The continuing story of dhat syndrome

Sumathipala et al (2004) raise an important argument regarding culture-bound syndromes. We agree that dhat, although considered an exotic neurosis of the orient, is a symptom that has been observed worldwide. The use of the term ‘syndrome’ cannot be justified in this case. We see it more as a mere symptom of common disorders like depression, anxiety and somatisation. Mumford (1996) argued that dhat should be primarily regarded not as the focus of a culture-bound syndrome but as a culturally determined symptom associated with depression. It has been stated by Kuruppuarachchi & Williams (2001) that in Sri Lanka somatic complaints override the more recognised presenting symptoms appearing in the diagnostic criteria for conditions such as depression. The language used facilitates this as the vocabulary does not promote expression of symptoms like low mood. It is our belief that ‘semen loss anxiety’ too is a form of communicating distress seen in those with these conditions. We would also like to highlight the fact that the current classification systems such as ICD–10 (World Health Organization, 1992) and DSM–IV (American Psychiatric Association, 1994) do not give clear operational guidelines to come to a proper diagnosis of culture-bound syndromes. As a result, many clinicians tend to make a diagnosis based on arbitrary guidelines. In Sri Lanka clinicians come across many patients presenting with ‘dhat syndrome’. However, on further exploration one of the common neurotic and depressive disorders can be recognised as the cause. The belief that seminal fluid is precious is still largely prevalent. It is considered by many lay people that 100 drops of blood make one drop of semen. Buddhism, while discouraging promiscuity, does not proscribe sexual activity. However, the erroneous belief that all sexual activity is sinful is widespread among Buddhists. The anxiety regarding loss of semen may be related to this belief. Dhat is also promoted by practitioners of alternative and complementary medicine. This is obvious in many advertisements appearing in the newspapers boasting different forms of cures for loss of semen.