ADD/ADHD in North America

Chosen peer review article: Timmi, Sammi ADHD is best understood as a cultural construct; The British Journal of Psychiatry (2004)

          It is difficult to describe a condition as culture bound without a lot of criticism from the culture it is tied up in. Attention deficit disorder and Attention Deficit Hyperactivity Disorder (ADD & ADHD) were unheard of before the 20th century (History). According to the article I chose “There is still some debate in the literature whether Attention-Deficit Disorder/Hyperactivity (ADHD) is best conceptualized as a biological disorder or if it is best understood as a cultural construct.” (Rhode et al.) ADD/ADHD has varying biological, cultural, and individual dimensions. Its evaluation/treatment also varies in different cultures. I will discuss these things and more.

          There is a biology to everything, even culture bound syndromes. Different nations and ethnicities may have very similar or even very different cultures but their similarities may present similar factors that create a certain illness/behavior. According to research, brain scans of people with ADD/ADHD have similarities that are different from those not diagnosed with the disease, but not everyone diagnosed is given brain scans (Malloff). The frontal lobes, the area responsible for executive functions such as “attention to tasks, focus concentration, make good decisions, plan ahead, and learn and remember what we have learned” is impaired (Maloff). Current treatment is generally amphetamines which stimulate the frontal lobe. Alternative therapies include: diet changes, behavioral therapy, counseling, family therapy, and biofeedback (History).

          My chosen article states that “immaturity of children is a biological fact, but the ways in which this immaturity is understood and made meaningful is a fact of culture.” There are many personal and ecological factors that negatively influence the mental health of children such as the loss of extended family/family support, pressure on schools, academic pressure, a breakdown in the moral authority of adults, disciplinary confusion, hyperactive family life, and a competitive economic market that value certain behavioral norms. “Throw in the profit-dependent pharmaceutical industry and a high-status profession looking for new roles and we have the ideal cultural preconditions for the birth and propagation of the ADHD construct.” (Timmi)

Works Cited

Timmi, Sammi; ADHD is best understood as a cultural construct; The British Journal of Psychiatry (2004)

History of ADHD;

Rhode et al.; Rohde, L. , Szobot, C., Guilherme P., Marcelo, S., Silvia, M., & Silzá T Attention-Deficit/Hyperactivity Disorder in a Diverse Culture: Do Research and Clinical Findings Support the Notion of a Cultural Construct for the Disorder?; The Journal of Biological Psychiatry; Volume 57, Issue 11, 1 June 2005, Pages 1436-1441;

Neufeld & Foy; Neufeld, P. and Michael, F.; British Journal of educational studies; Historical Reflections on the Ascendancy of ADHD in North America, c. 1980-c. 2005

Maloff; Maloff, Jared; the Biology of ADD;

Anorexia Nervosa in North America

The article I found is called “’Culture’ in Culture-Bound Syndromes: the Case of Anorexia Nervosa” by Caroline Giles Banks.  In this article, Banks explores a cultural cause of Anorexia in the United States that is often not considered.  Often, anorexia is expressed in more secular terms and associated with dieting to obtain the cultural ideal of thinness.  Banks looks at two case studies of religious women previously diagnosed with anorexia nervosa.  Through participant observation and interviews, Banks came to understand their anorexia as being related to their religious beliefs and practices.  Both women studied showed that “self-starvation can be expressed by contemporary anorectics in the West though religious symbols and idioms about food and the body” (881).  In the cases of Margaret and Jane (the two women studied), they “do not see themselves as ‘sick’ or ‘anorectic’.  Rather, they understand their starvation as a literal attempt to meet the normative ideals about controlling the body provided by their religious traditions” (881).

