Bah-tschi: Understanding the Thai Hyperstartle Phenomenon

The human startle response represents an evolutionary defense mechanism designed to protect the organism from immediate predatory threats, yet its expression is mediated by neurobiology and culture. In transcultural psychiatry, few conditions illustrate the nexus between neurophysiological reflexivity and sociocultural conditioning as vividly as bah-tschi (also transcribed in clinical literature as bah-tsi, baah-ji, or bah-tsche). Recognized as the Thai cultural equivalent of the Southeast Asian latah syndrome, this rare condition manifests as an exaggerated startle reaction accompanied by involuntary imitative behaviors, automatic obedience, and dissociative trance states.

Bah-tschi: The Thai Hyperstartle and Dissociative Syndrome

1. Concise Definition

Bah-tschi (noun) is a culture-bound hyperstartle and dissociative syndrome indigenous to Thailand, characterized by an exaggerated neurobehavioral reaction to unexpected sensory triggers such as loud noises, sudden gestures, or tactile teasing. Following an initial startle paroxysm, affected individuals enter a transient altered state of consciousness marked by involuntary echolalia (repetition of words), echopraxia (imitation of movements), coprolalia (spontaneous utterance of obscenities), and automatic obedience to external commands.

In psychiatric nosology and medical anthropology, bah-tschi belongs to the cross-cultural spectrum of startle-matching disorders. Rather than representing an isolated structural brain pathology, it is conceptualized as an idiom of distress and a culturally patterned neurobehavioral reaction. While universal human neurocircuitry underpins the primary acoustic startle reflex, bah-tschi represents the secondary elaboration of this reflex into a structured behavioral performance sanctioned, maintained, and elicited by specific social environments.

Though historically grouped under atypical hysterias or dissociative psychoses, modern transcultural formulations regard bah-tschi as a culture-specific dissociative condition that straddles the boundary between neurobiology and social role enactment. The condition predominantly affects marginalized or socially subordinate individuals, most frequently middle-aged or elderly women in rural communities, where teasing, social theater, and communal interactions serve as environmental precipitants.

2. Etymology & Linguistic Origin

The term bah-tschi originates from the Central and Southern Thai colloquial expression baah-ji (written in Thai script as บ้าจี้, phonetically rendered in the Royal Thai General System of Transcription as ba-chi or baa jee). Linguistically, the lexeme is a compound formed by two distinct functional words: baa (บ้า), signifying “mad,” “crazy,” “infatuated,” or “overly excitable,” and chii or ji (จี้), which directly translates to “tickle,” “poke,” or “provoke with a gentle touch.” Thus, the literal denotation of the construct is “tickle-crazy” or “tickle-sensitive madness.”

Western psychiatric literature adopted phonetic romanizations of the term throughout the late nineteenth and early twentieth centuries. Early European travelogues, military medical accounts, and comparative psychiatric manuals documented the phenomenon under varying orthographies, including bah-tsche, bah-tsi, and bah-tschi, largely influenced by German, Dutch, and British transcription conventions applied to Siamese dialects. Transcultural psychiatrists systematically aligned the condition with the classic Malayan term latah, establishing bah-tschi as the definitive Thai ethnonym for the regional startle-matching disorder.

3. Pronunciation & Grammatical Form

In international psychiatric discourse, the term is pronounced phonetically as /bɑː-tʃiː/ (standard English approximation: bah-CHEE) or /bɑː-dʒiː/ (approximating bah-JEE). In native Central Thai, the expression bears falling tone on the initial syllable and high tone on the second syllable: bâa-jíi.

Grammatically, the term operates across several syntactic categories:

• Noun (singular/uncountable): Designates the condition or syndrome itself (e.g., “The patient exhibited acute symptoms characteristic of bah-tschi”).
• Adjective / Predicative Nominal: Describes an individual susceptible to the startle-matching state or prone to ticklishness (e.g., “In rural villages, an elder known to be bah-tschi was frequently provoked by onlookers”).
• Colloquial Thai Idiom: In everyday contemporary Thai vernacular, baah-ji has broadened slightly beyond psychopathology to describe someone who is easily persuaded, highly impressionable, or habitually reacts with comic exaggeration to external suggestions.

