On the other hand, Karp believes that one’s culture causes the labelling of the culture bound syndromes. His discussion point is between Universalists and particularists. Universalists hold that culture bound syndromes are not limited to one particular culture; in contrast, particularists argue that culture bound syndromes are limited to one particular culture. Karp summarises that one’s particular culture causes the labelling of the culture bound syndrome. In his work, he demonstrated understanding of the fact that there are universalities, but that in terms of a specific type of behaviour being labelled, he feels that this is relative to particular cultures (Karp: 1985. 221). He puts emphasis on the notion of culture, and he feels that culture is the main factor that causes the emergence, and because of this fact he believes that “there may be such things as culture bound syndrome. The existing literature, however makes a better case for the existence of local idioms in which universal syndromes are interpreted and manifested” (ibid. 222).
The syndromes may be a result of factors operating in that culture whether one can find the case rarely universally or in one particular culture. The assumption is that there is something crucial in the cultural and social setting – perhaps beliefs and values that shape perception of the world and its mysterious forces; or perhaps particular types of standardised social situations, such as disadvantaged roles – that over time fosters and/or predisposes toward temporary or chronic disorder. Such a condition may well be regarded by locals as a type “sickness”, but may well be regarded by outsiders as a psychiatric abnormality (Hughes. 10). So there might be such syndromes that could be so designed in any of the industrialised societies in the same way as one looks, for example, to the particulars of Malay society for precursors and behavioural expressions of latah.
Example of culture bound syndrome: Anorexia Nervosa
Here is an example of a culture bound syndrome in Western culture, Anorexia Nervosa. “Anorexia nervosa is not to be found in the usual lists of culture bound syndrome, though cultural and social factors are sometimes noted in medical reports” (Prince. 199). Anorexia’s psychological factors are an individual's body image, whereby they may see themselves as being and bilious irrespective of their actual size. This distorted body image is a source of considerable , and losing weight is considered to be the solution. However, when a weight-loss goal is attained, the anorectic still feels overweight and in need of further weight-loss. The attainment of a lower weight is typically viewed as a victory, and the gaining of weight as a defeat. "Control" is a factor strongly associated with anorexia, and an anorectic typically feels highly out of control in their life. However, the nature of the condition with respect to such psychological factors is highly complicated. It is often the case that other psychological difficulties and mental illnesses exist alongside anorexia in the sufferer (Anorexia website).
Despite the fact that this psychiatric phenomenon is not really rare any more and can be found in lots of places, the syndrome is highly culture bound. There are lots of presumptions and researches are going on, but the exact cause is not discovered yet. The question is whether this type of behaviour pattern that is considered a dysfunction in many Western cultures, is considered something entirely different in other cultures, and therefore anorexia exists around the world, but is prevalent in Western cultures because of certain Western cultural factors. (Kopiec). For example, the strong influence of Western and advertised , such as , are also frequently viewed as being implicated in triggering eating disorders in anorexia patients especially teenage girls, although it has recently come to light that there appear to be girls exhibiting anorexic behaviours in remote parts of that have not been exposed to modern forms of . These girls link their self-starvation to causes. Although usually associated with western cultures, the exposure to western media has caused the disease to appear in some third-world nations. Just as gendered factors such as sexual stress influence the onset of koro, the pressures upon western females – e.g. “the slim, youthful body is beautiful and healthy: the fat person is slovenly, ugly, prone to disease and lacks self-discipline” (Prince. 199) - influence women who live in western cultures. It is not only found in regionally western culture but also reported in the westernising countries like Japan and it shows that anorexia demonstrates that this disease may be endemic to Western cultures. (Kopiec).
The Paradox of the Culture Bound Syndrome: the Case of Attention Deficit Disorder in North America
Anorexia is an example that could be categorise as a culture bound syndrome and at the same time could be familiar to American Psychiatric Association. And the previous part of the essay demonstrated the intermediateness of the assumptions of culture bound syndrome. In this part, I shall examine a paradox, i.e. that the culture bound view of psychiatric phenomenon can be applied the other way around. A common disease in western culture can be a culture bound syndrome from the perspective of other cultures, e.g. Attention Deficit Disorder. Demonstrating the abstraction of the assumption and distinctive system of the American health service and change of culture will show a contradiction in the perception of this disease.
