Iich'aa
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Iich'aa (, pronounced “eech aaw”, no inflexion) is a
culture-bound syndrome In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or c ...
found in the
Navajo The Navajo or Diné are an Indigenous people of the Southwestern United States. Their traditional language is Diné bizaad, a Southern Athabascan language. The states with the largest Diné populations are Arizona (140,263) and New Mexico (1 ...
Native American culture. Symptoms include epileptic behaviour (nervousness, convulsions), loss of self-control, self-destructive behaviour and fits of violence and rage. It can, together with other
culture-bound syndrome In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or c ...
s: notably amok ( Indonesian), gila mengamok ( Malay), cafard ( Polynesian) or mal de pelea ( Puerto-Rican), be grouped in the taxon SMAS syndrome (Sudden Mass Assault Syndrome).


Mothway


The Mothway myth

Iich’aa translates to “moth craziness” or “
taboo A taboo is a social group's ban, prohibition or avoidance of something (usually an utterance or behavior) based on the group's sense that it is excessively repulsive, offensive, sacred or allowed only for certain people.''Encyclopædia Britannica ...
-breaking”, which refers to the ancestral
Navajo The Navajo or Diné are an Indigenous people of the Southwestern United States. Their traditional language is Diné bizaad, a Southern Athabascan language. The states with the largest Diné populations are Arizona (140,263) and New Mexico (1 ...
beliefs about this disorder. The literal translation of iich’aa is “one who falls into the fire”. Attraction to light and fire is a characteristic of the
moth Moths are a group of insects that includes all members of the order Lepidoptera that are not Butterfly, butterflies. They were previously classified as suborder Heterocera, but the group is Paraphyly, paraphyletic with respect to butterflies (s ...
. The moth's behaviour, in
Navajo The Navajo or Diné are an Indigenous people of the Southwestern United States. Their traditional language is Diné bizaad, a Southern Athabascan language. The states with the largest Diné populations are Arizona (140,263) and New Mexico (1 ...
storytelling, is said to be a consequence of butterfly people (a mythical population) having “gone wild” after committing
incest Incest ( ) is sexual intercourse, sex between kinship, close relatives, for example a brother, sister, or parent. This typically includes sexual activity between people in consanguinity (blood relations), and sometimes those related by lineag ...
. The symptoms of iich’aa are said to be caused by the violation of the taboo of brother-sister
incest Incest ( ) is sexual intercourse, sex between kinship, close relatives, for example a brother, sister, or parent. This typically includes sexual activity between people in consanguinity (blood relations), and sometimes those related by lineag ...
. This may or may not be scientifically correct (as
inbreeding Inbreeding is the production of offspring from the mating or breeding of individuals or organisms that are closely genetic distance, related genetically. By analogy, the term is used in human reproduction, but more commonly refers to the genet ...
, in general, can lead to a higher possibility of congenital birth defects especially in small populations, however, it hasn't been proved in the specific case of iich’aa). However, the myth serves the prohibition of
incest Incest ( ) is sexual intercourse, sex between kinship, close relatives, for example a brother, sister, or parent. This typically includes sexual activity between people in consanguinity (blood relations), and sometimes those related by lineag ...
among the
Navajo The Navajo or Diné are an Indigenous people of the Southwestern United States. Their traditional language is Diné bizaad, a Southern Athabascan language. The states with the largest Diné populations are Arizona (140,263) and New Mexico (1 ...
.


