Running Amok in Malaysia

Running Amok is a rare culture bound syndrome most prevalent in Malaysia, Puerto Rico, and the Philippines although there are traces of it in modernized cultures. Running Amok refers to a condition in which an individual becomes erratic and irrational and causes havoc along with the homicidal and subsequent suicidal actions of such individuals, which often result in the fatalities and injuries of other individuals. An individual on an Amok spree is usually killed by bystanders during an attack if they do not commit suicide first.  Running Amok is considered to be a psychiatric condition. This CBS was discovered about two centuries ago among primitive island populations and interestingly, culture was considered a predominant factor in the development of the condition. This was thought to be a result of the geographic isolation of the tribes and their spiritual practices. The characterization of Amok does not recognize that some of the behaviors of the CBS have been observed in western cultures with no geographic isolation and although it is considered a rare disease, displays of Amok’s characteristic violent behavior have become common not in the indigenous societies they are thought to have originated, but among modernized cultures. Mythology considered Running Amok to be an involuntary ailment caused by an evil spirit entering the body, resulting in violent behavior the afflicted individual was unaware of.

Culture is the most important factor in evaluating the manifestation of Running Amok. A strong belief among cultures with frequent cases of Running Amok is that the condition is culturally induced, with there being cultural factors only observed among these primitive tribes that caused Amok. Culture also heavily determines behaviors that individuals will manifest. Characteristic of a CBS, Running Amok occurs in many unrelated cultures. Biologically, Running Amok is considered the result of a mental disorder, personality pathology, and psychosocial stressors. Certain individuals may also be predisposed to the characteristic behaviors of Amok. Individually, patients are assessed for risk factors known to be affiliated with violent behavior. After an episode, the attacker often experiences amnesia.

In these cultures, Running Amok is presently being evaluated as an outcome of an undiagnosed psychiatric condition. Prevention is considered the only way to avoid the consequences of Running Amok because it is virtually impossible to stop an Amok attack without being at risk of losing one’s life. Prevention is only possible with prompt recognition and treatment of the Amok. In the professional sector, individuals displaying this erratic behavior often seek the help of medical practitioners before homicidal and suicidal behavior manifests. Patients even prefer seeing physicians instead of psychiatrists because of the stigma associated with mental disorders. Additionally, there is no medication proven to treat specifically violent behavior, although antidepressants can be used for individuals experiencing depressive disorders. In the popular sector, the patient’s family and social support network are enlisted in psychotherapy, a technique often used to prevent violent behavior.


Saint Martin M.D. J.D., Manuel L. “Running Amok: A Modern Perspective on a Culture-Bound Syndrome.” Prim Care Companion J Clin Psychiatry, June 1999. Web. 20 July 2012. <Running Amok: A Modern Perspective on a Culture-Bound Syndrome>.

Nervios in Latin America

Nervios is a culture-bound syndrome that is indigenous to Latin American populations. The term is sometimes used interchangeably with ‘nervousness’ or ‘anxiety’, although the article says it is not synonymous with formal diagnostic criteria of anxiety disorders found in the DSM, nor is it acknowledged by biomedical practitioners. As with many other culture-bound syndromes, nervios can be an explanation of an illness, a symptom, or a cause of another illness. The symptoms of nervios encompass a wide range of symptoms of Western illnesses, from depression to schizophrenia. Biological symptoms include crying fits, shaking, or trembling. Additionally, nervios is said to occur mainly in women. However, many symptoms appear to be more psychological in nature and include feelings of depression or sadness, and feelings of hopelessness. Despite the numerous emotional and interpersonal symptoms in addition to physical symptoms, Latin American communities do not consider nervios to be a mental illness. Puerto Ricans in particular differentiate between types of nervios; ‘ser nervioso’ is to be a nervous person in general, as a personality type; ‘padecer de los nervios’ is literally ‘to suffer’ from nerves, and is more of an illness associated with depression; ‘ataques de nervios’ are nervous attacks that can occur as a result of a particularly stressful event. From a social and cultural perspective, nervios can be a way of expressing distress from everyday problems and conflicts, such as family fights. The causes of this illness vary, and can be attributed to the experience of financial difficulties, food and work problems, accidents, not eating well, or drinking too much. Nervios carries a broad variety of interpretations across different Latin American regions, demographic groups, and communities; so much so, in fact, it has been argued that nervios defies the definition of a culture-bound syndrome. However, analysis of responses to questions concerning the causes, symptoms, and treatments revealed that: “A single, shared system of knowledge about nervios exists for each sample of respondents.” (Baer 315-333)

A doctor or psychologist (professional sector) appears to be recommended to give treatment for nervios; according to the article, there seems to be a preference for psychotherapy over medication. Folk healers (folk sector) and home treatments (popular sector) do not seem to be as well documented for treatment. The DSM-IV-TR is said to include a listing for nervios, making me assume that it may be recognized to some extent in Western medicine.

