Folk Illness


A folk illness is hard to categorize under the Western model of biomedicine. The word illness, as opposed to disease, refers to afflictions suffered by a certain groups of people who use specific cultural tools to deal with and explain their symptoms, the suspected causal agents, and preferred treatment. As noted by Arthur Rubel, the word “folk” is then applied “to those illnesses of which orthodox Western medicine professes neither understanding nor competence”. While this expansive definition may be unwieldy, Rubel maintains that it allows for the inclusion of “a number of seemingly bizarre syndromes which are reported in anthropological, medical, and psychiatric literature from many areas of the world”.[1]

Folk illnesses are sometimes referred to as culture-bound syndromes. These afflictions are typified by repetitions of deviant behavior and are referred to as “illnesses” within a culture or group of cultures. These “illnesses” are identified by local names and tend not to fall into biomedical models of disease. Folk illnesses may simply represent the different ways that different cultures determine and interpret mental illness. As observed by Ronald Simons, however, the notion of culture-bound syndromes is inherently a Western concept. In fact, many culture-bound syndromes can be found within Western culture, such as premenstrual syndrome. While often seen as a universal affliction, premenstrual syndrome is actually absent in many cultures across the globe.[2]

Some scholars propose using etic and emic perspectives when analyzing illness and disease. Researchers in biomedicine would provide the etic, or outsider perspective, while the emic, or insider perspective, would emerge from studies of ethnic or folk illnesses. In other words, while certain illnesses in different societies may not fit into biomedical definitions of disease, there may still be validity in looking at causal agents within biomedicine to better understand symptoms of folk illness and vice versa. Research on the prevalence of a folk illness includes analyzing the temporal, spatial, and individual distribution of the illness, which allows for the determination of hypotheses of causation.


Arthur J. Rubel conducted one of the most preeminent studies on the epidemiology of folk illness, and in 1984 published “Susto: A Folk Illness”. A physician, a medical anthropologist, and a psychological anthropologist collaborated on this book. Rubel's initial study focused on the methodological problems inherent in researching folk illness, such as the complex intersections of cultural understanding of affliction, etiology and the manifestation of the illness itself. What was evident in the 1960s was that while the scientific community acknowledged the existence of unique afflictions, diagnoses, and healing methods in different cultures, there was still a dearth of information on the epidemiology of these illnesses. Rubel attempted to fill that research gap, and his pioneering work in this field led to further research within the anthropological and biomedical communities.[3]

In 1980, Dan Blumhagen published an article asserting that hypertension is a folk illness within Western society. He interviewed 117 men over a year using Arthur Kleinman's explanatory model format.[4] The people Blumhagen interviewed had their own ideas of how they contracted hypertension, and a belief system about how their bodies were reacting to the affliction. Blumhagen observed: “in one typical individual the causes of hypertension included ‘family arguments’, the physical reaction was described as ‘ballooning veins’, the symptoms were felt as ‘dizzy spells and flashing lights’, and the patient feared the possibility of a ruptured blood vessel, leading to ‘loss of a kidney’”. Blumhagen was able to put together a model based on his findings because his subjects had similar beliefs about the causation and resulting symptoms hypertension.

Blumhagen concluded that folk, or culturally derived beliefs, should not be considered in isolation from formal biomedical causes and diagnoses. Instead, he argued that “the two are closely interdependent, the popular condition of ‘hyper-tension’ clearly echoing the expert one, while at the same drawing on associations with more familiar words such as ‘tension’ and ‘pressure’”. Blumhagen demonstrated that even in Western society, individual beliefs about illness and its causation can influence the manifestation of an illness. His work indicated the need for physicians in every cultural setting to take note of individual illness beliefs as part of the diagnosis.[5]

Case Studies


This folk illness is also known by the terms jani, pasmo, espanto, or perdida de la sombra, depending on where it is found. Patients include females and males, rich and poor, urban and rural, and indigenous and non-native peoples. It can be found throughout Latin America and in Texas, California, New Mexico, and Colorado within Spanish-speaking communities. What makes this affliction unique among folk illnesses is that it is not only found among the speakers of a single language group or to one socio-cultural entity, but among those across language barriers and geographic borders.

