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Resurgence of Koro: Perception of mankind
Asian Journal of Psychiatry 4 (2011) 153–154
Contents lists available at ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Letter to Editor Resurgence of Koro: Perception of mankind
Sir, Koro is a culture bound syndrome prevalent for the past century in south-east Asian countries. It first appeared in the form of an epidemic affecting the Chinese in 1865 (Mattlelaer and Jilek, 2007). The epidemics at Singapore in 1967 (Ng, 1997) and North Bengal in 1982 (Chowdhury et al., 1988) are noteworthy of mention in the history of Koro. It has various names like ‘Suoyang’ in China (Bernstein and Gaw, 1990), ‘Jhinjhini bimari’ or ‘Kattao’ in India (Chowdhury and Bagchi, 1993), and ‘Rok Joo’ in Thailand (Ungvari and Mullen, 1994). The massive outbreak of Koro in the central, northern and southern districts of West Bengal, India in 2010 reached epidemic proportions over the past two months and sent clinicians, civic officials and researchers helter-skelter. The splurge of ‘disco’ as colloquially termed by laymen occurred following major festivals in the month of October, 2010. The Hindus celebrated the auspicious Durga Puja while the Muslim community enjoyed the holy Id-Ul-Fitr. The migrant labourers had just returned to their place of employment while others were preparing to take reins of their previous work schedule. Varied age groups suffered from the ‘deadly’ disorder sending ripples of panic not only in numerous villages but also victimising the metropolis of Kolkata whereby individuals ran from pillar to post seeking remedy. Better known as ‘mass hysteria’ (Chowdhury and Brahma, 2005) Koro has created a dilemma in the minds of researchers regarding its sudden volcano like eruption. Unlike previous outbreaks with a male preponderance, the present episode had a significant female population complaining of retraction of breasts with fear of impending death or doom. Likewise, the male counterparts presented with tingling sensation all over their body associated with retraction of the penis. Few complained of heat emanating from the body with rise in body temperature. Children as young as 7 years of age to the elderly in their seventies have been struck with ‘disco’, the prelude being news of Koro circulating amongst friends and peer groups in the neighbourhood or work place. The interval between hearing the news and actual presentation by the affected individual was approximately 24–72 h. The rural mass had overvalued ideas of retracting penises which was being shared by others; even delusions were noted in a few victims. The anxiety precipitated was so intense that the victims, on advice of seniors and colleagues, jumped into nearby ponds and remained submerged together in neck or waist-deep water for hours until the symptoms receded. They avoided medical assistance for fear of death. Rather, the villagers preferred adherence to sacred folkmedicine. Those who failed to achieve this sort of therapy had buckets of water poured on them. However, villagers who could not be cured with folk-medicine had to resort to medical assistance with anxiolytics and antipsychotics. The unaffected 1876-2018/$ – see front matter ß 2011 Elsevier B.V. All rights reserved. doi:10.1016/j.ajp.2011.04.005
mass put on amulets containing decorticated seeds of bottlegourd sold by priests and exorcists. Most men and women in villages applied a sludge of lime on their arms, forehead and ear lobules as a preventive measure. In sharp contrast, the educated masses turned up in emergency units and Medicine out-patient departments with symptoms of anxiety. Few required hospitalisation due to complaints of panic related episodes and loss of consciousness. The disease manifestation took a wild turn when city inhabitants of Kolkata were caught unawares and civic authorities sent special medical personnel to provide assistance to those affected. An acute anxiety was perceived by the individuals as death seemed inevitable owing to the loss of the symbol of manhood. They could not cite the cause of the mystery of the disappearing penis but there was a palpable tension in the masses of becoming afflicted. Physical examination did not reveal a retracted penis; instead, any injury or damage caused to the penis was due to overzealous attempts at preventing retraction. Medically, patients were treated with low dose anxiolytics, some needed SSRI’s but use of antipsychotics was grossly not indicated. Associated with this all were counselled thoroughly regarding false beliefs they harboured because anatomically the genitals cannot shrink or retract in the manner typically feared. Overall, the total duration of this episode of Koro persisted for a period of two months, with complete resolution of symptoms and no residual effects in any of the affected individuals. The most interesting part of the outbreak is that the cause and effect of Koro is still shrouded in mystery; individuals remain completely unaware of the cause of the sudden explosion and the very sudden recession. They have perceived it as a miraculous phenomenon created by ‘Allah’ or ‘The Almighty’ which has occurred due to some wrongdoings or misgivings in their daily life. To prevent further recurrences the village leaders urged the folks to pray and read the holy ‘Koran’. The aftermath of the disaster has taken a serious toll on the civic authorities and mind of the researchers providing newer directions of study. The characteristic help seeking attitudes and the management profile define Koro as a cultural phenomenon with a definite psychopathology and peculiar perception by those afflicted. Contributors Mausumi Sinha designed the study, wrote the protocol, analysed the events and drafted the final manuscript. Role of funding source Not applicable. References Bernstein, R.L., Gaw, A.C., 1990. Koro: proposed classification for DSM-IV. Am. J. Psychiatry 12 (12), 1670–1674.