Baer, Roberta D. et al. “A cross-cultural approach to the study of the folk illness
Nervios.” Culture, Medicine, and Psychiatry 27 (2003): 315-37. Print.

Susto- Latin America

Susto is a cultural illness found in Latin America and in the United States among Latino communities. Most people categorize Susto as a fright illness resulting from a traumatic experience or situation. The more serious the disturbance the greater chance in complete soul loss of the person. Some of the causes of this sickness are an encounter with an animal especially aggressive ones or contact with an evil spirit. Another cause is being involved in a bad situation maybe making a bad mistake or causing a car accident. Latin America children and infants are more likely to experience Susto due to scary dreams and nightmares. In older people learning about the death of a close friend or family member can cause this illness. It is believed that these bad spirits travel in the wind and air. Breathing of cold air or not properly cooling down after sweating can be a cause of general illness.

The use of “magical” plants of local herbs is important to the people of the highlands in Ecuador because they have a large amount of these plants at their disposal. The highlands of Latin America are filled with indigenous and mestizo people and they find the use of plants and prayers are a great source of healing. They are a very poor people and even treatment from a curandero can be very expensive for them.

In the article I read it discussed the use of traditional practitioners in Ecuador named curanderos and limpiadores the “cleaners” to treat these folk and cultural illnesses. The use of herbs and plants are the main source of treatment in the Latin American countries. I found through more research that a bouquet of basil, sage, and rosemary are swept over the body while prayers are said. I also read that marijuana tea with citrus blossoms is used to remove the spirits causing the fright illness. The use of what we in america consider aromatherapy are also used, eucalyptus being the main plant.

The use of magical plants by curanderos in the Ecuador highlands
Journal of Ethnobiology and Ethnomedicine 2009, 5:3 doi:10.1186/1746-4269-5-3
Anthony P Cavender (
Manuel Alban (

Brain Fag Syndrome in Nigerian Students

This syndrome seems to occur in southern Nigerian students.  Raymond Prince wrote the article in 1960’s. It seems out of date but it looks at different dimensions of the syndrome so I chose it. Brain fag seems to be a syndrome only brought up recently to talk about the effectiveness of CBS’s. Prince talks about the symptoms prevent the individual from doing his work, many head symptoms, and inability to grasp what he reads or hears in lecture, memory loss, visual difficulties, inability to concentrate and inability to write.  Prince discusses the causes of the disease, finding that the syndrome is not caused by genetics, intelligence, parental literacy, study habits or family responsibilities.  He hypothesizes that the syndrome is related to the imposition of European learning techniques.  European learning techniques emphasize isolated endeavors, individual responsibility and orderliness, all of which are foreign to Nigerians who are used to a collectivist society. At the end Prince suggest that new learning techniques would solve this issue, such as group learning and group examination techniques that fit more with the Nigerian personality.

Culturally, the Nigerians aren’t used to this idea of individualism and so I think that the hypothesis is a solid argument. Like many others in college, I’ve felt these symptoms during school but the Nigerians must have had a very different social context for this to turn into an illness.  I think my summary of the article covered many aspects of how the illness affects the individual and culture. Biologically it cannot be diagnosed, and there is no evidence of it being genetically passed on. However much like anorexia, the society sees that many individuals are being greatly affected by these symptoms and it reacts labeling the syndrome.

The professional sector may diagnose the syndrome as an anxiety disorder and may suggest either drugs or group therapy treatments. Medical treatments include drugs like benzodiazepines or lorazepam. Phosphorus is also suggested to patients.  In other sectors there are treatments like relaxation and breathing exorcises but I had difficulty finding academic articles that could speak to these.


