Keeping culture-bound syndromes in cultural context: the case of Koro

摘要

Descriptive psychopathology is the principal method of structuring clinical and research practices in contemporary psychiatry. The recent cultural competency movement and the creolizing effect of globalization make it imperative that clinicians take seriously the role of culture in psychiatry. The culture-bound syndromes, among which Koro is a classic example, are embedded in the DSM-IV and represent a diagnostic tool explicitly designed to account for cultural factors. Through a case report of a North American man with schizophrenia who describes what some would call Koro-like symptoms, we aim to describe and comment on the clinical use of culture-bound syndromes. The subject’s complaints, while descriptively similar to Koro, are best accounted for by his main diagnosis of schizophrenia and psychological and cultural dimensions specific to his personal history and his life in North American society. Little is gained clinically by giving his complaint the exotic label ‘Koro’ or ‘Koro-like’; worse, the real cultural basis of his complaint is lost. We argue that meaningful cultural formulations will only be achieved if culture-bound syndromes are kept in their cultural context.