Culture-Specific Pathology: Biological v. Psychological Basis

A Discussion of Culture-Bound Syndromes:

Across societies we see human universals of disease but we also see apparent illness experiences unique to regions and belief systems. These culture-bound illnesses suggest that some illnesses may exist exclusively in a certain society and are unique based on the cultural traits of that society. These culture-bound phenomena are especially relative to the time and place they exist. Within a society, social roles and stressors can play a strong role in the creation and definition of an illness episode or syndrome. Societies possess a culturally formulated “symptom repertoire that can unconsciously determine the expression of an abnormal experience such as illness. Further, a healer will facilitate which symptoms are considered appropriate to the society and influence how individuals form their perception and expression of their illness. These factors can create the distinct syndromes we ostensibly, and perhaps erroneously, observe as culture-bound syndromes.

There are pathogens in existence that can affect any human on the globe. There is certainly physiological variation among populations, genetic instances of resistance, and other such biological differences; so, pathogens may influence an individual’s body uniquely per person. Beside this idiosyncratic factor is the influence of culture. All illnesses are likely universal but their manifestation, interpretation, and expression are locally and culturally understood.

This locality variable is very salient when we look at psychological illness. A good example is schizophrenia. It varies so widely from society to society, yet at its underlying structure it is the same neurobiological problem in the human brain. The surface structure of an illness like this has broad variation relative to the afflicted’s sociocultural environment. Another psychological example is phii pob. This is quite specific to certain Thailand societies but the physical details of the illness are something that any human can experience. It stems from social conflict and anxieties and has both mental and somatic symptoms. Similar to phii pob is susto, which is specific to traditional Mexican societies. It too is a cultural mode of dealing with some social conflict that — in some cultural and psychological way — manifests physically.

In any illness state in humans, whether culture-bound or globally recognized, the pathogen or underlying cause is universal. What varies with illness experiences is the actual, outward expression that is “bound” due to the person’s worldview and social context or norms. To clarify, the distinction is disease is universal, illness is culture-specific.

It seems that evidence of culture-bound disorders mainly derive from psychological illnesses or the co-occurring psychological component of a disease syndrome. This leads me to think that the fully cultural mind, rather than the mostly physical body, is where the illusion of culture-bound disorders comes from. The mind is idiosyncratic and also shares exclusive perceptions and knowledge through culture. Naturally, a mental or somatic illness will be uniquely manifested, expressed, explained, and perceived relative to an individual’s culture and personality. So, to say that culture-bound disorders exist is somewhat of a manipulation, or perhaps a misinterpretation, of human variation.

It seems to me that the specific or non-specific disorders we see in a society are not necessarily produced by that society’s culture, but are rather an epiphenomenon of culture itself. A society’s “symptom repertoire” is just a cultural trait and it strongly shapes the entire illness experience of an otherwise non-cultural disease. The relativity of illness is intrinsic to human experience. I feel that we can demarcate illnesses as distinct or unique to a society but to name them as culture-bound disorders, or syndromes, is useless at least and redundant at best. However, culture-bound disorders as a biochemical concept may not be very useful, but as a social tool their study and acknowledgement is indeed useful to enlighten biomedical research and therapy.

11 Comments

    1. I’d say the allergy biologically is the same immunological hyper-response but the context will influence things. For instance, exposure at a very young age may reduce allergen reactions, so if a food is present or not would be the factor (so cultural and/or geographical). But overall, allergy is biological so the allergic reaction wouldn’t vary, just the rate of exposure to the allergen would possibly differ.

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  1. Fascinating post. But didn’t the Europeans bring over something that wiped out many already present in the “New World?” The expression of death doesn’t seem cultural! Still, I get your point. I believe Susan Sontag wrote similarly. Illness as Metaphor. And Michel Foucault as well.

    In India I noticed all the latest psych. meds for sale in tin foil wrap at roadside drug stores. So it’s a bit of a stretch to suppose that the so-called schizophrenic would be seen as a holy person in India. Like anywhere else, there are subcultures with competing views.

    Don’t know too much about South America but am interested.

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    1. With the Native Americans it would be that there immune system (biology) wasn’t able to fight the disease, their susceptibility had little to do with their culture really. The situation with them would be the illness was likely seen as a demonic spell or curse brought by the white man but the disease ran it’s course like it would in any human body, just with a less effective immunological response such that they more readily succumbed to the symptoms (the measels virus can lead to dehydrating diahrrea, pneumonia, and encephalitis in vulnerable populations).

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      1. Right so I guess we could say there’s a biological substratum and a cultural layer of interpretation. But then again, culture/social influences can play a role in altering biology. For instance, stress, malnutrition or sleep deprivation make our immune system less effective (?) So it really is complicated, I guess.
        Not sure if epigenetics would play a role in this or not. I’m not a scientist nor have I thought it out too carefully. Hoping you might shed some light on the details. 🙂

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        1. Yes, epigenetics fits here in that culture and social context and environmental factors that can be an impetus for some genotype-phenotype event. So culture itself plays a role biologically in disease but in a very subtle way, whereas how a disease is felt, understood, treated, or made into a social role is purely cultural. That’s why culture-bound syndromes are real psychologically but considered irrelevant biologically by say, a medical doctor or social scientist that is making a distinction between the mental and physical aspects of a pathology.

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  2. Thanks you compel me to look up some terms I haven’t thought about since university and high-school. I drifted away from the sciences and went full bore into the humanities. On that note, I do agree that many so-called mental illnesses are perhaps cultural creations. I often wonder if some folks would do better if immersed in a different milieu.

    Having said that, quite possibly some people are just wired insane. I don’t say this as a judgment because their mere existence would be permitted by God (my belief). And even if they are ruinous to others, facilitate the occupation of otherwise democratic countries, or cause world wars, they still are permitted… up to a point. But this enters into theology, which is relevant I’d say but not the direct focus of your post.

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  3. My own experiences of having been sent home “palliative care only” with a diagnosis of “terminal melanoma” (that was over 8 years ago, have been over 7 years tumour free) lead me to a partial agreement, and a partial claim that the spectra of influences from and between our various levels of systems is far more nuanced than a simple biological/cultural dichotomy indicates; and I acknowledge that as a useful first order approximation.
    It seems that the reality of us as individuals is at least 16 levels of interacting systems, and culture (narrowly defined) is but one of those levels (more broadly defined as external mimemics it is probably dominant in 4 levels of systems in most of us).
    And we seem to be an extremely complex set of open, complex-adaptive systems.
    And when considering complex systems it pays to keep Goodheart’s law in mind “Any statistically observed regularity tends to collapse when pressure is applied to it for control purposes” (the more deeply one recursively applies that the more interesting it gets).
    The other idea that seems to be central is one Jordan Peterson keeps stressing – the context sensitive balance between order and chaos – and as a biochemist that seems to be true at all levels of evolution, from the sub atomic on upwards.
    Arohanui

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    1. Indeed. The failures and shortcomings of modern medicine are inherent to it’s purpose. A large institution with myriad levels of specialization and focus that is interacting on micro- to macro-scales within myriad domains of society and physiology will be burdened and faulty. Discussions like this are part of the growing sophistication of medicine to account for more and to develop more practical concepts, protocols, and technologies. Thanks for your excellent commentary!

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