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Culture Bound Syndromes

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with Hasan Razeq LMHC

“Only after it became a culturally agreed-upon expression of internal distress did it become widespread.” (Bures, 2017)

When I was growing up in the quiet suburbs of central Maryland we had one rule for door and window etiquette: avoid the wind. The son of two immigrants from the West Bank, I grew up navigating a minefield of culture bound phenomena. One such concept is known in Arabic as Lafhet Hawa or slapped by the wind. I was taught that a sudden gust of air from opening a window or stepping out the door was grounds for immediate illness. We took great care to avoid sitting near an open window or hurrying out the front door on a windy day, fearing that the air could cause sudden onset of flu like symptoms. Of course, any time I exposed myself to this mysterious foe I immediately came down with a case of the sniffles or a generalized muscle soreness. This belief of ailment from the wind is not one unique to Arabic culture. In a Korean household, one would have great fear of fan death where by an electric fan running over night while you slept would lead to death from the wind it generates. If you were in the Czech Republic you may be cautioned by locals when standing near an air conditioning unit or even a fridge for fear of “nastydnout od ledvin” meaning “to catch a cold from the kidneys.”

Today I practice psychotherapy at Linwood Community Services, a small clinic in downtown Buffalo. In the Northeast it’s considered by many to be a “sanctuary city” welcoming refugees from Iraq, Syria and other parts of the developing world. With culturally diverse clients comes curious expressions of internal distress. Speaking to them in their native tongue I am often told tales of demonic possessions and symptoms spontaneously emerging as if called forth by some unseen entity. This entity is known by many Arab folk as Jinn. Akin to demons from the Abrahamic theologies, Jinn can take on different forms and perform the supernatural. It is believed that these spirits cause aliment to the mind, body and soul.

These entities can be inadvertently called upon to cause harm in a number of ways. Indiscretion in religious practice, visiting places where senses may be impaired by darkness, and exposure to unsanitary areas (including the culturally perceived unsanitary spaces where dogs inhabit) put you at risk for a run in with a Jinn.

The symptoms often described to me include: panic, anxiety, catatonia, melancholy and some psychotic features that do not meet criteria for Schizophrenia Spectrum Disorders. I often will pose a similar question to my Arab clients regarding this curious source of symptoms. Can you help me understand why it is that only my Arabic speaking clients seem to have run-ins with these Jinn while my English-speaking ones seem not to be affected by them at all?

One client who we’ll call Ahmed, an older gentleman who served in Saddam’s army in Iraq for over eight years, sat forward in his chair with a look of confusion. His face, dark and wrinkled from years in the desert sun, responded:

“What do you mean? Jinn are not concerned with foreigners!”

An ever-changing world has made cultural competency in clinical practice an ethical imperative that shapes the lens via which we as clinicians conceptualize psychopathology. Sometimes giving language to the client’s internal experience of the world helps shed light on the message they are trying to communicate to us. One that is often lost in the categories of the DSM rather than viewed as an expression of trauma in a world that looks culturally different than what they have grown up in. When I am told stories of Jinn causing psychiatric symptoms I hear the client really saying:

“I don’t know how to use the words from your DSM to tell you where in my body I feel it, but when I was a child I learned that people who were in pain described their interactions with Jinn and that’s how we all knew they were hurting. I’m trying to do the same thing here in your office.”

I know the wind is harmless to me when I leave my home or open the window on a warm day. Should symptoms emerge for me by happenstance, I find myself wondering what internal distress my body is attempting to communicate to the world around me. It’s not psychosomatic. It’s a culture bound diagnostic criteria.

 

Many thanks for our graphics:

Wind blowing through window: Photo by manyfires on Flickr. Retrieved from: https://www.pinterest.com/pin/222083825348742936/

Jinn retrieved from http://oriental-magic.blogspot.com/2011/10/