4. Detailed Conceptual Explanation

At its core, bah-tschi encompasses a complex sequence of physiological, affective, and behavioral phenomena occurring across three recognizable phases: the precipitating sensory intrusion, the dissociative startle paroxysm, and the subsequent recovery phase. The initial stage is precipitated by an unexpected sensory trigger. This stimulus may be auditory (a sudden shout, a clap of thunder, an object falling), visual (a rapid darting movement or thrusting of an object toward the face), or somatosensory (a sudden jab, poke, or tickle to the ribs or abdomen).

Upon perception of the trigger, the individual does not display a typical, self-limiting startle jerk. Instead, their motor apparatus undergoes a profound, disinhibited surge that bypasses corticolimbic inhibitory controls. During this second phase, normal volitional self-regulation collapses, and the subject enters a transient dissociative state lasting from several seconds to several minutes. In this altered conscious frame, the individual becomes hyper-attuned and hypersuggestible to external commands and ambient social stimuli.

Within this dissociative window, the prototypical symptoms emerge in rapid succession. Vocal outbursts often feature raw coprolalia—involuntary shrieking of taboo, sexually explicit, or anatomically vulgar phrases that stand in stark contrast to the patient’s customary modesty and deference. Simultaneously, the person may exhibit intense echolalia, repeating words, questions, or insults shouted by nearby instigators, or echopraxia, meticulously copying bodily motions, aggressive stances, or awkward gestures performed in front of them.

Furthermore, command automatism (automatic obedience) frequently manifests. If an instigator sharply commands the startled individual to throw an object, undress, drop to the ground, or strike a bystander, the person often complies reflexively without conscious hesitation. Despite executing these actions, the person demonstrates distinct emotional agony or terror throughout the episode, often weeping, trembling, or begging instigators to cease the provocative actions.

The concluding recovery phase begins as the provocative stimuli subside. The individual abruptly regains cognitive orientation and baseline motor control, commonly accompanied by physical exhaustion, autonomic dampening, deep sighing, and embarrassment. A degree of retrograde or lacunar amnesia is often reported regarding specific acts committed during the paroxysm, although the individual retains full insight into their vulnerability to the affliction.

5. Historical Development

The academic documentation of bah-tschi mirrors the broader history of transcultural psychiatry, colonial medicine, and twentieth-century cross-cultural neurology. Throughout the nineteenth century, European physicians stationed across colonial territories began observing bizarre behavioral syndromes featuring exaggerated startle, imitative automatisms, and involuntary vocalizations across distinct ethnic groups.

In 1897, British physician Dr. William Gilmore Ellis published his foundational treatise on Malayan latah in the Journal of Mental Science. Within his comparative notes, Ellis cited reports from Siam (modern-day Thailand), explicitly identifying bah-tschi alongside Siberian miryachit and North American jumping Frenchmen of Maine as regional manifestations of the same clinical entity. Ellis and his contemporaries debated whether these behaviors represented hereditary nervous degenerations, focal epileptic variants, or culturally molded forms of hysteria.

In the mid-twentieth century, transcultural psychiatrist Pow Meng Yap formalized the classification of atypical, non-Western psychopathological conditions under the rubric of culture-bound syndrome. Yap classified latah-spectrum conditions—including Thai bah-tschi, Burmese yaun, and Filipino mali-mali—as “fright-reaction” and “imitative-dissociative” neuroses. He hypothesized that while the biological substratum was universal, traditional cultures with strict norms of social hierarchy and emotional restraint fostered dissociative pathways to express suppressed tension.

During the 1980s, medical anthropologist Ronald C. Simons spearheaded extensive field research across Southeast Asia, capturing startle syndromes on film and conducting neurophysiological assessments. Simons advanced the “neurocultural model,” arguing that while startle is a hardwired brainstem reflex, societies like Thailand and Malaysia have transformed an exaggerated physiological variant into a codified, socially performed idiom. Over subsequent revisions of psychiatric nosologies—including the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and DSM-5—bah-tschi and its regional analogs moved from “exotic syndromes” toward recognized cultural concepts of distress.

6. Theoretical Foundations

The conceptual framework explaining bah-tschi spans neurobiological, psychodynamic, and sociocultural paradigms, generating enduring debate between universalist and relativist schools of psychiatric thought.