The British Journal of Psychiatry (1960)106: 559-570doi:10.1192/bjp.106.443.559

Dhat in Eastern India

In the article, “Culture-bound syndromes: the story of dhat syndrome” the topic of culture-bound syndromes as well as a more indepth look at the illness “dhat” was examined and analyzed. In the analysis of culture-bound syndromes (CBS) it is discussed that this classification of illness is culturally relative. Each culture has its own set of diseases and illnesses that are not part of mainstream categorized diseases and whose names are culturally specific. An example of a CBS is dhat. This illness is found within the Eastern Indian culture and only affects the males of this community.  A common name for this illness is semen-loss anxiety. It is believed that loss of semen through means such as nocturnal emission, urine and masturbation causes such anxiety among these men that they develop symptoms associated with depression. These symptoms include fatigue, weakness, anxiety, loss of appetite, guilt and sexual dysfunction.

This illness can be evaluated based on biological, cultural and individual dimensions. Within the realms of culture, it is a clear culturally based disease. Within this community, semen is seen as a very important aspect of a man. It is believed that it takes 40 days for 40 pieces of food to be converted into one drop of blood. After this conversion, 40 drops of blood is necessary to produce one drop of semen so any loss of semen that is apart from reproduction is seen as detrimental. Semen is the key to the survival of the population so all sperm cells are vital. This leads into the understanding of the effects on the individual. Since so much importance is placed on semen then these men begin to experience immense amounts of stress and anxiety. Questions arise about their fertility which could lead to concern about their importance within their community. It is possible that the inability to reproduce could damage the self-image of each male. These concerns lead to biological ramifications. The anxiety causes depression-like symptoms that manifest into physical and psychological issues. Symptoms such as loss of appetite and fatigue begin to wear on the body leading to even more severe medical disparities.

Treatment for this illness is still being researched. Psychological help is being made available to these men in hopes of reducing the amount of anxiety and depression they experience. Western medicine is also looking into this illness to possibly find a way to tie in professional medical practices for the biologically manifested issues without conflicting with the cultural values. Other cultures have demonstrated similar illnesses associated with semen-loss anxiety so it is a collaborative effort to locate the appropriate treatment.


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.

Baridi Among the Bena Peoples in Tanzania

In the article Baridi: A Culture-Bound Syndrome Among the Bena Peoples in Tanzania researchers went to Ilembula village in Tanzania and interviewed the Bena people about baridi.  They found out that family had an important role in the life of the Ilembulian Benas.  Family unity and respecting your family, especially elders, was very important.  Baridi was defined by the informants that were interviewed as being caused by acting against culture which meant, “neglecting the values, norms, and customs maintaining unity among the family.” Baridi would cause someone to feel cold and restlessness and then move on to fatigue and loss of appetite.  Advanced baridi would cause deformations in joints, weakness in limbs, and mental disturbance.  The treatment started with the diagnosis and then moved on to fixing relationships with the family mainly through an apology and public confession.  The main prevention of baridi was to have self control, and to be considerate of others in the family.

The illness itself is caused by the individual’s actions.  They choices they make when dealing with their family is what determines whether they get baridi or not.  The rules they are supposed to follow are based their cultural beliefs, and if someone is affected with baridi they acted against the culture.  The most severe form of baridi is laana which results in social and economic losses including losing your job, failing an exam, losing property, lack of a marriage partner, and loneliness.

The professional and folk sectors were commonly combined in the treatment of the illness. The first step of the treatment was being diagnosed with baridi by a traditional healer.  The traditional healer would interview the person and tell them what actions led to them getting the illness.  They would then have the person give a public confession to the family, an apology, and the healer would determine whether the person had to give any gifts or money to the family members that were offended.  The healer might also include herbal remedies.  Commonly people with the illness would combine these treatments with hospital treatments as well.

Baridi: A Culture-Bound Syndrome Among the Bena Peoples in Tanzania

J Transcult Nurs 2005 16: 15 Anitta Juntunen

Ghost Illness amongst Native Americans

Ghost illness is a culture bound syndrome where spirits or “ghosts” are viewed to be directly or indirectly linked to a person’s illness.  Ghost illnesses are very common in many Native American cultures and this belief still hold true today in many Native American communities.  In western societies we have witnessed increased mortality amongst people who are grieving the death of a loved one and this is especially true when the loved one was a husband or wife.  This high mortality of grieving persons would be considered a type of ghost illness in many Native American cultures.  With these deaths it is believed that the dead loved one caused the death of the person left behind in order to bring them back together.[1]  It is also believed that the spirit of deceased loved ones can cause disease and illness to the living.