The Mothway healing ceremony

Mothway is also the name of the healing ceremony used to heal iich’aa between 1940 and 1957. Mothway is part of the subgroup Mountain Chant, itself part of the subgroup Holyway of Chantways.
Navajo The Navajo or Diné are an Indigenous people of the Southwestern United States. Their traditional language is Diné bizaad, a Southern Athabascan language. The states with the largest Diné populations are Arizona (140,263) and New Mexico (1 ...
ceremonies are divided between chantways and
rite Rite may refer to: Religion * Ritual, an established ceremonious act * Rite (Christianity), sacred rituals in the Christian religion * Ritual family, Christian liturgical traditions; often also called ''liturgical rites'' * Catholic particular ch ...
s. Chantways are characterized by a rattle accompanying the singing of a ceremony. The three types of Chantways are Holyway, Lifeway and Evilway. Holyways focus on the restoration of good. Mothway was controversial amongst Navajo, associated with witchcraft, and thus soon became extinct. Descriptions report the patients wearing
coyote The coyote (''Canis latrans''), also known as the American jackal, prairie wolf, or brush wolf, is a species of canis, canine native to North America. It is smaller than its close relative, the Wolf, gray wolf, and slightly smaller than the c ...
skins (animals associated with
incest Incest ( ) is sexual intercourse, sex between kinship, close relatives, for example a brother, sister, or parent. This typically includes sexual activity between people in consanguinity (blood relations), and sometimes those related by lineag ...
in
Navajo The Navajo or Diné are an Indigenous people of the Southwestern United States. Their traditional language is Diné bizaad, a Southern Athabascan language. The states with the largest Diné populations are Arizona (140,263) and New Mexico (1 ...
culture) and the performance of sexual intercourse.


Native American views on mental illness and diagnostic

The
DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a c ...
Glossary of
Culture-Bound Syndromes In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or c ...
includes the following disorders specific to Native Americans (ordered here by decreasing frequency of diagnostic]): susto, “fright” or “soul loss”; dissociative trance disorder;
spirit possession Spirit Possession is an altered state of consciousness and associated behaviors which are purportedly caused by the control of a human body and its functions by Supernatural#Spirit, spirits, ghosts, demons, angels, or Deity, gods. The concept ...
; mental illness due to
witchcraft Witchcraft is the use of Magic (supernatural), magic by a person called a witch. Traditionally, "witchcraft" means the use of magic to inflict supernatural harm or misfortune on others, and this remains the most common and widespread meanin ...
; ghost sickness; iich’aa and piblotoq. According to the Thomason survey on the assessment and diagnosis of
American Indian and Alaska Native Native Americans (also called American Indians, First Americans, or Indigenous Americans) are the Indigenous peoples of the United States, particularly of the lower 48 states and Alaska. They may also include any Americans whose origins lie ...
( AIAN) clients, most clinicians (60%) believe that counsellors should assess their
Native Native may refer to: People * '' Jus sanguinis'', nationality by blood * '' Jus soli'', nationality by location of birth * Indigenous peoples, peoples with a set of specific rights based on their historical ties to a particular territory ** Nat ...
clients’ acculturation type to be able to make an accurate diagnostic using the ”patient explanatory model” of disease (framing of the disorder in concordance with the patient's values and beliefs) and prescribe the right treatment. The acculturation type can range from “traditional”, “marginal”, “bicultural”, “assimilated”, and “pantraditional”. Selecting the right one is important because: * the syndromes are linked to AIAN culture and not specifically to AIAN genes, * but mainly, the willingness of the patient to accept the diagnostic and the success rate of the treatment process depends on the framing of the diagnosis, making an appropriate treatment possible. Historically, before Native Americans were exposed to
European colonialism The phenomenon of colonization is one that stretches around the globe and across time. Ancient and medieval colonialism was practiced by various civilizations such as the Phoenicians, Babylonians, Persians, Greeks, Romans, Han Chinese, and Ar ...
, the concept of “
mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...
” per se was unknown. Thus, still today, there is little to no stigma around it in most tribal groups, as limited or no distinction is made between mental and physical symptoms. The view of the American Indian physician and clinical psychologist Mehl-Madrona resumes the discourse “All illness is an illness of the spirit that manifests itself in the body, mind, and emotions” and “We all carry within our souls the capacity to heal ourselves”. Traditionally, amongst AIAN people, deviant behaviour is treated in one of two ways. Either, if seen as voluntary, scolding and exclusion from the community, as a punishment. Or, if seen as involuntary (such as all the listed syndromes above), a “healing process” begins. The healer listens attentively to the patient, they then creates a metaphor to represent the issues(s), which is in turn used in a ceremony, where the patient takes an active role in “fighting the illness”. Those metaphors are often already set out in storytelling and culturally transmitted through generations, such as in the case of iich’aa being represented by a
moth Moths are a group of insects that includes all members of the order Lepidoptera that are not Butterfly, butterflies. They were previously classified as suborder Heterocera, but the group is Paraphyly, paraphyletic with respect to butterflies (s ...
, a symbol of love, temptation, and foolishness in
Navajo The Navajo or Diné are an Indigenous people of the Southwestern United States. Their traditional language is Diné bizaad, a Southern Athabascan language. The states with the largest Diné populations are Arizona (140,263) and New Mexico (1 ...
culture. Hence, the
moth Moths are a group of insects that includes all members of the order Lepidoptera that are not Butterfly, butterflies. They were previously classified as suborder Heterocera, but the group is Paraphyly, paraphyletic with respect to butterflies (s ...
itself isn't related to the syndrome (despite some ancestral stories linking it to contact with a moth, fictional or real), but the
moth Moths are a group of insects that includes all members of the order Lepidoptera that are not Butterfly, butterflies. They were previously classified as suborder Heterocera, but the group is Paraphyly, paraphyletic with respect to butterflies (s ...
's erratic behavior is a metaphor for that of the patient, serving a descriptive and sense-making function.


