Amok in indigenous island and modern industrialized societies

“Running amok” refers to a mentally perturbed individual that engages in unprovoked, homicidal and subsequently suicidal behavior, oftentimes involving an average of ten victims. Formerly considered a rare psychiatric culture-bound syndrome, Saint Martin believes that “amok” is also prevalent in contemporary industrialized societies. Although it was not classified as a psychological condition until 1849, it was first described anthropologically two hundred years ago in isolated, tribal island populations such as Malaysia, Papua New Guinea, Puerto Rico, the Philippines, and Laos, where geographic seclusion and indigenous spirituality were cultural factors implicated in this CBS. For instance, spirit possession by the “hantu belian” or evil tiger spirit of Malay mythology was believed to be the source of the involuntary, indiscriminate violence that characterizes amok. Individual dimensions such as grief, acute loss, and interpersonal stress were also thought to contribute; for instance, an 1846 Malay incident was caused by an elderly man’s bereavement of his wife and child, while the offender in a 1998 Los Angeles incident suffered financial bankruptcy. Furthermore, individual variables, such as predisposition to aggression, and individuals with recurring cognitive themes such as persecution and revenge are instigating elements. Initial narratives by amok witnesses differentiated two forms that reiterate individual causative factors: “The more common form, beramok, was associated with a personal loss and preceded by a period of depressed mood and brooding; while the infrequent form, amok, was associated with rage, a perceived insult, or vendetta preceding the attack” (Saint Martin 2009).  In native cultures, sacred healers of the folk sector operated under cultural ideology where illness was believed to be of supernatural origin, so amok was tolerated and/or offenders were brought to trial.

As Western expansion encroached on remote cultures, incidence of amok decreased, reinforcing the view that culture was responsible for its pathogenesis. The author postulates that the escalating frequency of mass homicides in industrial cultures in the past quarter century represents amok, citing that attackers often have a history of mental disturbance and that modern episodes involve the same number of victims. Hence, biological dimensions of this illness include psychosis, personality disorders, and delusional disorders (in amok), and depressive or mood disorders (in beramok), as these maladies possess genetic elements. Also, dissociative disorder is suggested in instances where the assailant’s attack ends in exhaustion and amnesia for the event. Historically, this disorder has not been treated in the professional sector of Western biomedicine either; rather, perpetrators were apprehended and enter the criminal justice system or die by their own volition.

The author disputes classification of amok as a CBS since it seems to appear cross-culturally, and argues instead that culture is the mediating mechanism that determines how the violence manifests. For example, Jin-Inn Teoh claimed that amok appeared universally but that its mode of expression in terms of weapons and methods was culture-specific. Furthermore, John Cooper posited that its affiliation with suicide, a practice transcending cultures, disproves the classification of amok as a CBS. In essence, the author contends that amok is a product of mental illness, which has the same etiology and psychosocial precipitants worldwide. He advocates prevention by identification of individuals with risk factors and treatment of underlying psychological conditions. In addition to coworker, neighbor, friend, and family observations of susceptible individuals, Saint Martin states that physicians are uniquely positioned to collect data regarding those vulnerable to amok, since, “Many of these patients preferentially consult general and family practitioners instead of psychiatrists owing to the perceived stigma attached to consulting a psychiatrist, denial of their mental illness, or fear of validating their suspicion that they have a mental disorder” (Saint Martin 1999). Under the professional sector model, these individuals should be involuntarily committed if feasible, submitted for psychological evaluation, treated with drugs suitable for the diagnosed condition, and undergo psychotherapy. This is consistent with the biomedical paradigm, which is reductionist in focus, assigns irreversible diagnostic labels, imbues practitioners with enhanced credibility, and entitles practitioners to legally sanctioned authority such as mandating hospitalization of patients and controlling modality of treatment. Uncharacteristically, however, Saint Martin also recommends mobilizing the patient’s social support network, which is a holistic approach more aligned with folk sectors of medicine.

References

Cooper, J. (1934). Mental disease situations in certain cultures: a new field for research. Journal of Abnormal Sociology and Psychology, 29: 10–17.

Saint Martin, M.L. (1999) “Running Amok: A Modern Perspective on a Culture-Bound Syndrome”. Primary Care Companion to the Journal of Clinical Psychiatry, 1(3): 66-70. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181064/?tool=pmcentrez

Teoh, J-I. (1972). “The changing psychopathology of amok”.  Psychiatry, 35: 345–351

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