In 1846, in the province of Penang, Malaysia, a respectable elderly Malay man suddenly shot and killed 3 villagers and wounded 10 others. The following case reports illustrate the typical violent behavior reported in amok episodes in Malay tribes: However, since the belief that amok is culturally induced had become deeply entrenched, its connection with modern day episodes of mass violence went unnoticed. Inexplicably, while the frequency of and interest in amok among primitive tribes were decreasing, similar occurrences of violence in industrial societies were increasing. Modern occurrences of amok in the remaining tribes are almost unheard of, and reports in the psychiatric literature ceased around the mid-20th century. The decreasing incidence of amok was attributed to Western civilization's influence on the primitive tribes, thereby eliminating the cultural factors thought to cause the violent behavior. Over the next 2 centuries, occurrences of amok and interest in it as a psychiatric condition waned. These observers reinforced the belief that cultural factors unique to the primitive tribes caused amok, making culture the accepted explanation for its pathogenesis in these geographically isolated and culturally diverse people. Shortly after Captain Cook's report, anthropologic and psychiatric researchers observed amok in primitive tribes located in the Philippines, Laos, Papua New Guinea, and Puerto Rico. Because of their spiritual beliefs, those in the Malay culture tolerated running amok despite its devastating effects on the tribe. According to Malay mythology, running amok was an involuntary behavior caused by the “hantu belian,” or evil tiger spirit entering a person's body and compelling him or her to behave violently without conscious awareness. Amok attacks involved an average of 10 victims and ended when the individual was subdued or “put down” by his fellow tribesmen, and frequently killed in the process. He described the affected individuals as behaving violently without apparent cause and indiscriminately killing or maiming villagers and animals in a frenzied attack. Captain Cook is credited with making the first outside observations and recordings of amok in the Malay tribesmen in 1770 during his around-the-world voyage. Furthermore, the belief that amok rarely occurs today is contrary to evidence that similar episodes of violent behavior are more common in modern societies than they were in the primitive cultures where amok was first observed.Īmok, or running amok, is derived from the Malay word mengamok, which means to make a furious and desperate charge. However, characterizing amok as a culture-bound syndrome ignores the fact that similar behavior has been observed in virtually all Western and Eastern cultures, having no geographical isolation. DSM-IV, 1 which is the current consensus opinion on psychiatric diagnosis, depicts amok as a cultural phenomenon that rarely occurs today. The primitive groups' geographic isolation and spiritual beliefs were thought to produce a mental illness not observed elsewhere in the world. The psychiatric literature classifies amok as a culture-bound syndrome based on its discovery 2 centuries ago in remote primitive island tribes where culture was considered the predominant factor in its pathogenesis. Although episodes of multiple homicides and suicide by individuals with presumed or known mental disorders occur with alarming regularity today, there are virtually no recent discussions in the medical literature about the recognition and treatment of these individuals before their suicidal and homicidal behavior occurs. Except for psychiatrists, few in the medical community realize that running amok is a bona fide, albeit antiquated, psychiatric condition. The term also describes the homicidal and subsequent suicidal behavior of mentally unstable individuals that results in multiple fatalities and injuries to others. The general public and the medical profession are familiar with the term running amok, the common usage of which refers to an irrational-acting individual who causes havoc.
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