This is an updated article from the NYT. Of course, in a fantasy world, some of these could be "real," or the result of a curse. Great for intercultural misunderstandings for your unfortujnate players!
Jim Chapin
New York Times Magazine, 1.5.6
Regional Disturbances
By LAWRENCE OSBORNE
Americans get anorexia. Nigerians get 'brain fag.' Malaysians suffer from 'hyperstartle syndrome.' How culturally specific is mental illness?
T he little house looks like most of the others in the Malaysian jungle hamlet of Kampung Sebiris. The louvered windows are trimmed with heavy curtains, the tiled floor is immaculate and cushioned chairs line the walls. Even though it is over 90 degrees, there is no fan; outside, humid forest spreads out beneath a mist-wrapped mountain. As in many rural Malay homes, in the front room there is an ornate display cabinet filled with knickknacks: teapots, wooden pineapples, gaudy silk flowers. The jungle comes right up to the glass slats, and the whistling of insects is deafening.
But this is no typical home. Sitting on a woven mat in the center of the room is a gray-haired woman named Dibuk ak Suut. Wrapped in a pale green sarong, the slender 59-year-old matriarch is comfortably surrounded by her husband, daughter and grandchildren -- but her eyes flash nervously from side to side. Her husband, Sujang, has just served us cups of weak hot chocolate. He is in a playful mood. "Watch this," he whispers to me in Malay.
Standing up, he suddenly claps his hands. Dibuk gives a start, shudders and leaps to her feet. Everyone roars with laughter. Dibuk's delicate, slightly lopsided face goes into a glassy trance. She begins shrieking: "Grasshopper! Grasshopper! GRASSHOPPER!"
Sujang then winks like Popeye, and Dibuk does the same. The family howls in merriment. Sujang goes into a comical dance, shaking his shoulders slinkily and wiggling his hips. Still locked in her seeming trance, Dibuk does likewise. She waves her hands in front of her face and mops her cheeks with a small cloth. She sweats profusely and bares her teeth in hysterical laughter.
After a few minutes, Sujang goes up to her and taps her firmly on the shoulder. The mimic-trance is over. Dibuk sits down and mops her face.
"Are you O.K.?" her daughter, Catherine, asks.
"Was I talking nonsense again?" Dibuk asks.
"Not too bad this time," Catherine says. "You didn't say anything
obscene."
The family recomposes itself, and we drink our lukewarm chocolate. Then, a few minutes later, a cat creeps up to Dibuk from behind. Suddenly noticing it, she gives another violent start and begins pawing the air in front of her.
"Cat," she cries. "Cat! Cat!" She then starts screaming a Malay slang
word for penis.
Sujang leans over to me. "It's cats that get her the most," he murmurs. "They make her more latah than anything."
The Suuts are farmers living in the hills behind the tiny trading town of Lundu in Sarawak, the Malaysian side of Borneo. The kampungs, or villages, here are incredibly isolated, connected by a solitary road winding through plots of coconuts and pineapples. Outsiders rarely visit. Yet in recent years, Western scholars have become intrigued by women like Dibuk. She is a latah, suffering from an intriguing mental disturbance known in the West as hyperstartle syndrome.
The startle reflex is a universal one. When we are jolted by surprise, we tend to scream, shout obscenities or make involuntary gestures. And some of us are a lot jumpier than others. But with latahs, as sufferers are known, these reactions become prolonged to an extreme degree. In Malay village life, people who are susceptible to such exaggerated reactions are deliberately provoked further -- through furtive pokes in the ribs or tin pots thrown behind their backs -- to induce a frenzied startle-trance. Over time, latahs become so sensitive that trances can be triggered by a falling coconut.
Latahs tend to blurt out offensive phrases, much like sufferers of Tourette's syndrome. (Indeed, Georges Gilles de la Tourette, the French discoverer of the syndrome in the 1880's, explicitly compared it to latah.) Latahs also often mimic the actions of people around them or obey commands, including requests to take off their clothes. Afterward, latahs often claim to have no memory of what they said or did. While latahs experience profuse sweating and an increased heart rate while in a trance, there is no clear physiognomic source for the condition. What is clear, however, is that in Malaysia, interaction with latahs has become a complex form of social play. Instead of being shunned, latahs are accepted, even celebrated, for their oddity.
