Last week I shared the TALE OF TAMEDO: the story of a man on the streets. If you missed that episode, or you’d like to see it again in one piece, you can find it here. Today I’ll be shining the light on another often misunderstood aspect of mental illness. Enjoy.

Most Nigerians are familiar with stories of people’s privates going missing or impotent after a touch. The victims are usually men and the object usually the penis. (There have been reports of instances in women, involving the nipples, but they don’t seem as common.)

The story typically goes something like this. A man is in the street or market or some other public place. A stranger (or sometimes a familiar person) suddenly touches him, whereupon he may feel an unusual sensation (sometimes described as a shock), and the sudden awareness that his manhood has been affected — either taken away or robbed of potency.

You know what comes next. The “victim” raises instant alarm and accosts the “culprit.” Passersby and onlookers transform into a street court, complete with judge and jury. A demand is made of the accused, to restore or replace the affected organ, and if he is so unfortunate as to unable to do, he may not live to see another hour.

If he’s lucky, the police may arrive on the scene in time to prevent a lynching, in which case they take statements from both parties. As soon as they can, they take the complainant for psychiatric evaluation.

Yes, you read that right. The person making the complaint. Because, you see, there’s actually a name for this phenomenon…

It’s called “koro.”

And it’s recognised as a psychiatric disorder: a culturally-specific form of anxiety disorder. That is, unlike other mental illnesses, this particular variant of anxiety disorder is rooted in specific cultural beliefs.

“Koro” is not a Nigerian name, by the way. It’s from Malaysia, where a similar phenomenon is recognised. The name is believed to be related to the Malay word for “head of turtle,” as their version involves beliefs about the penis shrinking. Like a turtle head.

The first case of anything like koro on record comes from China, about 300 BC. But one of the earliest documented cases in Nigeria dates to 1975, and was recorded by a Dr. Sunday Ilechukwu, a psychiatrist posted to Kaduna. Here is an account of the event (from the April 14, 2008 edition of Harper’s Magazine — you’ll find the link at the end of this post):

Dr. Ilechukwu was sitting in his office when a policeman escorted in two men and asked for a medical assessment. One of the men had accused the other of making his penis disappear. This had caused a major disturbance in the street. As Ilechukwu tells it, the victim stared straight ahead during the examination, after which the doctor pronounced him normal. “Exclaiming,” Ilechukwu wrote, “the patient looked down at his groin for the first time, suggesting that the genitals had just reappeared.”

According to Ilechukwu, an epidemic of penis theft swept Nigeria between 1975 and 1977. Then there seemed to be a lull until 1990, when the stealing resurged. “Men could be seen in the streets of Lagos holding on to their genitalia either openly or discreetly with their hand in their pockets,” Ilechukwu wrote. “Women were also seen holding on to their breasts directly or discreetly, by crossing the hands across the chest. . . . Vigilance and anticipatory aggression were thought to be good prophylaxes. This led to further breakdown of law and order.” In a typical incident, someone would suddenly yell: Thief! My genitals are gone! Then a culprit would be identified, apprehended, and, often, killed.

Koro: spiritual or physical?

Now, you might be thinking, “This Doc Ayomide doesn’t even understand the spiritual world. He doesn’t know that there are evil forces at work.” (What the Yoruba, to whom I belong, call “awon aye” — malicious spiritual forces.) Or as some people I know would say, “Just pray it doesn’t happen to you.”

Have you noticed, though, how it’s things we don’t understand that we tend to spiritualise? So for example, it used to be thought that lightning was the arrow of the gods. But I’m sure no one you know really believes that anymore. (Right?)

Or, people used to believe in “abiku” and “ogbanje”: that a woman who kept losing children in early infancy was being revisited by the same child over and over again. But since we’ve understood about sickle cell disorder (which is almost entirely a Black disease) and have gotten better at treating it and improving survival, abiku has become almost entirely unheard of.

I’ve seen people who believed themselves to have been shot with a “spiritual arrow” in the leg that left them paralysed on one side. (Most like stroke, of course.) And many doctors are familiar with stories of family members believed to have died of “poisoning” by “enemies in the village”: the person having deteriorated inexplicably, with significant weight loss, over a period of maybe months — a course of illness very similar to what obtains in some late-stage organ cancers.

Those are just a few examples of how we spiritualise what we don’t understand. In the same way, mental disorders are highly prone to being spiritualised. They remain the blind spot on our health landscape, poorly understood by educated and uneducated alike. (Not even all doctors get it.)

So the ”mystery” of missing manhood is understandable in psychiatric terms. First, koro only occurs to those who believe it’s possible for genitals to actually be stolen or damaged by touch. It’s also commoner among those with a poor understanding of biology. And it’s almost unheard of in the West — not because they don’t have African magic — but because of better widespread knowledge of biology and lack of penis-stealing beliefs.

This prior belief is also why koro tends to occur in epidemics: the belief that it can happen is heightened when reports of it are widespread. In a sense, one could describe koro as a disorder of expectation. Apparently a person with such a prior belief experiences a touch (often by a stranger), that is either accompanied by a unusual sensation or makes them think of their genitals. And they become convinced the worst has happened.

By the way, you might not be aware, but where it’s claimed that a penis has disappeared, it’s often not actually checked. The word of the person claiming is usually enough for bystanders who already believe penis-stealing possible. Even when it’s checked, it’s often only to confirm the stolen/damaged organ has been “restored.” (A visit to a commercial sex worker often being part of this “confirmation.”)

These days (in the cases I’ve seen), the claim is often that the organ has been rendered impotent. Which is, of course, harder to “confirm.” Especially since it’s actually harder to have an erection when you’re anxious. (Although, if the affected person continues to have an early morning erection, that may point to the problem being more likely psychological than physical.) Again, efforts of the police must be acknowledged: they’ve saved many an unwitting innocent from lynching.

I realise all this might be hard to swallow. Really, I get it. It’s not easy to simply shed long-held beliefs. So I ask only that you at least be open to the question: what if we’ve been wrong about missing organs all this time? That maybe it’s not that I’m medicalising a spiritual problem. Maybe it’s we who’ve spiritualised a medical problem.

Please keep in mind I speak from not just theoretical knowledge or hearsay, but personal experience with actual cases. if you’re struggling to believe all I’ve said, consider: how much of that reluctance is based on what you’ve only heard? And consider I’ve seen this real-life.

What we can learn from koro

Luckily koro is not common (except when there’s an epidemic, which hasn’t been for years now). I can count the cases I’ve seen on my hands. But if there’s one thing we can learn from the koro phenomenon, it is this: what we believe before an event says a lot about how we will interpret 

When, a priori, we see mental disorders as spiritual, we won’t consider the option of medical help till it’s too late. And this spiritualising has sometimes lead to death. Yes, our beliefs can become a life-and-death issue. Wrong beliefs aren’t harmless. They can hurt. They can kill. And both the person holding & the one held against lose.

It’s time we change the conversation. It’s time we bring mental disorders & mental health issues out of the corner. It’s time we stopped talking about it in whispers & with pointing fingers, but with listening ears & open arms. When we empower ourselves by learning about mental health issues, we empower others & empower them to empower others.

Here are a few links to start you off:

• Wikipedia on koro

• The Harper’s Magazine article on koro

• http://www.livescience.com/28015-penis-snatching-panics-koro.html

• http://io9.com/5944722/koro-syndrome-the-irrational-fear-of-lethal-genital-shrinkage

• http://www.ncbi.nlm.nih.gov/pubmed/17727356

Join me again this Friday at 6 pm!