Severe psychiatric disorders found in primitive cultures but not in Western society. The term is usually applied to functional conditions such as amok, latah, koro, witigo, and voodoo death.Amok, or “running amok,” is a sudden homicidal mania first discovered in Malaya, but also found in other areas, including the Philippines, Africa, and Tierra del Fuego. It appears to be similar to the Viking disorder known as “going berserk.” While there were many cases in Malaya and the Philippines at the beginning of this century,the number has greatly diminished since modern medical care and improved education have been instituted.The disorder occurs in males with schizoid personalities. In the brief prodromal phase they become more withdrawn and brooding than usual, then suddenly leap to their feet with a bloodcurdling scream, pull out their dagger and rush wildly about stabbing anyone or anything they encounter. After killing or wounding all the people and animals within reach, they are usually killed by others or end up by mutilating or killing themselves. The few who escape death claim they cannot remember the episode, or state that the world suddenly went black and that they tried to slash their way out of the darkness.Running amok can usually be distinguished from violent episodes that occasionally occur in other disorders. The paranoid or catatonic schizophrenic experiences delusions or hallucinations and can usually remember the episode; neither of these facts applies to amok. Another condition, known as pseudoamok, has also been compared to it. In this case an excited patient brandishes a weapon but avoids harming anyone, and when he is cornered, he meekly gives himself up. This is probably a hysterical disorder and not true amok, since in the latter condition the patient actually commits violence and will never surrender.The explanation of amok is largely a matter of conjecture. Kraepelin believed it could result from a variety of organic conditions, among which he mentioned malaria, epilepsy, and schizophrenia. Arieti and Meth (1959) employ a “sociopsychodynamic” interpretation, in which they suggest that it is a sudden expression of repressed rage in accordance with the accepted behavior of the society—and when this cultural acceptance disappears as a result of Western influence, the disorder also disappears. They suggest, too, thatamong the Bantu the belief that a person can escape death by killing another individual may be a contributing factor. Release of repressed rage may also explain the rare schizoid individual in Western countries who suddenly “goes berserk” and kills everyone around him.Juramentado (Spanish for cursed person). This acute disturbance is believed to be limited to Mohammedan men ethnologically related to the Malays and Moros, although a similar disorder has been reported in India and Siberia. As in amok, the individual is suddenly overwhelmed by a state of frenzy during which he rushes into the street stabbing everyone he encounters. After the attack—if he has not been killed by others—he lapses into a stuporous sleep, from which he awakens in a disagreeable state of mind but with a complete amnesia for the homicidal episode.The causes of this disorder are none too clear, but in many cases the sudden seizure appears to be precipitated by the excitement of religious rites involving music, dancing, and incantations. The attack may also be preceded by a devastating emotional experience such as the death of a loved one, infidelity on the part of the wife, fear of disgrace, or an accusation of cowardice. In some cases the afflicted individual had been depressed for a long period, and had given up all work and lost all interest in life.A number of similar but less violent conditions have also been observed. The Philippine disorder, delahara, is more prevalent among women than men; the African disorders, tropenkohler and rtiis- ala, afflict young males primarily. As Kisker (1964) notes: “Victims of these disorders start quarrels and rapidly work themselves up to a frenzy of speech and gesticulation, without apparent object or cause. The attack, which may last anywhere from a few minutes to a few hours, is followed by utter exhaustion.”Voodoo Death. This strange psychosis, technically termed thanatomania (preoccupation with death), is found in many primitive societies. In some cases an individual who seems healthy in every respect becomes convinced that he has transgressed a taboo, and as a result withdraws from the world and dies within a few days. In other cases the same thing occurs except that the patient becomes convinced that he has fallen under the spell of a sorcerer who wishes to eliminate him. Van der Hoeven (1956) relates the case of a New Guinea sorcerer who had been offended by a young man. Taking revenge, he told the young man that on the day before he had placed an object poisoned by witchcraft in his path. The youth fell ill immediately, and was dead within two days. Interestingly, the Dutch government tried the sorcerer and imprisoned him for bringing about the young man’s death.We can only speculate about the mechanisms through which fear or expectancy can lead to death. It may be that autosuggestion or autohypnosis is involved, for we know that these processes can be used in some cases to affect the activities of the autonomic nervous system and, through this system, control the functions of the heart and other vital organs. Many people today accept the Hindu claim that they can achieve “suspended animation” through this means. Yet this process is said to take years of training, while the voodoo effect—which leads to actual death—can apparently be produced in a matter of hours and with no training at all.A number of other tribal disorders deserve brief mention. A condition known as arctic hysteria was first observed among the Chukchee of northern Siberia early in this century. Its most outstanding symptom was extreme suggestibility, during which the patient imitated the movements and actions of other people (echopraxia). Another disorder, pibloktoq, was observed during Admiral Peary’s expedition. The victims were Eskimo women who experienced attacks of uncontrollable excitement, during which they would shriek, sing at the top of their lungs, rush about and tear off their clothing until they collapsed into unconsciousness. The disorder was believed to be a long- pent-up response to the insecurities and frustrations endured by these women, who were considered the property of the male and who could therefore be bought, sold, or exchanged at will.Similar disorders have been observed in other arctic areas, such as Iceland, the Faroe Islands, the Kamchatka Peninsula, the Kirghiz Steppes of Russia, and among the Samoyeds, Yakuts, and other Siberian tribes.Another set of disorders has been found among the Diegueno Indians of lower California: kimilue and echul. The tribal medicine men regard both these disorders as sexual disturbances. In kimilue the victim becomes apathetic and disinterested in life, loses his appetite, and has vivid sexual dreams. Echul is somewhat similar but may involve convulsive seizures. The disorder appears to be precipitated by crises such as the loss or death of a wife, husband, or child.