The neurophysiological model posits that bah-tschi involves a dysfunction or hyper-responsiveness of the brainstem reticular reflex arc. The primary acoustic startle reflex is mediated through caudal pontine structures, specifically the nucleus reticularis pontis caudalis (NRPC), which transmits efferent impulses down the reticulospinal tract to spinal motor neurons. In typical individuals, cortical descending pathways exert rapid inhibitory control over this primitive circuit. Neurobiologists hypothesize that in individuals affected by bah-tschi, transient failure of prefrontal cortical inhibition—whether triggered by autonomic hyperarousal, neurochemical variations in glycinergic or GABAergic pathways, or learned stress conditioning—allows hyperstartle and subsequent automatic motor release to proceed unfettered.

The psychodynamic framework approaches bah-tschi through the lens of ego defense mechanisms and trauma. According to this perspective, the sudden startle ruptures the individual’s psychological equilibrium, precipitating an acute regression of the ego. In this state of psychological surrender, suppressed aggressive and sexual drives escape superego censorship, surfacing as coprolalic outbursts and socially prohibited motor behaviors. The symptom serves as an unconscious compromise: it allows the individual to transgress rigorous societal codes of conduct without incurring moral culpability, as the community views the behavior as involuntary.

The sociocultural and anthropological paradigm, championed by researchers like Ronald Simons and Michael Kenny, rejects strictly reductionist neurogenetic models. Anthropologists observe that bah-tschi is not evenly distributed across the population; it is disproportionately observed in individuals occupying lower socioeconomic, domestic, or occupational rungs—most notably women in rural or traditional agrarian communities. In hierarchical societies where open verbal confrontation or rebellion is forbidden, the bah-tschi performance operates as an institutionalized “safety valve.” The teasing dynamic establishes an interactive game: community members deliberately trigger the subject, who responds with ritualized, theatrical shock, receiving attention, laughter, and momentary immunity from standard etiquette.

7. Key Components, Types & Dimensions

The clinical presentation of bah-tschi can be disaggregated into specific phenomenological dimensions and behavioral expressions:

• Sensory Trigger Vulnerability: Hypersensitivity to acute, unannounced stimuli. While unexpected acoustic blasts are most prevalent, tactile probing around sensitive anatomical zones (flanks, neck, axillae) serves as a potent provocative mechanism in Thai communities.
• Hyperstartle Paroxysm: An exaggerated physical motor jerk, marked by sudden axial flexion, bilateral arm extension, gasp responses, and immediate facial terror that exceeds normative human startle reflexes in amplitude and duration.
• Echolalia and Coprolalia: Compulsive, repetitive verbalizations immediately following startle. Words voiced by bystanders are mirrored instantaneously (echolalia), interspersed with strings of profanities, obscene anatomical references, and taboo sexual terms (coprolalia) voiced without deliberate intent.
• Echopraxia: Involuntary imitation of observed somatic motor actions. If an onlooker drops an arm, falls down, or executes an absurd physical dance in front of the startled individual, the patient mirrors the precise sequence in an automated fashion.
• Command Automatism (Automatic Obedience): Immediate, unreflective execution of verbal commands issued by an authoritative or startling voice. Commands to “drop that!”, “strike him!”, or “throw it!” are executed prior to conscious cognitive appraisal.
• Dissociative Trance State: A transient narrowing of the conscious field, marked by depersonalization, derealization, autonomic surge (tachycardia, tachypnea, diaphoresis), and an inability to assert subjective volition.
• Post-Paroxysmal Asthenia and Affective Distress: The rapid resolution of the episode leaves the individual physically fatigued, emotionally drained, and acutely self-conscious of their public vulnerability.

8. Examples & Illustrative Cases

To ground the construct within real-world observations, transcultural clinical literature documents detailed ethnographic vignettes that demonstrate how bah-tschi functions within Thai social spaces.

Case Illustration 1: The Rural Marketplace Incident
A 58-year-old rural woman working in an open-air provincial market in Northern Thailand had been known for decades among local merchants as exhibiting baah-ji. While negotiating with a wholesale vendor, a nearby cart tipped over, producing a sudden, deafening clatter of metal pans. Instantly, the woman gasped, leaped upward, and began violently throwing vegetables from her stall into the air while shouting explicit colloquial profanities regarding genitalia. A passerby jokingly shouted, “Slap your cheeks!” In her startled, dissociated state, the woman vigorously tapped her own face three times before staggering against the counter. Within sixty seconds, her agitation ceased. She dropped her hands, breathed heavily, wiped sweat from her forehead, and expressed profound shame, apologizing to surrounding customers while collecting the scattered produce.

