Many years ago I sat in a case conference alongside a well-intentioned and earnest young psychiatrist from another country. He was doing just fine in his assessment of a new patient until he reached a point where he speculated she may be displaying early signs of psychosis. This, it transpired, hinged on the fact that at some point in the interview she had confessed to having, "˜butterflies in her stomach.’ It was a source of humor for a few moments, partly because this exact example is often used in teaching sessions to illustrate accepted cultural norms. But, it also showed just how easy it could be to misinterpret and possibly even misdiagnose and treat someone due to a simple lack of insight into culture.
Like so many other conditions and disorders, panic is known to be universal. The way it reveals itself however may differ from place to place. Even as a casual tourist it quickly becomes clear that people express themselves in very different ways in different parts of the world. But, even within the same country, there can be differences in the way a group or culture expresses themselves. For example, Rachman and De Silva (2003) point to the fact that many African Americans report higher levels of physical sensations during panic, especially numbing and tingling sensations in the extremities. They also report more intense fears of going crazy or of dying.
The same authors mention that amongst the Chinese, dizziness is a frequently cited symptom of distress. Chinese people view dizziness as a feature of disharmony and those diagnosed with panic disorder say dizziness is a prominent feature. An interesting contrast is then given about Khmer refugee patients in the United States. The so-called "˜sore-neck syndrome’, a type of panic disorder, refers to a commonly reported fear of dying due to some rupture of vessels in the neck causes by high blood pressure and wind pressure.
During my training, if memory serves, my exposure to the cultural aspects of mental health lasted all of two hours or so. It was a while ago and perhaps things have improved some since. Then, it perhaps wasn’t so surprising when we consider that most research was conducted in Western societies. I certainly hope things have improved. In a shrinking world I can’t help but think it would be useful for us to understand cultural differences in greater depth.
Rachman, S., De Silva, P. (2003) Panic Disorder (2nd ed) the facts. Oxford University Press,