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• W200820104 abstract "This paper provides an introduction to the concept of culture-bound syndromes and the application of this concept to Native Americans. Culture-bound syndromes are patterns of abnormal behavior that are only found in specific cultures or sub-cultures. Counselors and others who work with Native American clients should understand the controversy over culture-bound syndromes and the ways that Native American clients may express psychological distress in culturally-specific ways. A list of Native American culturebound syndromes is presented, and suggestions are made regarding their diagnosis in Native clients. ISSUES IN THE DIAGNOSIS OF NATIVE AMERICAN 2 While some mental disorders and syndromes are thought to be universal, others are only found in specific cultures or sub-cultures (Lilienfeld & Arkowitz, 2009). Native Americans, like all human beings, are subject to experiencing psychological distress. There is good evidence that several forms of psychopathology existed among indigenous peoples in North America prior to European colonization (Waldram, 2004). Indigenous peoples experienced many challenges in daily life and were not immune to conditions such as anxiety, depression and suicide. Negative feelings, maladaptive responses to stress, and disorders with a large biological component (such as schizophrenia) have been found in every culture studied (Stevenson, 2010). Indigenous people in North America experience mental disorders common to all human beings, but they may also experience mental disorders that are only found in their own tribal cultures or sub-cultures. The DSM-IV-TR (American Psychiatric Association, 2000) included an appendix with a glossary of “culture-bound syndromes,” defined as “recurrent, locality-specific patterns of aberrant behavior and troubling experience;” they “are localized, folk diagnostic categories” (p. 898). These culture-bound syndromes may or may not correspond to DSM-IV-TR mental disorders. They have also been called “ethnic neuroses,” “culture-reactive syndromes,” and “folk diagnoses” (Hughes, Simons, & Wintrob, 1997). Some culture-bound syndromes have been found to occur only in Native Americans. The concept of culture-bound syndromes is controversial. Are there mental disorders or syndromes that only exist in one or a few cultures, or are those syndromes simply local cultural variations of forms of psychopathology that are universal? ISSUES IN THE DIAGNOSIS OF NATIVE AMERICAN 3 Proponents of universalism believe that all human beings have basically the same underlying psychological mechanisms that are common to various forms of psychopathology across cultures. On the other hand, cultural relativists argue that all forms of psychopathology are linked to the cultural meanings in particular contexts (Stevenson, 2010). Hughes (1998) suggested that the DSM-IV-TR’s assumptions about the ontologic status of the culture-bound syndromes are unacceptably ambiguous. Since culture should be considered in every diagnosis, the claim that some syndromes are unique or specific to a particular culture may be unnecessary. Another criticism is that when culture-bound syndromes are separated from other mental disorders they become a museum of exotic, static entities, rather than simply culture-specific expressions of the same underlying psychopathology (Hughes, 1998). The idea that some mental disorders are present in all cultures does not preclude the possibility that some disorders may exist only in certain cultures. For example, some Inuit seal hunters in Greenland experience a condition called kayak angst (which is considered a culture-bound syndrome) characterized by feelings of panic while out on the ocean. But from the point of view of Western psychiatry the condition could also be seen as panic disorder with agoraphobia (Lilienfeld & Arkowitz, 2009). So kayak angst could be seen either as a disorder specific to the seal hunters, or it could be seen as a unique cultural expression of panic disorder. It is likely that while general forms of psychopathology such as depression and anxiety are universal, the ways that these syndromes are expressed are determined by cultural values, norms, and traditions. Experts agree that culture can shape both the experience and the expression of mental disorders in significant ways (Simons & Hughes, 1985). If culture influences the ISSUES IN THE DIAGNOSIS OF NATIVE AMERICAN 4 expression of all disorders, then in a sense all mental disorders are culture-bound. If that is true, then there is no need to have a separate category of culture-bound syndromes in our diagnostic systems. The American Psychiatric Association, which sponsors the development of the diagnostic manuals used by counselors, psychologists, psychiatrists, and