Culture-Bound Syndromes: Falling Out, Blacking Out

The anthropological literature describes traditional ways that African Americans express psychiatric distress and other forms of emotions. Data gathered through clinical case reports, in-depth household interviews, and a review of emergency services records in the city of Miami all point to falling out as a culture-bound syndrome. Falling out is the general term used to describe variations of a syndrome that are believed to be functionally equivalent: falling out, blacking out, and indisposition. Falling out and blacking out are terms used most often in the southern United States, whereas indisposition is the term used in Haiti.

Falling out is conceptualized as a dissociative reaction that is associated with constricted consciousness and designed to cope with anxiety. The most common descriptions note a sudden collapse or fainting spell that may be preceded by dizziness or “swimming in the head.” The syndrome may occur with or without warning. Individuals who report falling out indicate an awareness of their surroundings, although some report an inability to move. Some individuals claim they are unable to see, although their eyes are open and there is no indication of physical impairment. An analysis of emergency services data from Miami suggests that the syndrome is not the result of chronic organic illness (it can be differentiated from illnesses such as epilepsy) but a psychological reaction to specific stressors.

Falling out is not treated as an illness until or unless it becomes disabling. Falling out is viewed as a reasonable response when attending a funeral or receiving shocking news, and it has been described as common in stressful school situations and very hot weather. Episodes of such behavior have been noted during religious services and ceremonies. Falling out is reportedly tolerated in the context of intense anger, rage, or fear. Falling out episodes prevent the individual from completing an undesirable or harmful act in response to intense anger. In the context of trauma, episodes may become chronic and thus debilitating because they interfere with employment and life functioning. Finally, falling out has also been noted in the context of inner-city life, particularly when multiple stressors such as overcrowding, high crime, and financial concerns are present.

It is not known how widely this syndrome occurs among African Americans because the existing prevalence data are based on studies conducted during the 1970s. However, the data support the hypothesis that falling out is more prevalent among people of African descent living in the United States than among other ethnic groups. Estimates indicate a prevalence of 23% among Bahamian households and 10% among southern African American households in Miami. Studies also suggest that most Haitians report having known someone who has fallen out.

[Page 137]The relationship between help-seeking behavior and patterns of psychological and physical distress similar to falling out (anxiety and somatic symptoms) has been explored. An association between anxiety and somatic symptoms as a characteristic idiom of distress has been demonstrated; these symptoms have a stronger association with help-seeking behavior among African Americans than among European Americans. Efforts to initiate group and network therapy for cases of falling out conceptualized in this way have failed.

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