chapter 1 - Bentham Science

Culture-Bound Syndromes The Primitive Mind and Modern Man 213
JUST WHAT CONSTITUTES A MENTAL DISORDER?
Culture-bound syndromes often involve bizarre behavior that in the West might defy categorization, or be relegated
to schizophrenia or hysteria.
To be sure, the symptoms are distressing and disruptive, but to the people of the particular cultures, the symptoms
are common enough so as to not be viewed with alarm. The patient experiences some sort of distress and for a time
is unable to fulfill one’s usual social functions, but the symptoms are not regarded as psychiatric in nature.
Indigenous people will treat culture-bound syndromes with folk remedies, shamanic healing, or the symptoms will
simply be allowed to run their course. These localized syndromes usually have local names, and we will discuss a
few of them below.
The issue of how “mental disorder” should be defined is somewhat controversial. It is difficult to see how “mental
disorder” can be universally defined across cultures because of a fundamental difference in local social practices,
values, cultural and even scientific beliefs. Particularly in recent years, it has become apparent that what constitutes a
mental disorder depends entirely on the context, on social identity, and on the proper interpretation of cultural factors.
People can perceive reality in fundamentally different ways, yet be clearly sane. People in primitive cultures believe
the world is populated by a variety of unseen creatures, ghosts, witches, spirits, demons, and that animals have souls
that can come back and harm you unless you make amends to them after a hunt. We might find their criteria for
perceiving reality to be fundamentally at odds with modern criteria, yet they are perfectly sane.
The DSM-IV-TR states that it is important to take into account an individual’s ethnic and cultural context in
evaluating whether a mental disorder really exists. The cultural identity and the degree of involvement with the
culture of origin are important factors to consider. A person’s culture may have particular explanations or
interpretations of symptoms of distress, e.g., evil spirits, violation of a taboo, or other cultural explanations that do
not fit into Western psychiatric theory (DSM-IV-TR, p. 897).
Deviant behavior in one cultural setting might be acceptable, even praiseworthy, in another. What is considered
dysfunctional or crazy in the West (e.g., seeing ghosts, hearing voices when no one is present) may be perfectly
normal in other cultures. In some cultures it is common for people to have vivid feelings of being visited by deceased
ancestors, while in our culture these might be considered to be hallucinations or delusions indicative of psychosis.
In recent times in the West there has been an epidemic of sorts of people claiming they have seen aliens from other
worlds or have been abducted by them, and then returned to Earth after experiments were conducted on their bodies.
Depending on how you look at it, these people could be considered schizophrenic, but a number of mainstream
scientists and mental health professionals have argued that the reality of purported abductions cannot be entirely
ruled out. A notable Harvard psychiatrist, Dr. John Edward Mack wrote a book of his research from interviewing
abductees, entitled Alien Abduction: Creating a Modern Phenomenon (1994).
For Native Americans it is normal to hear voices when alone, whereas this could be diagnosed as schizophrenia by
conventional psychiatrists. The idea that illness is caused by malevolent spirits, the curse of an enemy, the evil eye
or the violation of taboos may seem to be preposterous in our culture, but today these ideas are completely
normative to the majority of people in the world. And in an earlier period in the West, people thought it to be
perfectly credible that vampires existed and sucked blood from the living. People who experienced hallucinations
and ecstatic trances were sometimes hailed as saints (e.g., St. Therese of Avila or St. Joan of Arc), whereas in our
society there is a tendency to put the “psychotic” label on people who see or hear strange things.
Thus, it is important to take cultural factors into account in assessing whether a particular behavior is a mental
disorder. Moreover, in many cultures the ways illness is explained and treated are completely different than in in the
West. Even a clear case of schizophrenia will be looked upon as spirit influences-some adverse spirit has interlocked
with the patient, or the patient is obsessed by a spirit who disturbs his mind and causes it to malfunction. In such a
case the attitude might be that the individual is totally subjugated by a foreign spirit. The distortion in reality is not
attributed to the patient, but to the molesting spirits. One’s own spirit is as it were put aside and the mental confusion
is imposed by the intruding spirits.