When culture, religion, and mental illness collide

There was an interesting article the other day in the magazine Psychiatric Times about OCD in Egyptian Adolescents. Much of the article discussed how religion and culture can affect the manifestations of OCD, and I found these effects fascinating.

Writes psychiatrist Ahmed Okasha:

Previous Egyptian studies on psychiatric phenomenology have shown a prevalence of culturally determined symptomatology, where religion and prevailing traditions seemed to color not only the clinical picture of the condition, but also patients' attitudes about their disorder...The role of religious upbringing has been evident in the phenomenology of OCD in Egypt. The psychosociocultural factors are so varied that they can affect the onset, phenomenology and outcome of OCD. They can even affect response to treatment. The emphasis on religious rituals and the warding-off of blasphemous thoughts through repeated religious phrases could explain the high prevalence of religious obsessions and repeating compulsions among our Egyptian sample...The female gender is surrounded by so many religious and sexual taboos that the issue becomes a rich pool for worries, ruminations and cleansing compulsions in women susceptible to developing OCD.

(Emphasis mine)

It was the last sentence that really struck me, because it shows how culture impacts the expression of mental illness, and it enables us to look at the interplay without pointing fingers.

Here at ED Bites, I write a lot about biology. I spent much of my life in training to become a biologist of one sort or another, and I loves me some interesting science. This explains some of my emphasis on the biology of eating disorders (old habits die hard...), and some of the emphasis stems from the fact that the biological issues are, in general, much less discussed in popular media than the cultural aspects. This doesn't mean that I think culture is irrelevant; far from it. Your culture and your environment has a profound impact on who we become and what illnesses we may or may not have.

The religious atmosphere in Egypt doesn't cause OCD, but it does influence the content of your obsessions and compulsions, and the meaning you may attribute to them. Could living in a world where religious rituals reign supreme make you more likely to develop OCD? Perhaps. As Okasha points out, these rules certainly make a fertile feeding ground for ruminations and worries. And to someone susceptible to developing OCD, these feeding ground doesn't need much fertilizer for an obsession to grow.

I wish there were more articles looking at the intersection of culture and eating disorders in this way. In the stereotypical newspaper article about the pressure to be thin or dieting celebrities, these pressures are equated with causing eating disorders. And while that's not exactly true, that doesn't mean that culture is completely irrelevant. It appears that cultures where there has been less emphasis on the thin ideal, non-fat phobic anorexia appeared to be much more common than the Western fat phobic type. That doesn't mean there isn't a biological basis for body image distortion and fat phobia, just that it is only expressed under certain conditions. Recent research from Hong Kong has shown that as China has increasingly adopted Western ideas of weight control, the proportion of people suffering from fat phobic anorexia has also increased (Lee et al, 2009).

You can't win the fight of nature vs. nurture because it isn't a fight at all. That's just not how it works. Nature and nurture each have their push and pull on who we become, but it's not a tug of war and winner takes all. It's more of a dance, with both Nature and Nurture taking the lead at different times. If only this could explain why the heck I have two left feet...

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Anonymous said...

Hi, i'm a long-time reader, first time commenter, and I just wanted to say THANK YOU for your amazing journal. I'm a 16-year-old girl battling through ED, and I find that your posts are some of the most inspiring and intelligent ones related to this topic on the internet. As a wannabe future physicist / scientist myself, I find that your viewpoint of ED from a completely logical perspective to be really helpful, as it takes out the emotion and frustration from the disorder, allowing one to see it as it is. It is a delight to see my google reader box light up with one of your posts, and I just feel I need to say a ginormous THANK YOU. :)
Best wishes,

Carrie Arnold said...


Thanks for your lovely comment- I'm glad you find my blog helpful. And yay for future girl scientists! Although I mostly write about science now, I still love the field and the process.

As a side note, your name brings a smile to my face because my favorite books when I was little were the Madeleine books, and I still have bits and pieces memorized (I also read them to the girls I baby-sat for!).


KristineM said...

I have been interested in the cultural aspects of mental illness for a long time. After I read your post I went directly to a file in which I have a few articles that I ripped out of newspapers and magazines, before I was reading internet media. I immediately found an article from the NYT magazine dated May 6, 2001 called "Regional Disturbances, case study: lata, location: Borneo, Malaysia." The sub-header says "Americans get anorexia, Nigerians get 'brain fag', Malaysians suffer from 'hyperstartle syndrome'. How culturally specific is mental illness? Here is the link http://www.nytimes.com/2001/05/06/magazine/06LATAH.html?scp=1&sq=Regional%20Disturbances%20anorexia&st=cse It is a fascinating article.

Anonymous said...

Hi! Great blog! I was searching for Okasha's article and came across your blog posting. The article was originally published in 2004 in PSYCHIATRIC TIMES, although perhaps they've republished it. (Someone E-mailed me the article as scanned images a few years ago and I'm glad to find that PSYCHIATRIC TIMES now has it on their web site in textual form.)

The subject of some forms of OCD being culture- and/or religion-related was addressed by Dr. Lee Baer in his book, THE IMP OF THE MIND, where the imp in your mind chooses an obsession that will bother you the most. As Dr. Baer says in his book:

"Why has this chapter focused on the religious obsessions of Christians? ... Do Jews, followers of Islam, and members of other organized religions have religious obsessions like these? Yes, although they often take a different form ...

"Apparently, in religious bad thoughts, as with all others, the Imp of the Perverse operates in his usual way, tormenting the sufferer with bad thoughts of doing whatever the surrounding culture considers the most inappropriate thing he or she could possibly do. Since what is considered most inappropriate varies from culture to culture and religion to religion, so do the thoughts the imp seizes upon to cause his mischief."

In Christianity, religion-related OCD is usually called scrupulosity. Martin Luther suffered from it - see my web page on OCD and religion, which also has links to information on OCD in Judaism and Islam.

Keep up the good work on your blog!

tuxedo suit said...

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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