Barry Glassner said in his book that if Huckleberry Finn and Tom were alive now, they would definitely be diagnosed with ADD. They are probably two of the healthiest children in collective Western history and are popular idols for children. However the changes of society do not leave the children who are diagnosed as ADD. There are one million children in the United States who take a drug for ADD, and in the world the number of children diagnosed with ADD are estimated as 2% to 9% of age from about six years to twelve years old. Also about three times to nine times more boys than girls suffer from the disorder (Scientific American, September: 1998, 66). Interestingly, this disease is gendered; as are anorexia and koro. And whilst there are more ADD children in North America than in UK actually this is, because of the difference in their respective health systems. The health service in the United States is individually or by organisation but it is considerably expensive. Individual insurance companies start to act when a doctor diagnoses a patient as a disease, otherwise people cannot get medication. In this system, the American Psychiatric Association plays an important role in categorising people’s illness and providing the way to get health service. This may be one reason why there are more diagnosed ADD children in the United States than in UK. British National Health Service starts medication from the time a patient comes to see a doctor, not the time when the patient is diagnosed with something. And also the NHS is supported by national welfare. Thus for people suffering from psychiatric diseases who live in the United States, identifying the medical condition of self according to the category is important. (Ellis and McGuire: 1993). Likewise the westernising country Japan, where the doctors are American-educated and use DMV-IV as their reference, has seen a rise in the number of ADD suffered children, and also their society is quite similar to the United States in when it begins to medically intervene with children.
Not only does the system makes ADD as a culture bound syndrome but also culture makes it visible the perception that ADD is a culture bound syndrome. Unlike a peaceful Huckleberry Finn’s time of America, now, the identity of the individual is different. It is found in school and even outside of the school, that children do not play outside a lot, but they do sit down inside the house and do play computer games. There is a contradiction among parents as well that they hope their children will be healthy, cheerful and full of energy as ideal children, but when they have too much energy such as hyperactivity, parents give children drugs to calm them down, because if they cannot do well in school, they cannot live in the culture well either. Hyperactivity or ADD can be a discord of the success. It is culture bound: if the culture does not require such success, children do not need to be diagnosed as ADD and take drugs. As an individual, the ADD diagnosed child could have a different life in different culture without being treated as an ADD suffered child (Lowe). The change of culture produced the birth of learning disabilities. Treatment of children in school shifted. This shift demonstrates that the emergence of the learning disability as culture bound where biological factors as well as cultural factors contribute to the emergence and formation of the disability (Kopiec). In fact the phenomena that we refer to as ‘learning disabilities’ are derived partially from our own culture, which places so much emphasis on learning academic skills. In a different society, where ‘success” depends less on the ability to make ones way through school, such a phenomena may be known or unimportant (Haring: 1977). The shift did not cause the emergence of new genetic behaviour: the behaviour existed prior to the shift. The shift caused the culture bound disorder to emerge where the genetic behaviour was always present, but the disorder was now culturally constructed. (Kopiec).
Difference of healing process in Western and Non-Western medicine
There are non-western medicine practices in the United States as in other countries. As well as Western medicine approaches to a disease with the idea of separation of body and mind, people in the United States tend to call non-Western medicine ‘Alternative Medicine’ (Brown: 1999. 5). This shows that in the United States, the centre of thought in medicine is Western medicine. As rare psychiatric cases are ‘exotic’, non-Western medicine is also outside of the category.
Depending on the healing process, approach to culture bound syndrome also needs to adopt the change. I will put forward two examples of complementary medicine, Ayurveda and Homeopathy. Ayurveda has one of the longest histories of non-Western medicine. On the other hand, homeopathy has developed mainly in Germany and Europe and has 100 years of its history. In terms of development of the medication, they have difference, but their approaches to patients resemble and are different from Western medicine. To understand clearly, I shall focus on medication for psychiatric diseases.