Case Illustration 2: The Domestic Teasing Dynamic
A 64-year-old matriarch residing in an extended rural household exhibited acute sensitivity to unexpected tactile contact. Her grandchildren frequently exploited this susceptibility as an entertaining pastime. Approaching silently from behind while she washed dishes, a family member gently poked her in the waist and yelled, “Jump into the river!” The matriarch violently jerked, echoed the word “River! River! Whore!”, and stepped rapidly toward the doorway in an automated attempt to march outward. A relative caught her arm to halt her trajectory, at which point she turned and mirrored the relative’s open-mouthed expression and waving hands for thirty seconds. Once the arousal subsided, she chided her family members for their lack of respect, describing an acute sensation that her “heart had flown away” and that her mind had momentarily emptied.

9. Measurement & Assessment

Assessing bah-tschi requires a rigorous multidisciplinary approach, combining neurological diagnostic procedures with culturally competent psychiatric evaluations. Because no single biomarker confirms the condition, assessment relies on clinical history, behavioral observation, and the exclusion of organic neurological pathology.

The clinical assessment begins with the Cultural Formulation Interview (CFI), established in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The CFI allows clinicians to explore the patient’s explanatory model of illness, identifying how local concepts such as khwan (the vital personal spirit in Thai cosmology) or wind-humor imbalances (lom) inform the patient’s subjective understanding of their susceptibility to fright.

Differential diagnosis is paramount to distinguish bah-tschi from life-threatening or degenerative neuropsychiatric disorders:

• Hereditary Hyperekplexia: A rare genetic disorder caused by mutations in the GLRA1, GLRB, or SLC6A5 genes, disrupting glycinergic neurotransmission. Unlike bah-tschi, hyperekplexia involves generalized muscular rigidity immediately following startle, lack of imitative or coprolalic behaviors, infant onset (“stiff baby syndrome”), and an absence of culture-specific dissociative performance.
• Tourette Syndrome and Chronic Tic Disorders: While Tourette syndrome involves involuntary vocal and motor tics including coprolalia and echopraxia, these manifestations are premonitory-urge driven, occur spontaneously across varied environments, and do not require an external startle provocation to occur.
• Startle-Induced Epilepsy: True reflex seizures triggered by startle present with characteristic electroencephalographic (EEG) epileptiform discharges (spike-and-wave patterns, focal paroxysms) and are typically accompanied by post-ictal confusion or tonic-clonic posturing, features absent in bah-tschi.
• Dissociative Disorders (DSM-5 / ICD-11): The clinician must assess whether the condition is limited to stimulus-bound hyperstartle or represents a broader Dissociative Neurological Symptom Disorder, Depersonalization-Derealization Disorder, or Dissociative Identity Disorder.

10. Applications & Practical Significance

The study and clinical awareness of bah-tschi hold direct significance for global mental health, transcultural clinical practice, medical ethics, and jurisprudence.

In cross-cultural clinical settings, recognizing bah-tschi protects migrant and diaspora populations from inappropriate psychiatric hospitalization, misdiagnosis, and aggressive psychopharmacological intervention. Clinicians unfamiliar with Southeast Asian idioms of distress risk misinterpreting startle-induced echolalia and coprolalia as acute catatonic excitement, schizophrenia, or severe mania. Understanding the condition as an interactive, culture-bound startle response allows practitioners to adopt supportive psychoeducational interventions, behavioral deconditioning, and stress-reduction techniques rather than unnecessary anti-psychotic regimens.

From a legal and forensic perspective, bah-tschi introduces crucial questions regarding criminal culpability and volition. In Southeast Asian legal history, court cases have surfaced where individuals in a startle-induced dissociative state injured bystanders or damaged property following an instigator’s command (e.g., being ordered to strike someone while holding an agricultural tool). Legal scholars and forensic psychiatrists emphasize that because the automatic obedience phase bypasses reflective mens rea (conscious intent), primary legal and moral liability rests upon the provocative instigator rather than the startled subject.

11. Research & Empirical Evidence

Empirical investigations into bah-tschi and related startle syndromes gained scientific rigor through the combined efforts of neurophysiologists, transcultural psychiatrists, and behavioral anthropologists during late-twentieth-century field campaigns.

