Do Some Cultures Have Their Own Ways of Going Mad?

Latif Nasser, Boston Globe, January 8, 2012

Anyone who follows psychiatry has noticed that the field is now in the midst of a debate that galvanizes its members every 10 to 20 years. At the center of the hubbub is psychiatry’s most sacred text: the Diagnostic and Statistical Manual of Mental Disorders.

The DSM, for short, is a compendium of over 350 ways our minds can fail us, from autism to kleptomania to voyeurism. What makes it onto the list matters: The DSM’s definition of “mental illness” can dictate whether an insurance company covers a treatment, or even whether a murderer is fit to stand trial. With the American Psychiatric Association gearing up to revamp the manual for the first time since 1994, mental health specialists have begun jostling over some of the most divisive issues in the field: whether someone mourning the death of a loved one can be justifiably treated for depression, for instance, or whether overdiagnosis and a black market demand for Adderall have trumped up a false ADHD epidemic.

And then there’s the back of the book.

If you turn to page 898 of the current edition — past the glossary and the alphabetical index of diagnoses — you’ll find a list of 25 little-known illnesses. These are the “culture-bound syndromes”: mental illnesses that psychiatrists officially acknowledge occur only within a particular society. Take, for instance, susto — a distinctly Latin American fear that one’s soul has panicked and left one’s body. Or pibloktoq, also known as “arctic hysteria,” in which Greenlandic Inuit strip off all their clothes and run out into the subzero Arctic tundra.

Depending on whom you ask, the notion that some cultures have their own ways of going crazy is either the ultimate in cultural sensitivity or the ultimate in Western condescension. And although these syndromes haven’t attracted nearly as much attention as Asperger’s or binge eating disorder, they are starting to come under fire from critics who don’t think that the appendix belongs in the book at all. Since the last edition of the DSM, in lectures and research journal articles around the world, a cluster of psychiatrists, anthropologists, and historians has attacked the validity of specific disorders on the list. To these critics, the very notion of a “culture-bound illness” is an outdated relic from the days of European empires.


Partly in response to the critics, the DSM’s editorial task force has convened a special committee of 20 advisers to figure out what to do with the category. Helming the committee is Dr. Roberto Lewis-Fernández, a clinical psychiatry professor at Columbia University who helped write the appendix nearly 20 years ago.

What to do with the appendix, however, is proving a thorny problem to solve. It’s not because no one is sure whether pibloktoq is a real thing, although that’s an open question. It’s because the whole debate turns on an issue that psychiatry itself has yet to agree on: how much mental illnesses are a manifestation of the cultures in which they arise. And whether, when it comes to how culture and human psychology intersect, it’s time to start seeing the West as a culture too.

The notion of a culturally specific disorder dates back to 1950s Hong Kong, where a British-trained psychiatrist named Pow Meng Yap found himself growing frustrated: The complaints he was hearing from his local patients in Hong Kong didn’t always match up with the descriptions in the standard psychiatric textbooks he had studied. In 1951, he published an article titled “Mental Diseases Peculiar to Certain Cultures,” in which he attempted to document ailments from far-flung corners of the colonial world, disorders that most Western psychiatrists had never encountered.

Collecting illnesses for his list, Yap drew on florid accounts written by anthropologists and psychiatrists around the turn of the last century. For instance, he mentioned three illnesses from colonial Malaya (now Malaysia): amok, an amnesiac homicidal spree which gave us the phrase “to run amuck”; latah, in which a startled victim falls into a trance and mimics or obeys anybody around her; and koro, the fear that one’s genital organs are retracting into one’s body, and that this will eventually lead to death. Yap himself was the first to admit that existing literature on these illnesses was a jumble, part observation, part “common prejudice.” But if psychiatry didn’t start looking at non-Western cultures, he argued, the field could never fully understand the human mind.

The first edition of the DSM, published the year after Yap’s paper, never mentioned culture. Nor did its 1968 second edition. The notion crept into the 1980 third edition by way of a bureaucratic disclaimer: “Culture specific symptoms . . . may create difficulties in the use of the DSM-III-R [either] because the psychopathology is unique to that culture or because the DSM-III-R categories are not based on extensive research with non-Western populations.”

Then came the 1980s. Paradoxically, at a time when the manual was increasingly being adopted overseas as the ultimate arbiter of psychological truth, it was coming under fire in America. Critics charged it was too much a product of its own time and place — for example, it had labeled homosexuality a mental illness in earlier editions, and included a version of the possibly faddish premenstrual syndrome in later ones. At the same time, from all over the world, a critical mass of new practitioners was emerging who combined psychiatric expertise with training in anthropology. Many of these doctors worked in cultures previously unrepresented in the field, and they lobbied the American Psychiatric Association to give more space to the cultural diversity of mental illness.