In 1994, the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M.-IV, recognized latah for the first time as a member of a new category of psychiatric illnesses known as culture-bound syndromes -- that is, mental disorders induced primarily by culture and not by any bodily pathology. Culture-bound syndromes are not only rare and exotic; they're also controversial, for they raise intriguing and profound questions about the very nature of mental illness. At the heart of these questions are age-old debates about the conflicting roles of nature and nurture.
Since the 1980's, Western psychiatry has become increasingly dominated by a biological model of mental disorders. You could argue that in America, especially, a whole regime of drug therapy has been based on this model, which assumes that mental illness arises straightforwardly from neurological malfunctions (like a serotonin imbalance in the brain). This has served to root modern psychiatry in the hard sciences. Nature, says modern psychiatry, lies at the root of mental disease, and medicine is required to treat it. The biological model further suggests that mental illnesses are universal afflictions -- that, in the same way people get diabetes, people get depressed.
But there are limits to this model. Why, for example, do so many American women get anorexia nervosa, while Papuan women almost never do? That certain syndromes flourish in some parts of the globe but not in others suggests that the form mental illness takes can be significantly shaped by a person's environment. Indeed, can culture actually breed mental illness, causing disturbances in people who in other environments would be healthy? Those who study latah increasingly say the answer is yes.
I t turns out that the world is full of culture-bound syndromes. Latah
is not even the only one in Malaysia. The D.S.M. lists two other Malay
syndromes known by their native names, koro and amok. Amok is a sudden
rage in which an otherwise normal person goes berserk, sometimes
killing those in his path. It was well known to the British colonial
rulers of Malaysia and has therefore passed into the English language:
"running amok" is as familiar to us as "going postal." (To this day,
cases of amok are reported in Malaysian newspapers.) Less well known
is koro, which primarily affects men. It is known in English as
genital-retraction syndrome: men with koro become convinced that their
penises are shrinking into their bodies. So delusional do such men
become that they often mutilate themselves, sometimes to death.
In Latin America, people fall prey to susto, in which those who have been severely frightened believe that their souls have separated from their bodies. In West Africa, meanwhile, young males suffer from a disability popularly known as "brain fag," characterized by a chronic inability to concentrate combined with blurred vision. In India, men suffering dhat become hypochondriacally obsessed with their semen discharges.
Arthur Kleinman, a medical anthropologist at Harvard, thinks that studying such exotic afflictions is a serious scientific endeavor. In fact, he says, it is essential for Western medicine: "There's no question that Western psychiatry is increasingly being forced to deal with the role of culture in creating mental illness." Lately, Kleinman has been studying changing patterns of suicide and depression in rural China and is convinced that even seemingly universal afflictions like depression can differ profoundly from culture to culture. "Both with rare syndromes like latah and with things like depression, we are finding conditions which our biology-dominated diagnoses cannot easily digest," he says. "All this makes many Western doctors very uneasy."
One puzzling characteristic of culture-bound syndromes is that they often take the form of social epidemics. A wave of koro, for example, swept the Malaysian peninsula in the late 60's. In other words, instead of being physiologically rooted in every afflicted individual, some syndromes can be infectious in a purely mental way. But what starts the chain of infection? In the case of latah, no scholar can say for sure. It may be that, at one time, a neurological disorder produced exaggerated startle reactions in some Malaysian women -- and that over time, as awareness of the affliction permeated the culture, the disease spread through social mimicry.
This does not mean, of course, that modern latah sufferers are consciously faking their afflictions. After all, American girls desperate to resemble their skinny peers aren't faking obsessions with food. As Kleinman writes in "Rethinking Psychiatry," his groundbreaking 1987 book, "mental illnesses are real; but like other forms of the real world, they are the outcome of the creation of experience by physical stuff interacting with symbolic meanings."
Malaysians themselves seem well aware of latah's social component.
"Latah is highly infectious," Dibuk responds when I ask if she knows
any other women who are afflicted. "A woman named Duyik, who lives in
Kampung Tebaro, has it. We caught it from each other."
Curious to see for myself, I hitch a ride down to Kampung Tebaro. It's a neat cluster of wood houses at the edge of the forest, and there Duyik Anak Gagang lives with her grandchildren and her son. Jolly and roly-poly, she breaks into a crooked smile as she shakes my hand. Then she chops her hand playfully at her teenage grandson, Jasni. "That one, he's always poking my ribs," she croaks. "Then I start dancing, I can't help it."
