In certain ways, all psychiatric disorders are more or less influenced by cultural factors, in addition to biological and psychological factors, for their occurrence and manifestation. ‘Major’ psychiatric disorders (such as schizophrenia or bipolar disorders) are more determined by biological factors and relatively less by psychological and cultural factors, but ‘minor’ psychiatric disorders (such as anxiety disorders, conversion disorders, or adjustment disorders) are more subject to psychological causes as well as cultural factors. In addition to this, there are groups of psychiatric disorders that are heavily related to and influenced by cultural factors, and therefore addressed as culture-related specific psychiatric syndromes.

Culture-related specific psychiatric syndromes, also called culture-bound syndromes⁽¹⁾ or culture-specific disorders,⁽²⁾ refer to mental conditions or psychiatric syndromes whose occurrence or manifestations are closely related to cultural factors and thus warrant understanding and management primarily from a cultural perspective. Because the presentation is usually unique, with special clinical manifestations, the disorder is called a culture-related specific psychiatric syndrome.⁽³⁾ From a phenomenological point of view, such a condition is not easily categorized according to existing psychiatric classifications, which are based on clinical experiences of commonly observed psychiatric disorders in western societies, without adequate orientation towards less frequently encountered psychiatric conditions and diverse cultures worldwide.

Around the turn of the twentieth century, during a period of colonization by western societies, western ministers, physicians, and others visited faraway countries, where they encountered behaviours and unique psychiatric conditions that they had never experienced at home. Most of these conditions were known to the local people by folk names, such as latah, amok, koro, susto, and so on, and were described by westerners as exotic, rare, uncommon, extraordinary mental disorders, mental illnesses peculiar to certain cultures, or culture-bound syndromes. The latter term implies that such syndromes are bound to a particular cultural region.⁽⁴⁾

Recently, however, cultural psychiatrists have realized that such psychiatric manifestations are not necessarily confined to particular ethnic-cultural groups. For instance, epidemic occurrences of koro (penis-shrinking panic) occur among Thai or Indian people, not only among the Southern Chinese as originally claimed; and sporadic occurrences of amok attacks (mass, indiscriminate homicidal acts) are observed in the Philippines, Thailand, Papua New Guinea, and in epidemic proportions in many places in South Asia,⁽⁵⁾ in addition to Malaysia where it was believed to most commonly occur. Terrifying examples of amok have recently occurred with frequency on school campuses and in workplaces in the United States.

Therefore, the term culture-bound does not seem to apply, and it has been suggested that culture-related specific psychiatric syndrome would be more accurate to describe a syndrome that is closely related to certain cultural traits or cultural features rather than bound specifically to any one cultural system or cultural region.⁽⁴⁾ Accordingly, the definition has been modified to a collection of signs and symptoms that are restricted to a limited number of cultures, primarily by reason of certain of their psychosocial features,⁽⁶⁾ even though it is recognized that every psychopathology is influenced by culture to a certain degree.

In order to organize and categorize the various culture-related syndromes, several different subgroup systems have been proposed by different scholars in the past, such as by cardinal symptoms or by ‘taxon’ (according to a common factor). However, instead of focusing on the clinical manifestation descriptively, it will be more meaningful to subgroup the syndromes according to how they might be affected by cultural factors.

It has been recognized that there are different ways culture contributes to psychopathology. Namely: pathogenetic effect (culture has causative effect), pathoselective effect (culture selects the nature and type of psychopathology), pathoplastic effect (culture contributes to the manifestation of psychopathology), pathoelaborating effect (culture elaborates and reinforces certain types of manifestations), pathofacilitating effect (culture contributes to the frequent occurrence of particular psychopathologies), or pathoreactive effect (culture determines the reaction to psychopathology). Furthermore, culture impacts differently on different types of psychopathology.
If the psychopathology is divided into that which is more biologically determined (such as organic mental disorders or major psychiatric disorders), psychologically determined (such as minor psychiatric disorders), or socio-culturally determined (such as culture-related specific syndromes or epidemic mental disorders), it can be said that a pathoreactive effect is observed for all types of psychiatric disorders while a psychogenetic effect is observed mainly for those psychiatric disorders which are more socio-culturally determined, such as culture-related specific syndromes or epidemic mental disorders.

Academically identified culture-related specific syndromes can be compared according to two parameters, namely, the different means of cultural impact and the specificity of the manifestation. It will be useful to determine the basic ways culture contributes to the psychopathology, namely: pathogenic, pathoselective, pathoplastic, pathoelaborating, pathofacilitating, or pathoreactive effects; and to what extent the manifested syndrome is: specific, mixed, or non-specific (Fig. 4.16.1). For example, the primary cultural contribution to koro is a pathogenic effect with specific manifestation; to latah a pathoelaborating effect with specific manifestation; and to susto a pathoreactive effect with non-specific manifestation.