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The Geography of Madness:
Penis Thieves, Voodoo Death, and the Search for the Meaning of the World's Strangest Syndromes
An early scene in Frank Bures's The Geography of Madness describes the author wandering through the crowded streets of Lagos, the largest city in Nigeria, bumping from person to person to see if anyone showed signs that his penis had been stolen.
Bures had traveled to Nigeria to research 'genital retraction syndrome,' or koro. He had heard stories of men swearing that their penises had shrunk into their bodies. A few years before his arrival, 12 alleged penis thieves had been burned alive by a fearful mob.
Westerners tend to attribute stories like this to superstition, but Bures was not convinced. We in the 'civilized' West are not free from superstition, mob violence, or diseases like koro; we have a culture all our own, as easy as it is to forget sometimes, and cultural pathologies come part and parcel with that.
Traveling from Nigeria to Thailand and from Borneo to Hong Kong, Bures investigated various 'culture-bound syndromes' - mental illnesses unique to a specific society or culture - to see what they might reveal about human culture and beliefs more broadly.
Though our bones don't break any differently in the United States than in Nigeria, it seems like our minds do. I spoke with Bures to help understand why.
Vlad Chituc: When I think of culture, I tend to think of things like food or fashion or religion - basically everything but penis theft. How does penis theft help to fill in our picture of culture in a way that more typical things don't?
Frank Bures: Culture is a complicated word, and everybody uses it but nobody tends to say exactly what it is. To me, looking at penis stealing seemed like the biggest doorway into that question, because what seemed obvious to me is that nobody in Nigeria doubted that this thing is true.
It's easy to see from the outside somebody else's culture, but it's much harder to see your own and the things that we all just agree are true. I was interested in looking in. I wanted to take that route through the stories of penis stealing to look at how culture is created through shared narrative, and then to turn that back on our own culture.
Your book is critical of the idea that culture-bound diseases like koro are just primitive superstition, and all we need to do is educate the ignorant people who think that penises can magically get stolen. You suggest that there's something deeper and more universal going on.
Yeah, when people say, 'If they just will see things like we do, these things will go away,' I think that misses the point. It's possible they'll go away, but is that correcting their views, or just replacing their narratives and assumptions and beliefs with our own? To recognize that we also do the same thing is important.
We're narrative creatures. We hear these stories and we believe, and the more stories you hear about something, the harder it is not to believe it, especially from people who you respect, because that's the core of social learning: looking toward people who have the accumulated knowledge in a culture and trying to get it from them. When people who we respect or who have status are sharing these same stories, it becomes even harder to doubt them.
You told this great story of a 2004 outbreak of the disease in a Chinese school.
In a little village called Fuhu in southern China, they call it suo yang or suk yang, depending on the language. One of the students was playing Ping-Pong and he felt his penis shrinking. He began to panic and went home to tell his parents. His mother held on to his penis while the dad called the local healer. She was an 80-year-old woman, and she remembered other panics. She believed it was caused by an evil wind that was coming through the village. She treated the boy and then the boy went back to school.
Then the headmaster of the school heard about this and called all 680 students, boys and girls, together in the courtyard. He described the incident in detail and said, 'This is dangerous. Watch out for this.' Then sure enough, the next day several boys felt their penises shrinking and ran home to get help. The day after that 60 more students were struck with it.
I like that story because it's a good microcosm of how these things work. We hear these causal chains of events and we perceive what the cause is, and then we sort of internalize that. It manifests and becomes real.
That reminds me of suicide epidemics that sometimes happen in the West. After Marilyn Monroe killed herself, there was a 12% increase in suicides in the next month - 300 more people.
Yeah, totally similar. These things are contagious. Being human is learning from other people around [you]. It's social learning.
What exactly is going on in cases like that? In cases like koro or mass suicides or voodoo death, on the surface it just looks like something spooky is going on. There are a few cases you discuss where even people in the United States who are convinced they are going to die get so anxious that they actually end up dying. How does that happen?
How does the belief translate into dying?
I don't really know. Nobody knows that exactly. The psychiatrist George Engel looked at 170 cases of people who died suddenly or unexpectedly, which is similar to voodoo death, when you just die even though you're not unhealthy or anything. He found there were various circumstances that precipitated it, like the loss of a spouse or a child or a sibling or a friend, the denial of a promotion or the loss of a job. One man died after the demolition of a hotel where he'd worked for 30 years.