In a seminal series of investigations, Ronald C. Simons (1980, 1985) conducted neurophysiological field recordings throughout Southeast Asia. Utilizing surface electromyography (EMG) alongside simultaneous audiovisual documentation, Simons established that the latency and initial motor configuration of the startle jerk in latah and bah-tschi subjects are identical to the universal human startle reflex mediated by the brainstem. However, in vulnerable individuals, the recovery curve of the acoustic blink and motor reflex failed to habituate upon repeated stimulation. This demonstrated that while the biological starting point is a hardwired physiological reflex, the downstream behaviors—echolalia, coprolalia, and command obedience—represent culturally shaped dissociative habits.

Subsequent neurological studies by Saint-Hilaire et al. (1986) and Bakker et al. (2006) examined startle syndromes comparatively across different populations. Their findings confirmed that cultural hyperstartle syndromes do not exhibit the paroxysmal sharp waves on EEG characteristic of reflex epilepsy, nor do they carry the persistent pathological hypertonia seen in genetic hyperekplexia. Neuroimaging research in functional movement disorders and dissociation further suggests that subjects demonstrating startle automatisms exhibit hyperconnectivity between the amygdala and motor execution regions, coupled with reduced functional connectivity between the anterior cingulate cortex and prefrontal inhibitory hubs.

12. Cultural & Cross-Cultural Considerations

Bah-tschi cannot be separated from the cultural tapestry of Southeast Asia and its comparative counterparts worldwide. In traditional Thai society, interpersonal interactions are governed by cultural ideals such as kreng jai (extreme consideration for others’ feelings and deference toward status) and riap-roi (polite, controlled, and modest comportment). Open conflict, vulgar speech, and defiance are deeply discouraged in everyday discourse.

Within this tight social framework, bah-tschi provides a paradoxical, culturally accommodated exception. An afflicted elder woman, ordinarily required to maintain immaculate deference, is socially excused when an unexpected poke prompts her to utter crude anatomical curses or mimic an authority figure. Anthropologists describe this dynamic as a ritualized subversion of social hierarchies. Paradoxically, the community often regards the behavior with affectionate amusement, integrating the individual into village social gatherings as an unwitting comic performer, even as the individual experiences subjective distress.

Cross-culturally, bah-tschi shares striking phenomenological congruence with startle syndromes documented across disparate geographic regions:

• Latah (Malaysia and Indonesia): The primary regional prototype, sharing identical clinical features of startle, coprolalia, and imitative automatisms.
• Mali-mali / Silok (Philippines): An identical startle-matching syndrome occurring in the Philippine archipelago, frequently described among working-class females.
• Yaun (Myanmar / Burma): A Burmese startle-dissociative syndrome provoked primarily by tickling and sudden surprises.
• Imu (Ainu of Northern Japan): A startle-reactive state historically recorded among women of the indigenous Ainu population, often triggered by a fear of snakes.
• Myriachit / Amurakh (Siberia, Russia): Described among indigenous Siberian populations by Cossack travelers and early ethnographers, marked by complete motor and verbal mimicry.
• Jumping Frenchmen of Maine (United States / Canada): Documented in lumberjack communities of nineteenth-century Maine and Quebec, demonstrating that culture-specific startle automatisms are not restricted to non-Western geographies.

13. Criticisms, Debates & Limitations

The academic discourse surrounding bah-tschi and startle-matching phenomena remains marked by intense theoretical disagreements between psychiatric universalists and medical anthropologists.

A major point of contention concerns the medicalization of what many anthropologists view as learned social role-playing. Scholars such as Michael Kenny have argued that classifying bah-tschi as a psychiatric “syndrome” or disease entity represents an artificial clinical reification imposed by Western nosologists. Critics suggest that individuals identified as baah-ji learn the role through continuous social conditioning, teasing, and behavioral reinforcement. Because onlookers react with laughter, attention, and playful baiting, the subject unconsciously adopts and sustains the behavioral script.

Conversely, neurological universalists criticize anthropological interpretations for underestimating underlying biological vulnerabilities. Neurologists argue that dismissing bah-tschi as pure theater ignores documented neurophysiological abnormalities, such as impaired sensorimotor gating, non-habituating reflex loops, and baseline autonomic dysfunction observed in experimental paradigms.

