Making Up Koro: Multiplicity, Psychiatry, Culture, and Penis-Shrinking Anxieties

Abstract

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.

Síndrome de koro associado a transtorno obsessivo-compulsivo: caso clínico e breve revisão

“…Tal como demonstrado, as crenças patológicas acerca dos genitais são muito comuns em todas as culturas. Para além disso, o koro foi, durante muito tempo, considerado como uma síndrome cultural, o que certamente contribuiu para a estigmatização e entraves à sua compreensão científica 8 .…”

“…Descrições semelhantes ocorreram em 1976, na Tailândia, registrando-se 350 casos de koro (338 homens e 12 mulheres) 7 que acreditavam ter sofrido um ataque vietnamita na capacidade reprodutiva, por envenenamento em massa da comida, bebida e tabaco 1 . Nas décadas de 1970 e 1980, também foram notificados casos na África, sobretudo na Nigéria, Costa do Marfim e Senegal, em que o desaparecimento do pênis era atribuído à magia negra, estando os homens afetados convictos de que teriam sido roubados por meios mágicos e teriam uma morte dolorosa 8 .…”

Koro-Like Symptoms Associated with Schizophrenia

“…Furthermore, Koro treatment methods are also variable ranging from a variety of folk reme-dies commonly employed in south-east Asia and Africa to psychopharmacology or psychotherapy typically used for cases occurring in the western world. Difference in treatment methods is regarded by some authors as a cultural recognition of Koro as a real syndrome existing in different cultures [10].…”

“…Even in non-western cases, there is a great heterogeneity among cases, depending on the local criteria used to diagnose Koro [10]. This case report describes a case of Koro-like symptoms associated with paranoid schizophrenia in a 66 years old New Zealand European male.…”

“…Incomplete or Koro-like states are believed to represent co-morbidities with other neuropsychiatric or neurological conditions. Koro is an example of the tension between the universality of general psychiatric symptoms as seen in western conceptions of mental illness, and the realization that people in nonwestern cultures experience psychiatric trauma and anxieties differently [10].…”