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Letter to Editor / Asian Journal of Psychiatry 4 (2011) 153–154
Chowdhury, A.N., Bagchi, D.J., 1993. Koro in heroin withdrawal. J. Psychoactive Drugs 25 (27), 257–258. Chowdhury, A.N., Brahma, A., 2005. An epidemic of mass hysteria in a village in West Bengal. Indian J. Psychiatry 47 (2), 106–108. Chowdhury, A.N., Pal, P., Chatterjee, A., Roy, M., Das Chowdhury, B., January 1988. Analysis of North Bengal Koro epidemic with three years follow-up. Indian J. Psychiatry 30 (1), 69–72. Mattlelaer, J.J., Jilek, W., 2007. Sexual medicine history: Koro-the psychological disappearance of penis. J. Sex. Med. 4 (5), 1509–1515. Ng, B.Y., 1997. History of Koro in Singapore. Singapore Med. J. 38 (8), 356–357. Ungvari, G.S., Mullen, R.S., 1994. Koro: the delusion of penile retraction. Urology 43, 883–885.
Mausumi Sinha* Department of Psychiatry, R.G.Kar Medical College, Kolkata, 700004 West Bengal, India *Tel.: +91 9830062350; fax: +91 3324399452 E-mail address: [email protected] (M. Sinha). 1 January 2011
Contents lists available at ScienceDirect
Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp
Letter to Editor Resurgence of Koro: Perception of mankind
Sir, Koro is a culture bound syndrome prevalent for the past century in south-east Asian countries. It first appeared in the form of an epidemic affecting the Chinese in 1865 (Mattlelaer and Jilek, 2007). The epidemics at Singapore in 1967 (Ng, 1997) and North Bengal in 1982 (Chowdhury et al., 1988) are noteworthy of mention in the history of Koro. It has various names like ‘Suoyang’ in China (Bernstein and Gaw, 1990), ‘Jhinjhini bimari’ or ‘Kattao’ in India (Chowdhury and Bagchi, 1993), and ‘Rok Joo’ in Thailand (Ungvari and Mullen, 1994). The massive outbreak of Koro in the central, northern and southern districts of West Bengal, India in 2010 reached epidemic proportions over the past two months and sent clinicians, civic officials and researchers helter-skelter. The splurge of ‘disco’ as colloquially termed by laymen occurred following major festivals in the month of October, 2010. The Hindus celebrated the auspicious Durga Puja while the Muslim community enjoyed the holy Id-Ul-Fitr. The migrant labourers had just returned to their place of employment while others were preparing to take reins of their previous work schedule. Varied age groups suffered from the ‘deadly’ disorder sending ripples of panic not only in numerous villages but also victimising the metropolis of Kolkata whereby individuals ran from pillar to post seeking remedy. Better known as ‘mass hysteria’ (Chowdhury and Brahma, 2005) Koro has created a dilemma in the minds of researchers regarding its sudden volcano like eruption. Unlike previous outbreaks with a male preponderance, the present episode had a significant female population complaining of retraction of breasts with fear of impending death or doom. Likewise, the male counterparts presented with tingling sensation all over their body associated with retraction of the penis. Few complained of heat emanating from the body with rise in body temperature. Children as young as 7 years of age to the elderly in their seventies have been struck with ‘disco’, the prelude being news of Koro circulating amongst friends and peer groups in the neighbourhood or work place. The interval between hearing the news and actual presentation by the affected individual was approximately 24–72 h. The rural mass had overvalued ideas of retracting penises which was being shared by others; even delusions were noted in a few victims. The anxiety precipitated was so intense that the victims, on advice of seniors and colleagues, jumped into nearby ponds and remained submerged together in neck or waist-deep water for hours until the symptoms receded. They avoided medical assistance for fear of death. Rather, the villagers preferred adherence to sacred folkmedicine. Those who failed to achieve this sort of therapy had buckets of water poured on them. However, villagers who could not be cured with folk-medicine had to resort to medical assistance with anxiolytics and antipsychotics. The unaffected 1876-2018/$ – see front matter ß 2011 Elsevier B.V. All rights reserved. doi:10.1016/j.ajp.2011.04.005
