In 2001, journalist Frank Bures came across an unusual BBC article about a mob that had killed twelve people in Nigeria, believing them to be penis-stealing witches, and then, few months later, he came across a similar article about five people in Benin. He travels the world looking for cases:
A culture-bound mental illness is one that only affects people who know about it, and especially people who believe in it. Often it doesn’t make sense from a scientific point of view (there’s no such thing as witches, and the penis can’t retract into the body). It sometimes spreads contagiously: someone gets a first case, the rest of the village panics, and now everyone knows about it / believes in it / is thinking about it, and so many other people get it too.
Different cultures have their own set of culture-bound illnesses. Sometimes there are commonalities — many cultures have something something penis something witches — but the details vary, and a victim almost always gets a case that matches the way their own culture understands it.
THESE PEOPLE ARE NOT MAKING IT UP. I cannot stress this enough. There are plenty of examples of people driving metal objects through their penis in order to pull it out of their body or prevent the witches from getting it or something like that. There is no amount of commitment to the bit which will make people drive metal objects through their penis. People have died from these conditions — not the illness itself, which is fake, but from wasting away worrying about it, or taking dangerous sham treatments, or getting into fights with people they think caused it. If you think of it as “their unconscious mind must be doing something like making it up, but their conscious mind believes it 100%”, you will be closer to the truth, though there are various reasons I don’t like that framing.
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The phrase “run amok” comes from Malaysia, where it referred to a specific phenomenon: some person who had been unhappy for a long time would suddenly snap, kill a bunch of people, then say they had no memory of doing it. Malaysian culture totally rolls with this and doesn’t hold it against them; the unhappiness is a risk factor for possession by a tiger spirit, which commits the killings. Although Malays have been doing this since at least the 1700s, there are some fascinating parallels with modern US mass shootings that suggest the damn tiger spirits have finally made it to the US common psychological origins.
I have seen exactly one demonic possession case in my ten years as a psychiatrist. The man fell to the ground, mouth foaming, chanting strange syllables and the names of Biblical demons. My attending doctor at the time — one of those people who somehow manages to be an expert in everything — was an expert in demonic possession, and told us that he was in no way psychotic, antipsychotics wouldn’t help him (except insofar as they help everyone by decreasing all behaviors), and he needed to “work through his issues”. The patient was uncooperative — he was only visiting MDs because the local bishop wouldn’t call in an exorcist until he got a psych exam — and eventually left against medical advice.
After going down the list, Bures asks the correct next question: how do we know whether or not our own mental illnesses are just as culture-bound as the Japanese or Malaysians’? Cultures that believe in witches have witch-related culture-bound illnesses; cultures that believe in demons have demon-related ones. We believe in science, so we should expect sciencey-sounding culture-bound illnesses, and these might be hard to tell apart from other, more physical conditions. So how suspicious should we be, and of what?
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Anorexia was mostly unknown in the West, until becoming “trendy” in the mid-1800s. During that period, doctors reported high prevalence of anorexia among “hysterics”, but the fad ended after about ten or twenty years, and it went back to being basically unknown. In 1983, famous singer Karen Carpenter died of anorexia, thrusting it back into the national news, and suddenly lots of people (in the West) were anorexic again.
Meanwhile, foreign doctors who trained in the West went back to their home countries, searched far and wide for it, and found almost nothing. The few cases they did see didn’t resemble the typical Western version at all – for example, one Hong Kong psychiatrist was able to find a woman who refused to eat out of grief when a boyfriend left her, but she didn’t think she was fat, or feel any cultural pressure to be thinner. The absence of anorexia abroad was especially surprising since anorexics tend to end up in the hospital with extremely noticeable malnutrition that doesn’t really mimic anything else. It’s not really possible to hide severe anorexia the way you can hide severe depression.
In 1994, Hong Kong got its own Karen Carpenter — a young girl died of anorexia, setting off a national panic and many public awareness campaigns. Near-instantly, anorexia rates shot up to the same level as the West, with the appropriate number of people presenting to hospital ERs with severe malnutrition.
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My own experience with sensitization: every so often my house gets infested by ants and some of them crawl on me. Then I get rid of the ants, but even after they’re gone, for a couple of weeks I can still feel hallucinatory ant-crawling feelings on my arms. You can think of this as setting a threshold that balances false positives and false negatives – my nervous system will always be noisy, get random itches, etc, when do I interpret any particular pattern of impulses as a crawling ant? If I set the threshold too high, I will miss real ants; if I set it too low, I will get fake ants. Presumably there’s some optimal threshold, and that threshold is lower when I know there are ants around and probably one will crawl on me soon. Somehow my brain does the proper Bayesian math under the hood, and so I am afflicted with a few weeks of false positives. Honestly I am getting away lucky; in delusional parasitosis this becomes a trapped prior and they feel it forever.
Bodily sensations seem to be especially sensitive to this.
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The ancient Romans loved war. If you loved war, and killed a lot of people, that made you glorious. Nobody worried it meant you were a bloodthirsty psychopath. Or if you were, it’s fine! The past twelve emperors were bloodthirsty psychopaths! Their families, concubines, and guards were all bloodthirsty psychopaths! You’ll fit right in! Relatedly, it doesn’t seem like the Romans had PTSD.
In our society, it’s commonly believed that War Is Hell, and if you enjoy it too much, you might be a bloodthirsty psychopath. Relatedly, estimates of what percent of veterans get PTSD range from 15% to 85%. I’m not sure the 85% number is accurate, but if it was, and I was a veteran, and I wasn’t getting PTSD, I might start worrying that this was starting to signal negative things about me. If my unconscious felt the same way, maybe I’d develop a few PTSD symptoms, just to be safe.
We’re conducting a massive experiment in how far you can take this. People now believe that you can be traumatized by hearing someone express the wrong opinion during a college class — and that intellectuals with sensitive souls and diverse equity-loving justice-promoting minorities will be traumatized most of all. I suspect all of this is true, if you believe it.
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“Okay, but gender dysphoria?”
Hopefully now the answer is obvious: it is and it isn’t. People have been having gender identity crises since the beginning of time. There’s some evidence some of this is biological; people with closer to opposite-sex hormone profiles and so on are more likely to end up transgender, and very off-base hormone profiles seem to produce gender issues pretty consistently. But in our modern society, which has a category/guess/narrative around this, it seems to happen orders of magnitude more often than in other societies. And in societies with different categories/guesses/narratives, it happens differently — a lot of people who are transgender today would have been cross-dressers or lesbians 30 years ago.
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So fine, yes, gender dysphoria shares some resemblance to culture-bound illnesses; I would put it around the same level as anorexia. But be careful: everything shares some resemblance to everything. What if transphobia is our culture’s version of the penis-stealing witch panic? Wise but evil women (gender studies professors) are using incomprehensible black arts (post-modernism) to make people lose their penises. Sure, those people are losing their penises through voluntary sex-change surgery, but this is just another case of the general principle that we replace the magical explanations natural to other cultures with the medicalized explanations natural to our own. And sure, other culture’s panics involved fake/illusory penis loss and ours involves the real thing, but this is just another case of the general principle that modern Western civilization turns other culture’s myths into reality. When they were telling tall tales about men who flew like birds, we went ahead and invented the airplane; when they imagined golems, we created working robots. Now we’ve finally gotten around to penis-stealing witches.
America really is the greatest country in the world.
