Sociocultural expression of psychiatric symptoms: a case report from South Asia

Background: In various cultures and religions, there are different understandings of what Western medicine calls ‘psychiatric’ symptoms. Different interpretations lead to different courses of action, with inherent advantages and risks, including lack of treatment or misdiagnosis. Patient findings: A 15-year-old married girl was admitted to the emergency room after jumping off the stairs in her in-law’s house; she claimed that a ‘jinn’ (spirit) in her head had told her to jump. Three different interpretations were given to this claim—psychiatric/biomedical (psychosis), traditional/religious (spirit possession), the claim of ‘jinn in the head’ as a cry for help. Discussion with the patient identified serious problems in her living environment, corresponding to a cultural taboo of not criticizing one’s in-laws. Conclusion: In specific vulnerable populations, it is important to look further than the ‘obvious’ manifestations of psychiatric symptoms and/or cultural expressions and search for the meaning behind the words, as the symptoms might be a disguised protest. Western medicine should take the cultural and social context into account, not only to avoid misdiagnosis and unnecessary treatment, but also to prevent further complications in the patient’s family situation.