The biological components of anorexia can be seen clearly in the resulting physical complications of not eating such as hypotension, lanugo, and bradycardia.  Unfortunately, as what is considered a mental disorder, the biological causes of anorexia are unclear.  “Medical researchers who take a biological approach to anorexia generally seek to located the cause of anorexia in abnormalities in mechanisms regulating hormone output that have biochemical influences on eating behavior and weight control” (870).   The individual choice aspect of anorexia has to do with the individual’s choice of eating and exercise behaviors.  Additionally, each individual’s health seeking behavior and understanding of what a proper body should be like can affect the prevalence and characteristics of each case of anorexia.

Treatment must be individualized because each individual understands the body in a different way and has a different relationship with food and exercise as the others.  According to Banks, “Treatment can only be successful the extent to which medical practitioners begin to recognize alternative cultural explanations for symptoms as well as the role of culture in their own diagnostic and biomedical systems” (881).  Overall, treatment must be done on a per-case basis because all individuals have a different relationship with their own culture and cultural ideals and practices leading to their experience with anorexia.

Caroline Giles Banks, ‘Culture’ in culture-bound syndromes: The case of anorexia nervosa, Social Science & Medicine, Volume 34, Issue 8, April 1992, Pages 867-884, ISSN 0277-9536, 10.1016/0277-9536(92)90256-P.

Zar in Africa and the Middle East

Zar is a culture bound syndrome of spirit possession that leads to disease in its hosts.  It occurs in countries throughout the Middle East and Northeast Africa, primarily affecting middle-aged women.  The term zar refers to not only the illness, but also to the healing rituals that treat it by pacifying the intruding spirits.  These spirits cover a spectrum of individual entities that constantly expands to include characters from current culture.  These include religious and political figures, and each have their own personality and whims.  Physical symptoms of zar include headaches, chest pain, anorexia, gastrointestinal disorders, fatigue, body aches, and fear.  Zar is most common among women who are infertile, divorced, unhappily married, unemployed, or with a family history of the condition.  Considering these life situations as risk factors, I think zar typically affects women who feel anxious and vulnerable from their life situations.  Women without a position in a stable family structure, or with a low quality of life because of poverty, are more apt to develop mood disorders like zar.  The way zar victims feel split between themselves and an intruding spirit resembles what the Western world calls multiple identity disorder.

Most people who experience the symptoms of this disease first seek treatment by Western physicians and traditional healers, who comprise the professional and folk sectors of healthcare.  If this treatment proves unsuccessful, the client will then turn to zar practitioners called shaykhas, who occupy a specific niche of the folk sector.  After diagnosing the condition, the shaykha conducts an inception ceremony, a week-long celebration with singing, dancing and feasting, that symbolizes a wedding for the client, the “bride” of zar.  This culminates in the client going into a trance and the shaykha negotiating with the spirit.  The end result of this treatment is a liberation from the negative symptoms of zar, but not from the spirit possession itself.  The client will continue to live as a host of the spirit, obligated to comply with that spirit’s demands. In an objective view of this therapy, the client benefits from the social support in the ceremony.  The resulting feeling of involvement and sense of belonging may help alleviate the causes that initially led to the sensation of spirit possession.

This information came from an article written by Sheikh Idris Rahim and printed in  pp. 146-147 of Encyclopedia of Multicultural Psychology, which can be accessed online through the following link:


Hwabyung of Korea

 The article that I read, Hwabyung in Korea: Culture and Dynamic Analysis, by Sung Kil Min was a look at Anger (fire) disease which is known as Hwabyung in Korean culture. What the disease basically entails is a strong feeling of anger with related behavioral and bodily symptoms. The anger is seen as a reaction to being the put in an unfair situation, usually social in nature and must be suppresses so as not to interfere with familial or social relationships. This suppressed anger continues to build till it finally causes Hwabyung, which can show itself through heat sensations (hot flashes redness of the face), somatization, respiratory oppression, insomnia, anorexia, depression, anxiety, and behavioral symptoms such as sighing, tearing, and an impulse to open doors or go out from closed situations. An interesting aspect of this is that even though patients become very depressed, they are still extremely talkative. Hwabyung symptoms are thought to symbolize the nature of fire, and other symptoms such as the open of doors are seen as the release of anger. Culturally, there is a unique sentiment known as Haan, which signifies the mixed mood of missing, sadness, suppressed anger and feeling of unfairness that results from societally tragic history, as well as from traumatic personal trials. This could be a product from any number of things including a failed romantic relationship to lower family class, to being swindled. An accumulation of feeling of haan and the inability to deal with such has been reported to be a major reason behind Hwabyung. While the disease has mostly been known for effecting women, it is also recognized for effecting people in the lower social class.

