Robert Bartholomew will not, on the strength of this book, ever be accused of neglecting primary sources. Exotic Deviance, a survey of errant behaviours and 'epidemics' - from latah and koro in the East to dancing mania and modern episodes of psychogenic illness in the West - is nothing if not comprehensive. In fact, this less than melodious polemic is almost justified in giving the impression that research in the dubious field of transcultural psychiatry has been conducted by a cabal of tenured gossips and stay-at-home plagiarists, all endlessly recycling the same unsubstantiated rumours.
Take, for example, Bartholomew's claim that the Malaysian phenomenon of latah, a 'conditioned behavioural response' in which older women utter profanities, mimic others and comply to various demands, contains no element of psychopathology. Besides consulting "all known legal and historical accounts of Malayo-Indonesian latah", Bartholomew has recourse to ethnographic observation and interviews conducted among his Malaysian in-laws. This combination of scholarship and on-the-spot reportage reaps its reward. Subject to close attention latah does indeed appear to be an idiom that has been "utilized by marginals, to gain attention and power by temporarily contravening local conduct codes". For Bartholomew it is neither appropriate to speak of sufferers nor to designate latah a condition, a state of trance or dissociation. This lexicon has, he claims, always been tethered to extra-medical objectives.
Politically, significant advantage was to be gained in successfully categorizing latah as a mimetic disorder within British-controlled colonial Malaya. It is conspicuous that the first recorded association of it as a behavioural anomaly occurred during the 1860s, yet written records of latah, without reference to disturbance or disease, appear in traditional Malay texts as early as the fourteenth century. The endemic presence of latah within this region justified the necessity of colonial custodial rule [by the Dutch and the British].
Similarly, Bartholomew asserts that koro, a so-called "culture-bound syndrome" of genital retraction, endemic in China but also found in other parts of South East Asia, has been misrepresented as a hysterical delusion by Western medics. After surveying much of the available literature, Bartholomew concludes that the cases of individual koro occasionally reported in psychiatric journals are far-removed from the collective episodes. While the former may have "physiological or psychiatric origins that, in rare cases, may be exacerbated by folk beliefs", large episodes are social delusions exactly paralleling the fortean catalogue of collective panics sparked by phantom menace:
Virtually all known "victims" of collective koro or koro-like phenomena return to a normal state of health within hours or days after being convinced the "illness" is over or never existed. Cases share a similar range of symptoms, including anxiety, sweating, nausea, headaches, and the koro-related "delusionary" conviction. The appearance of these symptoms per se is not necessarily indicative of psychopathology, as they reflect the spectrum of "normal" physiological responses to extreme anxiety in all cultures.
Exotic Deviance is slightly weaker in its discussion of the medieval dancing manias - especially in relation to tarantism, where Bartholomew cites but draws little more from the work of Italian anthropologist and philosopher Ernesto De Martino - but its criticism of medically-minded scholarship is no less pertinent. "Although some victims may have been epileptics, schizophrenics or hysterics," writes Bartholomew, "the large percentage of the populations affected suggested otherwise." The dancing manias appear, then, to have been in many instances highly ritualised, combining Christian and pagan beliefs. Those attending were not, as is so often suggested, merely "hysterical women". Once again, culture may unlock more than psychology.
Despite the fact that Bartholomew does concede the existence of one bona fide form of exotic illness - namely "collective conversion reaction", whose historical and cultural uniformity suggests "a unitary syndrome involving an abnormal state of psychological health" - he is tireless (sometimes tiresome) in his castigation of the medicalisation of foreign behaviour. One can't help but wonder: is it ever possible to use medical language "innocently", without imposing the insidious weight of the colonialist and racist baggage that Bartholomew detects? Do the benefits and immunities of the modern illness role also explain the native acceptance of medical interpretations of latah and koro? Bartholomew clearly thinks not.
The theoretical scaffolding upon which Exotic Deviance is constructed - an unwieldy "historical phenomenological sociology of knowledge approach' - is at times difficult to navigate, but Bartholomew does nevertheless successfully reveal how cultural ignorance or universalism has led to the mistaken diagnoses of apparently bizarre behaviours. By moving beyond the language of disease, this book moves closer to grasping some of the real motives and sentiments behind these seductively strange and remote episodes.
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