Jasni concurs. "I just clap my hands behind her back, and she starts throwing stuff around the room," he says. Although she is 69, Duyik becomes surprisingly agile while latah. She has been known to dance wildly for 30 minutes straight.
Duyik claims her condition can be traced to the trauma of childbirth.
"I became latah when my first son was born," Duyik explains to me
matter-of-factly. "It was such a big shock for me. You see, it's only
women who are latah. We don't know why. It's just the way it is."
"That's right," Jasni says. "I'll never be latah, I hope."
The family nods silently. Latah is indeed a condition that mostly strikes women, usually middle-aged or older.
"Is there a cure for it?" Duyik asks me with sudden urgency. "Is there
a drug I can take to help me?"
"I don't know," I say. Would a little Prozac -- the West's current
cure-all -- make Duyik less nervous, and less prone to latah? Perhaps,
but here in remote Borneo, pharmacological therapy is not a very
realistic option.
I ask Duyik what kinds of things she does while in a trance state. "I just mimic everything I see around me," she says. "Even the TV. While I'm latah, I apparently imitate everything I see on TV."
"Doesn't that make it a little dangerous?" I ask.
"Well," Duyik titters, holding a hand over her mouth to hide her
teeth, "I try not to watch too much wrestling."
O n the other side of the Malacca Straits, at the Woodbridge Hospital and Institute of Mental Health in Singapore, Ng Beng Yeong, an expert in culture-bound syndromes, walks me through the hospital's airy pagoda-style architecture during a monsoon. Ng began his career with a seminal 1991 paper on koro, intrigued by the late-60's epidemic of the disorder. As we open umbrellas and step through warm rain pools, Ng speaks passionately about the power of culture to make people neurotic.
"What struck me with koro is that here was a mental disease that was
directly caused by the traditional Chinese conception of health," he
says. "It came from inside the culture. Nearly all the men who
suffered from koro were ethnic Chinese."
In a conceptual system, he explains, which emphasizes opposing male and female "energies" -- think yin and yang -- men tend to be obsessed with their masculinity, which they fear can be sapped from them. A koro-like affliction, Ng explains, appears in ancient Chinese medical texts, where it is known as suo-yang.
"In ancient China, castration was the most feared punishment," he
continues. "So when you felt anxious or unwell, you would often become
obsessed with your penis." But in 1967, he goes on, there was an added
factor contributing to the koro epidemic on the Malaysian peninsula.
Racial tensions between Muslim Malays and non-Muslim Chinese were
running high, and among the Chinese there was a virulent rumor that
the Malays had poisoned their pork. The atmosphere was primed for
hysteria. "Koro was like a collective anxiety attack," Ng concludes.
"It was the manifestation of social unease."
In recent years, koro has almost disappeared from the Chinese diaspora in the Malacca Straits and Singapore. "It's almost as if changing social conditions produce changing syndromes," the doctor muses. But it has been replaced by equally strange phenomena. Ng himself has noticed a condition that the Chinese call wei han zheng, or "fear of being cold." Ng calls it frigophobia. Patients bundle up in the steamy Singapore heat, wearing wool hats and gloves. Like koro, he explains, frigophobia seems to stem from Chinese cultural beliefs about the spiritual qualities of heat and cold. "I don't really know," he laughs. "Maybe it's just a reaction to mass air-conditioning. Frigophobia is so new, it doesn't even exist in the psychiatric literature. So far, it's unique to Singapore. I'm as perplexed by it as anyone else. I wonder if it will be in D.S.M.-V."
We pause under the dripping eaves, and Ng looks up at the clouds. There is something else that needs to be explained.
"One thing I've noticed," he muses, "is that modern psychiatry is
essentially a Western import." In the East, Ng continues, patients
tend not to distinguish between mind and body. "Our patients rarely
talk about their moods per se, the way people in the West do," he
explains. So even with mental afflictions that appear to have a clear
biological basis -- like schizophrenia -- people's ways of expressing
them are shaped by culture.
I ask him how latah fits in this framework. "Well, we Chinese don't have latah," Ng says with a smile. "You'll have to ask the Malays about that."