Another guy was diagnosed with lung cancer, but it was a misdiagnosis. There was no lung cancer, but he died two weeks later. It functioned almost like a curse. It's tempting to overstate the power of these things, but you also don't want to understate the power of them either. It's hard to know what the parameters of it are, exactly.
I think there's an interesting bigger picture question: What does it even mean for a curse or a mental illness to be 'real'? People's penises aren't actually disappearing but these beliefs seem to affect the real world.
When we use that kind of terminology, people in our culture usually mean that it's physical or that you can find some neurological reason for it. I would disagree with that. I think there are two levels of realness. There's one where the person is really experiencing these things and really suffering, and to that extent it's real. Then there's another level where it gets a name or a diagnosis and the society agrees that this is a real thing. That can be very powerful to the person to feel that everybody agrees that this thing is really happening, and this is the chain of events that they're part of, and this is what's causing their suffering.
That's what everybody kind of craves, and that's one of the reasons people don't like you to suggest that their syndromes are partly cultural, because they interpret that as you saying it's not real or not physical. You're kind of taking that away.
I don't think that's true. I think penis theft is real to the person it's happening to, even if you can't measure it. But it doesn't really matter. The psychiatrist's job is to help the person who's suffering, however you have to deal with that, whatever terms you have to meet the person on to help them [with their] suffering is where you come in to meet them.
Is there a way to discuss culturally constructed diseases without stigmatizing or delegitimizing the experiences of the people who are being afflicted? One example I can think of is Dissociative Identity Disorder. There were only a few hundred cases a few decades ago, and now there are tens of thousands. People used to have only one alter ego on average, and now it's dozens, with some saying they have hundreds or even thousands. It's not fake in the sense that they're lying or pretending, but I don't think it's real that there are literally hundreds of people living in one person's body.
Not many people reading your book have experienced penis theft, but you could imagine a similar study on Dissociative Identity Disorder - and then I think things would get thornier.
It's a really difficult issue. One of the steps is to recognize, I think, that all mental illness and even a lot of the stuff that we think of as just purely physical have a degree of both physical and mental things going on. Then it's a question of to what extent is the psychology or the biology causing the suffering of the person? Then the next step is, how do you address that?
For example, if you're talking to somebody whose penis has disappeared, do you just tell them they're wrong? You don't do that to a person who's anorexic and say, 'You're not fat, you're skinny. Just get over it.'
I'm not educated in the ways that you should approach people about this, but I think we need to recognize that our mind is an active biological agent in these things. I have not yet gotten as much active pushback as I thought I would. People seem ready for this more complex model of health and the body.
Is there any mental illness that won't have this kind of interplay between psychology and biology? Do you think there are any mental illnesses that aren't culture bound?
There's no biological test for any mental illness that we know of or that I can think of. To say that any mental illness is purely biological seems premature at best, because we don't know the physiology of these things. There's none that I can think of that wouldn't have a cultural element to it, or an element of belief or narrative. How much, I don't know. It's a tough question and it would depend on the individuals.
Schizophrenia is the one that seems like it should be the clearest, just something broken in your head. But you have that 1992 study from the WHO showing that big variation between industrialized and non-industrialized countries, where the non-industrialized countries have a less severe form of it and a better recovery rate. So it partly depends not just on the ill person but on how all the people around them are interpreting the illness, too.
Are there other cases where we see this sort of variation in Western, industrialized nations?
There are a lot of other mass-psychogenic illnesses that are just feeling nausea or dizziness and abdominal pain or something like that. I love these stories, and they happen in schools a lot. It happened once in Belgium in 1999. People got headaches, dizziness, nausea, vomiting, abdominal pain, diarrhea and trembling, and they thought it was from drinking Coca-Cola. It spread to five other schools and 147 students total. There were 943 calls to the poison center. It ended up costing Coca-Cola somewhere between $100 to $250 million dollars to try to deal with it.
There's a fantastic book called Outbreak, edited by Robert Bartholomew. It's like 700 pages of stories like this, going on and on and on. He has written recently about some girls in New York who had a psychogenic motor-movement disorder. Those didn't use to happen in Western society quite as much. To catch that from somebody, you have to see it. Bartholomew thinks people are seeing it on social media and that's how it's spreading.
These things are all around us in some ways. That's why people shouldn't get too smug about penis stealing.
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