggered by perceived rejection or insult. Symptoms include persecutory thoughts, automatism, memory loss, and exhaustion. Afterward, the person returns to their normal state. Typically, Amok occurs in males between 20 and 45 years old who have experienced social status loss or major life changes. Although now rare, it primarily occurs in rural areas.
Another civilization edge syndrome is Dhat, occurring in India. Dhat manifests as vague bodily symptoms like fatigue, weakness, anxiety, loss of appetite, guilt, and sexual dysfunction attributed to the patient's belief of semen loss through nocturnal emissions urine and masturbation. The anxiety related to semen loss dates back thousands of years to Ayurvedic texts where even a single drop was believed to destabilize the entire body.
These illustrations of civilization edge syndrome represent some syndromes are found in Asia. Culture edge syndromes besides exist in Western society - one of the most good known 1s is anorexia. It is " an eating upset in which people deliberately starve themselves. It causes utmost weight loss, which the National Institute of Mental Health ( NIMH ) , portion of the National Institutes of Health ( NIH ) , defines every bit at least 15 per centum below the person 's normal organic structure weight. "
Categorizing Civilization Edge Syndromes
Culture edge syndromes have been categorised by McCajor Hall ( 1988 ) in the six following ways. The first manner is that he believes that in order to be a civilization edge syndrome, it must be a psychiatric unwellnesss that has non been originally caused and it must be recognised as an unwellness locally, nevertheless it must non be matched within a recognized class.
way is that it must be a psychiatric illness that has not been originally caused and is also recognized as an illness locally but it must also resemble a western class though it may lack some symptoms that are commonly regarded as the important part within other cultures. The third way is just simply that the psychiatric illness has not yet been recognized in the West. The fourth way is that the psychiatric illness found in many cultures may be originally caused but must only be regarded as an illness in one or a few of the cultures. The fifth way is that the psychiatric illness is accepted culturally as a form of illness but it would still not be regarded as an acceptable illness in the mainstream of western medicine. The sixth way is that the psychiatric illness or syndrome allegedly occurring in a given culture, but in fact does not exist at all in reality but is used to justify the expulsion and execution of an outcast in the same way witchcraft was.
According to psychiatrist Berry et al (1992), there are three types of syndromes. The first type is absolute syndromes, which can be found with the same symptom and incidence rates worldwide. The second type is cosmopolitan syndromes, where the same symptoms are present globally but with varying incidence rates between different cultures. Lastly, culturally comparative syndromes involve symptoms unique to a specific culture. However, the existence of culture-bound syndromes is still debated. Some psychologists hold a universalist stance, arguing that they do not exist, while others take a relativist stance and claim they do.
Culture Bound Syndromes and Their
Culture bound syndromes possess their own distinct characteristics and are exclusively observed within certain cultures. Psychologists such as Pfeiffer and McCajor Hall support this notion. According to Hall, for a syndrome to be classified as a culture bound syndrome, it must be acknowledged by the locals of that particular culture and should not be known in any other group, such as the Western society. However, if it is recognized as resembling a mental illness prevalent in the Western culture, the syndrome should exhibit at least some of its symptoms, but not necessarily all of them.
Pfeiffer suggests that civilization edge syndromes may not be adequately accounted for in the DSM IV. He argues that these syndromes should be examined in the context of specific cultures rather than from a singular viewpoint like that of Washington DC, where the American Psychological Association is located. Pfeiffer highlights four specific aspects that differentiate cultures. Firstly, he believes that different cultures experience varying sources of extreme stress, such as work, status, or health issues in one culture, and family relations in another. Secondly, he suggests that different cultures have different allowances and prohibitions regarding expressions and behaviors. What is considered an acceptable release mechanism in one culture may not be accepted in another. For instance, certain cultures prohibit alcohol consumption and therefore alternative ways of dealing with frustrations are necessary.
Therefore, a behavior can be exclusive to that behavior. The third aspect is that we may have culture-specific interpretations within us; this implies that a behavior is something, however, what we perceive it to mean for ourselves and the meaning we derive from it can be completely different.
