“Neurasthenia and Shenjing Shuairuo in Chinese Culture”

 

-I read an article based on the culture-bound syndrome of Shenjing Shuairuo, or Neurasthenia in western cultures. This article, by Lee and Wong, discussed how this once commonly diagnosed disease, had now made it on the DSM-IV list of “culture-bound syndromes” for its modern day prevalence in Chinese cultures. Neurasthenia was first coined in the United States in 1869, and was described as a disease with fatigue, headaches, anxiety, depression, and neuralgia. During the Victorian era this disease was commonly diagnosed in western countries, particularly the United States and Great Britain. As we progressed in the 20th century, the patients that were once diagnosed as having neurasthenia, were now typically diagnosed with more specific psychological or psycho-somatic diseases that better fit their actual symptoms. But the 20th century also saw the increase use of neurasthenia as a diagnosis for an array of symptoms in Asian countries, but mostly Chinese populations. The Chinese coined their own name for neurasthenia, “Shenjing Shuairuo” and described the symptoms based on principles of traditional Chinese medicine.

-The Chinese description of this illness was a “disharmony and imbalance of the qi (vital organs)”. The breakdown of the name “shenjing shuairuo” further describes the illness; “shenjing” means nerves or spirit, “shua” meaning degenerate, and “ruo” meaning weak. In China and in areas of high Chinese populations, the diagnosis of neurasthenia is often given to someone suffering from mental stress, depression, and anxiety. It is thought that using the diagnosis of neurasthenia or shenjing shuairuo in Chinese society because it is a very common term and diagnosis used between biomedical doctors and a lay person. This diagnosis is often used to prevent stigmatizing the patient, who may have actually schizophrenia or depression, and since this term is widely used and accepted, the person is much more likely to stay active in society and feel comfortable seeking and receiving psychiatric treatment.

-The articles I read made it clear that in Chinese society, the cultural prevalence of diagnosing a patient with shenjing shuairuo is in every sector or the culture- popular, folk, and professional. The articles stated that people in China were very quick and accepting of self-diagnosing themselves with this syndrome, and that traditional and biomedical practitioners both used this diagnosis rather frequently. They did state, however, that the professional sector doctors may do it more so patients don’t experience the stigma of mental disease, rather than clear-cut diagnosis.

References:

1-Lee, S., & Wong, K. C. (1995). Rethinking neurasthenia: The illness concepts of shenjing shuairuo among Chinese undergraduates in Hong Kong. Culture, medicine, and psychiatry, 19(1), 91-111. Retrieved from http://www.springerlink.com.proxy2.cl.msu.edu/content/j537g3k711631861/fulltext.pdf

2-Starcevic, V. (1999). Neurasthenia: cross-cultural and conceptual issues in relation to chronic fatigue syndrome. General hospital psychiatry, 21(4), 249-255. Retrieved from http://ac.els-cdn.com/S0163834399000122/1-s2.0-S0163834399000122-main.pdf?_tid=83ce0582fbfc74acb1b97bb51a0b5773&acdnat=1343003336_40df3f9e79b8806bc8b2f5665ee64f7e

ADD/ADHD in America

I chose to ADD, or ADHD because the majority of my family has it, including myself.  Most of my family is either on, or has at one time tried, medication for it. The exceptions would be myself, being epileptic it’s not something I’m able to do and have learned to make do, my grandfather, who used it to his advantage running his own dental practice, and the few who have not experienced any problems due to it.  However, as prevalent and obvious as it is in my own family, I believe its often over diagnosed and even more often over medicated.  With a CBS, as with any, so prevalent among society as ADD (affect up to 1 in 20 children in the USA) its difficult to take a step back however. ADD is actually just shorthand for ADHD, which is a behavioral disorder characterized by symptoms of inattention and/or impulsivity and hyperactivity.  These can significantly impact on many aspects of behavior and performance of ones life, and can do so throughout childhood and well into adult life.   I read an article that suggested ADHD may not be as predominanetly american as it seems, it merely caught on quicker here & we’ve done more research. It argues both sides, arguing social & cultural stresses are causation.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525089/