Dr. Robert Putsch outlines several clinical examples of patients who have suffered from ghost illness in an article “Ghost Illness; A cross-Cultural Experience with the Expression of a Non-Western Tradition in Clinical Practice.”  Here, Dr. Putsch outlines patients suffering from ghost illness from the Navajo and Salish cultures.

One clinical description was of a 27-year-old Navajo woman who was suffering from bilateral accessory breasts, postpartum depression and severe family problems.  After giving birth to her first child the woman complained of experiencing severe pain and swelling in both armpits.  Her family doctor advised her that her pain was caused by the “enlargement of accessory breast tissue, and he had counseled her to avoid breast-feeding in an attempt to further enlargement.”[2]  She was also experiencing postpartum depression and feared that she was “going crazy.”  After giving birth to her child the woman began having dreams where she was being visited by her dead father.  In the Navajo belief system the visitation of the dead in a person’s dream is a form of bad luck and these dreams may be followed by illness or even death.  The woman believed the inflammation to her breasts and depression was caused by her dead father and this belief was also shared by her family and community.  Her family also felt that some of her “crazy” actions, like driving too fast, were also caused by her dead father.  Medical staff treated her inflamed breasts and depression with medication.  They treated her illness through the use of family counselors and eased her mothers and husbands concerns of being harmed by the dead.

This paper was twenty pages and I found it difficult to adequately outline it in 400 words but what I found interesting was the integration of the biomedical system into their belief system.  At no point did the woman question the diagnosis made by the doctors.  What the woman and her community gave was the reason why she is experiencing the disease.  They seemed to only fill in the blank often left out by bio-medicine.  Western culture does this as well with many diseases.  People seem to assume that a person suffering from lung cancer was a smoker or that all people with aides are homosexuals.  I think this shows the individualism within our culture indicating that we see disease as being the fault of a person living a certain lifestyle.  The Navajo see illness as an attack from an outside source.  The person affected with illness in the Navajo culture is seen as a victim.

[1] Robert W. Putsch, “Ghost Illness; A Cross-Cultural Experience with the Expression of a Non-Western Tradition in Clinical Practice,” Drumlummon Views, Fall 2006-Winter-2007, accessed 7-20-12, Page 127.

[2] Putsch, Page 127.

Taijin kyofusho in Japan and South Korea

The CBS I chose to research is Taijin kyofusho. Taijin kyofusho or TKS, is a cultural variation of social anxiety.  TKS is a clinical syndrome that is most prevalent in Japan and South Korea.  The syndrome, which translates as “fear of interpersonal relations”, can be divided into two subtypes.  The first is the neurotic subtype and the second is the offensive subtype. The first subtype can be divided into a classical type and an avoidant type.  The classical type is the fear of being negatively judged due to physical signs of anxiety and feelings of shame due to anxiety.  The physical signs that they fear of being judged for can include sweating and tremors.

The second subtype, the offensive subtype, is what distinguishes TKS from the typical social anxiety disorder (SAD).  The offensive subtype is comprised of two factors.  As stated in the article I read, the factors are “a belief that one’s self or one’s behavior is flawed, inappropriate or offensive in someway and a fear that these flawed social presentations will offend others”.  The symptoms that are associated with this subtype further distinguish this disorder.  Individuals within this subtype report symptoms that are considered delusional according to the DSM system.  These symptoms are all fears.  They include fear of body odor and intestinal gas, fear of having stiff facial expression, fear of staring at and making eye contact with others, fear of a deformed body and fear of blushing.

Culturally speaking, this offensive subtype of TKS is mostly present in Asian cultures but studies have shown other cultures as having symptoms associated with the offensive subtype.  It was reported that there was an African-American women who had a fear of offending others by staring at their genital region in social situations.

Treatment of TKS can be done through Morita Therapy.  Morita Therapy was developed in the 1910s.  The goal of this therapy is to restore the mind to before the patient was caught up in their social fears.  Morita Therapy was originally characterized by rest and discipline.  It is now, however, done on an outpatient basis and in groups.