I n 1968, the anthropologist Hildred Geertz wrote a paper called
"Latah in Java: A Theoretical Paradox," in which she argued that the
raucous behavior of latah could be understood only in the context of
the courtly emotional restraint that is the cultural norm in Malaysia
and Indonesia. This highly decorous culture provided very few outlets
for intense emotion -- and latah had become one of them.
Yet here was the paradox: syndromes very like latah, Geertz reported, existed in several other cultures as well. In rural parts of the Philippines, for instance, a nearly identical condition known as mali-mali is widespread. In Siberia, there is a hyperstartle complex known as myriachit, while in Thailand it is known as baah-ji and in Japan, imu. In the 1930's, scholars made a curious film about hyperstartling among the Ainu, an ethnic minority in northern Japan. The faded reels show Ainu women being startled, waving their arms like windmills and running around in a frenzy. A form of latah has even been recorded among French loggers in Canada. (Perhaps they are startled by falling trees?) Sufferers are known in medical literature, rather improbably, as the Jumping Frenchmen of Maine. Were these all hyperstartle complexes different forms of latah, Geertz asked, or were they all unique syndromes?
After Geertz's paper appeared, a psychiatrist named Ronald C. Simons made a research trip to the oceanside hamlet of Padang Kemunting in West Malaysia. There he found a village in which latah was common. Now a professor emeritus at Michigan State, Simons was immediately convinced that latah was more significant than most Western researchers were prepared to admit at the time.
In 1978, Simons made a short documentary film about Padang Kemunting, in which latahs and their relatives were interviewed. One woman, Layut Binti Ali, describes her condition thus: "One sees a centipede, or a snake, or a coconut leaf falls, and one is startled. Then someone sees what happens. Later, when he sees me again, perhaps he'll poke me in the ribs." Pawang Lamun, an indigenous healer, is asked if ordinary people can become latah. He explains: "If we keep poking a normal person like that, she'll become a latah. It doesn't take long. Five days poking over and over, little by little, a person becomes quite flustered."
Throughout the film, an atmosphere of good humor prevails. When an august matriarch is startled and blurts out obscenities, everyone splits his sides. Nevertheless, latah is clearly a debilitating condition. The worst sufferers appear to be extremely anxious. And for the village's few male sufferers, latah -- seen by many locals as a feminine affliction -- is a source of deep shame.
In the years after making his film, Simons puzzled over Geertz's paradox. Was latah a universal pathology or a cultural oddity? In a 1996 book, "Boo! Culture, Experience and the Startle Reflex," Simons argues that latah-like syndromes exist in many cultures because the startle response is itself physiologically universal. It's just that some cultures are more fascinated (and amused) by the startle response than others, making people who are easily frightened objects of attention.
Simons also points out that doctors in the West have identified a rare disease known as hyperexplexia -- a hereditary neurological disorder that causes violent and attenuated startle responses (but no trance). Hyperexplexia, scientists have learned, is caused by a genetic alteration affecting glycine receptors in the brain and is treated by American doctors with the drug Clonazepam. Could Clonazepam, Simons asks, be used to treat latahs? "So far, no treatment has been offered to latahs at all," he notes. "There have been no drug studies whatsoever. That seems highly unsatisfactory to me, because many of these women really suffer from their condition."
Other researchers have strongly disagreed with Simons's suggestion that latah might be treated with drugs. Michael Kenny, an anthropologist at Simon Fraser University in British Columbia, has argued that latah has been unduly medicalized by the D.S.M.-IV. Latah is an elaborate cultural ritual, he argues, and nothing more. He says it is ethnocentric to call latah an organic illness. "All this psychiatrizing is another form of colonialism," Kenny says. "Latahs aren't bothered by being latahs. Nor is anyone around them. Why, then, is it a so-called syndrome?"
Such criticisms make Simons impatient. "If that's true," he says in response, "then why do latahs themselves ask if they can be cured?"
K uching lies on a bend of the Sarawak River on Borneo's northern coast. It's a bustling river town of peeling Chinese godowns, genteel English colonnades and pell-mell Malay markets that have not yet ceded ground to the air-conditioned malls of the Asian boom. The city's population is a microcosm of modern Malaysia: a polyglottal confusion of immigrant Chinese, Indians, Malays, Dyaks and Ibans.