The result was a seven-page appendix to the current edition of the DSM, published in 1994. After an essay advising practitioners “how to deal with culture in a clinical setting,” the appendix lists all manner of conditions specific to locales such as Iran, Haiti, Korea, and Mexico.

One illness on the list is dhat syndrome, particular to the Indian subcontinent. Indian men report a vast array of symptoms — among them headaches, forgetfulness, and constipation — that they attribute to a lack of vital fluid, namely, semen. Patients may blame the semen loss on excessive sexual activity, masturbation, nocturnal emissions, or even loss through urine.


Looking at the list of illnesses today, just 18 years after it was published, one can barely recognize the original impulse behind it. What once seemed to be a triumph for the forces of inclusivity now looks like a ghetto — or, as critics have called it, a “museum of exotica.”

What has also struck some critics, though, is that some of these supposedly exotic disorders appear strangely familiar, if you look hard enough. Bhugra, who is also former dean of the Royal College of Psychiatrists, points out that 19th-century Americans had their own version of dhat — a semen loss anxiety that led, in part, to the development of health foods like Kellogg’s corn flakes and Graham’s crackers, whose inventors created their products as panacea for ills caused by, among other things, masturbation.


If underlying mental illness is universal, then what looks like a “culture-bound syndrome” is likely to be a common problem that happens to show up differently in different settings. In this way of thinking, susto, or “soul loss,” could be seen as just a Hispanic way of describing what Americans know as plain old depression. {snip}

However, there’s another way to see the relationship between culture and mental health. A different group of thinkers — including, most prominently, cultural psychiatrists — sees culture as doing more than just giving different names to universal mental disorders. Culture doesn’t just shape what a mentally ill person calls his or her illness, they argue — it determines what counts as illness in the first place.

“Culture tells us what is normal, what is abnormal, what is deviant, what is not deviant, and where you seek help from,” says Bhugra.

If this is true — if it’s culture that decides what’s “crazy” and what’s reasonable behavior — then there may be no such thing as an illness that isn’t culture-bound. It’s not that a handful of disorders no longer belong in a cultural appendix; it’s that perhaps they all do.


What is not on the table yet — and considering that the DSM is ultimately published by American psychiatrists, may never be — is a deeper acknowledgment that far more mental illnesses might be cultural than we currently think. After all, commonly cited Western syndromes like chronic fatigue syndrome or multiple personality disorder are unknown in many countries, and yet the 1994 manual includes no British or American syndromes in its “culture-bound” category.


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  • VikingManx

    Retention of semen is an Aryan tradition thought to keep a man’s fighting spirit alive and well.

    Not surprising that it was common in India and White America.

    • Anonymous

      What you are actually referring to is the sexual frustration that produces violent tendencies, not the technical effects of impacted semen.  It is actually healthier for the male to ejaculate more often, thereby retaining a healthy gland function AND testosterone production.  Your comment reminds me of the film “Raging Bull”  wherein the original “Rocky” allowed his wife to sexually frustrate him so that he could take that frustration into the ring.

      • Anonymous

        I am pretty sure he was not referring to the difficulties incurred due to “impacted semen”.  Not sure what those difficulties entail, but I am sure I do not want to know.

        I suspect males used to get aggressive when they had no mate/release/sexual parntner whatever you want to call it  because nature told them if you can’t breed, you had best fight in the attempt to breed, or die.

        Maybe industrialization and technology got the wires crossed, and success isn’t about offspring but creating and inventing and helping etc… and just maybe that is what is wrong with us? Just guessing, but obviously something has gone haywire.

        • Anonymous

          You’re talking about symptoms and sociological expressions, I’m talking physiology.  Beyond that, are you really telling us that you have never teased a male or seen a male teased and become somewhat frustrated if he cannot satisfy his libido?  It doesn’t require a PhD to link physiological activity to social actions.  Instincts as you and VikingManx discuss here in a superficial way have hormonal and biological instinct behind them.  It doesn’t hurt to have a fuller understanding of what is going on, does it?

          If such knowledge is indecent to you, then perhaps you ought to leave such things and comments on such issues to those who can.  The real truth is that facts and knowledge are always an advantage.

