Laurie Kerridge

Prof. Swett Ph.D.

Psych 202A

July 15, 2011

How Depression and Culture are Inter-Related

Psychiatric diagnoses are shaped not only by history but by culture also. Inaccuracies in

the assessment and diagnosis of psychopathological conditions with culturally diverse groups

may result from the lack of understanding of cultural variants leading to symptoms resembling

psychopathology. Psychologists have increasingly recognized that certain disorders are culture-

specific to one or more societies, or culture-bound, although most of these conditions remain

poorly researched (see Table 1) (Kleinman, 1988; Simons & Huges, 1986).

Certain parts of Malaysia, India, China and several other Asian countries have witnessed

periodic outbreaks of a strange condition known as Koro wherein male victims believe that their

penis and testicles are disappearing and receding into their abdomen, and women believe their

breasts and vulva are retracting. Koro is spread largely by social contagion. Once one person

begins to have symptoms, others quickly follow suit, triggering widespread panic. In one region

of India in 1982, the koro epidemic was so out of control that the local government had to take to

the streets with loudspeakers to reassure terrified civilians that their genitals weren’t sneaking off

for a permanent camp-out in their abdomen. To prove their fears were unfounded, officials even

pulled out rulers and measured male residents’ penises.

You’ve likely heard the popular phrase, “running amok” and have probably used it in

general conversation. It means “going wild.” Specific to Malaysia, the Philippines and some

African countries is a syndrome referred to as amok. This condition is marked by episodes of

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intense sadness and brooding followed by uncontrolled behavior and unprovoked attacks on

people or animals (American Psychiatric Association, 2000). Some culture-bound syndromes

seem to be variants of conditions in Western culture. In Japan, social anxiety is typically

expressed as a fear of offending others, called taijin kyofushu. The risk of saying something that

might offend another or having unpleasant body odor is cause enough for this smelly condition.

In the United States, social anxiety is more commonly generated by fear of public

embarrassment and humiliation, such as making a fool of oneself in front of a group of peers

while giving a speech and belching in the middle of the sentence.

A person who strays too far up the y-axis might commit altruistic suicide because a group

dominates the life of that individual to such a degree that he or she feels meaningless aside from

this social recognition. Consider the Japanese ritual suicide, sometimes called hara-kiri. Samurai

warriors would disembowel themselves with a sword after the loss of a battle, which equated to

loss of honor. Now illegal and extremely rare, Hindu widows in some castes and regions of

India were expected to throw themselves on their husbands’ funeral pyre (a pile of wood for

burning a dead body) to prove their devotion, a practice called sati. Statistics show that the

suicide rate for American military officers is higher than for enlisted soldiers because he is

responsible for the group’s performance and his identity is his sense of honor and self-worth

(Conley 198). Another potential culture-bound syndrome is the unusual condition of body

integrity identity disorder in which people experience persistent desires to undergo operations to

amputate their limbs or body parts. Although responsible physicians would refuse to perform

such surgery, many have found willing doctors (First, 2004). Thus far, this disorder has been

reported only in the United States and Europe (Littlewood, 2004).

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Table 1- Common Culture-Bound Syndromes

SYNDROME REGION /POPULATION AFFECTED

DESCRIPTION

Arctic Hysteria Alaska Natives (Inuit) Abrupt episode accompanied by extreme excitement and frequently followed by convulsive seizures and coma.

Brain Fog West Africa Symptoms include difficulties in concentrating, remembering and thinking.

Latah Malaysia and Southeast Asia Found mostly among women; marked by an extreme startle reaction, followed by a loss of control, cursing, and mimicking of others’ actions and speech.

Mal de Ojo Spain and Latin America A common term to describe the cause of disease, misfortune and social disruption.

Windigo Native Americans Central and N.E. Canada

Morbid state of anxiety with fears of becoming a cannibal.

Wacinko American Indians Feelings of anger, withdrawal, mutism, suicide form reaction from disappointment and interpersonal problems.

Kyofusho Japan Guilt about embarrassing others, timidity resulting from the feeling that their appearance, odor and facial expressions are offensive to other people.

Boufee’ delirante Haiti Sudden outburst of aggression, agitation associated with confusion, psychomotor excitement, and symptoms resembling brief psychotic disorder.

Dhat India, Sri Lanka, China Extreme anxiety associated with a sense of weakness, exhaustion, and the discharge of semen.

Ode-ori Nigeria Sensation of parasites crawling in the head, feelings of heat in the head, paranoid fears of malevolent attacks by evil spirits.

(Source: DSM-IV APA, 2000; Hall, 2001)

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Culture strongly influences how people express their interpersonal anxiety but collectivist

cultures tend to be more concerned about their impact and effect on others where Western

individualistic societies absorb themselves in worry and concern for “self.” Chinese patients

frequently focus their thoughts “externally,” as opposed to ‘internally” on their emotional states,

as such, they may be more likely to notice somatic symptoms like aches and pains associated

with distress (Ryder et al., 2008). The focus on self in individualistic societies may contribute to

culture-bound disorders in Western cultures—eating disorders are largely specific to the United

States and Europe where the media bombard viewers with images of size zero models merely

wearing skin on their bones, contributing to the demise of female self-worth. (Keel & Klump,

2003; McCarthy, 1990).

The stigma of mental illness is also considerable in Indian society. A clinical trial and

study project is training laypeople in Goa, India to identify and treat depression and anxiety.

Almost 2,000 patients have been treated in community health clinics with the hope of dealing

with the staggering numbers of undiagnosed and untreated mental distress where a population of

more than one billion is served by fewer than 4,000 psychiatrists, most of whom are concentrated

in urban areas. “Health workers in the project carefully avoid all mention of mental illness, and

diagnoses of depression and anxiety, using words like “stress” and “tension” instead (Luczaj

2008). The predominant challenges are similar worldwide– financial, interpersonal conflict,

unemployment and alcoholism, often motivated by poverty. Thought to be an urban disease in

India, depression and anxiety are very much part of rural communities; being labeled as “crazy”

comes with a risk of being out-casted in many less affluent societies, but I believe this is shared

phenomenon across the globe.

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Works Cited

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed.). Washington, DC: Author

Conley, D. “You May Ask Yourself” W. W. Norton & Company. 2008. Print.

First, M. B. (2004) Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder. Psychological Medicine, 35, 919-928.

Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological Bulletin, 129, 747-769.

Kleinman, A. (1988). Rethinking psychiatry: From cultural category to personal experience. New York: Free Press.

Littlewood, R. (2004). Unusual psychiatric syndromes: An introduction. Psychiatry, 3, 1-3.

Luczaj, S. “Depression and Anxiety Across Cultures” Counselling Resource, 14 March 2008, Web. July 25, 2011. http://counsellingresource.com/features/2008/03/14/depression-anxiety-crosscultural/

McCarthy, M. (1990). The thin ideal, depression and eating disorders in women. Behaviour Research and Therapy, 28, 205-215.

Ryder, A. G. Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S., et al. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America. Journal of Abnormal Psychology, 117, 300-313.

Simons, R. C., & Hughes, C. C. (1986) The culture-bound syndromes: Folk illnesses of psychiatric and anthropological interest. Boston: D. Reidel.

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