Making up koro: multiplicity, psychiatry, culture, and penis-shrinking anxieties.

Koro is a syndrome in which the penis (or sometimes the nipples or vulva) is retracting, with deleterious effects for the sufferer. In modern psychiatry, it is considered a culture-bound syndrome (CBS). This paper considers the formation and development of psychiatric conceptions of koro and related genital retraction syndromes from the 1890s to the present. It does so by examining the different explanations of koro based on shifting conceptions of mental illness, and considers the increased recognition of the role culture has to play in psychiatric concepts. Conceptions of culture (deriving from colonial psychiatry as well as from anthropology) actively shaped the ways in which psychiatrists conceptualized koro. Cases under consideration, additional to the first Dutch descriptions of koro, include the ways in which koro was identified in white western cases, and the 1967 Singaporean koro epidemic. Following a number of psychiatrists and psychologists who have addressed the same material, attention is also paid to the recent genital-theft panics in sub-Saharan Africa, considering the implications of the differences between koro and other genital-theft panics. Finally, the paper addresses the role played by koro in the development of the concept of CBSs, which was first presented in the DSM IV in 1994. This is explored against the backdrop of emerging ideas about culture and psychiatry from the late colonial period, especially in Africa, which are central to modern ideas about transcultural psychiatry.

Ramadan fasting triggering koro-like symptoms during acute alcohol withdrawal: a case report from Oman.

This article describes a case of koro-like symptoms from Oman associated with alcohol withdrawal and illustrates how the socio-cultural practices of Ramadan-fasting affected the patterning and timing of presentation of severe alcohol withdrawal symptoms. The patient was severely distressed by the delusion that his penis had been amputated. The acute anxiety involving this delusion appears to be conceptually and phenomenologically similar to koro.

Koro--the psychological disappearance of the penis.

The aim of this article is to present a summarizing overview on ethnomedical aspects of koro (in Chinese called suo-yang), the panic anxiety state in which affected males believe that the penis is shrinking and/or retracting, and perhaps disappearing. While reduction of penile volume occurs physiologically due to vasoconstriction in cold temperature and intense anxiety, it is believed in certain cultures that genital shrinking leads to impotence and sterility, and eventually to death. Traditional Chinese medicine treats suo-yang, the reduction of the male principle yang, as a dangerous disturbance of the life-sustaining yin-yang equilibrium of the organism. Koro has therefore been held to be a Chinese "culture-bound" condition. However , the koro phenomenon is also known among diverse ethnic and religious groups in Asia and Africa, typically in cultures in which reproductive ability is a major determinant of a young person's worth. Koro epidemics of panic anxiety due to widespread fears of losing one's genitals, procreative ability, and even one's life, are triggered by rumors of genital disappearance supposedly caused in China by female fox spirits, in Singapore and Thailand by mass poisoning, and in Africa by sorcery, usually in the context of socioeconomic or political tension. Today, in contemporary Western societies, ideas of genital disappearance are not culturally endorsed. But historically, it should be remembered that in the late Middle Ages in Europe, a man could lose his membrum virile through magical attacks by witches. The conclusion is that the psychological disappearance of the penis is a universal syndrome that was described recently in Asia and Africa and already in Medieval Europe.

Understanding genital-shrinking epidemics in West Africa: koro, juju, or mass psychogenic illness?

A small-scale epidemic of genital shrinking occurred in six West African nations between January 1997 and October 2003. This article presents a summary and analysis of 56 media reports of these cases. A clinical formulation of these cases considers a variety of explanations from theory and research in social and cultural psychology, psychopathology, and anthropology. Of particular interest is a comparison of genital-shrinking distress in West African settings with koro, a culture-bound syndrome involving fears of genital retraction that is prominent in Southeast Asian settings. The paper concludes with a brief discussion of the role of culture in both the experience of genital-shrinking distress and conceptions of psychopathology.

Cannabis-induced Koro in Americans.

AIMS: Koro, an acute panic reaction related to the perception of penile retraction, was once considered limited to specific cultures. The disorder has appeared as part of a panic response to cannabis, but only in citizens of India. This study looked for cannabis-induced Koro in Americans. DESIGN: Given the relative rarity of cannabis-induced Koro, this work focused on individual case studies. PARTICIPANTS: Over 70 men responded by phone to report negative reactions to cannabis. Three of them (Caucasians aged 22-26 with years of experience with cannabis) spontaneously mentioned experiencing symptoms of Koro after smoking marijuana. FINDINGS: All three cases occurred after participants had heard about cannabis-induced Koro and used the drug in a novel setting or atypical way. Two of the men had body dysmorphia, which may have contributed to symptoms. All three decreased their cannabis consumption after the Koro experience. CONCLUSIONS: Koro, particularly cannabis-induced Koro, is not limited to Eastern cultures. Several factors may interact to create symptoms. These include previous knowledge of cannabis-induced Koro, the use of marijuana in a way that might heighten a panic reaction, and poor body image. In addition, these cases confirm previous work that shows that negative reactions to drugs can attenuate their use.

[Culture-bound syndromes: pertinence as a diagnostic category]. / Culture-Bound Syndromes: pertinence d'une catégorie diagnostique?

Culture-bound syndromes (CBS) are supposedly confined to one specific cultural areas. These syndromes were first studied by western anthropologists and psychiatrists working overseas, and later by practitioners treating patients from societies with traditional customs and values. The latest edition of the American Psychiatry Association classification (DSM IV) includes an annex on CBS. This report gives a concise background of the process that led to the inclusion of this annex. Then using Koro (a sudden and intense fear that the genitals organs will recede into the body) as an example, a number psychopathological parallels are drawn between CBS and classic manifestations of individual and mass hysteria. The pertinence of individualizing the CBS in the psychiatric nosography including the epistemologic implications is analyzed with reference to the concepts of the French and American Schools of Anthropology. Since attitudes toward mental illness are culturally determined and subject to variation in time and space, we feel that this debate should be placed within the context of a general dialectic between etic (universality) and emic (cultural specificity) rather than a controversy on the need for an annex on CBS in the DSM IV.

[Castration anxiety and oral envy in sexual relations. Analytic studies with ethnological observations]. / Kastrationsangst und oraler Neid im Geschlechterverhältnis. Analytisches Arbeiten mit einer ethnologischen Beobachtung.

Ethno-psychoanalysis is the study of the unconscious in foreign cultures. It can however also be of use in understanding unconscious elements operative in our own culture. To illustrate the point, the author describes the "Koro" epidemic which occurs periodically on the island of Hainan off the south of coast of China. This epidemic largely affects young unmarried men and the author pinpoints the unconscious conflicts underlying this collective phenomenon. It transpires that the epidemic is in effect a species of rite of passage in which a group of young males make the communal attempt to overcome castration anxieties which are themselves the product of covert gender envy. In the second section, Gerlach reports on his psychoanalytic encounter with a young man in Germany displaying similar symptoms. The profounder dimensions of this condition were only comprehensible to the author on account of his knowledge of "Koro".