          No one ever died because they couldn’t breed.  What you are talking about is instinct for the biological continuance of your genetics.  But studies that say that men will become more competitive among themselves when there are fewer females around are being highly selective;  haven’t you seen how women compete for one man?  The female equivalent of the male competitiveness is exhibited here, the men play king of the mountain and the women compete for the winner as the perceived “alpha male.”  Perceived is a very important word here because this is where social engineering and media come into play regarding your questions.  Back in the 1950s,  the socialist/communist movements in America declared their strategy of using then ignored causes like Civil Rights  and Segregation, to attack the core of American culture.   They declared that they would prop up the black man as the hero and dethrone the white man.  While most whites were distracted living the good life and/or by other issues, these tactics have become successful, and not only a little because the Feminist movement took them up as well.  So today, we are at a point where a significant number of young white males have no actual white identity, while white females face an ongoing onslaught of pressures to link up and miscegenate with non-white men, especially blacks.  Sometime ago, the National Organization for Women actually came out with a statement that followed a campaign of historical accusations against white men as the most evil men on earth, and called on white women to refuse to birth white babies.  Many young women who consider themselves feminists don’t know about this history, but it is real.  One of its earliest practitioners, long before that actual statement was officially made, was our current president’s white mother, who declared that she would not birth white children.

          Stay tuned Sonya610, a great deal of ongoing discussion on Amren posting boards is aimed at your questions.  But the short answer is that social engineering and movements like Feminism have dethroned the white male and replaced him with a mythological black superman.  This combines with our Christian culture of Christlike sacrifices for others and the long term political strategy of American aid to the world for political and moral influence.  Even George W. Bush “bent over backwards” to give more aid to Africa than any previous president.

          I hope that you will not be in any way offended by my long reply.  I hope that you can learn a couple things from it and realize that we are both working for the same thing; the survival and flourishing of the white race.

          As for VikingManx; I hope that he and you, especially HE will realize that as a very long time commenter on Amren, I am known for my thoroughness when discussing issues.   IT IS NOT MEANT AS A PERSONAL ATTACK.  Long time posters know that I favor Asatru as a cultural model for whites;  that is, the Nordic and Celtic cultural and spiritual influences and models over Christianity, which cannot be claimed as a exclusively white cultural identity and contains so many indefensible points for white race realists that I find its usefulness in terms of white survival questionable.  Some posters have very understandable strong feelings about being Christians and how that somehow defines them as whites, and they sometimes dislike what I write – to the extreme, but I am IMHO working in a way that I find necessary for me to in doing my part.  For example, Christianity will not allow us to claim that our ancestry is more important than anything, and that all is justified in insuring our genetic white heritage to survive and have a place in the sun.    I do as I do, because I am convinced of the futility of the other.  After all, time will show us who was right.  I think that time is shorter than some might think.

  • Anonymous

    Gee…imagine the wildly creative SSI/Disability claims all this will conjur!

  • Anonymous

    …they are starting to come under fire from critics who don’t think that the appendix belongs in the book at all.

    First they tell us we should be culturally aware. Then they tell us we’re supposed to be culturally sensitive. You can’t win. Cultural awareness today is racism tomorrow.

    Psychiatrists, points out that 19th-century Americans had their own version of dhat 

    This is an excellent reason to keep the appendix. Clearly some mental conditions appear in different cultures for the same or different reasons. Mental health practitioners should have access to this information otherwise they will waste their time reinventing the wheel every time something they could have known about wasn’t included because of PC motives.

  • Anonymous

    I think it’s Michelle Malkin who calls it “immigrant derangement syndrome” when committed here.

  • Anonymous

    Well apparently black males are diagnosed with schizophrenia at abornormally high rates in Western countries. Is it cultural? It must be cultural as we know it can’t be about race. Maybe we need to compare the statistics from the West to those diagnosed with schizophrenia in Sub-Saharan African countries.

    I do suspect the statistics will vary considerably.

    • Andy

      Books like that of the late Professor John R. Baker’s RACE capture enough detail about
      the varied Black behaviors in mid-continent Africa to raise questions of whether normal
      Black behavior is closer to what amongst Whites would be considered likely manifestations
      of emotional disorder.   Moreover, there is a good bit of indication within the US that Blacks
      having linked behaviors generally considered signs of severe and crippling psychoses in Whites are often able to continue working and to continue marriage relationships, whereas Whites with such manifestations rarely are able to.   There likely is a good bit of racial average differences in response to psychiatric medications, but I don’t know how one would ever get access to direct data.  Most reports I’m encountered have been anecdotal from “mental health” workers–informed impressions but nothing journal solid.  

  • Anonymous

    23 yr old beaten to death by mob in philly entertainment district ” indian is the suspect description” most likely economics phds or computer scientists. right. indians

  • Anonymous

    I bet Big Pharma sees dollar signs (or whatever currency) in this!

  • Anonymous

    ‘The men of my own stock,
    Bitter bad they may be,
    But, at least, they hear the things I hear,
     And see the things I see…………….’

  • Bon, From the Land of Babble

    These types of “cultural” psychiatric categories will be used as excuses by specious lawyers to “get their clients off.”

    It wasn’t his fault!!  The murder wasn’t his fault — it was pibloktoq!!  He did it because of susto (or latah or koro)!!

