Cultural or culture-related syndromes are disorders that have been identified exclusively in a particular society. Some of the best known cultural syndromes are Koro, which occurs in Southeast Asia, and Amok, which is typical of Indonesia and the Pacific.

In this article we will talk about the causes and symptoms of grisi siknis, a syndrome linked to culture that occurs among the Miskitos, natives of Honduras and Nicaragua. We will also describe some similar disorders that occur in other cultures.

What is the Grisi Siknis?

The Grisi Siknis is a specific cultural syndrome of the Misquito society , an ethnic group in Central America . The name is probably derived from the English words “crazy sickness”; in that case it could be translated as “illness of madness”. It is also known as “grisi munaia”, “Nil siknis” and “Chipil siknis”. This disorder was described by Philip A. Dennis in 1981.

It mainly occurs in adolescent women between 15 and 18 years old . Although Western psychology and psychiatry have attributed the appearance of episodes of grisi siknis to emotional discomfort and stress, traditional explanations of the Miskitos claim that it is an experience of possession by evil spirits or witches.

This esoteric account of the nature of the syndrome is fuelled by the fact that Western medicine and other treatments do not appear to be effective in resolving the symptoms of grisi siknis. By contrast, the herbal and traditional remedies of the Miskito healers are effective in dealing with the symptoms, perhaps by suggestion and placebo effect.

One of the most peculiar characteristics of grisi siknis is its contagious nature, which causes epidemics . For example, in March 2009 outbreaks of grisi siknis were described that affected many young people in the municipalities of Puerto Cabezas and Siuna in Nicaragua. These epidemics occurred shortly after Hurricane Felix, which wreaked havoc on the coast of Honduras and Nicaragua.

Symptoms of this disorder

The episodes of grisi siknis are preceded by physical and psychological symptoms such as anxiety, anger, irrational fear, headache, dizziness and nausea .

The onset of the attack coincides with the loss of consciousness that causes the person to fall to the ground. He then begins to run, immersed in a state of dissociation and lack of behavioral control.

During the crisis of grisi siknis it is frequent that the affected persons carry out aggressive behaviours against themselves or against invisible aggressors produced by hallucinations s ; those who have suffered episodes claim to see spirits or demons that come looking for them, sometimes to rape them or to have sex with them.

There is a great power of suggestion in this syndrome, partly because of the atmosphere of esotericism that is generated in crises and that reminds us of the classic cases of Folie à Deux.It is also common for people affected by grisi siknis to say the name of the next person who is supposed to suffer from it, although they are not necessarily right. There are mischievous accounts that tell of supernatural events that have occurred during episodes of this syndrome, such as victims speaking in unknown languages or vomiting hair, spiders or coins.

Grisi siknis can last several months, even a year, if not treated . During this period there are usually recurrent episodes with symptoms like those described above.

Causes and explanations

According to the DSM-IV-TR manual, grisi siknis is a psychological disorder that occurs as a result of stress, emotional shock and despair ; in this sense this syndrome has been related to dissociative flight, as is the case with Amok syndrome, another well-known cultural disorder. However, grisi siknis has been little studied and therefore its causes are not entirely clear.

The Miskitos attribute the grisi siknis to a destabilization in the spirit world, caused by the appearance of epidemic outbreaks or the action of dark wizards. These factors would lead to the possession of young girls by ghosts.

As we have seen, one possible explanation for the peculiar fact that grisi siknis is contagious is suggestion; thus, the appearance of this syndrome in several people at the same time could be influenced by contact with other cases of grisi siknis . Seen in this way, the syndrome would have certain similarities with the shared psychotic disorder, better known as Folie à Deux.

Similar cultural syndromes

Symptoms of anxiety, physical discomfort, and loss of control are very common in a number of disorders, including those that are specific to certain cultures. As with Grissyknis, in many cases these syndromes have been traditionally attributed to spirit possession.

1. Amok or mata elap

Alteration detected in Malaysian males that is characterized by the appearance of a dissociative episode during which aggressive behaviors occur . It is related to psychosis. After the amok attack the person does not remember what happened.

There are other cultural syndromes with symptoms very similar to those of amok and grisi siknis in different cultures, such as cafard, berserk, fighting sickness and iich’aa, identified in Polynesia, Scandinavia, Puerto Rico and the Navajo Indians, respectively.

2. Pibloktoq or Arctic Hysteria

The pibloktoq is produced among the Inuit of Greenland. It usually consists of a dissociative episode of about 30 minutes that occurs after a period of agitation, irritability or low mood. The person behaves in an aggressive and uninhibited manner , for example by taking off all clothes, shouting obscene words or eating faeces.

3. Windigo or witiko

The windigo is a mythological being from North America to which human and beastly characteristics are attributed. As a disorder, windigo is related to delusional experiences of possession that are accompanied by a compulsive desire to eat human flesh. Currently the existence of this cultural syndrome is highly questioned as such.

4. Nerve attack

This name is given to episodes of loss of control with screaming, crying, trembling and aggression that occur in some Latin American and Mediterranean cultures. It differs from panic attacks in that the symptoms occur spontaneously, without a trigger and without feelings of fear.

5. Bouffée délirante

La bouffée délirante (in French, “delirious breath”) is a type of psychotic break characterized by psychomotor agitation, violence, confusion and visual or auditory hallucinations. It is typical of Haiti and West Africa.

6. Tsar

Dissociative episodes with screaming, crying, laughing and singing out of control, as well as self-injury, attributed to experiences of spirit possession. In the African countries where it has been identified, such as Ethiopia, Sudan, Egypt and Somalia, it is not considered a pathology .

7. Disease of the spirits

In some Native American societies, a syndrome has been described that consists of intense preoccupation with death and the deceased, along with various physical and psychological symptoms: anxiety, weakness, loss of appetite, dizziness, confusion, nightmares, hallucinations, etc.

8. Hsieh-ping

Hsieh-ping, a cultural syndrome detected in Taiwan , is defined as a brief trance state during which the person believes he or she is possessed by ancestral spirits attempting to communicate with family members. Symptoms include disorientation and hallucinations.

9. Madness

According to the DSM-IV psychiatric manual, the term “madness” is used in Latin America to refer to a type of chronic psychosis that includes symptoms such as interpersonal difficulties, agitation, hallucinations, incoherence, impulsiveness and aggressiveness.

Bibliographic references:

  • American Psychiatric Association. Task Force on DSM-IV. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Text Revision. Washington, DC: American Psychiatric Association.
  • Barrett, B. (1997). Herbs and healing on Nicaragua’s Atlantic Coast. American Botanical Council, 41: 35-48.
  • Dennis, P. A. (1981). Part Three: Grisi Siknis Among the Miskito. Medical Anthropology, 5(4): 445-505.