On Having Your Uncle for Dinner: Transcultural Psychiatry

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It is a generally held that the major psychiatric syndromes are universal but that their expression is coloured by the prevailing culture. Culture bound syndromes are those folk illnesses in which alterations of behavior and experience figure prominently. However, many are not syndromes at all. Instead, they are local ways of explaining any of a wide assortment of misfortunes.

Such is the case with Obeah or Empacho . Study of the culture-bound syndromes aid in understanding the suffering human being, especially if the goal is to ameliorate that suffering. Thus it is necessary to consider not only the physiology, but also culturally significant beliefs and practices.

Some time ago I saw an Aboriginal Ojibwe man of 23 who was referred because of agitation, insomnia and not eating. He had no hallucinations but did hold the firm belief he was becoming a windigo. The windigo belief is exclusive to Algonquin Indians and is an evil spirit that could possess and infect human beings and transform them into cannibalistic creatures. Such worries were said to have begun in times of extreme winter famine when families were isolated and confined because of heavy snowfall. However he lived with his parents in a well insulated home on the reserve.

The existence of the windigo “psychosis” historically remains controversial but it is part of Ojibwe folklore.
So was this a case of windigo or a DSM delusional disorder? He did improve with antipsychotics in keeping with a basic psychiatric treatment principle very much like duck hunting…. ” I don’t know what it was, but I got it”
Traditionally he would have been executed.

This approach was how the Inuit dealt with Arctic Hysteria aka Piblokto. A case I referenced to earlier which certainly sounded like piblokto very likely was bipolar in the days before lithium. So she was handled in a traditional fashion.

On the subject of eating dead relations the Fore tribe of Papua ate the brains of their dead to assimilate certain personality traits. The problem was the risk of Kuru a fatal neurodegenerative condition much like Creutzfeldt disease. The last known case died but ten years ago. The New Guinea government has discouraged the practice.

The Sambia tribe of the same country encourage as a rite of passage oral sex between boys and their elders. The primary focus of the initiation ritual is to transform “boys” who are considered effeminate into fierce, strong, male warriors. Classifying this as homosexual pedophilia or sex abuse would not be taking into account prevailing cultural norms.

In Belize belief in the Obeah spirit was prevalent. Essentially bewitchment, it is part of the Caribbean collective unconscious brought over from Africa specifically Nigeria. In Belize the practice led to homes being shuttered at night to restrict evil humours.

A folkloric interpretation of psychosis as Obeah intrusion was observed when I was a student in Montreal where immigrants from former French West Africa (Obeah) or Haiti (voodoo) both interpreted schizophrenia as spirit intrusion  and which was referred to as “bouffe delirante“. Traditional practitioners were not incorporated into therapy however.

A case I dealt with up in the Arctic demonstrated the problems of classifying such things as spirit intrusion  diagnostically. A young Inuit man I saw, “hallucinated” an ancestral spirit…

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……encouraging him to marry a girl he wasn’t too sure about. He refused so the spirit and he “fought” as evidenced by bruises and abrasions. Was this a dissociation disorder? He saw a shaman and was given a polar bear amulet…

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…but asked me to hospitalize him further south to “weaken the spirit” and review and discuss the issues he had with marriage and responsibility. He also wanted a medication (placebo) to give him strength. Last I heard he was symptom free and single. Another duck hunting success.

Finally culture needs to be taken into account in the area of stigma and appearances. A young Greek boy of 21 presented with acute schizophrenia. The  parents who spoke no English said he just needed to get married and be responsible. So dad goes back to Cyprus and brings home a 17-year-old bride to be. The boy did get better with medications. We (nurses and I) were all invented to the wedding but I had to work. Apparently there was much Ouzo, spanakopita and baklava.

Memo to file: A novel approach to psychosis rehabilitation : A big fat Greek wedding….

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2 Responses to “On Having Your Uncle for Dinner: Transcultural Psychiatry”

  1. kristina nadreau says:

    Currently half of women in the USA are “depressed” & medicated with psychotropic pharmaceuticals.

    I have often questioned the diagnosis of post partum depression…. who would not be depressed to have no sleep for weeks, with a life controlled by a screaming child.

    • Allan Seltzer MD says:

      Many post partum cases have a pre existing history of depression. The blues are caused by abrupt progesterone withdrawal plus fatigue and exhaustion

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