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

Kuru in New Guinea

The article that I found using pubmed discuss all the major forms of the group of disease which Kuru falls into which are called spongiform encephalopathies. The major forms included: Sporadic Cruetzfeldt-Jacob disease (spCJD), fatal familial insomnia (FFI), sporadic fatal insomnia (sFI), familial or genetic CJD (f/g CJD), Iatrogenic CJD (iCJD), Kuru, new variant CJD (vCJD), and variably protease-sensitive. These spongiform encephalopathies use an infectious protein called a prion as the agent for the diseases. Not much is known about these sort of diseases. The article does state that prions appear because something has caused a protein to misfold into a much more stable from. Once they appear prions are so stable destroying them is impossible. Sometimes the damage caused goes unnoticed until much later in life. In the culture-bound syndrome (CBS) Kuru, the spongiform encephalopathy affects mainly children and women.
In the native cultures of Papau New Guinea they believed that in order to show respect to a person who has died the entire tribe much gather for a celebration in which they eat the body of the lost comrade. Men are allowed first pick at the cuts of meat and often select the lean muscle portions of the corpse. This leaves the fatty organs such as the intestines, liver, and nervous tissue for the women and children. Because there was no capability to have a cause of death determined so of the dead bodies could had already been inflicted with Kuru. Since the women were stuck eating the tissue that contained high levels of fat which was where this protein often occurs the women and children had a high risk of getting the disease.
Because this disease is often found in the brain there is not for sure way to test for the illness unless the individual is dead so that an autopsy can be performed. Since the prion protein is view difficult to destroy or remove, currently there is no cure for Kuru except for ending the cycle of cannibalism that started the problem. Presently work is being done around to world to figure out a way to reverse the misfolding of prion proteins, denature the protein or to get rid of it completely.

Article: Overview of Human Prion Diseases
http://www.ncbi.nlm.nih.gov/pubmed/22196171

Latah in Southeast Asia: Malayan Culture

Latah has been described as a culture-bound syndrome. This condition originated from Southeast Asia and it can occur by the startle reflex. A startle reflex can last up to 30 minutes. This outburst can consists of screaming, dancing, and a person laughing hysterically. According to the Malayan culture the term Latah comes from the root word “lata” and this means “fool” or “defect” (Winzeler). Some symptoms according to Winzeler include a person moving violently, crying uncontrollably, and shouting out sexual or vulgar language. A person can also engage in the imitation of others or things and have the same speech and movement over and over again. Latah syndrome occurs within the Malayan and Javanese cultures. What I found interesting about Latah is that when a person who has Latah is startled they usually imitate the behavior or obey the commands of the person that is around them or trying to get their attention. Most cases of Latah occur intentionally to amuse onlookers and to draw attention to the person who has Latah. It seems like Latah is somewhat gendered based after reading the article because it mentioned that middle-aged women usually get Latah. Winzeler also mentions that Latah can occur in individuals for a number of reasons. Death of a love one or a child and very traumatic experiences can be the reason Latah occurs in individuals.

It almost seems like individuals who struggle in controlling their emotions and behavior suffer from Latah. And since they cannot properly cope or deal with life struggles they act out and have these continued outburst. There appears to be a little controversy when it comes to Latah being identified as an actual illness because there is a lack of individuals who experience and report this syndrome. There are rarely no individuals who actually seek treatment and help for Latah. Also, I find it interesting that there have been no reports on traditional remedies for Latah. Perhaps, Malayan people and their culture do not classify or view Latah as a mental illness. Western culture once again tries to classify Latah as a disease or mental illness and this may not be the case within the Malayan culture.

