Emil Kraepelin and comparative sociocultural psychiatry.

Emil Kraepelin, well known as the principal designer of modern psychiatric nosology, is less well known for his pioneering work in comparative sociocultural psychiatry. This paper is trying to document Kraepelin's role as the inaugurator of systematic investigations into culture-dependent differences in psychopathology. Despite his many responsibilities as clinician, teacher, hospital administrator and scientific author, Kraepelin considered cross-cultural comparison of such importance that he spent considerable time on the preparation of then very cumbersome overseas expeditions. His first research journey in 1904 to Southeast Asia led to the programmatic formulation of comparative psychiatry as a scientific endeavour designed to contribute to the better understanding of psychopathological processes and to a comprehensive comparative ethnopsychology ("Voelkerpsychologie"). Kraepelin's main cross-cultural research project, planned to extend to seven non-European countries and to involve many foreign colleagues, was prevented by World War I and postwar complications. One year before his unexpected death, Kraepelin conducted comparative studies with American Indian, Afro-American and Latin American patients at psychiatric institutions in the United States, Mexico and Cuba in 1925. In his writings Kraepelin commented on certain differences in the incidence and presentation of psychopathological phenomena that he considered to be due to ethnic-cultural characteristics or social conditions. This paper discusses in detail Kraepelin's observations on the pathoplastic and pathogenic effects of cultural and social factors, and demonstrates the influence of his ideas on the development of modern social and transcultural psychiatry.

The metamorphosis of 'culture-bound' syndromes.

Starting from a critical review of the concept of 'culture-bound' disorders and its development in comparative psychiatry, the authors present the changing aspects of two so-called culture-bound syndromes as paradigms of transcultural metamorphosis (koro) and intra-cultural metamorphosis (Salish Indian spirit sickness), respectively. The authors present recent data on epidemics of koro, which is supposedly bound to Chinese culture, in Thailand and India among non-Chinese populations. Neither the model of Oedipal castration anxiety nor the model of culture-specific pathogenicity, commonly adduced in psychiatric and ethnological literature, explain these phenomena. The authors' data on Salish Indian spirit sickness describes the contemporary condition as anomic depression, which is significantly different from its traditional namesake. The traditional concept was redefined by Salish ritual specialists in response to current needs imposed by social changes. The stresses involved in creating the contemporary phenomena of koro and spirit sickness are neither culture-specific nor culture-inherent, as postulated for 'culture-bound' syndromes, rather they are generated by a feeling of powerlessness caused by perceived threats to ethnic survival.

Initiation in Papua New Guinea: psychohygienic and ethnopsychiatric aspects.

Initiation ceremonials in traditional Papua New Guinea and North American Indian cultures serve important psychohygienic functions in establishing the youth's final identity and thereby warding off the frustration, anxiety, and depression which are associated with anomie and role confusion. Inititations in Papua New Guinea are presented as a process of social learning in which group consciousness and loyalty are established through revelation of ancestral secrets, testing by ordeals, and ego-stregthening rewards. Structually patterned archetypal collective symbols gain direct access to the young person's unconscious when skillfully transmitted in the initiatory psychodrama of death and rebirth. Medical complications occuring during initiation procedures are rare accidents which have to be weighed against the psychological and social benefits for individual and group. Initiation ceremonials help the young to achieve a sense of sexual and socio-cultural identity from which feelings of emotional security and social belonging are derived.