Two Nigerian psychiatrists, both based in London, have called for
the diagnosis of ‘brain fag’ to be expunged from the new edition of
the psychiatrists’ diagnostic bible –
Diagnostic and Statistical
Manual of Mental Disorders (DSM-V) –due to be published early
next year.
Dr Chiedu Obuaya, a Registrar at Chase Farm
Hospital, Enfield, and Dr Oyedeji Ayonrinde, who works at Bethlem
Royal Hospital, told delegates at the Royal College of
Psychiatrists’ Annual Meeting that the term was widely used in
texts and diagnostic manuals to describe overworked West African
students.
Symptoms attributed to the ‘condition’ include
the loss of ability to concentrate, learn and think, and is usually
accompanied by blurred vision and pain, pressure or tightness
around the head or neck.
Brain fag is a ‘culture-bound syndrome’, one
of hundreds of mental health conditions produced by a particular
social environment. DSM-IV have added an appendix in its fourth
edition listing various ‘culture-bound syndromes’.
Dr Obuaya said: “Every time the diagnostic
manuals are revised a lot of the definitions and diagnostic
criteria for different mental illnesses are rigorously evaluated.
The culture-bound syndromes are colourful and exotic and something
students tend to revise for their exams.
“But they are just cut and pasted into the new
editions and they don’t undergo any level of scrutiny. No-one is
looking at whether they are relevant today. All were described a
long time ago in a colonial context and there is poor scientific
evidence for a lot of them. We were interested in brain fag, but
all of them need to be scrutinised. We are in 2008 and need to ask
ourselves if culture bound syndromes are relevant to modern-day
psychiatry.”
The two psychiatrists carried out manual and
electronic searches to find the origins of ‘brain fag’. They found
the term in eighteenth, nineteenth and twentieth century scientific
literature and evidence from contemporary newspapers of brain fag
in Britain, the United States and Australia. Newspapers and
magazines ran advertisements for quack remedies claiming to cure
brain fag.
Drs Obuaya and Ayonrinde concluded that brain
fag was a 19th century British culture-bound syndrome
associated with mental fatigue and impaired study. It emerged
following the introduction of the 1870 Education Act, which
provided free compulsory elementary education for all. Its symptoms
were identical to the syndrome later described by the same name in
West African 150 years later.
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References:
Royal College of Psychiatrists' Annual Meeting, Imperial College, London, 1 - 4 July 2008