A West African folk illness called Pobouh Lang, characterized by compulsive geophagia, pallor, weakness, edema, depression, anxiety, and social isolation, has been examined in cultural context and with reference to pertinent biological, ethnographic, and historical literature on geophagia. Some features of the illness are probably related to iron lack and other nutritional deficiencies, Other features are related to the ambiguous cultural definition of, and negative response to, the manifest behavior. - The determinants of the cultural response are unclear, but they may involve a relatively recent increase in the prevalence of the syndrome or unidentified features of the ethos that make it hard to assimilate geophagic habits. - In many cultures geophagia is accepted behavior with either medicinal, hedonistic or religious overtones. In such contexts the psychiatric elements of the syndrome seem not to occur, even where an element of malnutrition is present, as in the present day rural American South or during pregnancy among the Serer. In our opinion the interest of this analysis lies in its demonstration of the mix of biologic, social, and psychological factors in one specific example of illness or misbehavior. Saying that Pobouh Lang is caused by nutritional deficiency is wrong. Saying that Pobouh Lang is caused by socially defining a certain group of people as sick or morally weak is also wrong. But both statements contain an aspect of the truth. - One can think of other behaviors such as alcoholism and homosexuality which would yield to similar analyses. - In both instances, there is accumulating evidence for the operation of biological components (14, 18, 27). It must be remembered, however, that these biological elements only help to explain behavior, not "disorder". Disorder may not be inherent in the behavior itself, but in the way in which it is perceived and evaluated in a social context. - Furthermore, behavior such as secretiveness, depression and anxiety may not be an intrinsic part of the syndromes called homosexuality, alcoholism or Pobouh Lang, but secondary symptoms based on individual responses to societal pressures. - Failure to disentangle the elements of such complex processes of behavior, definition as disorder, and emotional reaction has led to great confusion. It seems to us that some of the controversy, for example, between geneticists, dynamic psychiatrists and labelling theorists may be due to a failure to specify which level of the phenomenon is being discussed. - Analysis of the behavior known as Pobouh Lang requires inputs from the biological, psychological and social sciences. One expects the same will hold true for many of the conditions we consider instances of psychiatric disorder. © 1974 Springer-Verlag.