An example of this is that in the past, certain women were labeled or accused of being witches because of culturally specific interpretations of their behavior (Ussher 1992). The fourth aspect proposed by Pfeiffer is that we have not explored the variety of culturally specific approaches to treating illnesses, but folk medicine serves as a good example of how indigenous people treat their ailments. Another good example is that in Western sciences, illnesses like fever and cough can be cured through the use of drugs, while in Asian culture, the Chinese rely on natural sources such as herbs and acupuncture to heal the same illnesses that Western culture is curing, albeit with different methods.
The suggestion that Culture-bound syndromes should be treated by common people's medicine implies that they are inconsistent with the purposes and intent of the ICD and DSM. Despite Pfeiffer and Hall having different perspectives, they both agree that the syndrome is determined by the culture itself. This indicates that not every culture-bound syndrome needs to adhere to Western scientific norms and can be unique in its own way. Behaviors can be misunderstood or misinterpreted, as what may be normal in one culture may not be in another.
Lee conducted a survey in the early 1960s among a random sample of Zulu adult females. The findings showed that more than one-third of these women reported experiencing hallucinations involving angels, babies, and small, hairy men. Moreover, over half of them engaged in prolonged screaming behavior which could last for hours, days, or even weeks. These behaviors would typically be deemed abnormal in Western society; however, it is important to acknowledge that few of these women
displayed other signs of mental disturbance. Within their own culture, their hallucinations and screaming were considered acceptable. This survey highlights the presence of varying ethical standards and beliefs across different societies, even if they are not universally accepted.
Zulus view hallucinations and shouting as normal and acceptable, even though these behaviors would be considered abnormal in Western cultures. Conversely, behavior can be deemed abnormal or indicative of mental illness if it goes against societal norms. According to Sam (1996), Western psychological explanations do not account for the experiences and behaviors of individuals from different cultures, as psychology is heavily influenced by Western perspectives and ignorant of other influences. Yap (1974) argues that mental disorders are prevalent across all cultures, suggesting that symptoms arise from within individuals and cluster together to form specific categories of mental illness. He also believes that comparative psychopathology aims to establish commonalities between different cultures, similar to how comparative psychology explores culturally specific expressions of universal human problems and disorders addressed by the ICD and DSM. Additionally, Yap suggests that CBSs like Latah are cultural manifestations of a "primary fear reaction" unique to local cultures.
There is evidence suggesting that civilization-bound syndrome does not exist. An example of this is the condition known as 'Dhat', which was studied in a publication called "Culture-bound syndromes: the narrative of Dhat syndrome" in The British Journal of Psychiatry. The study had two objectives, firstly to collect clinical and empirical studies on Dhat syndrome and review the existing literature, and secondly to gather historical data from various countries and time periods. The approach adopted for this was a combination of manual and electronic literature searches to
obtain relevant information.
They conducted research on the origin and description of semen-loss anxiety in various civilizations and settings. The findings revealed that while Dhat syndrome was typically associated with Asia, other cultures in Britain, USA, and Australia also historically explained similar symptoms. This suggests that the prevalence of this condition is widespread worldwide, even though it is primarily considered a syndrome from the East. They concluded that semen-loss anxiety (Dhat) is not exclusively limited to one culture, as previously believed. Therefore, they recommend modifying the concept of culture-bound syndromes according to DSM-IV guidelines.
When collecting and analyzing research data, similarities were found in the perception of seed loss and its importance among Western culture, Chinese culture, and the Indian subcontinent. Furthermore, historical records show that this belief can be traced back to Aristotle's time and is also present in Ayurvedic texts from the 5th millennium BC to the seventh century AD on the Indian subcontinent. This indicates that despite using different terminology, people have similar thoughts on this matter. This discovery is significant as it reinforces the universal concept that mental health disorders are prevalent and culture-bound syndromes are just variations of these disorders with specific symptoms. Hence, there is no need for new diagnostic criteria for culture-bound syndromes since they essentially represent different forms of existing mental health disorders.
'The British Journal of Psychiatry' asserts that the syndrome known as 'taijin kyofusho' in Japan is comparable to the western form of societal phobic disorder. Both syndromes cause individuals to experience intense fear regarding their bodies, body parts, or even bodily functions that may be considered displeasing by others. By comparing taijin kyofusho to societal phobic disorder,
it can be observed that both share symptoms of anxiety, albeit to varying degrees. Hence, it can be concluded that they are essentially the same syndrome or mental illness. It is possible to view culture bound syndrome as a syndrome unique to a particular culture, which may not exhibit all the symptoms found in western culture.
