Abstract: Transcultural psychiatry lies at the fringe of general western psychopathology. It embodies many of the commitments of the broader discipline, but because it deals with patients from non-western cultures, it has developed its own diagnostic categories to deal with the ‘new’ psychiatric syndromes ‘discovered’ within colonised populations since the end of the nineteenth century. These categories include koro, latah, and amok, the three exemplary syndromes evoked when discussing the central theoretical construct of transcultural psychiatry: culture-bound syndromes. How these non-western syndromes are understood changes over time, and the variations between conceptualisations of mental illnesses in non-western cultures can be used to show how the sub-field of transcultural psychiatry relates to the diagnostic criteria of general psychopathology, while at the same time carving out a space for itself as a semi-autonomous field with its own objects of study. That is, transcultural psychiatry uses boundary working to expand its remit by enveloping new objects from non-western cultures. It is not the same as general psychiatry, because it focuses on different psychiatric objects, uses different theories to understand these objects, and adapts the central concepts of general psychiatry to understand these objects. Transcultural psychiatry is at the forefront of the psychiatric expansion under global mental health strategies that a number of people have recently commented upon (eg. Miller, 2014).
The transcultural psychiatric syndrome examined in this paper is koro – the patient’s fear that their penis is shrinking, and if it retracts completely into the abdomen, that they will die. In Traditional Chinese Medicine and Ayurvedic Medicine, koro is not specifically considered a mental illness, but is primarily a somatic illness. It was not until the end of the nineteenth century that it was articulated as a psychiatric syndrome. Since, it has been multiply understood; each time there is a major change in the central theoretical assumptions of general western psychiatry – from Emil Kraepelin to Psychoanalysis to the DSMIII – koro is rearticulated to fit with the new theory. This makes it an unstable “boundary object”.
This paper will examine these three important episodes in the history of koro to illustrate how major changes at the centre of psychiatric theory affect the transcultural psychiatry that is practices at the fringe of the discipline. The episodes are: (1) Kraepelin’s (1904) comparative psychiatry, which used koro as an exemplar of a mental illness found in another culture as a variation of a universal condition; (2) PM Yap and the construction of “culture-bound syndromes” (1965), where koro was used as a model for “culture-bound psychogenic illnesses” within a psychodynamic framework; (3) Gaw & Bernstein and the attempt to include culture-bound syndromes in the forthcoming DSMIV (1991), with their epidemiological rendering of koro that was a part of an ongoing process to draw a boundary between psychoanalysis (that had formerly dominated transcultural psychiatry) and transcultural psychiatric practices more aligned with the psychiatry of the DSMIII, which involved splitting koro into two forms (epidemic or “cultural”, and individual). In all of these cases, the psychiatrists had to reconstruct koro to fit their theoretical interests.
These episodes show how culture-bound syndromes are theory-bound objects in a constant flux of renegotiation depending on the dominant theoretical models used in psychiatry. Studying transcultural psychiatry allows us to question the limits of western psychiatric knowledge, because it considers the differences between general western psychiatric conditions, which are often thought to be universal (such as schizophrenia), and conditions in other cultures that are not (usually) found in western patients (such as koro). CBS are understood not as bound by the cultures in which they are manifest, but by the culture of psychiatry that is currently accepted. Studying the boundary objects of this discipline can help us understand how transcultural psychiatric knowledge is constructed.
Organiser: Professor Sonu Shamdasani (UCL)
Supported by the British Psychological Society
Time: 6pm to 7.30 pm.
Location: Arts and Humanities Common Room (G24), Foster Court, Malet Place, University College London.
From the Torrington Place entrance to UCL, enter the campus on Malet Place. After fifty metres, you will find Foser court on the right hand side. Turn right under the underpass, and enter via the second door on the right. The common room is straight ahead.