While Western medicine starts it medication from categorising (diagnosing) the patients into a big group of DSM-IV according to their symptoms, complementary medicine sees the patients as individuals and starts from particular details about them. In other words, the entrance of western medicine is a big hole, but that of complementary medicine is the tiny eye of a needle.
Holistic practitioners are concerned to ensure continuing good health and preventing problems that might occur, as well as treating illness. They assume a person exists on many levels and take into account not only the body but also the mind and spirit of an individual. The mind and spirit are not seen simply as part of the body; each is considered to be a complete system, constantly interacting with one another and of equal importance. The three systems, that are mind, body and spirit, can be said to be integrated principles of the whole. Because of the uniqueness of the individual, holistic practitioners do not think that diagnosis can be standardised. Often two people who have previously received orthodox treatment and have been diagnosed with the same disease will receive different treatment from the same alternative practioners. For instance, an herbalist or homeopath may give two individuals two completely different remedies for what appears to be the same problem exhibiting similar symptoms. (Brown. 4).
Ayurveda means ‘knowledge of life’ or the ‘science of life’. Its essence is balance. It has 5000 years of history and the system places equal emphasis on treating the body, emotions, mind and spirit. Practitioners consider that disease is created by an imbalance of the three humours or doshas, that’s is Vata, Pitta and Kapha. Vata can be correlated to the physical and mental activities ascribed to the nervous system by modern physiology. However Ayurvedic treatment aim to rebalance the imbalance between these humours. Ayurveda does not see these doshas separately; harmonisation of these three doshas is the important healthy goal. Unlike Western medicine, it is unthinkable to balance one’s body without thinking about it as a whole. Also the entire chemical process operating in one’s body can be attributed to Pitta, and the aspects of metabolism involved in constructing the physical body to Kapha. It is quite ironic that some Western media promote Ayurveda but at the same time put pressure on people who are anorexic, for example. (Ibid. 45).
The word ‘homeopathy’ is derived from the Greek ‘homoios’, meaning like and ‘pathos’, meaning suffering. The central principles of homeopathic medicine differ from those of Western medicine. Homeopathy is a holistic form of medicine where diagnosis takes into account the individual physical and emotional characteristics of the patient. Remedies are chosen to match the symptoms as closely as possible. The emphasis on prevention and one’s involvement with one’s own cure. Homeopathic remedies help the body to help itself. Homeopaths categorise each individual into constitutional types to assess which remedies will best suit them. The important point is that the background of a patient is important to match the remedy for the patient, not a background of their diseases. In Western medicine, it is the disease itself rather than the individual that it treated (Lockie: 2000. 8).
Conclusion
In these non-Western medication systems, categorisation is not an important tool to cure individuals, however for the health system like in the United States immediate diagnosis and categorisation of the disease are significant to cure individuals. However, my conclusion is that because of the idea of categorisation, there is always inclusion and exclusion: the borders of category. This abstraction bears the term culture bound syndrome. Categorisation is one of the convenient tools to offer medication in a particular society, but it is not useful and relevant for understanding the phenomenon. It is like seeing a painting through already coloured grasses. The birth of culture bound is already culture bound. “ Perhaps, if a term is really needed for this collection of unusual disorders, we should simply stay with something like “folk psychiatric disorders”, but only as a term of convenience and not of analysis” (Hughes. 12). Overall whilst it showed the contradiction of Western medicine and it may be useful to remedy western medicine, the term culture bound does not mean anything if the field of cure is non-Western.
Bibliography
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Karp, Ivan. “Deconstructing Culture–Bound Syndromes” Social Science & Medicine 1985
Kopiec,Rob Culture-bound Syndromes
Leng,Gwee Ah, “ Koro: A Cultural Disease.” In Simons, Ronald C. & Charles C. Hughes, eds. The Culture Bound Syndromes: Folk Illness of Psychiatric and Anthropological Interest. 1985. Dordrecht: D. Reide .l
Lock, Margaret. “The Politics of Mid-life and Menopause: Ideologies for the Second Sex in North America and Japan.” In S. Lindenbaum & M.Lock eds, Knowledge, Power & Practice. 1993. California
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