mass put on amulets containing decorticated seeds of bottlegourd sold by priests and exorcists. Most men and women in villages applied a sludge of lime on their arms, forehead and ear lobules as a preventive measure. In sharp contrast, the educated masses turned up in emergency units and Medicine out-patient departments with symptoms of anxiety. Few required hospitalisation due to complaints of panic related episodes and loss of consciousness. The disease manifestation took a wild turn when city inhabitants of Kolkata were caught unawares and civic authorities sent special medical personnel to provide assistance to those affected. An acute anxiety was perceived by the individuals as death seemed inevitable owing to the loss of the symbol of manhood. They could not cite the cause of the mystery of the disappearing penis but there was a palpable tension in the masses of becoming afflicted. Physical examination did not reveal a retracted penis; instead, any injury or damage caused to the penis was due to overzealous attempts at preventing retraction. Medically, patients were treated with low dose anxiolytics, some needed SSRI’s but use of antipsychotics was grossly not indicated. Associated with this all were counselled thoroughly regarding false beliefs they harboured because anatomically the genitals cannot shrink or retract in the manner typically feared. Overall, the total duration of this episode of Koro persisted for a period of two months, with complete resolution of symptoms and no residual effects in any of the affected individuals. The most interesting part of the outbreak is that the cause and effect of Koro is still shrouded in mystery; individuals remain completely unaware of the cause of the sudden explosion and the very sudden recession. They have perceived it as a miraculous phenomenon created by ‘Allah’ or ‘The Almighty’ which has occurred due to some wrongdoings or misgivings in their daily life. To prevent further recurrences the village leaders urged the folks to pray and read the holy ‘Koran’. The aftermath of the disaster has taken a serious toll on the civic authorities and mind of the researchers providing newer directions of study. The characteristic help seeking attitudes and the management profile define Koro as a cultural phenomenon with a definite psychopathology and peculiar perception by those afflicted. Contributors Mausumi Sinha designed the study, wrote the protocol, analysed the events and drafted the final manuscript. Role of funding source Not applicable. References Bernstein, R.L., Gaw, A.C., 1990. Koro: proposed classification for DSM-IV. Am. J. Psychiatry 12 (12), 1670–1674.
154
Letter to Editor / Asian Journal of Psychiatry 4 (2011) 153–154
Chowdhury, A.N., Bagchi, D.J., 1993. Koro in heroin withdrawal. J. Psychoactive Drugs 25 (27), 257–258. Chowdhury, A.N., Brahma, A., 2005. An epidemic of mass hysteria in a village in West Bengal. Indian J. Psychiatry 47 (2), 106–108. Chowdhury, A.N., Pal, P., Chatterjee, A., Roy, M., Das Chowdhury, B., January 1988. Analysis of North Bengal Koro epidemic with three years follow-up. Indian J. Psychiatry 30 (1), 69–72. Mattlelaer, J.J., Jilek, W., 2007. Sexual medicine history: Koro-the psychological disappearance of penis. J. Sex. Med. 4 (5), 1509–1515. Ng, B.Y., 1997. History of Koro in Singapore. Singapore Med. J. 38 (8), 356–357. Ungvari, G.S., Mullen, R.S., 1994. Koro: the delusion of penile retraction. Urology 43, 883–885.
Mausumi Sinha* Department of Psychiatry, R.G.Kar Medical College, Kolkata, 700004 West Bengal, India *Tel.: +91 9830062350; fax: +91 3324399452 E-mail address: [email protected] (M. Sinha). 1 January 2011