Underlying this illness is the belief that each person is made up of a physical body and a number of immaterial spirits; the latter can leave the corporeal body and wander aimlessly during periods of dreaming or when a person experienced an unsettling experience. Indigenous Latin Americans believe that a person is afflicted by susto when he or she somehow upset the “spirit guardians of the earth, rivers, ponds, forests, or animals, the soul being held captive until the affront has been expiated”. [6] Non-indigenous patients, on the other hand, do not implicate spirits in the loss. Instead, these patients attribute the flight of their souls to an accident or unsettling fright.

Some of the symptoms associated with susto are depression, the neglect of daily activities, stomach and muscle pains, loss of appetite, reduced contact with others, and general anxiety or tension. The cure for these symptoms varies from region to region, but there are some shared aspects. A healer is asked to diagnose the problem and to determine the instance that causes the soul to detach from the body. It is then necessary to coax the soul back to its home, through entreaties to the spirits in the case of the indigenous healers or through creating a directional pathway in non-indigenous cases. Patients are often massaged and made to sweat during the process. In many cases, the individual is rubbed or 'swept clean' of the illness using various tools such as eggs, medicinal brushes, and even guinea pigs.[7] The following video demonstrates a child undergoing a curing ritual in Ecuador.


Psychiatrist and anthropologist Edward Foulks first analyzed pibloktoq among the Inuit in 1972. This affliction is also called Arctic hysteria. It is manifested by episodes of manic behavior, during which a patient might take off clothes, make unintelligible noises, roll around in frigid water or snow, and generally act out of what is considered a normal, culturally accepted behavioral pattern. Foulks noticed that many pibloktoq symptoms are similar to those in biomedical diseases such as schizophrenia, none matched up exactly with the conditions found in pibloktoq patients. Foulks also noted that there was no physiological cause underlying the condition, such as a vitamin deficiency. In essence, both physical and psychological elements were at play within those who developed the illness, and these elements were further shaped by the Inuits' culture and environment. For instance, ear infections that are prevalent among the Inuit could lead to damages of the central nervous system and the brain, which can result in aberrant behavior. From cultural and psychological standpoints, the Inuits tend to be very strict with their children, putting them under severe pressure at times. These expectations could impact some more than others; those who suffered cerebral infections in the past would more likely act out to find relief from such pressure.[8] Again, the pibloktoq example demonstrates the importance of studying illness and disease in a biocultural context.

Hmong Sleeping Death

The Hmong Sleeping Death, also known by the medical term Sudden Unexpected Nocturnal Death Syndrome (SUNDS) was responsible for a surprising number of deaths among Southeast Asian immigrants to the United States between 1977-1982[9] . The victims were typically men between the ages of 25-44 in seemingly good health with no prior heart conditions. Autopsies revealed nothing except the victims died of sudden heart stoppage[10] . Alarmingly, the rate of death among Laotian-Hmong men equaled "the sum of the rates of the leading five causes of natural death among United States males (54)[11] . Victims would go to sleep, have a nightmare, show signs of struggle during sleeping like making gasping noises or choking sounds, and then die. Even after extensive investigations, researchers were still unable to find out what the causes of these sudden deaths were. They did, however, manage to find a connection between all of those who had died: they had been refugees who had experienced trauma within their homelands.

Shelley Adler (1991), a folklorist who has studied the Hmong Sleeping Death, has posited that a supranormal nightmare is responsible for the fatalities. Adler uses the term nightmare to refer to an evil spirit, similar to an incubus, that is responsible for "pressing the life" out of its victims (55). Much like what happens during sleep paralysis, the victim senses that he is conscious and feels a presence in the room with him, but is unable to move or respond in any way to his intense fear. He cries out in the night and within a few hours is found dead. A quote from Ge Xiong, a survivor of SUNDS illustrates what occurs during these nightmares:

The first night he woke suddenly, short of breath, from a dream in which a cat was sitting on
his chest. The second night, the room suddenly grew darker, and a figure, like a large black dog,
came to his bed and sat on his chest. He could not push the dog off and he grew quickly and
dangerously short of breath. The third night, a tall, white-skinned female spirit came into his
bedroom from the kitchen and lay on top of him. Her weight made it increasingly difficult for
him to breathe. .. . He attempted to turn onto his side, but found he was pinned down. After
fifteen minutes, the spirit left him. [Tobin and Friedman 1983:440] (Adler, 1991, p. 57)

Adler suggests that it is a combination of the Hmong's strict religious beliefs, the trauma that they endured in the homeland at the hands of an oppositional government, the stress related to their dislocation, and the guilt that many Hmong refugees felt because of their inability to practice their religion within their new homeland that contributed to death of so many Hmong immigrants from SUNDS.
Sudden unexpected deaths during sleep occurs in many Asian cultures. In Japan, the syndrome is known as pokkuri and bangungut in the Philippines[12] .


