MEDICINE AS CULTURE 2
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Culture-Bound Syndromes
Lay Health Beliefs & Explanatory
Models
Culture Bound Syndromes
What are Culture Bound Syndromes?
They are constellations of symptoms, classified as “disease” or
“dysfunction”, which are characterised by one or more of the following
elements:
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They cannot be understood apart from their specific cultural or subcultural context.
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The aetiology of a traditional illness summarizes and symbolizes core
meanings and behavioural norms of that culture.
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Its diagnosis relies on culture-specific technology as well as ideology.
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Successful treatment is accomplished only by participants in that culture.
Although its symptoms may be recognised and similarly organised
in other (e.g. western) cultures, they are not perceived as belonging
to the same ‘disease’ or ‘dysfunction’
The DSM IV recognizes in its Appendix the
following „culture bound syndromes“
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Amok, ataque de nervios, bilis and colera,
boufée delirante, brain fag, dhat, falling
out or blacking out, ghost sickness, hwa
byung, koro latah, socura, mal de ojo,
nervios, piblotoq, qi-gong psychotic
reaction, rootwork, sangue dormido,
shenjing shuairuo („neurasthenia“), shinbyung, spell, susto, taijin kyofusho, zar
Are there western „culture-bound
syndromes?
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Some Authors give us the following list:
Anorexia Nervosa, Adolescence, drug abuse,
chronic fatigue syndrome, petism among old
people who live surrounded by cats and dogs,
ADHS, bulimia nervosa, Munchhausen by
proxy, obesity, premenstrual tension
syndromes, multiple personality disorder, type A
personality, involutional paraphrenia: (Spain,
Germany) paranoid disorder occurring in
midlife.
Others say: all Psychiatric categories,
regardless of culture, are always culturally
ANOREXIA NERVOSA
ANOREXIA NERVOSA
Anorexia nervosa (North
America, Western
Europe): severe restriction
of food intake, associated
with morbid fear of
obesity. Other methods
may also be used to lose
weight, including
excessive exercise. May
overlap with symptoms of
bulimia nervosa
“KORO” : The Disappearing Penis
“KORO”
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Koro is typically defined as a culture bound syndrome
involving:
delusions of genitalia shrinkage;
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acute anxiety;
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psychosomatic complaints;
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the conviction among some individuals that death will occur
once the genitalia fully retract.
What does the DSMIV suggest to mental health
practitioners (also to social workers?) when
encountering clients from a different cultural
context (e.g. migrants or ethnic minorities):
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Note the individual‘s ethnic or cultural reference group, his
language and involvement in host culture and culture of
origin (degree of integration or assimilation)
Elicit his cultural explanations of his illness (his
„explanatory model“ for his compaint)
Note his interpretations of social stressors, social supports.
What stresses exist in his environment? What is role of religion and kin networks in coping and in providing support?
Be aware of and describe the differences in culture and
social status of client and clinician and the difficulties in
communicating and mutual understanding („doctor-patient
relationship“)
Lay Health Beliefs & Explanatory
Models
Lay Health Beliefs
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Lay health beliefs refer to the set of beliefs held by
individuals about their health (and how to maintain
it), AND about all illness and diseases known to
them.
 An understanding of people’s ideas about health
maintenance, disease prevention and causation is
crucial to the success of health education and
health promotion programmes, particularly in
multicultural societies
Explanatory Models (EM)
of particular illnesses
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One way in which differences between lay and
professional beliefs about health and illness have been
conceptualised is the Explanatory Model Framework.
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EMs are based on lay and professional health beliefs
and are used in response to particular or specific illness
episodes. They are developed and used to cope with
a specific health problem.
Kleinmann , A (1980) Patients and Healers in the Context of Culture. Berkley: UCLA Press.
Explanatory Models
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Explanatory models (EMs) are the
notions and beliefs about an
episode of illness held by both
lay individuals and health
professionals.
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EMs provide explanations of
sickness and treatment which
guide choices among available
therapies and therapists and
which give personal and social
meaning to the experience of
sickness.
Explanatory Models
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Structurally, it is possible to distinguish five
major questions that EMs use to explain each
illness episode:
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1. Aetiology (what caused the illness?)
2. time and mode of onset of symptoms
3. Pathophysiology (what happens in body?)
4. course of sickness ( the degree of severity
and whether it is chronic or acute)
5. treatment
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