Controversial DSM-IV-TR classification of AIAN culture-bound syndromes

The
DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a c ...
definition might be well-meaning, as a
culture-bound syndrome In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or c ...
is a “recurrent, locality-specific patterns of aberrant behavior and troubling experience;” and a “localized, folk diagnostic” category. However, two main points of critic arise. They might have been addressed by the renaming into “cultural concepts of distress” in the
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiat ...
, not listing “some of the best-studied culture-bound syndromes and idioms of distress that may be encountered in clinical practice” as in the
DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (''DSM''; latest edition: ''DSM-5-TR'', published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a c ...
. # The existence of some of these symptoms hasn't been supported by any contemporary data. For example,
piblokto Piblokto, also known as pibloktoq and Arctic hysteria, is a condition most commonly appearing in Inughuit (Northwest Greenlandic Inuit) societies living within the Arctic Circle. Piblokto is a culture-specific hysterical reaction in Inuit, especi ...
q or “Arctic hysteria” has only been reported in 40 cases throughout history and has recently been called out as a
culture shock Culture shock is an experience a person may have when one moves to a cultural environment which is different from one's own; it is also the personal disorientation a person may feel when experiencing an unfamiliar way of life due to immigration ...
reported by European explorers, rather than a disorder rooted in
Inuit Inuit (singular: Inuk) are a group of culturally and historically similar Indigenous peoples traditionally inhabiting the Arctic and Subarctic regions of North America and Russia, including Greenland, Labrador, Quebec, Nunavut, the Northwe ...
culture. The Thomason survey indeed reported that 71% of the respondents (specialising in Native American patients) have never diagnosed a client as having a
culture-bound syndrome In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or c ...
. Comments indicate that professionals are not convinced of the “accuracy or thoroughness” of this classification. # The separation between general forms of psychopathology and
culture-bound syndrome In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or c ...
s stigmatises and discriminates
minorities The term "minority group" has different meanings, depending on the context. According to common usage, it can be defined simply as a group in society with the least number of individuals, or less than half of a population. Usually a minority g ...
. These conditions are not reimbursed by third-party payers, which can affect diagnosis and access to treatment. This is especially problematic because it only seems to apply to non-western syndromes. Western
culture-bound syndrome In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or c ...
s, as for instance “
anorexia nervosa Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by Calorie restriction, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. Individuals wit ...
”, don't get the same stigma. Thus, it is debated whether this separate category is even needed. Culture can affect the experience and expression of mental disorders, hence, a consensus could be that general forms of
psychopathology Psychopathology is the study of mental illness. It includes the signs and symptoms of all mental disorders. The field includes Abnormal psychology, abnormal cognition, maladaptive behavior, and experiences which differ according to social norms ...
might be universal, but the ways that these syndromes are expressed are determined by cultural values, norms, and traditions. Then, iich’aa, might be a local name, for a shared cross-cultural syndrome.


Lack of research

There is still a lot of research to be done to explore the neurological aspect, genetical predispositions, and environmental effects regarding iich’aa. The demand for AIAN related issues hasn't yet been met with necessary funding and interest of the general public.


References

{{reflist Navajo culture Culture-bound syndromes Rampages