Brain fags and other mental problems you probably won't get in America.

The state of the universe.
July 11 2011 6:58 AM

A Bad Case of the Brain Fags

And other mental problems you probably won't get in America.

Illustration by Mark Alan Stamaty. Click image to expand.

In 1951, Hong Kong psychiatrist Pow-Meng Yap authored an influential paper in the Journal of Mental Sciences on the subject of "peculiar psychiatric disorders"—those that did not fit neatly into the dominant disease-model classification scheme of the time and yet appeared to be prominent, even commonplace, in certain parts of the world. Curiously these same conditions—which include " amok" in Southeast Asia and bouffée délirante in French-speaking countries—were almost unheard of outside particular cultural contexts. The American Psychiatric Association has conceded that certain mysterious mental afflictions are so common, in some places, that they do in fact warrant inclusion as "culture-bound syndromes" in the official Diagnostic and Statistical Manual of Mental Disorders.

The working version of this manual, the DSM-IV, specifies 25 such syndromes. Take "Old Hag Syndrome," a type of sleep paralysis in Newfoundland in which one is visited by what appears to be a rather unpleasant old hag sitting on one's chest at night. (If I were a bitter, divorced straight man, I'd probably say something diabolical about my ex-wife here.) Then there's gururumba, or "Wild Man Syndrome," in which New Guinean males become hyperactive, clumsy, kleptomaniacal, and conveniently amnesic, "Brain Fag Syndrome" (more on that in a moment), and " Stendhal Syndrome," a delusional disorder experienced mostly by Italians after gazing upon artistic masterpieces. The DSM-IV defines culture-bound syndromes as "recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular diagnostic category."

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And therein lies the nosological pickle: The symptoms of culture-bound syndromes often overlap with more general, known psychiatric conditions that are universal in nature, such as schizophrenia, body dysmorphia, and social anxiety. What varies across cultures, and is presumably moulded by them, is the unique constellation of symptoms, or "idioms of distress."

Some scholars believe that many additional distinct culture-bound syndromes exist. One that's not in the manual but could be, argue psychiatrists Gen Kanayama and Harrison Pope in a short paper published earlier this year in the Harvard Review of Psychiatry, is " muscle dysmorphia." The condition is limited to Western males, who suffer the delusion that they are insufficiently ripped. "As a result," write the authors, "they may lift weights compulsively in the gym, often gain large amounts of muscle mass, yet still perceive themselves as too small." Within body-building circles, in fact, muscle dysmorphia has long been recognized as a sort of reverse anorexia nervosa. But it's almost entirely unheard of among Asian men. Unlike hypermasculine Western heroes such as Hercules, Thor, and the chiseled Arnold of yesteryear, the Japanese and Chinese have tended to prefer their heroes fully clothed, mentally acute, and lithe, argue Kanayama and Pope. In fact, they say anabolic steroid use is virtually nonexistent in Asian countries, even though the drugs are considerably easier to obtain, being available without a prescription at most neighborhood drugstores.

So culture-bound syndromes certainly aren't reserved to exotic, foreign countries that are difficult to pronounce: America has its own hodgepodge collection based on our singularly weird hang-ups. But let's talk about those unpleasant fags—which seem to be  quite a problem in Africa and some other parts of the world. Brain Fag Syndrome has historically affected Nigerian college students, but has also been documented among non-Caucasians in Liberia, Uganda, the Ivory Coast, and South Africa, and very rarely those in Brazil, India, Malaysia, China, and Ethiopia.

The phenomenonology of Brain Fag Syndrome is captured in a prototypical case described by Bolanie Ola and his colleagues in a 2009 review from the African Journal of Psychiatry:

A Yoruba male … who when studying for an exam began to have sharp pains in his head and could not grasp what he was reading. He slept more than usual, and had difficulty forcing himself to go to school in the morning. When writing the examinations, he felt he knew the answers, but was unable to recall them; his mind was blank. His right hand was weak and shook so that he couldn't write. Because of these symptoms, he was forced to postpone the writing examinations for several years. His symptoms improved greatly with Largactil (an antipsychotic medication) and reassurance.

From this example we can see the abbreviated origins of the fags—it refers to "brain fatigue," not the derogatory term for homosexuals. (Nigeria isn't exactly known for its progressive attitudes toward gay rights, so you'd be forgiven for thinking otherwise; but in fact we gays are much more likely to be referred to as old-school Sodomites worthy of God's smiting than "fags" over there.) The important thing here, as in the foregoing condition of muscle dysmorphia, is the unique cultural constellation of symptoms of brain fag, such as painful sensations around the head and neck, cognitive impairments that hinder studying and reasoning, and sleepiness.

Ola and his colleagues, as well as other scholars studying Brain Fag Syndrome, suggest that the disorder may be a somatic manifestation of the rather sudden Westernization of African education; the collective nature of traditional African culture clashes with the highly individualistic and competitive nature of our own. As many as 40 percent of Nigerian university students may experience brain fag symptoms, says Ola, but the percentage who get the full-blown syndrome seems to be decidedly lower. In any event, if you're an American student reading this, I wouldn't recommend you invoke brain fag as a defense when explaining to your professor your academic failures; even if it's true, it will only complicate matters for you.

Perhaps the best-known culture-bound syndrome is koro, in which the patient is convinced that protruding bodily organs, such as the male genitalia or female nipples, are retracting or disappearing into his or her body. Individuals experiencing this delusion are furthermore morbidly afraid that this retraction will inevitably result in their death, and so present to clinicians with debilitating anxiety. Descriptions of koro can be found as early as 2,000 years ago in China, when the Nei Jing (or, the Yellow Emperor's Classic Text of Internal Medicine) included mention of "penis-shrinking," and the belief that genital retraction is related to a faulty yin-yang system and prognosticates an early death.

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