Culture-Bound Syndromes
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Culture-Bound Syndromes L. A. Rebhun
Every known cultural group has ways of describing things that go wrong in body and mind. Although biological causes can be identified for many sicknesses, the way local groups identify, understand, classify, interpret, and respond to conditions is cultural, not biological (Kleinman, 1980). Differences in how local groups understand normality and abnormality are particularly marked for psychological and behavioral syndromes. The term “culture-bound syndrome” developed out of the attempts of psychiatrists and anthropologists to make sense of named syndromes observed in groups outside the middle class, Western European, and North American setting in which contemporary medicine developed. Pow Ming Yap, a psychiatrist, coined the term “culture-bound syndrome” in the 1960s (Yap, 1962, 1969) when he noted that scholars working in Asian, Pacific, and tribal societies described behavioral syndromes unknown to mainstream psychiatry at the time and denominated only by terms in local languages. Describing these as “atypical psychogenic psychoses” (1962) and later “atypical culture-bound reactive syndromes” (1969), he argued for their inclusion in psychiatric literature as local variations of universal psychiatric disease categories described in psychiatric manuals, and urged his colleagues to work on their organized classification. Although he believed that local beliefs, values, and social structure influenced the symptomatic presentation of such ailments, at base, they reflected universal disorders of the human mind (Yap, 1969). Since the 1960s, the way theorists have used the term “culture-bound” and interpreted the various syndromes falling under that category has reflected not only different approaches of disparate disciplines to medical classification but also disputes over the meaning and significance of the concept of culture itself as well as greater attention by theorists to both intra-cultural variation and inter-cultural connections. While the term has been attacked as inaccurate and ethnocentric by some, others have sought to expand its use to a greater range of phenomena, including behavioral syndromes described by U.S. and international psychiatry. Anthropologists,
sociologists, psychologists, and psychiatrists use and argue over the term, and debates on its meaning and use reflect not only theoretical changes within disciplines but conflicts in orientations of these different disciplines. Definitional debates bring up thorny issues of the philosophical relationship between culture and biology as well as of the universality of medical categories.
A CONTROVERSIAL TERM In 1994 the American Psychiatric Association decided to include an appendix on culture-bound syndromes in its Diagnostic and Statistical Manual, version Four (DSM-IV). This marked a turning point in psychiatry’s treatment of culture, and together with revisions in other parts of the DSM to use more culturally and ethnically inclusive language (Good, 1996), constituted a major step in attempts to reconcile
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