Location, Location, Location


Any realtor will tell you it’s all about location, and any psychologist worth their salt won’t disagree. In fact, there are many surprising ways in which mental illnesses are affected by geography. Recently we’ve discussed a few different risk factors for schizophrenia that are location-based; urban residence and immigrant status are both correlated to schizophrenia risk. In fact, even the presentation of schizophrenia differs geographically. While European patients tend to have delusions of poisoning or religious guilt, Japanese patients are more affected by delusions of slander. Despite these differences, schizophrenia is generally recognized to appear throughout the world. This isn’t true of every mental illness.

A culture-bound syndrome is defined by the DSM-IV as “a recurrent, locality-specific pattern of aberrant behavior and troubling experience.” Basically, these are mental illnesses that you can only get if you live in a certain place. The DSM-IV listed 26 such culture-bound syndromes including the Korean Hwabyeong, and “falling-out”, which is found only in the southern United States. While the location specificity makes all of these illnesses interesting, some jump out in particular, like Southeast Asia’s koro, in which individuals suffer from the overpowering belief that his or her genitals are retracting and will disappear.

Another such disease is found primarily in Nigeria, and is known as “brain fag syndrome” (BFS), where “fag” is short for “fatigue”. Symptoms of BFS are cognitive impairments, sleep issues, pain and burning sensation in the head and neck, and limited aphasia; BFS is found almost exclusively in students and apprentices, especially those receiving a western education. These symptoms can be debilitating enough that they delay the studies of patients for years.

There are many theories as to the origin of BFS. One of the most prevailing is that BFS could be primarily attributed to culture shock. The theory is that being taught in a western-style education system is just so culturally different from everyday Nigerian life that it drives stress levels too high. It has also been more recently discovered that almost 50% of BFS sufferers use stimulants in an attempt to improve their studying. So basically, it’s possible that BFS is a combination of culture shock and drug use.

This actually brings us back to schizophrenia, and in particular, the immigration risk factor. If culture shock is so stressful that living in another culture part-time could cause a mental disorder, imagine what full immigration would cause. What if a hypothetical person, let’s call him Mark, were to move from a high-performing, high-stress, relatively urban college environment in the US to a hippy commune in rural British Columbia. In addition, let’s say Mark is a recreational cannabis-user, who sometimes dabbles in harder drugs. All of a sudden, Mark seems like he’s asking for a mental disorder. Obviously there are other significant risk factors like genetics, but the power of location should not be underestimated.


A.D.A.M. (2013, March 8). Times Health Guide: Schizophrenia. The New York Times .

Guarnaccia, P. J., & Rogler, L. H. (1999). Research on Culture-Bound Syndromes: New Directions. American Journal of Psychiatry , 156, 1322-1327.

Ola, B., Morakinyo, O., & Adewuya, A. (2009). Brain fag Syndrome – a myth or a reality. African Journal of Psychiatry (12), 135-143.

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