Treatment of this disease is varied from person to person. Often sufferers will go to physicians, pharmacists, traditional herb physicians, Christian faith healing, shaman rituals and psychiatrists looking for treatment. The methods used to combat this disease can be psychotherapy, drug treatment, family therapy, community approaches, often integrated with traditional and religious healing methods or through the use of haan-puri, which is basically the sentiment of resolving, loosening, unraveling and appeasing negative emotions with positive ones. An example that Min gives of this is if the haan of a mother was caused by poverty, and a violent husband, the haan-puri might be a result of the success of her son, for which she endured the hardships for.

Sung Kil Min. Hwabyung in Korea: Culture and Dynamic Analysis. World Cultural Psychiatry Research Review, Jan 2009 accessed 7/20/12

Obesity In America

In a study
done by Dr. Philip T. James called, “The Worldwide Obesity Epidemic”, Obesity
and BMI are examined globally. The study focuses on BMI data to create an
analysis of regional obesity across the globe. The prevalence rates for obese
individuals vary widely from country to country. The Middle East, Europe and
North America have the highest obesity rates. Also, women in most countries
have a higher BMI distribution and higher obesity rates when compared to their
male counterparts. Another part of the study indicates that individuals who
have abdominal obesity have enhanced morbidity. These individuals were also
found to have early childhood stunting as well low birth weight rates.

Biologically, individual body chemistry varies widely. Metabolic rates are not constant from person to person and can cause one person to become overweight easier than
another. In terms of culture, obesity in the U.S. has become part of our
culture. The foods that have become staples of the “American Diet”, contribute
greatly to the obesity epidemic. The average American diet consists of high
fat, sugar, and sodium content. On an individual basis, obesity can be combated
with a disciplined diet and physical activity. Environment can inhibit both of
these factors in some cases. As we learned in last week’s material, lower
socioeconomic communities are affected most.

Treatment has recently become centered around preventative action. Body Mass Index, or BMI, is the main scale used to measure and evaluate obesity. The normal BMI
should remain within 18.5 to 24.9 kg/m^2. Individuals outside of the normal BMI
had increased prevalence of diabetes, hypertension, gall stones, and coronary
heart disease. Evaluation of obesity has also recently focused on children just
over the age of 3 years old. Childhood obesity is a strong precursor to adult
obesity and increases the prevalence of the diseases mentioned. In the popular
sector, drugs and “quick fix” fitness plans seem to be an ever growing form of
treatment. In the professional sector, diet plans and fitness regimens can be


Anorexia nervosa is an eating disorder, prevalent in Westernized societies, characterized by individuals who have a fear of weight gain. Dieting and over exercising are common with this disorder. While the causes of this disorder are not known, genes and hormones are thought to increase an individual’s risk in having this. According to PubMed Health, “risk factors for anorexia include: being more worried about, or paying more attention to, weight and shape, having an anxiety disorder as a child, having a negative self-image, having eating problems during infancy or early childhood, having certain social or cultural ideas about health and beauty, and trying to be perfect or overly focused on rules.” It usually begins during teen years, common in females, and is primarily seen in white women that are high achievers.

