Do some cultures have their own ways of going mad?

Ideas

January 08, 2012|By Latif Nasser

(Peter Sucheski for the Boston Globe)

Anyone who follows psychiatry has noticed that the field is now in the midst of a debate that galvanizes its members every 10 to 20 years. At the center of the hubbub is psychiatry’s most sacred text: the Diagnostic and Statistical Manual of Mental Disorders.

The DSM, for short, is a compendium of over 350 ways our minds can fail us, from autism to kleptomania to voyeurism. What makes it onto the list matters: The DSM’s definition of “mental illness” can dictate whether an insurance company covers a treatment, or even whether a murderer is fit to stand trial. With the American Psychiatric Association gearing up to revamp the manual for the first time since 1994, mental health specialists have begun jostling over some of the most divisive issues in the field: whether someone mourning the death of a loved one can be justifiably treated for depression, for instance, or whether overdiagnosis and a black market demand for Adderall have trumped up a false ADHD epidemic.

And then there’s the back of the book.

If you turn to page 898 of the current edition — past the glossary and the alphabetical index of diagnoses — you’ll find a list of 25 little-known illnesses. These are the “culture-bound syndromes”: mental illnesses that psychiatrists officially acknowledge occur only within a particular society. Take, for instance, susto — a distinctly Latin American fear that one’s soul has panicked and left one’s body. Or pibloktoq, also known as “arctic hysteria,” in which Greenlandic Inuit strip off all their clothes and run out into the subzero Arctic tundra.

Depending on whom you ask, the notion that some cultures have their own ways of going crazy is either the ultimate in cultural sensitivity or the ultimate in Western condescension. And although these syndromes haven’t attracted nearly as much attention as Asperger’s or binge eating disorder, they are starting to come under fire from critics who don’t think that the appendix belongs in the book at all. Since the last edition of the DSM, in lectures and research journal articles around the world, a cluster of psychiatrists, anthropologists, and historians has attacked the validity of specific disorders on the list. To these critics, the very notion of a “culture-bound illness” is an outdated relic from the days of European empires.

“A group of us think that the time has come to abandon it,” says Dr. Dinesh Bhugra, the Indian-British president-elect of the World Psychiatric Association, an umbrella organization representing more than 200,000 psychiatrists in 117 different countries.