Summary: In an isolated tribe in the interior of Tanzania the authors found that approximately 200 persons among an intake population of 10,000 persons presented at the bush clinic with kifafa, a convulsive seizure disorder that often leads to severe burns in those afflicted. Many of these patients showed parkinsonian symptoms and/or other neurological abnormalities and mental détérioration; there was high mortality. A frequent variant of the disease in children involved head nodding, which was often a precursor of later grand mal seizures. Transient psychotic episodes were seen in approximately 20% of all patients. The clinic patients were followed up to 10 years. The necessarily simple anticonvulsive treatment with phenobarbitone reduced the seizure frequency and intensity in the majority of cases. We shall discuss possible reasons for the high prevalence of seizure disorders in this tribe. Genetic factors appear to be of major importance and are reflected in the demonstrated high family incidence. Genetic analysis of the data does not support chromosomal, multifactorial, X‐linked, or autosomal‐dominant modes of inheritance. Analysis by the Li‐Mantel method indicates that the segregation ratios are compatible with a hypothesis of single autosomal‐recessive inheritance. Clinical and genetic data suggest that a hitherto unknown systemic disease of the central nervous system is highly prevalent in this isolated population. RÉSUMÉ Les auteurs décrivent une maladie convulsivante, le “kifafa” (mot swahili désignant cette affection), observée chez 200 sujets environ appartenant à une tribu isolée de la Tanzanie comportant 10.000 âmes; les porteurs de la maladie souffrent souvent de brulûres graves secondaires à des chutes dans les feux domestiques. Un grand nombre de ces malades ont des symptômes parkinsoniens et/ou d'autres anomalies neurologiques, ainsi qu'une détérioration men tale; le taux de mortalité est élevé. Une variante fréquemment observée chez L';enfant se manifeste sous forme de balancements de la téte qui constituent souvent un signe précurseur des crises de Grand Mai. Des épisodes psychotiques transitoires sont observés dans 20% des cas. Certains malades ont été suivis pendant 10 ans. Un traitement anticonvulsivant nécessairement simple (phénobarbital seul) réduit la fréquence et la gravité des crises chez la plupart des malades. Les auteurs discutent les diverses possibilityés pouvant expliquer L';importante prévalence de la maladie dans cette tribu. L';importance de facteurs génétiques est certaine et explique bien L';incidence familiale particulièrement élevée. L';analyse génétique n'est pas en faveur d'un mode de transmission multifactorial, liéà L';X ou dominant autosomique. Une étude par la méthode de Li‐Mantel montre que les rapports de ségrégation sont compatibles avec L';hypothése d'une hérédité de type récessif autosomique. Ces données cliniques et génétiques démontrent L';existence d'une maladie systémique du système nerveux central jusqu'ici méconnue; cette affection est extrêmement répandu...

The aim of this article is to present a summarizing overview on ethnomedical aspects of koro (in Chinese called suo-yang), the panic anxiety state in which affected males believe that the penis is shrinking and/or retracting, and perhaps disappearing. While reduction of penile volume occurs physiologically due to vasoconstriction in cold temperature and intense anxiety, it is believed in certain cultures that genital shrinking leads to impotence and sterility, and eventually to death. Traditional Chinese medicine treats suo-yang, the reduction of the male principle yang, as a dangerous disturbance of the life-sustaining yin-yang equilibrium of the organism. Koro has therefore been held to be a Chinese “culture-bound” condition. However , the koro phenomenon is also known among diverse ethnic and religious groups in Asia and Africa, typically in cultures in which reproductive ability is a major determinant of a young person's worth. Koro epidemics of panic anxiety due to widespread fears of losing one's genitals, procreative ability, and even one's life, are triggered by rumors of genital disappearance supposedly caused in China by female fox spirits, in Singapore and Thailand by mass poisoning, and in Africa by sorcery, usually in the context of socioeconomic or political tension. Today, in contemporary Western societies, ideas of genital disappearance are not culturally endorsed. But historically, it should be remembered that in the late Middle Ages in Europe, a man could lose his membrum virile through magical attacks by witches. The conclusion is that the psychological disappearance of the penis is a universal syndrome that was described recently in Asia and Africa and already in Medieval Europe.

This article reviews traditional non-Western approaches to the treatment and prevention of substance abuse and dependence. Therapeutic practices reported here are based on Buddhist, Taoist, Hindu, Islamic and shaman ic traditions as well as on syncretistic Christianized folk beliefs. Traditional practitioners operate outside the official health care system but in some areas in collab oration with it. Analysis of these practices reveals general principles of traditional healing and permits hypotheses on the advantages and disadvantages of traditional approaches.

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Emil Kraepelin, well known as the principal designer of modern psychiatric nosology, is less well known for his pioneering work in comparative sociocultural psychiatry. This paper is trying to document Kraepelin's role as the inaugurator of systematic investigations into culture-dependent differences in psychopathology. Despite his many responsibilities as clinician, teacher, hospital administrator and scientific author, Kraepelin considered cross-cultural comparison of such importance that he spent considerable time on the preparation of then very cumbersome overseas expeditions. His first research journey in 1904 to Southeast Asia led to the programmatic formulation of comparative psychiatry as a scientific endeavour designed to contribute to the better understanding of psychopathological processes and to a comprehensive comparative ethnopsychology ("Voelkerpsychologie"). Kraepelin's main cross-cultural research project, planned to extend to seven non-European countries and to involve many foreign colleagues, was prevented by World War I and postwar complications. One year before his unexpected death, Kraepelin conducted comparative studies with American Indian, Afro-American and Latin American patients at psychiatric institutions in the United States, Mexico and Cuba in 1925. In his writings Kraepelin commented on certain differences in the incidence and presentation of psychopathological phenomena that he considered to be due to ethnic-cultural characteristics or social conditions. This paper discusses in detail Kraepelin's observations on the pathoplastic and pathogenic effects of cultural and social factors, and demonstrates the influence of his ideas on the development of modern social and transcultural psychiatry.