Finally, historical accounts of bah-tschi recorded during the colonial era have been scrutinized for orientalist bias. Early European observers frequently depicted the phenomenon through a paternalistic lens, using reports of exaggerated startle, imitativeness, and automatic obedience to support racist tropes regarding the supposed “childlike” or “hyper-suggestible” nature of Southeast Asian populations. Contemporary transcultural psychiatrists stress the need to balance empirical neurobiological data with nuanced ethnographic accounts that center the dignity and voices of affected individuals.

14. Related Terms & Distinctions

To ensure precise diagnostic and conceptual boundaries, bah-tschi must be differentiated from closely associated psychiatric and neurological conditions:

• Latah: The overarching Malay/Indonesian linguistic and psychiatric prototype. Bah-tschi is the direct Thai ethnomedical equivalent, sharing the same core symptoms but embedded within Thai cosmological and linguistic conventions.
• Hyperekplexia (Startle Disease): A monogenic neurological disorder marked by severe generalized muscular stiffness, unbending falls, and an absence of imitative actions or command obedience. Bah-tschi involves transient dissociation and motor mimicry without generalized muscular rigidity.
• Tourette Syndrome: A chronic neurodevelopmental disorder involving fluctuating motor and phonic tics. Tourette-related coprolalia arises spontaneously from an internal premonitory urge, whereas bah-tschi requires an acute, external sensory startle stimulus to elicit vocalizations.
• Dissociative Trance Disorder: A diagnostic category under ICD-11 referring to states of altered awareness not associated with an immediate startle stimulus. Bah-tschi represents an acute, stimulus-bound subtype of dissociative reaction.
• Catatonia: A neuropsychiatric syndrome characterized by immobility, mutism, waxy flexibility, or purposeless excitement. Although catatonia can present with echophenomena (echolalia and echopraxia), these are persistent, ongoing manifestations rather than paroxysmal responses triggered by acute startle.
• Startle Epilepsy: A form of reflex epilepsy wherein sensory startle triggers true cortical or subcortical seizures with diagnostic electroencephalographic (EEG) epileptiform activity and subsequent post-ictal confusion.

15. Summary / Key Takeaways

Bah-tschi serves as an illustrative case study in how human physiology and cultural frameworks converge to shape psychopathology. The condition illustrates that while basic human reflex arcs are rooted in ancient evolutionary biology, their manifestation, elaboration, and social meaning are deeply governed by local cultural matrices.

Clinically, bah-tschi demonstrates that dissociative states can be provoked through acute sensory channels and channeled into structured behavioral repertoires such as echolalia, coprolalia, and command automatism. For modern mental health clinicians working in diverse global environments, understanding bah-tschi reinforces the importance of cultural competence, accurate differential diagnosis, and the critical distinction between culturally patterned idioms of distress and underlying structural neurodegenerative disease.

In summary, bah-tschi (bah-tsi, baah-ji) illustrates the fluid boundary between neurological reflexivity, psychological dissociation, and cultural role enactment. By examining this Thai hyperstartle condition through integrated neurobiological, psychodynamic, and ethnographic perspectives, contemporary medicine gains a richer understanding of the varied ways the human mind navigates vulnerability, stress, and social connection.

References

• Ellis, W. G. (1897). Latah, a mental malady of the Malays. Journal of Mental Science, 43(180), 32–40. https://doi.org/10.1192/bjp.43.180.32
• Kenny, M. G. (1978). Latah: The symbolism of a putative psychiatric disorder of Malaysia and Indonesia. Medical Anthropology Newsletter, 9(2), 11–13. https://www.jstor.org/stable/648398
• Simons, R. C. (1980). The resolution of the latah paradox. The Journal of Nervous and Mental Disease, 168(4), 195–206. https://doi.org/10.1097/00005053-198004000-00001
• Simons, R. C., & Hughes, C. C. (Eds.). (1985). The culture-bound syndromes: Folk illnesses of psychiatric and anthropological interest. D. Reidel Publishing Company. https://doi.org/10.1007/978-94-009-5251-5
• Yap, P. M. (1969). The culture-bound reactive syndromes. In W. Caudill & T. Y. Lin (Eds.), Mental health research in Asia and the Pacific (pp. 33–53). East-West Center Press. https://psycnet.apa.org/record/1970-00569-001