There are biological dimensions of anorexia nervosa that have to be present in order for it to be diagnosed properly. There needs to be an overall loss in bone strength, muscle, and body fat, sensitive to cold, dry mouth, depression, blotchy skin, skin covered with hair, and confused or slow thinking. Since you are not consuming enough nutrition, your body is feeding on itself, thus eating away at your fat, muscle, bones, and ultimately, your internal organs. Anorexia is a disease that slowly kills you, and mentally, most individuals have very difficult times coming back from it.

Culturally, thinness is preferred in Western societies and is considered ideal and beautiful. Dieting and exercising are the norm in our society and it is idealized that in order to have the perfect body, you must be thin. Advertisements, actors, actresses, singers, and models all prove this point in society, that if you are not thin, you are not good enough, and are unattractive by societies’ standards. This pushes individuals to go the extra step, to do whatever it takes, so that they can feel beautiful, which ultimately can lead to anorexia, and their death.

There are different tests that are available to be done to an individual, if others suspect them of having anorexia; some of these include albumin, bone density test, CBC, electrocardiogram, electrolytes, kidney functions tests, liver function tests, total protein, thyroid function tests, and urinalaysis.

Treatment for anorexia itself is a whole other process, since the person with the disorder needs to recognize that they actually have an illness. If the person does not think they have anorexia, they will deny they have an eating disorder, and will only enter treatment when their condition becomes serious. The ultimate goal of treatment is to have an individual return to a normal body weight and have regular eating habits. Different therapies that are available are cognitive behavior therapy, which is a form of talk therapy. These are available in groups, with the person’s family, or individually. Medications are available as well, such as antidepressants, antipsychotics, and mood stabilizers. These can help treat depression and anxiety that goes with having anorexia, though there is no proof that it actually decreases an individual’s desire to loose weight.


PubMed Health. (2012, 02 13). Anorexia nervosa. Retrieved from

Shin-Byung Korean Women

Shin-byung is a cultural bound syndrome that affects Korean women.  The first stages include somatic complaints like dizziness or gastrointestinal problems.  This syndrome is when a spirit tries to enter the females body and take over it physically and mentally.  Those with the syndrome report having vivid dreams about spiritual entities telling them to let these spirits into their bodies.  Once this starts to happen they usually consult a shaman or psychiatrist or physician for help.  It is said that there are three stages to shin-byung.  First of which is the prodromal phase, where the victim experiences the somatic symptoms and some anxiety.  The second phase is the trance phase.  This is when the victim reports having dreams of being beckoned to let spiritual beings into her body.  The last phase is possession.  The victim can show signs of double or even multiple personalities from the possession of one or more spiritual beings.  The second and third phase can range from taking a few weeks to decades to complete.  Once the possession is complete the women is considered a shaman herself now due to the possession.  This is in most cases welcomed because a shaman is a well respected member of the community and is a step up in the social ladder for women.

On the cultural level, these women go to shamans and other healers to see how this can be remedied, depending on the culture.  Where as inAmericathese people would be considered mentally unstable and put together in a special institution.  On the individual level these women have a choice to have a shaman try and convince the spirit to not control the host they have chosen, or let the process take place and assume the role of a shaman themselves.  If they do reject the spirit it is believed that they will live a life of torment from the spirit because it was not allowed to take possession of its intended host.

In western culture there have been similarities seen between Shin-byung and multiple personality disorder.  There is still some debate as to whether the condition is considered a mental illness or not.  As for a treatment, there is no known treatment other than having a shaman try and convince the spirit to leave the intended host alone and find another.

Amok …a Malaysian Disorder

The phrase “running amok” originated with this disease.  It originated in Malaysia and is a dissociative disorder.  It is mostly in males around the ages of 20-45 and its symptoms include brooding and frequent outbursts. They become exhausted after this and it seems to be precipitated by some sort of insult and is a sociopathic type of disorder. Men suffering from this suffer a loss of status within their own community. It often occurs in rural regions of this country. Treatment of this syndrome is similar to that of other psychiatric disorders.  Sometimes these patients are suicidal and require hospitalization.  Cases of amok are becoming less and less and better treatments become available.  This behavior can resemble mania and such disorders as bipolar disorders.  The origin however is in Malaysia as a culture bound syndrome. Some patients suffering from this have become suidical. I do not think people with this disorder in Malaysia had any type of treatment that was helpful just like people nowadays with similar diseases, treatment is difficult for these chronic disorders today just as it has been in the past.


