The importance of penis panics to cultural psychiatry

The Boston Globe has an excellent article about supposedly culture specific mental illnesses and how they are an ongoing puzzle for psychiatry’s diagnostic manual.

These conditions are called culture-bound syndromes in the DSM but they’ve always had a bit of ‘looking at the natives’ feel about them as many syndromes that are unknown in many non-Western cultures (anorexia, for example) aren’t listed as ‘culture bound’ in any way.

The Boston Globe article reminded me of a paper just published in the Journal of the History of Medicine and Allied Sciences by historian Ivan Crozier where he explores how koro – the fear that the genitals are fatally shrinking into the body – has been central to the definition of the ‘culture-bound syndrome’.

The history of how this fear, usually presenting as a penis shrinking anxiety and initially reported in South East Asia, became a prime example of a supposedly culture-specific mental illness, highlighting a bias at the centre of psychiatric definitions.

Penis shrinking fears have been reported from all over the world, but only certain cases tend to get defined as a ‘culture-specific syndrome’, because of our assumptions about what counts as the ‘real’ disorder.

Koro is a particularly good syndrome with which to play up the tension between psychiatric universalism on the one hand, and ethnic bias on the other. This disruption is clear when one surveys the varieties of koro. Some people (SE Asians) have koro because they belong to the “right” culture. Others do not, because they are suffering from another primary disorder (occidental sufferers), or because there is little in the way of psychiatric provision in their country (e.g., in Africa), and because there are other working explanations for dealing with penis panics (such as witchcraft).

Likewise, sometimes the material artifacts of masculinity are of crucial importance for explaining koro as a part of a culture (the penis clamps and piercings in Asia), but not in others (the pills western men can take when they are concerned about the penis size). These differences in treatment are not trivial. They point to an ethnocentrism in psychiatric conceptions of illness that is embodied in the DSM IV in the very place that is meant to address culture: the CBSs [culture-bound syndromes section].

Sadly, the Crozier’s academic article is locked behind a paywall (demonstrating a strange culture bound syndrome endemic in Western academia) but The Boston Globe article in free to access.

Link to Boston Globe article (via @DebbieNathan2)
Link to locked article on koro and culture-bound syndromes.

View the original article here

The psychiatry of vegetarianism

A fascinating but unfortunately locked review article on the psychology of vegetarianism has this paragraph on how avoiding the pleasures of cooked flesh has been seen as a mental illness in times past.

How vegetarians are seen has shifted radically over time. During the Inquisition, the Roman Catholic Church declared vegetarians to be heretics, and a similar line of persecutions occurred in 12th century China (Kellman, 2000). In the earlier half of the twentieth century, the sentiment toward vegetarians remained distinctly negative, with the decision not to eat meat being framed as deviant and worthy of suspicion.

Major Hyman S. Barahal (1946), then head of the Psychiatry Section of Mason General Hospital, Brentwood, wrote openly that he considered vegetarians to be domineering and secretly sadistic, and that they “display little regard for the suffering of their fellow human beings” (p. 12). In this same era, it was proposed that vegetarianism was an underlying cause of stammering, the cure for which was a steady diet of beefsteak.

In contrast, research shows the general attitude to vegetarianism has generally shifted to be, shall we say, somewhat more positive.

Link to locked article. Forbidden fruit and all that.

View the original article here

The trouble with psychiatry

If you want an incisive critique of modern psychiatry, look no further than an excellent article in The New York Review of Books.

It brilliantly captures the fights over diagnosis and the DSM, the problem of drug companies buying influence by paying physicians, and why the promises of drug treatments are often propped up with marketing hype.

The article is well-informed, doesn’t mince words, and the author is no anti-psychiatry flak. She’s Marcia Angell, ex-editor of the New England Journal of Medicine, one of the world’s leading medical journals.

One of the leaders of modern psychiatry, Leon Eisenberg, a professor at Johns Hopkins and then Harvard Medical School, who was among the first to study the effects of stimulants on attention deficit disorder in children, wrote that American psychiatry in the late twentieth century moved from a state of “brainlessness” to one of “mindlessness.” By that he meant that before psychoactive drugs (drugs that affect the mental state) were introduced, the profession had little interest in neurotransmitters or any other aspect of the physical brain. Instead, it subscribed to the Freudian view that mental illness had its roots in unconscious conflicts, usually originating in childhood, that affected the mind as though it were separate from the brain.

But with the introduction of psychoactive drugs in the 1950s, and sharply accelerating in the 1980s, the focus shifted to the brain. Psychiatrists began to refer to themselves as psychopharmacologists, and they had less and less interest in exploring the life stories of their patients. Their main concern was to eliminate or reduce symptoms by treating sufferers with drugs that would alter brain function. An early advocate of this biological model of mental illness, Eisenberg in his later years became an outspoken critic of what he saw as the indiscriminate use of psychoactive drugs, driven largely by the machinations of the pharmaceutical industry.

If you want a great insight into the difficulties of psychiatry and how they’ve emerged, this article is one of the best introductions you could hope for.

Link to article in the NYRB (via 3QD).

View the original article here

Animated psychiatry

Beards and Bowties is a wonderful animated short film about the outdated stereotypes of psychiatrists that still persist.

It’s been created by psychiatrist Kamran Ahmed and is a light-hearted exploration of how psychiatry is perceived by people he meets and others in the medical profession.

The film notes that the important speciality is stigmatised, not just by the general public but by other doctors, and it aims to show a more accurate picture of what psychiatry can be.

I note, however, that the film portrays other doctors and psychologists almost entirely as stereotypes, to the point where the psychiatrist shoves the bearded, pipe-smoking psychologist out of the way to show his medical certificate! Thanks colleague.

Psychodynamic types would probably mutter something about projective identification but I’d probably just mark it down as a little ironic.

However, the film is still hugely entertaining and captures the diversity of modern psychiatry.

Link to ‘Beards and Bowties’ on YouTube (via @rcpsych)

View the original article here