Although the term "culture-bound" refers to a concept of culture that comes from an earlier period in anthropological theory in which culture was seen as relatively unchanging and localized, contemporary anthropologists increasingly see such syndromes as not only characterized by the same historical changes and globalization that affect all cultural phenomena, but as derived from such changes directly. For example, Carr posits that the incidence of amok may have risen under colonialism and with urbanization in Malaysia because Malaysian rural culture had insufficient ways of dealing with the sharp rise in interpersonal conflict when the society came under stress (Carr, 1985). Eguchi (1991) theorizes that phenomena such as fox possession became psychiatric syndromes, defined as disease, only when the religious context in which they originally appeared changed. When most people no longer believed in fox spirits, those who did were labeled as delusional, and therefore sick. Jilek and Jilek-Aal (1985) discuss koro epidemics as manifestations of anxiety about violent ethnic conflicts, and Lindenbaum (1979) describes how the Fore people responded to an epidemic in their midst through concepts of sorcery. Marano (1985) believes that the whole concern of Western observers with windigo psychosis derives from a misunderstanding of a rise in witchcraft accusation within a colonial context, and Winzeler (1995) discusses early descriptions of both amok and latah as part of the creation of stereotypes of deficiency in colonized Malaysians.
These approaches suggest that culture-bound syndromes are involved with culture change in several ways. For one, the incidence and types of expressions of distress may rise with rapid and forced cultural change. In addition, as beliefs change, those who hold to older patterns may become newly classified as sick within their home communities. And in addition, the very concept of culture-bound syndromes may result from misunderstandings that ensue when members of politically dominant groups attempt to study dominated groups and classify their behaviors.
Theorists of diverse disciplines do not agree on how to understand behavior and emotion cross-culturally and debates over culture-bound syndromes in the current literature reflect their differences. Theorists continue to debate which named syndromes ought to be included in the category "culture-bound syndrome," whether such a theoretical category has any utility, and how to understand cross-cultural differences and both how and whether to include more cultural diversity within biomedical disease classifications. These debates as well as the interest of the ethnographic material itself make the field of "culture-bound syndromes," whether one accepts or rejects the term, continually lively.
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