WELLCOME^ IMAGESsleep problems, loss of appetite, gastric problems, shakiness,
muscle tension, attention and memory problems, loss of appetite
and shortness of breath. Most symptoms attributed to meno-
pause on, for example, checklists used by medical researchers,
fall into this categor y.
Dealing with distress
Distress syndromes are also tied to culture-specific (ethnophysi-
ological) ideas of what conditions exist, what their symptoms
are, and what causes them. For each cultural syndrome, the
symptoms thought most characteristic and important in the eth-
nophysiological model tend to be amplified by attention and
anxiety about them, so that the syndrome takes a very specific
shape. For example, the Cambodian syndrome kyol goeu is be-
lieved to be caused by a blockage of the flow of the body’s essen-
tial wind, often in the neck, and neck pain is an important sign
of the illness and a trigger for an attack. Distress syndromes such
as kyol goeu are often characterised by brief, episodic attacks re-
sembling seizures or cardiac events – similar to western psychia-
try’s Panic Attack – with acute and rapidly escalating symptoms
of sympathetic nervous system arousal (palpitations, shortness of
breath, sweating or chills, and so forth).
Another striking case of a cultural syndrome is the ancient
Greek concept of ‘hysterical suffocation’ – a concept attested as
early as the third century BC and that seems to have remained
vital for at least 1,000 years, when medi-
cal encyclopaedists continued to preserve
and update the tradition on this condi-
tion. The idea that a woman’s uterus (hys-
tera, in Greek) could move around the
body and cause problems is attested in
Greek medical writing and in popular
culture – for example, on amulets urging
the uterus to stay put – throughout that
period. Women who experienced chok-
ing sensations might well believe they
were in danger of choking to death on
their own wombs, and a well-attested tra-
dition describes the kind of attack that
might follow – in this case, a dead faint,
chilling of the extremities, deafness, ina-
bility to talk, and other symptoms. Early
or chronic signs of hysterical suffocation
might include muscle tension, headache,
fatigue and dizziness.
Because both the chronic and the acute symptoms of hyster-
ical suffocation were of the kind exacerbated by sympathetic
nervous system arousal – and a sensation of choking is a com-
mon cross-cultural symptom of intense anxiety – it seems likely
that the tradition reports on a real phenomenon similar to mod-
ern kyol goeu and other cultural syndromes, and similar, in some
ways, to menopause.
Western medicine acknowledges a condition called meno-
pause, with symptoms including insomnia, ‘irritability’, memo-
ry problems and different kinds of pain, caused by a fluctuating
or deficient supply of oestrogen. Because we’ve heard that men-
opause might cause such sensations, we are more likely to notice
them and, consciously or unconsciously, to link them to the cul-
tural construct ‘menopause’. Because these kinds of symptoms
are easily a mplified by anxious arousa l, they will tend to become
more frequent and more distressing, creating a syndrome of dis-
tinct character. The hot flushes typical of the western concept of
menopause bear strik ing similarities to the episodic fits, spells or
seizures typical of other cultural syndromes; hot flushes as de-
scribed in modern medical literature share many symptoms in
common with Panic Attack, and many people suffering a west-
ern hot flush would meet criteria for that condition.
Distress syndromes are not ‘all in the head’; they can cause
severe physical suffering, both acute and chronic, and they can
be pervasive. But culture is an important input into how these
syndromes are experienced. There’s a case to be made that in
ignoring the cultural context of menopausal syndrome, we fail
to understand it, and therefore to address it effectively.History of menopause
Susan P Mattern is distinguished research professor in the Department
of History at the University of Georgia. Her latest book is The Slow Moon
Climbs: The Science, History, and Meaning of Menopause (Princeton, 2019)Shaping a syndrome
Medical treatment, shown in a Khmer painting.
Local anxieties about characteristic symptoms tend
to shape cultural syndromes such as kyol goeu in
Cambodia, historically believed to be caused by a
blockage of the flow of the body’s essential wind