other mental health specialists, takes the position that psychopathology is universal, but specific cultures exhibit psychopathology in culturally specific ways. The culture-bound syndromes are considered different enough from general forms of psychopathology that they should have their own labels. Psychopathology is universal, but cultures vary in how it is expressed (Simons, 2001). Both the DSM-IV-TR and the DSM-5 contain lists of culture-bound syndromes, suggesting that they are real syndromes, but they are not coded and are not included in the main part of the manual, which gives them a secondary status. Since they are not coded the treatment of these conditions is not typically reimbursable by third-party payers. This practical consideration could affect how often culture-bound syndromes are diagnosed by counselors, psychologists, and psychiatrists. Native American Culture-Bound Syndromes The DSM-IV-TR appendix (American Psychiatric Association, 2000) refers specifically to Native Americans as experiencing ghost sickness (among many tribes), pibloktoq (among the artic and subarctic Inuit), and iich’ aa (a pattern of behavior similar to amok, among the Navajo). A fourth syndrome, susto (fright), also called soul loss, is described as a folk illness affecting people in many cultures, presumably including Native Americans. The placement of these conditions in an appendix indicates that although these syndromes can be diagnosed, they are not mental disorders in the same ISSUES IN THE DIAGNOSIS OF NATIVE AMERICAN 5 sense as the mental disorders in the main part of the manual. The DSM-IV-TR also has a reference to Navajo “frenzy” witchcraft as a condition that may have symptoms that meet diagnostic criteria for Dissociative Fugue (p. 524). The condition is characterized by the sudden onset of a high level of activity (such as running), a trancelike state, and potentially dangerous behavior (American Psychiatric Association, 2000). However, the disorder Dissociative Fugue was omitted from the DSM-5, which was published in 2013, and there is no mention of Navajo “frenzy” witchcraft in DSM-5. The glossary of culture-bound syndromes in the appendix of the DSM-IV-TR was not intended to include all such syndromes. Rather, it “lists some of the best-studied culture-bound syndromes and idioms of distress that may be encountered in clinical practice” (American Psychiatric Association, 2000, p. 899). The DSM-5 includes a similar glossary of conditions called “cultural concepts of distress” (p. 833) rather than culture-bound syndromes. No explanation for the change in terminology was provided, but it suggests that these conditions should be seen as heavily influenced by culture, but not necessarily bound or limited to one specific culture. The change in terminology may have been prompted by the controversy over culture-bound syndromes in the literature since DSM-IV-TR was published. Three syndromes included in the DSM-IV-TR glossary were omitted in the DSM-5 glossary (ghost sickness, pibloktoq, and iich’ aa, a condition listed under the heading “amok”). Susto was retained in the DSM-5 glossary. The only mention of Native Americans in the DSM-5 glossary is the statement that they may experience a condition similar to Kufungisisa (“thinking too much”) (p. 835). Table 1 presents a list of the cultural syndromes which are included in the DSMIV-TR and the DSM-5. These are considered some of the most well-established Native ISSUES IN THE DIAGNOSIS OF NATIVE AMERICAN 6 American culture-bound syndromes, but the list is not comprehensive. Some of these syndromes are thought to occur in individuals from many tribes (such as ghost sickness and soul loss) while others have only been found in specific tribes. Table 2 presents several additional Native American culture-bound syndromes that are described in the literature. Table 1 Native American Cultural Syndromes Included in the DSM-IV-TR and the DSM-5 Syndrome Source ________________________________________________________________________ ghost sickness DSM-IV-TR, p. 900 pibloktoq (arctic hysteria) (Inuit) DSM-IV-TR, p. 901 soul loss (similar to susto) DSM-5, p. 836 and DSM-IV-TR, p. 903 iich’ aa (moth madness) (Navajo) DSM-IV-TR, p. 899 “frenzy” witchcraft (Navajo) DSM-IV-TR, p. 524 fatigue from thinking too much DSM-5, p. 835 and DSM-IV-TR, p. 900 ________________________________________________________________________ ISSUES IN THE DIAGNOSIS OF NATIVE AMERICAN 7" @default.
• W200820104 created "2016-06-24" @default.
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• W200820104 date "2014-01-01" @default.
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• W200820104 title "Issues in the Diagnosis of Native American Culture-Bound Syndromes" @default.
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