Marques, L and Robinaugh,D. Cross-Cultural Variations in the Prevalence and Presentation of Anxiety Disorders.  Expert Review of Neurotherapeutics.  Pp 313-322.  Feb 2011.

Maeda, F and Nathan, J. Understanding Taijin Kyofusho, Through its Treatment, Morita Therapy. Journal of Psychosomatic Research, Vol. 46, No. 6.  Pp 525–530. 1999…files/Maeda_1999JPsychosomRes.pdf


Bulimia Nervosa in American Culture

The CBS that I chose is the eating disorder bulimia nervosa in the American culture.  This CBS is characterized by an individual’s binge eating, followed by behaviors to
compensate their eating which include vomiting, excessive exercise, misuse of
diuretics, laxatives, or enemas.  It is commonly seen more in females than males with symptoms appearing during an individual’s early teens to early twenties and can follow a chronic or episodic course.  The development of the disorder is psychologically
based with damaging effects seen on a physiological level.  Medical complications associated with the disorder include gastric rupture, nausea, dental erosion, enlarged salivary glands, esophageal damage, heartburn and sore throat, electrolyte imbalances,
fatigue, paresthesias, seizures, and cardiac arrhythmias.  In addition to the mentioned medical conditions resulting directly from the disorder, there are a number of psychiatric conditions that are commonly seen in those with bulimia, these include mood, substance-related, anxiety, and personality disorders.

As I mentioned earlier, the biological dimension of this illness takes a heavy toll, physically and mentally, on the individual suffering from it.  Culturally, we place
great importance on body image, which can be seen all around us as consumers in movies, television shows, and advertisements.  When we find someone that fits this image, we hold them on a pedestal or alter them to remove or enhance the undesired quality.  All this leads into the individual dimension of the illness.  The glorification of
those with what society considers ideal qualities can have a major affect on the self esteem of someone who is suffering from the illness.  This can lead to those individuals taking measures to try and resemble the examples that surround them every day.

Current methods for the treatment of bulimia include pharmacologic and psychotherapy interventions, with the two being used concurrently at times.  Pharmacologic interventions involve the use of medications such as antidepressants and inhibitors.  Psychotherapy helps the individual look at the cognitive aspects of the illness and address the obsession with their body image and their low self-esteem.  Treatment can also be done on a cultural level by showing individuals with body types more common with those in the rest of society.



Assessment and Treatment of Bulimia Nervosa

Ghost Sickness in Navajo Tribes

(Pages 126-131)
This article was about a specific Navajo woman who was suffering from “Ghost Sickness”. She was being haunted by her father who had died six years earlier of a ruptured appendix, and know he was giving her nightmares and “making her drive recklessly”. Another thing that came from her ghost sickness was that she had not been able to have children for about five years, and then when she was finally able to have a child, she started swelling up in her armpits, which doctors told her was called bilateral accessory breasts. Finally, she suffered from postpartum depression after having her baby, and family problems, specifically, anger towards her husband. She and her husband decided to resolve her issues by first performing a ceremonial to take care of her father’s spirit so she would no longer suffer from ghost sickness. To address the issue of her swollen armpits, cosmetic surgery was planned, if the swelling did not go down naturally. And finally, for her postpartum and family problems, she was to have a diagnosis done for the postpartum, and her husband (who was Hispanic and catholic) agreed to respect her culture and her views.
Biologically, this disease has no real dimensions, it can affect some physical aspects of a person (such as the infertility and swollen tissue) but it is not something that is seen as biological. Culturally, this disease is seen as a real way of explaining someone’s problems, especially in instances when the person being afflicted is associated with the death of someone else. In the case of the Navajo woman, she was the one who found him ill, with his appendix burst. The individual dimensions of the disease are the different ways different individuals express and experience the disease. Different people would have different symptoms from the ghost sickness, and they would have different reasons for being afflicted as well.
In the Navajo culture, the disease is treated through ceremony. It is seen as something that is spiritual, and is therefore something that needs to be addressed spiritually. The Navajo culture exists in America, so American culture also plays a role in this disease today. The American culture tries to treat the different symptoms separately. In this woman’s case, they treat the swelling as physical, something to be removed, and the family issues and reckless behavior as mental and treat it as such.