Over the last year I have examined a number of culture-bound syndromes that comprise a combination of psychiatric and/or somatic symptoms viewed as a recognizable disease within specific cultures or societies. One of the more interesting types is Brain Fag Syndrome (BFS). The first cases of BFS were described in 1960 by Dr. Raymond Prince in the British Journal of Psychiatry. He reported on a “very common psychoneurotic syndrome occurring among the students of southern Nigeria” that is typically initiated after intensive periods of intellectual activity. More specifically he wrote that:
“The symptoms are such as to prevent the student from carrying on with his work and include various unpleasant head symptoms accompanied by inability to grasp what he reads or what he hears in a lecture, memory loss, visual difficulties, inability to concentrate, inability to write, etc.”
Other researchers (such as a team led by Dr. Bolanie Ola – writing in a 2009 issue of the African Journal of Psychiatry) have noted that BFS comprises a wide range of somatic complaints (as noted by Dr. Prince) but can also include cognitive and sleep-related impairments, as well as localized pain in the head and neck. BFS is seen as an interesting phenomenon in the field of transcultural psychiatry. For some researchers, BFS was controversially included (for the first time) in the fourth edition of American Psychiatric Association’s 1994 Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), and included as a culture bound syndrome such as the Koro (the genital retraction syndrome that I reviewed in two previous blogs examining male Koro and female Koro).
Since the publication of Prince’s seminal paper over 50 years ago, BFS has been documented among non-Caucasians in various African countries (Ethiopia, Liberia, Ivory Coast, South Africa, and Uganda), and a few countries outside of Africa (Brazil, India, Malaysia, China). However, the number of cases from those countries outside of Africa are exceedingly rare. There also appear to be similar syndromes such as the Trinidadian illness ‘studiation madness’ that has similar symptoms to BFS.
The term ‘brain fag’ was the name of the disorder that the students themselves called it (and appears to be a shortened version of ‘brain fatigue’). Based in his early research, Dr. Prince believed that BFS was not caused and/or associated to genetic predisposition, general intelligence, parental literacy, study habits or family responsibilities. He believed that BFS was related to:
“The imposition of European learning techniques upon the Nigerian personality [and that] European learning techniques emphasize isolated endeavour, individual responsibility and orderliness – activities and traits which are foreign to the Nigerian by reason of the collectivistic society from which he derives, with its heightened ‘orality’ and permissiveness”.
Dr. Ola and his colleagues questioned the extent to which BFS is an objective or subjective phenomenon. They asked a number of pertinent questions: Is BFS one phenomenon or a variant of other known disorders? Is BFS a mental illness? Ola and colleagues described the case of a young male student from Yoruba.
“When studying for an exam [he] began to have sharp pains in his head and could not grasp what he was reading. He slept more than usual, and had difficulty forcing himself to go to school in the morning. When writing the examinations, he felt he knew the answers, but was unable to recall them; his mind was blank. His right hand was weak and shook so that he couldn’t write. Because of these symptoms, he was forced to postpone the writing examinations for several years. His symptoms improved greatly with Largactil (an antipsychotic medication) and reassurance”.
Much like the early findings of Prince, Ola and his colleagues suggest that BFS may in sufferers be “the somatic manifestation of the rather sudden Westernization of African education”. The authors also claimed that between 6% and 54% of Nigerian university students may experience brain fag symptoms although those with the “full-blown syndrome” appear to be significantly lower. However, a more recent paper in the ASEAN Journal of Psychology claimed that among secondary school students, BFS is prevalent in 20-40% of students.
A more recent paper by Bolanie Ola and David Igbokwe in a 2011 issue of Africa Health Sciences, cites some work carried out on the etiology of BFS by Guinness in 1992 (although no reference is provided for the study itself). Guinness reported five independent factors associated with the syndrome: (a) the financial implications of education which represented the change from subsistence to cash economy; (b) fear of envy and bewitchment which represented the intense cultural response to education; (c) parenting in the pre-school years which was the independent family variable; (d) academic ability; (e) attributes of the school.
In a paper examining the factorial validation and reliability analysis of the Brain Fag Syndrome Scale (BFSS) by Ola and Igbokwe, it was argued by the authors that there was a lack of consistent findings relating to the etiology, pathophysiology and risk factors of BFS. This, they argued, reflected the “lack of standardized reproducible diagnostic criteria” for the syndrome. In short, they asserted that different studies had used different instruments to assess BFS and that only a few followed the description first formulated by Prince. They claimed that 60% of the BFS studies they reviewed simply reported the rates of BF symptoms rather than BFS. Following psychometric evaluation on 234 participants (aged 11- to 20-years), Ola and Igbokwe claimed that the BFSS is a valid and reliable two-dimensional instrument to assess BFS and can therefore be used in future studies. At least there is now an instrument that can be used to carry out empirical research more systematically.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Fatoye, F.O. (2004). Brain fag syndrome among Nigerian undergraduates: present status and association with personality and psychosocial factors. Ife Psychologia, 12, 74-85.
Fatoye, F.O. & Morakinyo, O. (2003). Study difficulty and the ‘Brain Fag’ syndrome in south western Nigeria. Journal of Psychology in Africa, 13, 70-80.
Igbokwe, D.O. & Ola, B.A. (2011). Development and validation of the Brain Fag Propensity Scale. ASEAN Journal of Psychiatry, 12, 1-13.
Morakinyo, O. (1980). Psychophysiological theory of a psychiatric illness (the Brain Fag syndrome) associated with study among Africans. Journal of Nervous and Mental Disease, 168, 84-89.
Morakinyo, O. & Peltzer, K. (2002). Brain Fag symptoms in apprentices in Nigeria. Psychopathology, 35, 362-366.
Ola, B.A. & Igbokwe, D.O. (2011). Factorial validation and reliability analysis of the brain fag syndrome scale. African Health Sciences, 11, 334-339.
Ola, B.A., Morakinyo, O. & Adewuya, O. (2009). Brain Fag Syndrome – a myth or a reality. African Journal of Psychiatry, 12,135-43.
Peltzer, K. & Woldu, S. (1990). The brain fag syndrome in female Nigerian students: intercultural analysis and intervention of gender change. Curare, 13, 141-146.
Prince, Raymond (1960). The “Brain Fag” Syndrome in Nigerian students. British Journal of Psychiatry, 106, 559-570.
Wikipedia (2012). Brain fag. Located at: http://en.wikipedia.org/wiki/Brain_fag