Types of Syndromes

Despite controversies over the term "culture-bound syndrome" the concept remains important in the medical anthropology literature. A number of theorists have attempted to classify syndromes named in the anthropological and psychiatric literature into types. For example, Simons and Hughes (1985) divide culture-bound syndromes into:

• startle matching (as in latah)

• sleep paralysis (a reference to a number of syndromes in which people experience choking and/or paralysis during sleep or while falling asleep, often attributed to attack by spirits and possibly related to sleep disorders of physiological origin) (Hufford, 1982; Simons & Hughes, 1985)

• genital retraction (koro)

• sudden mass assault (amok)

• running (pibloctoq or "arctic hysteria" in which suffers tear off their clothes and run about in a state of high agitation)

• cannibal compulsion (windigo) (see below for discussions of syndromes).

Simons and Hughes (1985) posit that startle matching (latah) and sleep paralysis have a neurophysiological basis, whereas genital retraction (koro), sudden mass assault (amok), and running (pibloktoq) do not, and they further state that fright illness (susto) and cannibal compulsion (windigo) probably ought not to be considered culture-bound syndromes, because they do not have specific enough descriptions to be useful as psychiatric terms and because they make the category "culture-bound syndrome" too heterogeneous to be really useful. In addition, the theorists mark windigo as a problematic term because of controversies over whether it ever actually existed. This division of phenomena remains in line with Yap's original idea (1962, 1969) that culture-bound syndromes constitute local variations of universal phenomena, and adds a more critical appraisal of existing literature by rejecting some terms as non-specific or inaccurate.

In the case of windigo, Marano (1985), in Simons and Hughes' collected volume, claims that despite an extensive literature on the phenomenon, in fact there never has been such a syndrome among Northern Algonquin peoples. Literary descriptions posit that some Northern Algonquins suffer from fits in which they experience a compulsion to kill and eat human beings. Marano claims that some Algonquin peoples believed that compulsive cannibals lived among them as part of their understanding of witchcraft, and that some individuals were accused of being windigo, and even executed on the basis of that accusation.

But just in the same way that the majority of people accused of witchcraft in Western and Southern Europe in the 16th century actually were not casting spells, cavorting with demons, or holding black masses, and the majority of people accused of vampirism in Eastern Europe at the time were not in fact undead blood suckers, the unfortunates accused of being windigo were not really cannibals. At the time that many Algonquins were fearing windigos, and many anthropologists were collecting data, Native Americans were undergoing severe hardships from disease, conquest, and both political and economic domination. Like other societies under stress, they expressed their trauma through fear of attack by witches. The Algonquin belief that witchcraft took the form of cannibalism was mistaken by early researchers for the presence of actual cannibalism (Marano, 1985).

Hall (2001) provides an even more critical typology of how the term "culture-bound syndrome" is used. He posits that theorists use the term to refer to:

1. apparent psychiatric illnesses not attributable to an identifiable organic cause or corresponding to a Western disease category;

2. locally recognized and named psychiatric syndromes;

3. discrete disease entities not or not yet recognized by Western medicine;

4. named local illnesses which elaborate symptoms found in Western populations but not named as syndromes in the West;

5. culturally accepted explanatory models of sickness not matching allopathic categories and which in Western settings might indicate delusions;

6. states or sets of behaviors involving communing with spirits, or possession by spirits, or loss of one's soul not necessarily seen as pathological within their own cultural setting, but indicating delusion, psychosis, or hallucination in Western nosology;

7. syndromes reported to anthropologists or other foreigners but not directly observed, which may be used to justify punishment or execution of an outcast.

Hall's formulation more clearly presents the idea of "culture-bound syndromes" as a result of theorists in the United States, the British Commonwealth, and Western Europe looking at societies they consider exotic and trying to make sense of what they categorize as foreign illness categories and bizarre behaviors. Although an exhaustive list is beyond the scope of this entry, I now turn to more extended considerations of particular syndromes named in the literature to more fully elucidate the points made above.

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