 

Source

Robert Winzeler. The Study of Malayan Latah. Indonesia, No. 37 (Apr., 1984), pp. 77-104 Published by: Southeast Asia Program Publications at Cornell University Stable URL: http://www.jstor.org/stable/3350936 . Accessed: 20/07/2012

http://www.jstor.org.proxy1.cl.msu.edu/stable/pdfplus/3350936.pdf?acceptTC=true

 

Dhat Syndrome in the Indian Subcontinent

In this article, the authors hypothesized that when analyzing culturally diverse clinical populations suffering from dhat syndrome or “semen-loss anxiety” and the associated symptoms of anxiety the results would show that this syndrome and its symptoms would be found across many different cultures. Thus, disproving the concept that dhat syndrome is culturally bound. This syndrome, “semen-loss anxiety” was analyzed among clinical populations from the Indian subcontinent, Sri Lanka, China, and Western countries. “Semen-loss anxiety” and its correlating symptoms of anxiety, depression, etc. were found among all of these populations suggesting that dhat syndrome or “semen-loss anxiety” is not culturally bound. It was also mentioned that this syndrome seemed to be historically/economically related because it was found to be diminishing in Western countries that were becoming more and more industrialized/urbanized.

The naming of dhat syndrome came from the Indian culture, more specifically the Sanskrit word, “dhatu” which meant  ‘elixir’ or ‘constituent of the body.’ Men suffering from dhat syndrome experience symptoms such as fatigue, weakness, anxiety, loss of appetite, and sexual dysfunction. In the Indian culture, these symptoms were thought to be due to the loss of semen either from masturbation, nocturnal emissions, or urination. The Indian culture believed that semen originated through a chain of conversions starting from the consumption of food. It was believed that food was converted into blood and that blood was converted into flesh and that flesh was converted into marrow and that marrow was converted into semen. Thus an imbalance in semen seemed to be due to an imbalance in any of the essential bodily constituents which were believed to cause the significant somatic symptoms mentioned previously. To lose semen would mean to lose the essential balance of the body. This is where the dhat related symptoms of anxiety and depression stem from. As a result, an individual’s state of health, biological, physical and/or psychological, can be damaged from these dhat related symptoms.

When evaluating a clinical population of men from Sri Lanka who suffered from sexual dysfunction attributed to “anxiety-loss syndrome”, the men were clinically diagnosed with significant somatic symptoms such as anxiety, hypochondriasis, or stress reaction. Thus, although not exclusively stated in this article some forms of possible medical treatment for these men could be to alleviate these psychological symptoms.

SOURCE:
A. Sumathipala, S. H. Siribaddana and Dinesh Bhugra. Culture-bound syndromes: The story of dhat syndrome. The British Journal of Psychiatry. 2004. 184:200-209.

Chalk Eating In Georgia

The article I choose to summarize was about a very interesting culture bound syndrome known as chalk, or kaolin, eating. Chalk eating is a specific type of Pica. As the article states Pica is “the persistent eating of non-nutritive substances.” Such substances as ice, paint chips, or in this specific case in Georgia kaolin, are ingested. Pica is commonly found in the mothers of patients have it in their childhood, along with many pregnant women in the rural areas of Georgia. This particular article focuses on the eating of kaolin, otherwise known as chalk. With the help of a colleague, they were able to interview 21 people who admitted to ingesting kaolin and discussed their findings.

Some interviews were done in person, others were on the phone. All of the people interviewed were black and only one was male. Reasons why these people chose to eat chalk varied from liking the taste, to pure cravings, to doing it because they knew others who did it. They acquired it from a number of different sources such as the store, friends, or directly from a kaolin pit. Almost all of the respondents reported that they enjoyed the taste of chalk and it did not make them sick. Fourteen of the people questioned said that they knew of others with the same habit. When asked, most of them did not know what others thought about their chalk eating. Though, this does seem to be strange in our culture. After the interview responses, I think kaolin ingestion is something driven by the mind to fulfill a desire.  The article did not discuss any treatment available for this other than the advice from a doctor to stop or limit the ingestion of chalk.

