Culture-Bound Syndrome: Agonias

A culture-bound syndrome is defined as “a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture”. During Week 7 of my course, we learned about some common culture-bound syndromes, such as mal de ojo, susto, empacho, and caida de mollera. I wanted to learn more about other culture-bound syndromes that affected people around the world.

I researched a great deal of different syndromes, including Latah from Malysia and Indonesia, lanti from the Philippines, imu from a population in Maine, and a great deal of others (Simon). However, the culture-bound syndrome that really caught my eye is called agonias. The author of the article where I discovered this phenomenon defined agonias as “a culture specific somatic phenomenon of Portuguese immigrants” (James). The Azores Island is an autonomous region of Portugal that is extremely remote. Religion plays an extremely large role in the community, as all of the major community celebrations are centered on religious holidays. In this community, it is difficult for family members to talk about their relationships with each other. The only exception to this typical practice is if the actions of family members physically hurt other family members. Physical symptoms are widely accepted as a normal conversation topic in this community.

Agonias is anything that is off balance or causing physical discomfort or anxiety in a person. It has been described as the feeling of “missing air” in their chest, a burning from within, indigestion, loss of sight, and even the inability to sleep or eat. The perceived causes of agonias ranged from spousal mistreatment, talking about troubles to a friend, or even that it was God-given and incurable. Some believe that they experience agonias because they are anxious about sin. Essentially, people use social and religious implications to explain why they are experiencing certain physical symptoms that cause discomfort.

Azoreans believe that the only cure for agonias is God. They believe that through prayer, His divine power is the only thing that can cure them from their ailments. They refer to God as “the great physician” and rely on Him to fix everything from insomnia to a broken spine. However, they believe that “God works through the mechanisms in the body and it is a person’s duty to employ natural remedies without relying on them exclusively” (James). Many Azoreans will go to their local healer and seek a regiment of natural remedies that they feel will help cure their specific symptoms of agonias.

Although I support and believe in the power of prayer, I worry that solely relying on natural remedies and fervent prayer could be unsafe. For example, if an Azorean has a wound that is infected on their hand, they need to be treated with antibiotics to avoid acquiring larger health problems. I worry that if this community does not seek medical treatment for serious conditions, their ailment will progress, cause bigger problems, and could lead to life threatening situations. There needs to be education that respects their beliefs, yet reiterates how important supplementing treatment with allopathic therapies is to their health.

These conclusions can be applied to all culture-bound syndromes. Although many are harmless, some populations could be putting people at serious risk for developing major health concerns. Health education needs to be implemented into these societies that respect each culture’s beliefs and opinions, but gives alternatives for how people can appropriately manage their health concerns and conditions.

Works Cited

James, S. (2002). Agonias: The social and sacred suffering of azorean immigrants. Culture, Medicine and Psychiatry, 26(1), 87-110. doi:

Simon, R. (2001). Introduction to culture-bound syndromes. Psychiatric Times. 

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