Thomas Szasz, an American psychologist, dismisses the idea that civilization-bound syndromes and mental health disorders truly exist. He argues that these concepts are nothing more than myths, with no real evidence to suggest that they are biologically-based causes of mental illness. In an article by 'The New Atlantis', Szasz even ridicules the attempts of prominent American psychiatrists throughout history, including Benjamin Rush, who is considered the father of the profession.
In the late 18th century, Rush wrote that mental diseases have been mysterious. He attempted to classify them as equal to other diseases of the human body and show that the mind and body are affected by the same factors and subject to the same laws. Szasz sought to correct this misunderstanding in his book "The Myth of Mental Illness: Foundations of a Theory of Personal Conduct". This influential work by Thomas Szasz transformed perspectives on the psychiatric profession and the ethical consequences of its practices.
According to Thomas Szasz, psychiatrists absolve individuals of responsibility for their actions by labeling unwanted behavior as mental illness. Additionally, he criticizes Freudian psychology as a pseudoscience and warns against the dangerous expansion of psychiatry into all aspects of modern life. Szasz argues that psychiatry is not a true medical science but rather a social control system. He believes it is simply a means for people
to deal with problems caused by others in life. Furthermore, Szasz claims that psychiatry masquerades as a medical field through the use of terminology that gives it a medical appearance, making it a pseudo science. Ultimately, his goal is to challenge the existence of concepts like mental health disorders and culture-bound syndromes.
In conclusion, some individuals, such as Yap, argue that civilization edge syndromes are only mental health disorders but on a smaller scale. Another psychologist, Thomas Szasz, also denies the existence of civilization edge but still maintains that mental health disorders do not exist. However, according to an article in the new Atlantic, Szasz is now seen as a fictional figure and is not taken seriously. He is often regarded as a foolish believer in outdated ideas. Most medical students graduate without ever hearing his name. Overall, his beliefs and views are considered outdated and irrelevant, leading to his marginalization in the field of psychology.
'The British Journal of Psychiatry' conducted historical research on the Dhat syndrome, a civilization bound syndrome. They examined how the belief in the loss of semen was perceived and attacked. The research findings indicated that all cultures shared the belief that semen is valuable and losing it is undesirable. This supports the concept of universality in mental health disorders, suggesting that they exist everywhere and are similar in nature. Therefore, it can be inferred that the Dhat syndrome may not truly be a civilization bound syndrome and its prevalence may have been exaggerated. In their research, the journal concluded that the Dhat syndrome should modify its criteria to align with the DSM IV, further validating the idea of universality.
Unfortunately, despite claims
that culture-bound syndromes are outdated, there still exist psychologists who hold their own perspectives and beliefs which demonstrate the existence of these conditions. Psychologist McCajor Hall provides a good example of this. Hall's belief is that if a syndrome is only found in specific cultures and does not exhibit all the symptoms of a Western classification, then it can be considered a culture-bound syndrome. Hall challenges the notion that all disorders and syndromes must conform to Western science or be categorized under Western mental health disorders, as they can exist in various forms anywhere. Psychologist Pfeiffer further supports the idea of culture-bound syndromes by highlighting the variability of cultures. He argues that a problem in one culture may not be considered a problem in another culture, emphasizing that behaviors are deemed acceptable or unacceptable solely based on the specific cultural context.
It can be observed that civilization bound syndromes do exist, but not entirely and their prevalence may not be very high. The existence of civilization bound syndromes is supported by psychological perspectives, such as those of Pfeiffer and Hall. According to them, although some civilization bound syndromes may share symptoms with western mental health disorders, they are still considered as distinct cultural syndromes. One reason for this is that a universal approach may result in misdiagnosis. Pfeiffer also argues that different cultures may have different problems, making it impossible to claim that all cultures around the world face the same issues. This is particularly true given that there are numerous mental health disorders yet to be discovered, and our understanding of the human mind is still limited due to its complexity.
By reiterating our previous statement,
we reaffirm the existence of civilization-bound syndromes.
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