Like "nerves", koro has been described in a variety of locales mostly in Asia and among Asian immigrants to other areas. A few individual cases of men panicked that their genitals are shrinking have also been recorded in other cultural settings, but here the phenomenon does not seem to have become formalized as a widespread belief (Chowdhury & Bera, 1994; Earleywine, 2001; Fishbain, Barsky, & Goldberg, 1989). Koro sufferers are usually male, and during episodes they become convinced that their genitals are shrinking up inside their bodies. Koro sufferers also manifest acute anxiety, and often believe that full genital retraction will result in death. Cases of women fearing breast and genital shrinkage have also been recorded, but more rarely (Cheng, 1996; Jilek & Jilek-Aal, 1985). Koro was first mentioned in Western medical texts in 1895, although its mention did not become widespread until the 1960s (Chowdhury, 1998). Although often described as a Chinese culture-bound syndrome, the word koro itself is of Malay origin, and refers to the head of a turtle. The equivalent term in Mandarin would be suoyang, but that is not the term commonly used in English language literature (Cheng, 1996).
In addition to reports of individuals manifesting koro, some researchers have reported on widespread outbreaks or "epidemics" of koro (Bartholomew, 1994; Cheng, 1996; Jilek & Jilek-Aal, 1985). Jilek and Jilek-Aal posit that the epidemics of koro they analyze in Thailand and India were related to the movement of ethnically distinct political refugees into new areas or anticipated military attacks from ethnic rivals, where local people feared engulfment or destruction from their adversaries. They theorize that the belief in disappearing sexual organs is a metaphor for the fear of being unable to reproduce and sustain families, to dying as a people due to perceived aggression from ethnically distinct others, and compare koro epidemics to the ghost dance religion of the Coast Salish people under military attack from colonists as a reaction to the stresses of conquest. Rather than look at koro as an individual phenomenon related to Oedipal castration fears, they argue for its comprehension as an idiom of distress (Nichter, 1981), incomprehensible outside its political setting (Jilek & Jilek-Aal, 1985).
Interestingly, some theorists have adopted the term koro to refer to any case of believed genital shrinkage or disappearance, no matter the cultural setting (Earleywine,
2001; Fishbain et al., 1989; Moodley, 1985; Yap, 1965). The increased use of the term koro by physicians to describe patients outside its historical cultural settings seems a further development of Hall's "named local illnesses which elaborate symptoms found in Western populations but not named as syndromes in the West" (Hall, 2001) in which the non-English term has been usurped to fill a nosological need.
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