Culture-Bound Syndromes: Entire Disease Category Your Doctor May Be Missing

Jumping Frenchmen of Maine, a rare disorder characterized by an unusually extreme startle reaction, is similar to Latah. It was first identified during the 19th century in Maine and Quebec among an isolated population of lumberjacks of French Canadian descent. This image shows a group of lumberjacks who have just downed a giant sequoia (California, 1905). Image credit: Library of Congress, Washington, DC

May 23, 2016 by Rafid Rahman

How is that possible?

A physician goes through four years of medical school, at least two-three years of residency (postgraduate medical training), and potential fellowships.

Why would a doctor not know about an entire category of disease?

Answer: Physicians, themselves, are confused about these mysterious diseases.

Let me elaborate.

Physicians are not always sure how to treat culture-bound syndromes, so the category may not be discussed in great detail until specialized training takes place. The classifications for these diseases are continuously under debate in the medical community.

In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the standard classification of mental disorders in the United States – actually reclassified them in DSM-5 [1] in 2013 under ‘Cultural Concepts of Distress’ to more accurately describe the cultural influences.

Thus, doctors may easily overlook the category… making it imperative for patients to be knowledgeable about the existence of these peculiar diseases.

Metaphorically, physicians tend to look for horses instead of zebras when they hear hoof beats.

What does that mean?

The old adage signifies that physicians are trained to diagnose diseases in a pyramidal fashion. Treat the symptoms of the most common disease and move onto more rare, lesser-known diseases if the treatments don’t seem to work.

Although this method may seem like a guess-or-check system, physicians are rigorously trained in recognizing prevalent, difficult-to-treat diseases. I mean, they should be… right? They spend at least a decade of their lives learning basic sciences and clinical medicine!

So, the challenge remains… how to define culture-bound syndromes?

Ranging from diseases that include psychiatric, genetic, environmental, neurological, or even cultural origins, scientists have not been able to explicitly define the category of culture-bound syndromes. Moreover, the illnesses are included into this category because they are traditionally seen in specific cultures or locations of the world, and because the patients may present with a wide range of severity that may or may not include DSM listed symptoms for each disease.

Basically, this category of disease is a conglomeration of misfits that are not unified by common disease pathology or presentation as seen in traditional western medical classifications, but associated by clinically important cultural differences.

You may be asking right now… Why should I worry about culture-bound syndromes if I don’t live in that culture or location? I won’t be affected or get the disease, right?

Answer: Maybe, maybe not.

The reason why patients should know about the existence of this often overlooked treasure chest of diseases is for the same reason why it was recently reclassified under Cultural Concepts of Distress in DSM-5. Physicians, medical anthropologists, and other scientists have studied and come to the conclusion that the term ‘culture-bound syndrome’ may overemphasize the regional diagnosis of the disease, which may cause physicians worldwide to miss potential cases [2].

Which makes it particularly important for patients to be aware of this category of disease, so they can spark the discussion with their doctors, if their physicians are having a difficult time finding a solid diagnosis. Even if patients do not know specific diseases in the category, bringing up the topic with their puzzled physicians may give the doctors the extra hint they need to diagnose the appropriate disease and formulate the proper treatment plan.

What should patients do next?

Even though this potential hole in a physician’s training may make you want to run for the hills, be assured that your doctor has years of in-depth, expertise in many areas and there are always specialists in every field to help you out. So don’t drop everything and start reading WebMD just yet!

However, it is important to be familiar with at least a few diseases so you can better communicate with your physician.

Disease of Interest: Latah [3]

Latah is commonly presented in Southeast Asia and has been documented by European observers for more than a century.

The disease can be provoked with shock or acute fright, which results in social tics: imitative gestures, words, actions, obey commands, or situations where patients cannot control his or her emotions.

Disease of Interest: Gururumba [4]

Gururumba is more prevalent in New Guinea and describes the actions of a person, usually a married man, who burglarizes homes and takes items of little importance.

However, the person thinks the items are invaluable and he/she runs away for a period of time, but then returns without the items or knowledge of the event.

Disease of Interest: Amok [5]

Amok has been seen in various areas of Southeast Asia and Scandinavia and it usually presents as a violent, homicidal rage. Typically, the person does not pre-meditate the attack, nor does he or she usually remember it but insulting actions towards the Amok patient can provoke a ferocious episode.

Although this is not a comprehensive list, it gives patients an insight into the world of culture-bound syndromes, and maybe -just maybe- this knowledge will help a countless number of people bridge the gap of knowledge between the physician and patient.

_____

1. Culture concepts. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013. Washington, DC: American Psychiatric Association

2. Tseng W. 2006. From peculiar psychiatric disorders through culture-bound syndromes to culture-related specific syndromes. Transcult Psychiatry 43: 554-576

3. Bhidayasiri R. & Truong D.D. 2011. Startle syndromes. Handb Clin Neurol. 100: 421-430

4. Paniagua F.A. 2000. Culture-bound syndromes, cultural variations, and psychopathology. In: Cuéllar I, Paniagua FA, eds. Handbook of Multicultural Mental Health: Assessment and Treatment of Diverse Populations. New York: Academic Press; 140-141

5. Bartelsman M. & Eckhardt P.P. 2007. Mental illness in the former Dutch Indies — four psychiatric syndromes: amok, latah, koro and neurasthenia. Ned Tijdschr Geneeskd. 151: 2845-2851

Source: Culture-Bound Syndromes: Entire Disease Category Your Doctor May Be Missing | Medicine, Opinions | Sci-News.com

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