A couple of readers of my last blog post, on PTSD and Cultural Variance: Implications for Third Culture Kids, commented on specific features of their childhood that could perhaps be explained by cultural features from West Africa – the part of the world that had hosted them during their early years. It had already been bothering me that I’d not found culture-bound syndromes for West Africa, given my own story, and these other TCK stories stoked my curiosity. And you know what curiosity is…
I found an article by O. F. Aina and O. Morakinyo, published 2011 in the African Journal of Psychiatry, and titled: “Culture-bound syndromes and the neglect of cultural factors in psychopathologies among Africans”. Well, my curiosity was satisfied. This is a very readable work, and clearly describes six different culture-bound syndromes established in the literature as prevalent amongst West African populations.
The authors argue for a relativistic, rather than universalistic, approach to psychopathologies, claiming that a proper understanding of these “depends largely on appropriate cultural factors” (2011:279). In order to properly treat symptoms, they claim, it is crucial that practitioners acknowledge culture-bound syndromes, and understand that these are “caused and maintained by culture specific psychological factors such as beliefs, values and attitudes” (2011:279).
I’ll cut to the chase, though, and outline the six culture-bound syndromes the article mentions.
Brain Fag Syndrome
First described by Raymond Prince, in 1960, after observations of students in Nigeria. Symptoms include, “unpleasant head and neck symptoms such as pain, burning and crawling sensations, visual disturbances of dimmed vision, pain and tearfulness in the eyes; cognitive impairments such as inability to concentrate… Other symptoms are body weakness, burning or migrating pains” (2011:280). Students engaged in intensive study were primary sufferers, and after a review of the literature the authors conclude that Brain Fag Syndrome is “a depressive equivalent”, and is best managed with “antidepressant drugs combined with psychotherapy such as supportive therapy, cognitive therapy and relaxation techniques” (2011:280).
This syndrome is most associated with Northern China and has been known of since 7000 BC (2011:280). Koro represents a triad of experiences: First, that the genitals (or sometimes tongue) are retracting in to the body, or have been stolen. Second, that this retraction or disappearance will lead to death. Thirdly, emotions of fear, anxiety and panic. Koro has been known to surface on an individual or communal level, with outbreaks sometimes spreading across a community. One sociological explanation for this culture-bound syndrome is that, rather than being a mental illness, it is instead a form of collective behaviour, sometimes associated with mental illness but not always (2011:280).
This syndrome is named for a Yoruba word meaning “hunter of the head” (2011:281). Symptoms include “a sensation of an organism crawling through the head and sometimes through other body parts, together with noises in the ears and various other somatic complains including palpitations” (2011:281).
The authors cite a survey of 30 traditional healers in Yorubaland (south-west Nigeria) in which this syndrome featured as “a nero-psychiatric condition with the following manifestations: the person is “attacked” at night while asleep, awakens and is unable to sleep again with agitation and exhibition of abnormal behaviour and may bleat like a goat” (2011:281). Eating in dreams, followed by illness upon waking, was seen as symptomatic of having been poisoned by an enemy. Other diagnosis include “parasomnias such as sleep terror, sleep walking and sleep paralysis, and to a lesser extent, nocturnal or sleep epilepsy” (2011:281). Interestingly, the authors note that, in Africa, “the night is regarded as a sacred time when the evil ones (witches, evil spirits or demons and departed ancestors) go around wreaking havoc on people; the most vulnerable time is from midnight to early morning, such as 3-4am” (2011:282).
This is a psychopathological syndrome found among the Senegalese, that literally means “bad person”. This affects children, who exhibit “withdrawal, undue sensitivity, depression and temper tantrums…. [also] crying episodes often terminated by akinetic spells [impaired muscle movement” (2011:283).
First observed in Senegal, manifestations include “earth (sand) eating, pallor, depression and social withdrawal with up to 0.5% of the Serer population being affected” (2011:283). This syndrome has been likened to the DSM criteria for ‘pica’, the eating of non-nutritive substances for a significant period of time. I myself have vivid memories of a child I grew up with suffering so much from this that he was physically retrained to prevent further opportunities of sand-eating.
Again, as I observed in my last blog post, while these culture-bound syndromes may seem… well, bound to the populations normally associated with the locations they are associated with, globalisation has complicated this people-place relationship. Raised abroad, Third Culture Kids, and other children of highly mobile backgrounds, may well take on the cultural experiences of health and illness of their hosts. In so doing, if and when they themselves experience mental or emotional strain, symptoms of this may manifest cross-culturally, complicating both diagnosis and treatment.
If you are a mental health professional, while expertise in all culture-bound syndromes may be impossible, simply holding an increased awareness of the cultural variations in health and illness will make you a stronger advocate for your clients’ mental health.
If you are a Third Culture Kid, information about culture-bound syndromes relating to your host country, or countries, could be invaluable at times of mental or emotional stress.
Whether the stress you experience exhibits as PTSD, as anxiety, or as a range of ‘unexplainable’ symptoms – knowledge is power. And the more resources we have at our disposal to manage stress well, the better. Perhaps this is where knowledge of culture-bound syndromes best contributes to the growing cross-cultural community, for it contributes to our arsenal of collective knowledge and resources.
Thanks for doing the further research, Dr. Rachel. My childhood place in West Africa was Nigeria; three adult years took place in Liberia. Though I never lived in Yorubaland, some aspects of Ogun oru ring a bell. (my bell!)
Hi, Rachael — I will send you directly to Dr. Doug Ota, whose book about how international schools can best meet the needs of their very mobile population is called Safe Passage — he spent years observing TCKs and then creating a program in the international school in The Hague that he says has been very successful.