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Reintegration Today magazine is published quarterly by the Center for Reintegration as an information resource and community forum for people interested in all aspects of severe mental illness, particularly the process of recovery and reintegration back into society.
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Normal Behavior or Mental Illness: How Definitions of Normal and Abnormal Behavior Differ Across Cultures
No one debates the fact that mental illnesses exist everywhere in the world; however, a lesser known fact is that what is considered abnormal behavior in one culture, may be considered perfectly normal and even revered in another. Take Japan for example – a country that did not even have a word for mild depression until five years ago. Why? Because the Japanese culture, with its history of Buddhism and acceptance of sadness and suffering encouraged people to embrace that experience, not seek help for it.
Additionally, certain types of abnormal behavior may be found in some cultures and not in others. One such example is koro. This syndrome is found in China and in Southeast Asia, and is characterized by the irrational fear of one’s sexual organs shrinking or withdrawing into the body, leading to loss of sexual identity and ultimately death.
These differences are of immense interest and importance to psychiatrists trying to diagnose and treat people with mental illnesses from different cultures as individuals may present symptoms that are not consistent with recognized mental illnesses, such as those defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The term “culture-bound syndrome” is used in such instances and is defined in the manual as:
“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.” DSM-IV (488)
The following are a few examples of these “culture-bound syndromes”, some of which are comparable with recognized mental illness and some of which are unique to specific regions of the world and groups of people.
SYNDROME |
DESCRIPTION |
Boufée Deliriante
(West Africa and Haiti) |
A 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.
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Ghost Sickness
(American Indian groups) |
A 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, and a sense of suffocation.
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Involutional Paraphrenia
(Spain and Germany) |
Paranoid disorder occurring in midlife.
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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.
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Zar
(Ethiopia, Somalia, Egypt, Sudan, Iran, and elsewhere in North Africa and the Middle East) |
An 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.
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Taken from: Glossary of Culture-Bound Syndromes - (a well-done listing with links created for “Traditional Chinese Society”, a course by Timothy M. Hall at U.C.S.D.) http://weber.ucsd.edu/~thall/cbs_glos.html
Dennis O’Neil, Professor of Anthropology at Palomar College in California, provided information for this article. More information on this topic is available at http://anthro.palomar.edu/medical/.
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