Though their data is limited, they believe that “kaolin ingestion is a form of pica that meets the DSM-IV criteria of a culture-bound syndrome.”  The only complication it may create is over-indulgence, but other than that it has shown no signs of leading to other psychopathology. The article reads that “kaolin ingestion appears to be a culturally-transmitted form of pica.”

http://journals.lww.com/smajournalonline/Abstract/1999/02000/Chalk_Eating_in_Middle_Georgia__A_Culture_Bound.5.aspx

Grigsby, Kevin R., Bruce A. Thyer, Raymond J. Waller, and George A. Johnston. “Chalk Eating in Middle Georgia: A Culture-Bound Syndrome of Pica?” Soutern Medical Journal. Southern Medival Association, Feb. 1999. Web. 20 July 2012. <http://journals.lww.com/smajournalonline/Abstract/1999/02000/Chalk_Eating_in_Middle_Georgia__A_Culture_Bound.5.aspx>.

Pica

Pica is categorized as an eating disorder. It includes the practice of repeatedly ingesting nonnutritive substances. Although it most often is seen in children between the age of 18 months and 2 years, it is also seen in adults (though very rarely). In fact, it is sometimes seen in pregnant women, often indicating some sort of nutrient deficiency. It is not always a threat to the individual’s health but depending on the substances being ingested, it can be life-threatening and very dangerous. Some substances that the person may ingest include, but are not limited to, dirt, fingernails, hair, cigarette butts, feces, or even needles. As addressed by Medscape, what makes this a culture bound syndrome is the view that culture holds on ingesting nonnutritive substances. If the act is viewed as a part of normal practice (aka culturally sanctioned) then it is not a disorder. It becomes a syndrome when the act is viewed as strange and unacceptable. Another important qualification is that the behavior must be inappropriate to the developmental level of the individual. For example, if an American baby puts sand in his/her mouth, we do not categorize that as a disorder but rather a normal mistake that babies make. If that same individual ate sand habitually at the age of 23, we would then start to categorize it as a disorder.

Pica is not always associated with biological causes. If that is the case, it is not considered severe and may not be addressed medically. When paired with mental retardation or another disorder, it is considered more detrimental. It also must last over a month to be considered. Treatment includes addressing nutrient deficiencies, mild aversion therapy and positive reinforcement, and even medication in cases where therapy is not a possibility (such as when paired with mental disorders).

Sources:

http://emedicine.medscape.com/article/914765-overview

http://health.nytimes.com/health/guides/disease/pica/overview.html

Falling out/Blacking out among Afro-Carribbeans and Black Americans

Falling out and blacking out occur primarily in southern U.S. and in Caribbean groups.  The disorder is described as a sudden collapse and fainting of the body usually occurring without warning. Symptoms can usually be described as an inability to move, inability to see with eyes open, dizziness, and sudden weakness of the body.

It is stated that falling out usually happens in context of intense anger, rage, or fear. Specifically, it is an accepted response when attending funerals, receiving shocking news, hot weather, and in stressful school situations. It is a coping mechanism for some as it prevents certain situations to escalate or produce an undesirable conclusion. Falling out can be chronic because of it’s use as a coping mechanism, and thus debilitating because it can affect everyday life. Studies do not suggest that it is a biological or genetic illness, but more of an environmental trigger that can cause it.

This disorder can also be found among Afro-Caribbeans in which symptoms are similarly described with episodes of a loss of consciousness. In the Bahamas, it shows that falling out happens to 23% of the population. In Haiti, it is referred to as “Indisposition.” The article states that most Haitians have known someone who has fallen out. Outside of that, not much else is known about the illness in the Caribbean region. It is not known why this illness occurs among African Americans (based on 1970’s data), but a hypothesis shows that falling out is more prevalent among people of African descent living in the U.S. than any other ethnic group.

It seems to be that falling out and blacking out are due to high levels of stress in an individual’s surrounding environment. The article states that the stress-induced illness has many roots in inner-city life because of the overcrowding, high levels of violence, safety issues, and financial concerns.

