Search

Starting from a critical review of the concept of 'culture-bound' disorders and its development in comparative psychiatry, the authors present the changing aspects of two so-called culture-bound syndromes as paradigms of transcultural metamorphosis (koro) and intra-cultural metamorphosis (Salish Indian spirit sickness), respectively. The authors present recent data on epidemics of koro, which is supposedly bound to Chinese culture, in Thailand and India among non-Chinese populations. Neither the model of Oedipal castration anxiety nor the model of culture-specific pathogenicity, commonly adduced in psychiatric and ethnological literature, explain these phenomena. The authors' data on Salish Indian spirit sickness describes the contemporary condition as anomic depression, which is significantly different from its traditional namesake. The traditional concept was redefined by Salish ritual specialists in response to current needs imposed by social changes. The stresses involved in creating the contemporary phenomena of koro and spirit sickness are neither culture-specific nor culture-inherent, as postulated for 'culture-bound' syndromes, rather they are generated by a feeling of powerlessness caused by perceived threats to ethnic survival.

Koro, a psychogenic anxiety syndrome interfering with genital body image and sexual functioning, has hitherto been described as occurring mainly in isolated cases of South Chinese males. The present communication reports an epidemic outbreak in November 1976 in Northeastern Thailand where within a few days at least 200 patients, most of them Thai and two-thirds males, were treated at local hospitals. Main presenting symptoms were acute anxiety, in some cases leading to fainting, (subjective) shrinking of the penis and impotency in men, shrinking and/or itching of the external genitals and frigidity in women; further complaints included initial nausea and dizziness, abdominal pains, headaches, facial numbness. All patients recovered after brief symptomatic intervention. Popular opinion and news media echoed the patients' paranoid projection of viewing the epidemic as caused by Vietnamese food and tobacco poisoning in a hideous assault against the sexual vitality and general health of the Thai people, in the context of a specific socio-cultural and politico-historical situation. It appears that an adequate interpretation of Koro and of analogous hysterical symptom formation would have to go beyond the hitherto applied psychoanalytic models by considering the specific sociodynamic factors involved in the pathogenesis of such phenomena.