This video shows a boy with latah, a folk illness found in parts of Southeast Asia. This affliction is similar to hyperstartle disorder, where people react strongly when frightened. However, those with latah also seem unable to stop mimicking others around them. In this film, the boy unwillingly responds to prompts from friends, who find his behavior very amusing.

Further Reading

Baer, R., Clark, L., & Peterson, C. (1988) “Folk Illnesses”. In: Louie S, ed. Handbook of Immigrant Health:183-202.

Boddy, Janice. (1988) "Spirit and Selves in Northern Sudan: The Cultural Therapeutics of Possession and Trance". American Ethnologist 15(1):4.

Blumhagen, Dan. (1980) “Hyper-Tension: A Folk Illness With a Medical Name”. Culture, Medicine and Psychiatry Volume 4:197–227.

Ong, A. (1988) "The Production of Possession: Spirits of the Multinational Corporation in Malaysia". American Ethnological Society 15(1):28.

Rebhun, L. (1994) “Swallowing Frogs: Anger and Illness in Northeast Brazil”. Medical Anthropology Quarterly 8(4): 360-382.

Rubel, Arthur J. (1984) Susto: A Folk Illness. Oxford: University of California Press.

Simons, Ronald C. (1996) Boo!: Culture, Experience, and the Startle Reflex (series in Affective Science). Oxford University Press.

Simons, Ronald C. (2001) “Introduction to Culture-Bound Syndromes”. Psychiatric Times 18(11).


  1. ^ Rubel, Arthur J. (1964) The Epidemiology of a Folk Illness: Susto in Hispanic America. Understanding and Applying Medical Anthropology. [compiled by] Peter J. Brown. Mountain View, CA: Mayfield Publishing Company (1998): 147-157.
  2. ^ Wiley, Andrea & Allen, John (2009) Medical Anthropology: A Biocultural Approach. New York: Oxford University Press.
  3. ^ Rubel, Arthur J. (1964) The Epidemiology of a Folk Illness: Susto in Hispanic America. Understanding and Applying Medical Anthropology. [compiled by] Peter J. Brown. Mountain View, CA: Mayfield Publishing Company (1998): 147-157.
  4. ^ Kleinman, A.
    (1976) Culture, illness and care: Clinical lessons from anthropologic and cross-cultural research". Annals of Internal Medicine, 88:251-258.
  5. ^ Launer, John (2003) Folk Illness and Medical Models. QJM: An International Journal of Medicine. Volume 96(11): 875-876.
  6. ^ Rubel, Arthur J. (1964) The Epidemiology of a Folk Illness: Susto in Hispanic America. Understanding and Applying Medical Anthropology. [compiled by] Peter J. Brown. Mountain View, CA: Mayfield Publishing Company (1998): 147-157
  7. ^ Rubel, Arthur J. (1964) The Epidemiology of a Folk Illness: Susto in Hispanic America”. Understanding and Applying Medical Anthropology. [compiled by] Peter J. Brown. Mountain View, CA: Mayfield Publishing Company (1998): 147-157
  8. ^ Wiley, Andrea & Allen, John (2009) Medical Anthropology: A Biocultural Approach. New York: Oxford University Press.
  9. ^ Munger, Ronald G. (1987) "Sudden Death in Sleep of Laotian-Hmong Refugees in Thailand: A Case-Control Study." American Journal of Public Health. Volume 77(9): 1187-1190.
  10. ^ Doyle, Larry. (January 11, 1987). "Medical Experts Seek Clues to 'Nightmare Deaths' That Strike Male Asian Refugees" United Press International
  11. ^ Adler, Shelley R. (1991) "Sudden Unexpected Nocturnal Death Syndrome among Hmong Immigrants: Examining the Role of the "Nightmare"." The Journal of American Folklore, Vol. 104, No. 411 (Winter, 1991), pp. 54-71
  12. ^ Munger, Ronald G. (1987) "Sudden Death in Sleep of Laotian-Hmong Refugees in Thailand: A Case-Control Study." American Journal of Public Health. Volume 77(9): 1187-1190.