Breast Cancer In Caucasian Women

There has always been a major concern with breast cancer in the United States. Caucasian women are said to have breast cancer more than any other race. This article outlines a study done for specific risk factors while scientists try to dissect the causes of high rates of breast cancer in Caucasian women. Increased risks have been associated with age, first pregnancy, early menopause, and breast cancer has even been associated with a fatty diet.

During the study, 785 women were interviewed at several different hospitals in New York City. The main focus was on women who were in pre and post menopausal stages. This was also considered the control group. Some of these women were coming into the hospital for various issues such as cancer (skin, lungs, etc.). The patients being studied were in the hospital specifically for a confirmed diagnosis of carcinoma of the breast. Carcinoma of the breast is malignant tumor of the breast (arising from milk glands and ducts).

All of these patients were interviewed after being classified as post or pre-menopausal. In the interviews, they discussed symptoms that they had been having over the past couple of months (pre-menstrual syndrome, spotting, etc.). Scientists found that these women were between the ages of 25 or older.

They also tested fertility rates in these women as well. For example, some people have children at a later age due to fertility difficulties. In both the menopausal and fertility factors, scientists found no biological difference between the control group and the group being studied. Breast cancer is being treated with chemotherapy and/or surgery to try to catch cancer early before it spreads in the body. The article was not specific on any particular cultural differences associated with the disease more in this race than others.

However, there are several individual dimensions to try to prevent breast cancer; self-examination every month, and going to get a mammogram at age 40.


Navajo Ghost Sickness

This article pays close attention to certain superstitious beliefs and actions of the Navajo tribe of Native Americans. According to Navajo folklore, the Anasazi are a group of prehistoric people who existed before the Navajo did. This tribe of individuals was killed off by the wind spirits due to trespasses committed against nature, what specifically defines a blasphemy against nature is not clearly defined. Some groups of the Navajo believe that the Anasazi ruins are still inhabited by their malevolent spirits and others view these spirits as their ancestors. The common shared theme is that these grounds are inhabited by long perished souls and the grounds are sacred. The Navajo believe that disturbance of the Anasazi grounds will antagonize the resting spirits here resulting in dire consequences. As a fundamental belief in Navajo culture, one should not disturb the dead, meaning treading on burial grounds or even viewing exposed prehistoric bones. Disturbance of the dead or exposure to them may leave an individual vulnerable to a condition termed “Ghost Sickness”. Ghost sickness is a Navajo sickness that is characterized biologically by unexplained nonspecific physical illnesses as well as sudden misfortunes after unearthing any artifacts related to the dead or disturbing grounds which may be inhabited by spirits. The Navajo people believe that Ghost Sickness is caused by a malevolent spirit inflicting retribution as penance for the disturbance of its grounds or artifacts. A Navajo concern which relates to modern-day archaeologists excavating these Anasazi lands is that if the perpetrator somehow escapes the spirits punishments then the bad luck will stick around with the inhabiting Navajo people, causing Ghost sickness in them. Navajo individuals take this sickness very seriously and completely avoid disturbing the dead, however some archaeologists insist upon proceeding with their excavations, often hiring Navajo religious figures to perform rituals protective against Ghost Sickness.

The only treatment of this illness discussed pertains to the folk sector, rituals performed by Navajo religious figures. The main strategy discussed for this illness was prevention by avoiding disturbing the dead. In the professional sector, it is debatable whether or not this is a real illness or if it is a psychological phenomenon.