Culture Bound Syndromes

Culture Bound Syndromes

Sam (1996) states that western psychological explanations don’t account for all the experiences and behaviour of people from other cultures, psychology being western culture bound and blind to influences from elsewhere

Defining Culture:

The word Culture refers to the beliefs, norms, and values (Standards of acceptable behaviour and thoughts) that govern the way people within a defined group (Such as society or a nation) interact with one another.
Each new member of the group has to learn these beliefs and understandings

Although ICD and DSM aim to be universal and scientific, culture bound syndromes do not fit comfortably into them. The DSM now lists 25 culture bound syndromes, but does not provide criteria for them. CBS raise a serious challenge to both of these classifications systems in this topic we will look at what are CBS. Finally whether CBS are really unique ways of being mad or localised manifestations of illness.

Definition of culture bound syndromes:

We musty always consider the ideas of ‘Value freedom’ and ‘value biases’
Behaviour that can be thought of as a disorder in one society may be thought of as an appropriate response or acceptable behaviour in another. In which case ICD-10 and DSM-IV aren’t going to be acceptable.
This would be described as a culture bound syndrome (CBS) as it is supposed to be specific to that culture. This is also known as a Culture bound Disorder (CBD) or Culture Specific Syndrome (CSS).

Not everyone accepts that CBS exist. ICD-10 defines them as localised forms of depression, anxiety and somatoform disorders – something being wrong with their bodies without there being physical evidence.

Culture bound syndromes of mental disorders are associated with ‘folk illnesses’ that are treated with ‘folk medicines’

ICD-10 defines CBS as behaviour that doesn’t easily fit into the usual categories and appears only amongst particular groups of people.

DSM agrees and adds the idea that other members of the specific culture consider them as illnesses.






Looking for patterns:

What we are interested to know is :
Do particular syndromes of pathological behaviour exist amongst specific groups of people at all?
Or, are they similar to syndromes that can be found everywhere, except that they are triggered by a feature of the culture in which they are found?

Every example of abnormal behaviour must be understood in terms of the norms and values of the group to which the person exhibiting it belongs. It wouldn’t make sense to apply DSM and ICD which reflect Western Cultural experiences, to the behaviour of some Malaysian Males.

Hall (1998) categorises CBS in the following way:
1. A psychiatric Illness (Not originally caused) which is locally recognised as an illness and which does not match a recognised western category;
2. A psychiatric illness (Not originally caused) which is locally recognised as an illness and resembles a Western category, but may lack some symptoms that are regarded as important in many cultures;
3. A psychiatric illness not yet recognised in the west;
4. A psychiatric illness (Which may or may not by organically caused) that is found in many cultures, but is only regarded as an illness in one or a few ;
5. Culturally accepted forms of illness which would not be regarded as acceptable in mainstream Western medicine;
6. A syndrome supposedly occurring in a given culture, but which does not in fact exist which is used to justify the expulsion or execution of an outcast in the same way as witchcraft was.

Arguments for and against the existence of culture-bound syndromes.

Here we ask the following three questions:
Do culture bound syndromes exist?
Can CBS be classified in any meaningful way?
Do the symptoms described as CBS actually exist everywhere (And as described by DSM and ICD) but influenced by culture or are the syndromes really specific to the culture in which they are found and do not exist anywhere else?

The development of the ‘global village’ will result in differences between people declining and therefore CBS declining

Yap (1974) believes that the conditions described in CBS actually exist everywhere but are triggered by factors in specific cultures making their forms vary.
Pfeiffer (1982), however, believes that the only way to understand these syndromes is as a response to the specific cultural circumstances that surround the individual but when clustered into a syndrome they are qualitatively different from other syndromes triggered by events in other cultures.
Universal or culturally relative?

Berry et al. (1992) argues that three positions can be taken in relation to abnormalities, mental disorders etc, these are:
1. Absolute:
Unchanging in terms of origin, symptoms etc. all cultures studies;
2. Universal:
Found in all cultures, but affected by cultural influences in terms of what brings them out, what forms they take etc.
3. Culturally relative:
Unique to some cultures and understandable only in terms of values and concepts held within those cultures.


Yap (1974) argues :
1. Human mental disorders are broad, spanning all cultures i.e. they are supra cultural. Thus it could be argued that symptoms emerge from within the individual and these symptoms cluster together to form discrete categories of mental illness. This was the precise starting point of contemporary psychiatry in the early work of Kraeplin in the late 19th Century;
2. Comparative psychiatry aims to establish common links across cultures in a similar manner to the way in which comparative psychology explores links seen as culturally specific expressions of common human problems and disorders that are addressed by the ICD and DSM. Yap (1974) believes that Latah is a local cultural expression of ‘primary fear reaction’

Commentary - CBS’s and the universal view of these disorders
Supracultural or specific to cultures? — Pfeiffer (1982) argues against the supracultural position on CBS’s. He agrees with Yap (1974) that the manifestations of illnesses, i.e. the human behaviours, may indeed be ‘a universally human character’, but argues that this is only one part of the issue. His view is that the diagnostic and classificatory systems of the Western world are so qualitatively different in nature to the folk illnesses and medicines specific to particular cultures that they cannot be integrated except by distortion. He writes:
‘The attempt to bring the culture-bound syndromes into a psychiatric diagnostic system is doomed to failure because the symptoms in the two spheres are selected and ordered from qualitatively disparate points of view.’

Why CBSs might not be ‘at home’ in the DSM?— Pfeiffer argues that CBSs must be viewed at the level of the individual culture, rather than from the vantage point of Washington DC, the home of the American Psychological Association, because they are specific in the following four aspects:
1. Cultures differ in those things that place people under unbearable stress; in one culture it may be work and status; in another, family relations.
2. Different cultures allow and ban certain expressions and behaviours. What might be permitted as a culturally acceptable release mechanism in certain cultures may not be allowed in others.
3. We may have culture-specific interpretations — a behaviour is one thing, but what we take it to mean and what sense we make of it, is entirely another. Think how certain women were ‘discovered’ to be witches because of culturally specific interpretations of their behaviour (Ussher 1992).
4. We have not explored the variety of cultural-specific ways of treating disorders, but folk medicine is a good example of the ways in which indigenous people treat their illnesses.

So, if CBS’s are a form of folk illness to be treated by folk medicine, then they are qualitatively inconsistent with the aims and purposes of the ICD and DSM


References:


Sam (1996) - States that western psychological explanations don’t
account for all the experiences and behaviour of people from other cultures, psychology being western culture bound and blind to influences from elsewhere

Hall (1998) - categorises CBS as a series of 6 points which
assess CBS existence.

Yap (1974) - believes that the conditions described in CBS actually exist
everywhere but are triggered by factors in specific cultures making their forms vary.
Berry et al. (1992) - argues that three positions can be taken in relation to
abnormalities, mental disorders etc

Pfeiffer (1982) - argues against the supracultural position on CBS’s. He
agrees with Yap (1974) that the manifestations of illnesses, i.e. the human behaviours, may indeed be ‘a universally human character’, but argues that this is only one part of the issue. His view is that the diagnostic and classificatory systems of the Western world are so qualitatively different in nature to the folk illnesses and medicines specific to particular cultures that they cannot be integrated except by distortion.
Concepts to note:
Define these terms:
Culture
Culture Bound Syndromes

What did they do or say?
Hall
Pfeiffer
Yap