Djinnati syndrome: Symptoms and prevalence in rural population of Baluchistan (southeast of Iran)
Introduction
The world in which we live has changed in many ways and understanding the psychological disorders requires local psychological studies. Without awareness of the psychology of people in their cultural context, we will not be able to understand the ideology and the reason behind people's actions (Bhawuk, 2011). Therefore, psychotherapeutic approaches should consider patients’ social, ethnic and cultural background. Providing cross-cultural psychotherapy is the major concern of the therapists who tend to treat patients with diverse backgrounds (Tseng and Streltzer, 2004) Obviously, considering cultural factors in assessing people with mental disorders and understanding their subjective experiences must be followed by accurate diagnosis, access to appropriate care, and effective treatment (Lim, 2006). If culture-bound syndromes are not studied, discussing and commenting on cultural explanations of diseases will remain incomplete. Culture-bound syndromes can be assessed as a cluster of symptoms and behaviors that are regarded as a disorder in the culture of a group, and usually affect the subject who belongs to that group (American Psychiatric Association, 2000, Spiegel et al., 2011). According to DSM-IV (American Psychiatric Association, 2000) a culture-bound syndrome is considered as a pattern specific to a location (culture), and a repetition of an abnormal behavior and troubling experience that may or may not depend on a particular DSM-IV diagnostic category. Most of these syndromes have been initially reported as problems specific to a particular culture or have a geographical origin (Shiraev and Levy, 2004). Many culture-bound syndromes are considered as dissociative disorders. Some examples of culture-bound syndromes/dissociative disorders include amok, bebainan, latah, pibloktoq, ataque de nervios and possession, shin-byung, enchantment, lack of spirit, and Zar (Gold et al., 2006, Spiegel et al., 2011). The main feature of dissociative disorders is a disruption in the “usually integrated functions of consciousness, memory, identity or perception of the environment. This rupture may occur suddenly or gradually, and it may be transient or chronic,” and includes depersonalization disorder, dissociative amnesia, dissociative fugue, dissociative identity disorder, dissociative disorder NOS (American Psychiatric Association, 2000, Spiegel et al., 2011). Janet, the French physician, used the term “dissociation” (de'sagre’gationmentale) to describe the cases where there seemed to be a lack of relationship between some parts of the nervous system that are normally associated (Kazdin, 2000, Spiegel et al., 2011).
Trance possession disorder is one of the dissociative disorders which is classified as dissociative disorder not otherwise specified (NOS) in DSM-IV-TR (American Psychiatric Association, 2000), dissociative trance disorder is a single or periodic disturbance in the state of consciousness, identity or memory that is indigenous to some specific areas or cultures. Possession trance is the common feeling of the personal identity or a new identity that is referred to the impact of the spirit, force, God, or someone else and is associated with stereotyped involuntary movements and is perhaps the most common dissociative disorder in Asia (American Psychiatric Association, 2000, Spiegel et al., 2011). Ancient civilizations such as Babylon, Assyria and Mesopotamia in 5000 years ago believed that there are many spirits and creatures that can possess the person and cause mental and physical diseases. Ancient Egyptians believed in the possession and tended to reject the evil spirits (Buckland, 2006). Researchers have reported their observations of the state of possession from various regions like Siberia (Korolenko and Muhamedzanov, 2001), India (Shanmugam, 1981), Singapore (Kua et al., 1986), Egypt (Nelson, 1971), New Guinea (Salisbury, 1968), Ceylon (Obeyesekere, 1970), South America (Pineros et al., 1998), and Iran (Bakhshani and Kianpoor, 1998). In Northeast Africa and Middle East, Zar has been reported as a common culture-bound possession syndrome (Grisaru et al., 1997, Kianpoor and Rhoades, 2006, Saedi, 1975). The states of inspired trance or possession trance in 90% of countries have been reported in a large global sample (Bourguignon, 2008) quoted by (Shiraev and Levy, 2004).
“Djinnati” is a culture-bound possession syndrome based on clinical observations in Baluchistan (Iran) that has been first reported by (Bakhshani and Kianpoor (1998). During the possession period, the subject introduces themselves with another identity called “Djinn”, the person who has possessed the patient and his/her thoughts (Bakhshani and Kianpoor, 1998, Kianpoor and Rhoades, 2006). In addition to Djinn, people in Baluchistan believe another type of possession: possession of fairy. According to a reports by During et al. (2011), until today, current prevalence and lifetime of dissociative trance disorder have not been studied in the Western countries or non-Western countries and no systematic study has been conducted on the general and psychiatric populations. Thus, the actual prevalence of these disorders is unknown. Although some investigations have been initially conducted on the “Djinnati” disorder as a dissociative trance disorder, to best of our knowledge, no systematic studies have been conducted on the prevalence of “Djinnati” syndrome and its symptoms in Iran and other countries.
Dissociative trance disorder may be confused with another mental disease when the therapists are not familiar with the cultural traditions of an individual with a particular ethnicity. Therefore, this study aimed to explore prevalence of “Djinnati” syndrome and its common symptoms and sign among rural population of Iran (Baluchistan region). We hope the results of the current study can be useful in the differential diagnosis and treatment of this disorder.
Section snippets
Methods
This cross sectional study conducted in 2011–2012 in rural areas of Baluchistan (southeast Iran) region. The study included 4129 (2101 male and 2028 female) permanent residents (who lived in the areas) aged 15–60 years. The participants were selected using a multistage random sampling technique. In the first stage, three out of 6 main cities of Baluchistan region were selected by simple random sampling technique. In the second stage, 3 rural areas of three cities were selected randomly.
Results
In this study, 21 (female) patients aged 15–60 were diagnosed with “Djinnati” syndrome, the highest frequency (38.1% of patients) being for those aged 20–30.
The average age was 35.76 and SD was 13.87. Table 1 shows the frequency distribution of people with Djinnati syndrome by gender, marital status and education level.
Table 2 shows the mean (SD) scores on the DES questionnaire for patients with “Djinnati” syndrome and the control sample. There is a significant difference (t = 6.9; P = 0.0001)
Discussion
Initially, we had 24 people participants who reported symptoms of Djinnati. However, further clinical interviews revealed that three of them had epilepsy. Therefore, only 21 patients had the diagnosis of Djinnati syndrome in current study. All participants with Djinnati were female and no case of this syndrome was observed in men. The prevalence of Djinnati was 0.5% in rural population aged 15–60 years and in the female population is 1.03%.
In a study on 30 villages in Southern Karnataka, India,
Contributors
All authors co-designed the study and wrote the manuscript. Dr. Bakhashani supervised the data gathering analyzed the data and edited final format of article. Mrs. Hosseinbore reviewed the literature and collected the data.
Conflict of interest
There is not any conflict of interest.
Funding
This research was supported in part by Zahedan University of Medical Sciences and Marvedasht Center of Sciences and Research – Azad University.
Acknowledgements
We would like to thank all participants in the study and their families, local healers, the staff of health centers for their support and help. We, also, are extremely grateful to Samaneh Babaei, Dr. Mahnaz Nowrozi Mousavi and Dr. Sadjadi for their help to write and edit the final article and Dr. M. Hosseinbore who helped us in examining the participants.
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