Loshini Rajentharan
Liverpool, United Kingdom

“Loshi suka melatah.”

A friend said this to me when I was thirteen, pointing out my exaggerated response to being startled. This was not a formal consultation or diagnosis: we were schoolgirls in Malaysia, and melatah belonged to the ordinary vocabulary of the world around us.

Years later, after medical school and training in psychiatry, I encountered the word again. This time it appeared among the so-called “culture-bound syndromes” of my specialty: latah, a phenomenon historically associated with Malaysia and Indonesia, characterized by an exaggerated startle response that may be accompanied by echolalia, echopraxia, automatic obedience, and other involuntary behaviors.¹

I was fascinated, not because I had never heard of latah, but because I had. Medicine was introducing me, with the solemnity of classification, to a word that already belonged quite comfortably to my childhood.

The same thing happened with another Malay word, amok, although its journey through the English language has been considerably more successful. Children can run amok at a birthday party. Rumors may run amok on the internet. An imagination can run amok. The word has found such a comfortable home in English that its foreignness is no longer even visible.

But amok has a longer and considerably darker medical and cultural history. Historical descriptions portrayed episodes of extreme violence in which a person might attack those around him, sometimes ending in his own death. The phenomenon attracted the attention of colonial administrators, anthropologists, and psychiatrists, who attempted variously to explain, classify, and diagnose it.^2,3 Over time, amok became one of the canonical examples of what psychiatry once called a culture-bound syndrome.⁴

In Malay, though, we also have mengamuk: to rage, to run amok, to behave with uncontrolled fury. And we have melatah. Both describe something a person does. While I had grown up hearing these words without thinking much about them, coming across them in psychiatry made me wonder what happened to their everyday meanings when they entered a textbook.

There is something peculiar about learning words from your own linguistic landscape after they have traveled abroad, acquired italics, accumulated citations, and returned wearing the clothes of medicine. I do not mean that medicine invented an illness out of a familiar word. The behaviors described in accounts of latah can be embarrassing, disruptive, or distressing and go well beyond my schoolgirl reactions.^1,5 Nor can the violence described as amok be equated with someone being angry enough to be described colloquially as mengamuk. Knowing the word in one setting does not necessarily mean understanding it in another.

Western observers had been writing about latah in Southeast Asia since at least the late nineteenth century. Robert Winzeler, who reviewed this literature and conducted ethnographic fieldwork in Malaya and Borneo, questioned whether it should straightforwardly be regarded as an illness or a syndrome. He examined its social functions and how local people understood it.⁵ What did the behavior mean to the person doing it, and to the people around them?

Amok attracted a rather different kind of attention. British colonial administrators Sir Frank Swettenham and Sir Hugh Clifford both wrote about it in nineteenth-century Malaya. Clifford associated it with sakit hati, an expression he linked to an emotional state that could culminate in homicidal-suicidal rage. Swettenham described the grim fate that often awaited the person who ran amok: he might not be taken alive.²

Later researchers offered other ways of understanding these accounts. Carr proposed that amok was a culturally recognizable pattern of behavior that could have several different causes, rather than a single underlying disease.³ Research in West Malaysia also found that individuals and their communities could regard amok as pathological while understanding it through local cultural expectations.⁶ It would be too convenient to tell this story as one in which outsiders saw illness and Malaysians saw only ordinary behavior. The literature does not support that neat division.

Meanwhile, English speakers were getting on with using “run amok” for birthday parties and unruly imaginations. Latah remained much more closely associated with Southeast Asia and with psychiatric and anthropological writing. The two words had taken very different journeys from the language in which I knew them.

Psychiatry has reconsidered how it discusses culture. The DSM-5 introduced the broader framework of cultural concepts of distress in place of the older emphasis on culture-bound syndromes.⁷ I find that useful because “culture-bound” can make it sound as though culture belongs mainly to the unfamiliar conditions at the back of the textbook. Yet a patient describing depression in an English clinic also brings a language, a family, and a set of expectations about suffering into the room. Those things may be familiar to the clinician, but familiarity does not make them irrelevant.

This is where grammar helps me think, although I would not expect it to settle a diagnostic question. Melatah and mengamuk describe actions; they do not, on their own, explain why someone behaves that way. A clinical label may help us recognize a pattern and decide what to investigate or treat. It still leaves us with questions about a particular person and setting.

I need diagnoses in my work. I also know how tempting it can be to feel that recognition of a diagnosis means I have understood the person. Encountering these familiar Malay words in psychiatric literature brought that temptation closer. I could recognize the vocabulary immediately and still have more to learn about the experiences being described.

I think back to my thirteen-year-old self: “Loshi suka melatah.”

My friend was teasing me, not diagnosing me. I did not have a case of latah syndrome. I was a schoolgirl who gave particularly satisfying reactions when startled. A word can inhabit a school classroom and a psychiatric textbook at the same time. It can mean something to the people who speak it every day and something subtly different to the people who study it. Years after leaving that secondary school behind, I became one of the people carrying the textbook. That may be why encountering latah in psychiatry felt so strange. Medicine was teaching me something about where I came from. But the place I came from had already taught me the word.

Sometimes, before deciding what a word means clinically, it may be worth asking what the people who gave us the word were doing with it in the first place.

Sometimes grammar remembers what medicine forgets.

References

1. Lim TT, Tan K, Eow GB, Bhidayasiri R. A South East Asian perspective of neuropsychiatric startle syndromes of latah. Parkinsonism Relat Disord. 2022;95:138–142. doi:10.1016/j.parkreldis.2022.01.013
2. Kua EH. Amok as viewed by British administrators in colonial Malaya. Br J Psychiatry. 2012;200(3):244. doi:10.1192/bjp.bp.111.100784
3. Carr JE. Ethno-behaviorism and the culture-bound syndromes: the case of Amok. Cult Med Psychiatry. 1978;2(3):269–293. doi:10.1007/BF00051007
4. Tan EK, Carr JE. Psychiatric sequelae of Amok. Cult Med Psychiatry. 1977;1(1):59–67. doi:10.1007/BF00114810
5. Winzeler RL. Latah in South-East Asia: The History and Ethnography of a Culture-Bound Syndrome. Cambridge University Press; 1995.
6. Carr JE, Tan EK. In search of the true amok: amok as viewed with the Malay culture. Am J Psychiatry. 1976;133(11):1295–1299. doi:10.1176/ajp.133.11.1295
7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Publishing; 2013.