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The following factors should be taken into account:

The question whether these disorders are merely local variations of recognised Western disorders, or whether they are unique to a specific culture, has been much debated. An example would be a psychotic condition such as schizophrenia.

Supporters of the first viewpoint hold the idea that all human beings are basically the same and that schizophrenia is present in all cultures. They do, however, acknowledge that symptoms can vary between cultures, for example, that the content of hallucinations in one culture might be quite different from that in another culture.

Supporters of the other viewpoint, however, are of the opinion that culture has such a strong impact on people that it is possible that certain unique syndromes are only found in specific cultures.

Variations within cultures
It should be realised that there are huge variations within one culture. As a matter of fact, it is believed that differences within a specific culture could be just as significant, if not more significant than between cultures.

Take for example the significant differences within the Afrikaner culture (that is putting aside the controversy what precisely an Afrikaner is). Many Afrikaners would say that there are more similarities between them and other cultures such as European and other African ethnic groups than between them and many Afrikaners. The controversy on how unique a culture really is, therefore continues.

Subcultures
There are many subcultures within a culture, and important differences exist between the subcultures and the main culture. The South African culture with its many subcultures serves as an example. Next to subcultures within the, for example, white South African culture (e.g. Afrikaans and English speakers), there are differences within these subgroups (e.g. the variations within the Afrikaner culture as already mentioned).

Culture changes
Culture is not static, but changes continuously. However, the impact of acculturation is not the same on all members of a specific culture and also does not occur at the same time. The different stages of Westernisation in which several black cultures in South Africa find themselves, is a typical example. Care should therefore be taken not to see, for example, all Zulus as having the same cultural characteristics: it speaks for itself that there is a huge difference between a Zulu living in the rural areas of KwaZulu-Natal and a Zulu who is a computer expert and lives in Johannesburg.

Treatment
Against this background it seems clear that care should be taken when diagnosing cultural-bound syndromes. This word of caution also applies to treatment, where it is an open question whether a person with a culture-bound syndrome should be treated by a health system foreign to the person, or rather by people from his or her own culture. In South Africa both systems are in place especially the Western medical model versus traditional healers) and several factors such as the choice of the patient, the impact of the family and other relatives and the availability and costs of services determine the final choice.

- Written by Prof. DAP LOUW, PH.D.(Psych.), PH.D.(Crim.) Head: Centre for Behavioural Sciences, Professor: Dept. of Psychology, UOFS

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