It was very difficult to find a written article about the treatment process in falling out because it generally tends to happen as an unexpected one time occurrence. In general, it is suggested that when a person looses consciousness that you check their pulse, and make sure that oxygen is somehow reaching the brain. If the person does not regain consciousness, then a medical professional should immediately be seeked out. As a long-term treatment, falling out can be cured by preventing environmental stressors. Definitely an easier statement said than done. However, due to the fact that it is an environmentally triggered illness, the only treatment process would be to seek out a different surrounding or find a different coping mechanism.

 

Jackson, Yo. “Culture-Bound Syndromes: Falling Out, Blacking Out.” Multicultural Psychology. 2006 :136-137. Web. 20 July 2012.

http://books.google.com/books?id=_hcurFqnQioC&pg=PA136&lpg=PA136&dq=falling+out+blacking+out+disorder&source=bl&ots=YSf83hWUtp&sig=TTeVe_FrHoS44nEElW8A3KYyrR8&hl=en&sa=X&ei=Ga0JUJrmN-To0QHLk734Aw&ved=0CFIQ6AEwAA#v=onepage&q=falling%20out%20blacking%20out%20disorder&f=false

Okpaku, M.D., Ph.D., Samuel O.. “Somatization and Psychologization.” Clinical Methods in Transcultural Psychiatry. 1998: 238. Web. 20 July 2012.

http://books.google.com/books?id=1roAZcsU_ZwC&pg=PA238&lpg=PA238&dq=falling+out+blacking+out+disorder+afro+caribbean&source=bl&ots=O8N2Gs52mg&sig=-Ry0xGNh9Rl5T63yNxBpilDHM30&hl=en&sa=X&ei=bq4JUPbNA-ja0QHNoozlAw&ved=0CFMQ6AEwAQ#v=onepage&q=falling%20out%20blacking%20out%20disorder%20afro%20caribbean&f=false

Obesity in the United States

Obesity is typically defined as the abnormal accumulation of body fat, which is in turn usually defined as 20% or more over an individual’s ideal body weight. 20-40% is considered mild obesity, 40-100% over is considered moderate obesity, and greater than a 100% more than ideal weight is considered to be morbid obesity. Ideal weight is defined as the weight corresponding to the lowest death rate for individuals of a specific height, gender, and age. The treatment and study of obesity is known as bariatric medicine.

The article I chose is “The Worldwide Obesity Epidemic”, an article published by Philip T. James, Rachel Leach, Eleni Kalamara, and Maraym Shayeghi.

http://www.nature.com/oby/journal/v9/n11s/full/oby2001123a.html

The major cause of obesity (at least in my opinion) is a hybrid of social and economic issues which have proven to be an effective combination for causing obesity. Specifically, I believe that the position processed foods have taken in our lives has profoundly affected obesity. Since the rise of processed food which is nearly always simultaneously packed with overly high levels of sodium and fats and an extreme lack of actual nutrition. There are many individuals in the United States who are malnourished not because they do not have enough to eat, but because the food that is widely available is not nutritious. This is made especially worse by the fact that these processed foods are incredibly cheap compared to food that is actually nutritious; because of this poverty is positively associated with higher obesity rates. Finally, this is also made worse by the extremely sedentary lifestyle that has emerged in the post-industrial United States.

In my opinion, not enough is being done towards the treatment and evaluation of obesity. Quick fix remedies are being extensively researched and marketed to individuals, but few work very well. Instead of convincing individuals that they need to change their lifestyle we try to provide them with drugs to solve their problems without having to change a thing(all the while making a tidy profit to boot) Unfortunately, I do not know what can be done to remedy this situation. The processed/fast food industry is too large and profitable for any action- such as the ban or taxing of processed fat, etc., etc. to ever occur. While we are still perfectly capable of simply changing our habits and eating healthier without government regulations ensuring it, this is not such an easy thing to do for those in poverty.