Peter Kedit, a local anthropologist, is showing me around town today. Over the years, he says, latah has spread from Malaysia's rural backwaters to its urban centers. "Here in Kuching, latah has become a kind of social rebellion," Kedit explains. "Some people are more hard-core latah than others, and they kind of lead on the rest. Then it turns into a subversive game. Some ham it up, but others truly can't help themselves." Most latahs in Kuching are women, Kedit says, but not all. He notes that some of the more baroque cases of latah can be found among the city's homosexual and transvestite populations. This may be because for many Malaysians, the malady has become firmly associated with femininity.
Across the river from the town center lies the sprawling suburb of Petra Jaya. Here, Iban and Dyak villages have begun sprouted up among the posh houses of Muslim ministers and Chinese businessmen, creating an incongruous patchwork of marble villas and wooden shacks.
In this neighborhood, a pair of old ladies have become known in the markets of Kuching for their latah antics. One of them is Serai, a frail 75-year-old. She welcomes me inside her son-in-law's house, with its sweltering front room of gaudy pink couches.
Thirty-five years ago, Serai explains, she was invited to join a
woodchopping team of women in the forests outside Kuching. The work
was arduous, and the other women constantly teased their inexperienced
companion. "They poked and poked me," she recalls a little mournfully,
"and I became latah."
Over the years, Serai says, she has gotten used to her affliction. And she is comforted by the fact that her close friend Amin Anak Jantan has developed the condition as well. "We're latah together," she says, wiggling her hips as if to demonstrate.
Serai sends me to a home nearby to meet her friend. Amin sits in a
room brimming with fake silk flowers; as I sit with her, I notice a
long line of ants crawling up the wall next to me. Amin somberly tells
me that she became latah in 1957, when her fifth son died of leukemia.
"I nearly went insane," she whispers. "It was the grief that made me
latah. I was completely traumatized. I fainted all the time."
I then ask what Amin gets up to with Serai in the Kuching markets. "We go shopping together," she says, drying her tears quickly. "But sometimes when we do, certain things will set us off, like cats or cars backfiring. We'll start imitating people for no reason. If we see this hunchback man who lives in the Chinese neighborhood, we'll both start imitating his hump." She gets up and demonstrates, theatrically rolling her shoulders forward. "Everyone thinks it's very funny, but it's not funny for us."
How can latah consistently strike two people at the exact same moment? It seems that Serai and Amin must have some control, even if they are unable to acknowledge it, over their affliction. And if they can remember what happens to them while in a trance state, then is it really latah? Is Michael Kenny right -- that latah is more of a ritual than an illness?
Latah is, in the end, a very slippery phenomenon. While some sufferers may simply be imitating trance behaviors in a bid for attention, others may well be predisposed to exaggerated startles for physiological reasons. Making things even more complex, every latah seems to have a unique explanation for her malady. Amin, for example, grew up in a traditional rural village called Banting, but she doesn't remember any latahs when she was a child. "There were none in my village," she says. "I only see latahs where people from different villages are thrown together, like here in Kuching. Mixing people together is what causes latah."
There is one thing that remains constant for all latah sufferers. Upon becoming afflicted, latahs become permanently sensitive t o startling.
It is a lifetime condition. Scholars have only encountered a few latahs who have overcome their symptoms. Even if latah is spread primarily by culture, then, it is a potent virus.
Indeed, the power of culture to propagate mental illness has become a subject of increasing fascination in the West. In recent years, scholars have seen mysterious maladies proliferate in a way that echoes the spread of latah. Multiple-personality disorder, for example, flourished among white, middle-class American women in the 1980's. And more recently, American and European psychologists have begun tracking apotemnophilia -- a new, disturbing condition in which sufferers desire to amputate one of their own limbs. The Internet, medical anthropologists say, is helping spread the condition globally. As with latah, there is no cure.
Indeed, the latahs of Petra Jaya tell me that they are at a loss to know what to do about their debilitating propensity to startle. For them, latah is not something they've made up in their minds. It is something beyond their control.
"I'd go to my doctor," Amin says seriously, her eyelids flickering as
she mops her face again. "But there's nothing they can do."
Lawrence Osborne, a frequent contributor to the magazine, last wrote about crime-scene forensics.
End of The Glorantha Digest V8 #388
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