Abstract
Koro is a culture-bound syndrome found mainly in southeast Asia often occurring in epidemics and known by various names such as shuk yang, shook yong, and suo yang (Chinese); jinjinia bemar (Assam); or rok-joo (Thai). It is chiefly characterized by a belief that the sexual organs (penis in males and breast/nipples in females) will retract leading to disappearance of the organ and ultimately death of the individual [1]. We report two cases of koro which presented to our department during the recent outbreak in northeastern India, perhaps more as an ‘epidemic’ than a pure culture-bound syndrome.
A 30 year old unmarried male carpenter hailing from a remote location of northeastern India, received a mobile phone call from his brother in the evening who told him to be vigilant about a disease in which the penis gets shorter. Twenty minutes after this call he started to experience twisting body movements and a feeling as if his penis was retracting into his abdomen. He grew extremely anxious and so did his family members. The next morning he was brought to our hospital with extreme anxiety and a feeling that he would die if the penis continued to involute. Upon admission to our department his physical and laboratory investigations were within normal limits. He was prescribed a low dose benzodiazepine and was offered supportive therapy. Three days after admission he was relieved of his symptoms and was discharged.
A 23 year old male hailing from a remote location of north eastern India, was brought to the casualty department at midnight by his friends and relatives in an anxious and distressed condition. He had calcium hydroxide paste applied to his ear lobules. He reported that he had heard television reports of ‘penis retraction disease’ and had then felt his penis gradually withdrawing into his abdomen. He also believed that this would ultimately cause obstruction to his intestines and that the chemical applied on his ear lobules could relieve him. No amount of reassurance could pacify him and he was kept under observation in the psychiatry ward. A detailed physical examination and laboratory investigations did not reveal any abnormality. Mental status examination revealed an anxious mood, but the thought process was normal and no perceptual disturbance could be detected. He was prescribed a low dose benzodiazepine, given supportive counseling and discharged. There has been no recurrence of symptoms.
At the time of reporting the above two cases, there was a state wide epidemic of the illness with multiple districts of Assam affected with thousands of cases. In both our cases the condition was induced in the patient from a particular source, i.e. receiving a long distance mobile phone call in one patient and watching a television programme in the other. The interesting observation regarding this is that technological advances such as mobile phones may also be mediators in the genesis of such psychiatric problems. In this context, the concept of ‘mass psychogenic illness’ (MPI) has been proposed by Dzokoto and Adams [2] who suggest that genital shrinkage is an idiom of distress in the socio-cultural backdrop of the concerned society. Another theory is that of ‘collective illusionary misperception’ [3], which states that the condition may be a rational attempt at problem solving that involves conformity dynamics, perceptual fallibility and local acceptance of koro-associated folk realities. Various authors are therefore of the opinion that this condition has incorrectly been termed a culture-bound syndrome and subjects its sufferers to a stigmatizing attitude, preventing scientific treatment [4,5].