Unusual psychiatric syndromes: an introduction

Abstract

‘Unusual’ and ‘new’ illnesses such as Gulf War syndrome, myalgic encephalomyelitis (ME), gender identity disorder (and the probably related apotemnophilia) may suddenly appear or become recognized in the major Euro-American centres of psychiatric research and training, or they may through globalization migrate or become recognized beyond these centres (as with anorexia nervosa now appearing in South Asia). Illnesses are often seen in new contexts through the migration of peoples around the world (thus spirit possession states and semen retention syndromes, such as dhāt, are increasingly being recognized in Europe). At the same time, patterns once familiar in one area may become uncommon (or at least fail to be diagnosed any more), yet persist in some cultures where they retain a strong hold on local. Or they may disappear altogether – e.g. late paraphrenia. Occasionally a psychiatric trope or idiom, such as trauma, maintains a fluctuating vogue. We can regard the range of psychopathology as extending from those illnesses for which we allow a discrete and distinct biological cause – the naturalistic – to those whose aetiology seems more intelligible in terms of cultural or personalistic processes. As psychiatric fashions change with the accretion of empirical data, illnesses may pass from the personalistic to the naturalistic, or in the other direction.