Medical anthropology: Cannibalism, Flying Foxes, Absinthe and white bread: the cultural basis of neurological disorders

Townsend Letter for Doctors and Patients, Nov, 2003 by Tim Batchelder

The Background

[ILLUSTRATION OMITTED]

To what extent is neurological disease culture-bound or bio-logically based around the world? My interest in this topic began in the late 1980s while studying linguistics and anthropology at Hamilton College. Oliver Sacks in An Anthropologist on Mars and other books pointed out how people with neurological disorders perceived the world and were defined by it very differently and uniquely. Later on I did graduate work in biological anthropology at CUNY with professor Shirley Lindenbaum, the original discoverer of a fascinating neurological condition called kuru. Since that time I have also studied with Paul Cox, PhD, another researcher studying neurological disease and anthropology, this time among a Polynesian culture. Today as part of my work in medical communications I talk to patients with MS every day about their experiences which has revealed some interesting patterns in the geography of this disorder. In this column, I'll look at these seemingly disparate disorders through the viewfinder of anthropology.

Kuru and Cannibalism

To understand the anthropology of neurological disease today one must first consider an elusive disease that appeared in New Guinea in the early 1900's called kuru, which occurred among the South Fore (Lindenbaum 1979). Between 1957 and 1968 over 1100 South Fore died from kuru (Lindenbaum 1979). Eight times more women than men contracted the disease since women were the prime participants in mortuary cannibalism, which is linked to the disease. Upon the death of an individual, the maternal kin females would remove the arms and feet, strip the limbs of muscle, remove the brains, and cut open the chest in order to remove internal organs. Lindenbaum (1979) states that kuru victims were highly esteemed as sources of food, because the layer of fat on victims who died quickly resembled pork. Women also were known to feed morsels such as human brains and various parts of organs to their children and the elderly. Initially kuru was thought to be a genetic disorder, then it was thought to be a slow virus, and eventually it was linked to a prion. All known prion diseases are fatal and are often called spongiform encephalies because they cause the brain to become spongy and riddled with holes (Prusiner 1995). Well known prion diseases include scrapie, bovine spongiform encephalopathy (mad cow disease or BSE), and Creutzfeldt-Jakob disease (CJD). There are three stages of the disease. In the ambulant stage unsteadiness of stance, gait, voice, hands, and eyes, deterioration of speech, tremor, shivering, and slurring of speech all occur (Gadjusek, 1973). In the sedentary stage the patient can no longer walk without support, more severe tremors and ataxia (loss of coordination of the muscles), shock-like muscle jerks, outbursts of laughter, depression, and mental slowing occur. In the terminal stage the patient is unable to sit up without support and experiences severe ataxia (loss of muscle coordination), tremor, slurring of speech, urinary and fecal incontinence, difficulty swallowing, and deep ulcerations. Treatments focused on herbs and reversing the sorcery and hex that was linked to the disease in the traditional etiology.

Pawpaw, Parkinson's, and Flying Foxes

After learning about kuru, I visited Dr. Paul Cox, an ethnobotanist living in Kauai and directing the National Tropical Botanical Garden where I participated in a fellowship on science journalism. He studies medicinal plants in Polynesia (many of which are later made into pharmaceuticals) and we experienced kava and many other popular herbal medicines in their native context. But Dr. Cox is perhaps best known for his research on a neurological disease in Guam that is closely related to the indigenous people's diet. Cox found that up to a third of Guam's indigenous Chamorro people had a neurological disease similar to Lou Gehrig's, Parkinson's and Alzheimer's diseases called ALS-PDC (amyotrophic lateral sclerosis-Parkinsonian dementia complex) with symptoms from muscle weakness and paralysis to dementia, and occurring at a rate as much as 100 times higher than in the continental US. The flying foxes are served at Chamorro weddings, village fiestas and religious events in their whole form washed and boiled. Unfortunately, the flying foxes eat cycad seeds, which contain a neurotoxin called BMAA (beta-methylamino L-alanine) that is retained at a high level (90%). The disease is three times more common in men than in women since men eat the entire bat while women eat only the breast meat. Other studies have also shown that people in Guam and in the West Indies who consume the pawpaw fruit or drink it as a tea, which is considered a sedative or aphrodisiac, have the highest rates of Parkinsonism (a relative of Parkinson's). This plant family contains certain alkaloids that act as insecticides.

Internet Absinthe

In a strange coincidence not long after meeting Dr. Cox, a good friend of mine called and asked me if I'd like to order some Absinthe off the internet. "Internet Absinthe?!!" I asked incredulously. And yes indeed we soon found bottles of the stuff available online. My shock was based on a dim recollection of some of the fantastically powerful effects of wormwood, a key ingredient in the drink, and its relation to neurological, shall we say, "abnormalities" (as well as a wonderful ability to purge the body of worms.) Absinthe is an emerald-green liqueur that became famous in turn of the century Paris and is now enjoying a comeback and contains a neurotoxin that may account for some of the creative genius of Vincent Van Gogh and other artists during this period. Alpha-thujone, the active ingredient in "La Fee Verte," or "the green fairy" can lead to the out-of-control firing of brain cells similar to the misfiring found in epilepsy as well as to addiction, hallucinations and delirium. Many late 19th century and early 20th century creative artists developed sophisticated rituals involving special spoons, water, sugar and sidewalk cafe locations. Baudelaire, Rimbaud, Verlaine, Toulouse-Lautrec and Picasso were other famous absinthe drinkers. Absinthe appears to work on the GABA receptor, a key component in the brain's system of self-control. Absinthe was eventually banned in France and many other countries, including the United States, where it is still outlawed. But today imitation absinthe beverages containing up to 55% alcohol are sold in Europe and Canada with much lower potency of 10 parts per million of the active ingredient versus 260 parts per million in old absinthe.