    Dont’t believe me?  Remember the Twinkie Defense used by Dan White’s lawyers to justify his cold-blooded executions of SF Supervisor Harvey Milk and Mayor George Moscone?  It worked.  Instead of being sentenced to LWOP or death for the two murders, Dan White was sentenced to five years in prison after which he was released.  (After which he committed suicide, he “offed” himself).

    Here in So Cal this past week, a 23 year old Hispanic  named “Itzcoatl “was recently caught after he carefully stalked and viciously stabbed to death four homeless men. Some of these poor souls were stabbed 40 times.  Itzcoatl’s family immigrated from Mexico City when he was a baby, later he became a US citizen, unfortunately.

    Already the psychiatric excuses are coming out — PTSS (Post Traumatic Stress Syndrome) from having served in Iraq.   I have no doubt PSST exists but it should not be used to excuse Itzcoatl’s vile actions which deprived four men of their lives.  

    PTSS is one of a zillion reasons to pull out of the Middle East NOW and never meddle in the affairs of those Third World countries (or any other) ever again.  One of a number of reasons I support Ron Paul over the other neo-con, pro-war RINO Republican candidates.  But I digress, and that is for another post.


    • Bon, From the Land of Babble

      Whether psychology is a science or not is in dispute, because psychology cannot prove its claims scientifically.

      What is science?

      Science is not about people and college degrees, it is about evidence. If you have the evidence, nothing else matters. If you don’t have the evidence, nothing else matters. The greatest amount of scientific eminence is trumped by the smallest amount of scientific evidence.

      Psychology’s history is marked by fads, each eventually abandoned after its shortcomings and failures became obvious — psychoanalysis, various novel therapies, lobotomy, schizophrenia and autism blamed on incompetent parenting or “refrigerator moms’, Recovered Memory Therapy (RMT), and Facilitated Communications.

      Psychology is being replaced by neuroscience as strong evidence suggests what presents as mental illnesses are actually symptoms of physical illness with psychological symptoms.

      Thomas Insel, director of the National Institutes of Mental Health (NIMH), states in Scientific American:

      The intellectual basis of this field is shifting from one discipline, based on subjective ‘mental’ phenomena, to another, neuroscience…Today’s developing science-based understanding of mental illness very likely will revolutionize prevention and treatment and bring real and lasting relief to millions of people worldwide.


  • Anonymous

    heres a quote just released from the mom of the 23 year old beaten to death randomly in center city philadelphia saturday by 4 hispanics (or persons of middle eastern or indian decent according to the media) but no actually HISPANICS..
    Kendall Kless ended her explanatory email to friends with: “Hug your kids, hug your friends. Tell them you love them.” your son is killed and that what you say!!?? no anger no outrage. blacks would be rioting or marching. i have lost all faith in my fellow whites to preserve their race or culture. pitiful, sad, pathetic. i disown you people.

  • Anonymous

    Psychology is a crock. Modern psychology has a deep commitment to self-worship and all major theories of motivation and personality assume that reward for the self is the only functional ethical principle. These values are hostile to our ability to form permanent relationships or to commit to such values as duty and self-sacrifice. Instead, with monotonous regularity, their literature sides with those values that encourage divorce and the breaking of family ties.

    Part of the problem is the nature of the therapeutic process. The psychotherapist is typically preoccupied with an individual patient, and he seldom challenges his version of the facts. He doesn’t listen to children, parents or the spouse who might be involved. Worse, some therapists encourage divorce on theoretical grounds. They teach that if either spouse feels the relationship has stagnated, the marriage is not worth saving.

    Their ideals give some counselors a strong bias against parents. In recovery group settings, patients are under pressure to describe how badly their families treated them. Patients thus become self-pitying “victims”-with a strong sense of moral superiority.

    With its emphasis on treating individuals in isolation and its hostility to social bonds, modern psychology has caused incalculable damage to our society. What if therapy was based on love, gratitude, respect and forgiveness-a therapy that strengthens a patient’s family instead of destroying it.  But no, this industry feeds the legal and medical fields and one must not fiddle with billable hours.

    Be careful from whom you seek counsel. 

  • Bon, From the Land of Babble

    That psychology is not a science is drawn from the conclusions of such people as the present director of the National Institutes of Mental Health (NIMH), and the past president of the American Psychological Association (APA).

    RE: Link provided above.

    There is no such scientific evidence, which is why mental health professionals, including the present directory of NIMH, flatly reject the claims made for psychotherapy. Read the link I provided above.

    The National Center for Biotechnology Information reports in a scientific article, The Effectiveness of Psychotherapy

    No specific modality of psychotherapy did better than any other for any disorder; psychologists, psychiatrists, and social workers did not differ in their effectiveness as treaters; and all did better than marriage counselors and long-term family doctoring.

    The burden of evidence is belongs to psychology to prove that it is a science, and this is a burden that psychology cannot meet.