Culture-Bound Syndromes

Abstract

Ethnopsychiatry comprises a large field of literature written from diverse perspectives, disciplines and orientations. Its status as an interdiscipinary activity presents formidable obstacles to researchers interested in comparative problems and the development of generalizations. These difficulties can be demonstrated by even a cursory examination of the material written on what has come to be called 'culture-bound syndromes'. In spite of the considerable body of specific studies written about these 'ethnic psychoses', as Devereux termed them. debates continue to swirl over how to define them, whether they are manifestations of psychopathology. and. by implication, the degree to which the categories of Western psychiatric nosology are readily transferable to other cultural and historical settings. This paper does not attempt to play the role of broker between universalists and particularists. If anything I favor the particularist position with respect to the impossibility of directly applying diagnostic categories across cultural boundaries. On the other hand I would not deny that there are universal processes which take their form through complex interaction with particular cultural, historical and social settings. The goal of showing how general forms can only be realized in particular settings is a vital one for anthropology, and the literature on culture- bound syndromes illustrates the problems involved. The problems can be severe. but no more so than those facing any observer of an exotic cultural setting. Because I perceive parallels between problems of translation in social and anthropology in general and the issues that have emerged in discussions of culture-bound syndromes, I seek to return to basic issues in this essay to examine some aspects of culture-bound syndromes that should be examined before assertions about pathology are made. While it can be shown that the very idea of culture- bound syndromes is controversial it cannot be argued that the literature discussing them has been significant for modern psychiatric practice. The DSM. the Burke's peerage of psychiatric disorders, does not include either the concept of the culture- bound syndrome or any of its specific instances in the compendium (l)*. The reasons for this omission are not difficult to discern. The vantage point of Western scientific medicine defines culture bound syndromes as forms found in other societies and at other times. The descriptions of Anorexia and Bulemia found in DSM III, for example. do not note either that the incidence or popularity of diagnosis of these syn- dromes is recent. Yet Raymond Prince has been able to show that the historical specificity of these syn- dromes could easily qualify them for status as culture-bound (see his paper in this issue). Thus we can say that while academic ethnopsychiatry debates the culture-bound/universal distinction, it has made little impact on psychiatric practice. This is un- fortunate. The concept of culture-bound syndromes raises questions of cultural and historical variation that are generally not addressed in clinical psychiatry, a positivistically oriented field which aims to explain all behavior in terms derived deductively from its