From the May 2016 issue of The Rotarian
Over the years, I have regurgitated my share of dodgy dishes eaten on the road. I have had my appendix removed in a Tanzanian hospital. I have watched helplessly, imagining the discovery of my shriveled corpse, as my blood pooled on the floor of a guesthouse room in Borneo after I pulled a leech off my ankle. I know that the last place you want to end up while traveling is in the hospital.
Yet, apart from the usual bodily afflictions that come with travel, even stranger maladies prey on our minds when we are abroad. Less well understood than their bacterial counterparts, these are what some scientists call “traveling pathologies.” I first came across them while researching cultural syndromes for my book, The Geography of Madness.
Cultural syndromes are things like ode ori, a condition found among the Yoruba people in Nigeria in which sufferers feel as though something is crawling through their head or another part of their body. In Japan, young people with hikikomori refuse to leave their rooms for years and cannot draw the face of their mother. In Bikaner, in northern India, people who come down with Gilhari syndrome feel as though a lizard has lodged itself under their skin and is slowly making its way toward their windpipe.
The list is long and colorful and controversial. Some Western scientists consider these to be local versions of universal conditions. Other people, including me, think they are inextricable from the place from which they emerge – that they are caused by an interaction between culture and biology. That’s why Americans have panic attacks with palpitations, tingling, trembling, and fear of “going crazy,” while Cambodians have “wind attacks,” a fear that the blood vessels in their neck will explode from accumulating too much wind. Both are related to anxiety. Both are shaped by culture.
In the 1970s and ’80s, an Italian psychiatrist named Graziella Magherini began to make note of tourists who came to Florence and, while viewing great works of art, experienced a mental breakdown. Often, they had to be put on a stretcher and taken to a psychiatric hospital. Magherini looked at 106 such cases and labeled the condition “Stendhal syndrome,” after the French novelist who described having such an experience in a Florence basilica. Russian writer Fyodor Dostoevsky may have had a similar affliction.
According to Magherini, such a breakdown is caused by the power of art over people who are psychologically vulnerable or by “coming into contact with great works of art without the mediation of a professional guide,” as one paper on the syndrome described it. That may be the case. But such experiences are not unique to Italy, regardless of the power of its art. Rather, I suspect there was a greater power at work, one the victims brought with them: the power of their own expectations.
A similar condition has affected some Japanese tourists in Paris. Researchers observed that in Japan, “Paris has, and holds, a quasi-magical power of attraction because the city is considered a symbol of European culture.” Besides the normal stresses of travel and the vast cultural differences, the authors noted that “disappointment linked to contact with the everyday reality [of Paris] is a factor of incomprehension and anxiety, but also of disenchantment and depression.” This was dubbed “Paris syndrome” by the media.
Paris syndrome is often mentioned in connection with Jerusalem syndrome, in which some visitors to the holy city have a psychotic break and are overcome by “the need to scream, shout, or sing out loud psalms, verses from the Bible, religious hymns, or spirituals.” Others channel characters from the Bible. Some of these people have pre-existing psychiatric conditions, but many do not. These latter types “possess an idealistic subconscious image of Jerusalem [and] … are unable to deal with the concrete reality of Jerusalem today.” Researchers consider the outbursts “an attempt to bridge the gap between these two representations of Jerusalem.”
In China in the 1990s, another traveling pathology was noted among passengers who rode overcrowded trains across the country and who sometimes began to hallucinate and attack fellow riders. Psychiatrists called this lutu jingshenbing or “traveling psychosis.” Continental Europe in the 19th century saw patients who entered a “fugue,” wandering sometimes hundreds of miles with no memory of where they had been. Cases multiplied after a Frenchman named Jean-Albert Dadas was diagnosed with the disorder in 1886, but later died down.
Like cultural syndromes, traveling pathologies are not simple biochemical breakdowns. Rather, they are the result of many factors, including a mix of our experience and our belief about it. They emerge from the space between our hopes and our reality, between the experience we expected and the one we actually have. Sometimes, for some people, that gulf is too great.
Cultural syndromes operate on the same principles: We all have a certain understanding of how things are supposed to go, about the possible chains of events stretching out into the future. If this, then that. Our world is built on presumed cause and effect, on carefully ordered stories from our so-called cultural scripts.
These teach us not only what happens, but why. Between the events, we see the cause, be it chemistry or God or wind or luck. We believe in these things, and our beliefs affect us in powerful ways. When they’re not making us, they can break us.
That’s why when I travel, even though I am wary of malaria and E. coli and organ failure, this other fear also lurks. Our own culture is often invisible until we leave it and find ourselves grasping for a rope. If I go to Cambodia, I can’t come down with a wind attack, because we are immune from the syndromes of other cultures. But I know I can never be immune from my own. Wherever you go, you bring a world with you.
Frank Bures is a frequent contributor to The Rotarian. His book, The Geography of Madness, was published last month.