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Amok Runner (v1.1)

Amok syndrome is an aggressive dissociative behavioral pattern derived from Malaysia that led to the English phrase, running amok.[1] The word derives from the Malay word amuk, traditionally meaning "an episode of sudden mass assault against people or objects, usually by a single individual, following a period of brooding, which has traditionally been regarded as occurring especially in Malaysian culture but is now increasingly viewed as psychopathological behavior".[2][3][4] The syndrome of "Amok" is found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR).[5] In the DSM-V, Amok syndrome is no longer considered a culture-bound syndrome, since the category of culture-bound syndrome has been removed.[1]

Amok Runner (v1.1)

The term amok originated from the Malay word meng-âmuk, which when roughly defined means "to make a furious and desperate charge".[6] According to Malaysian and Indonesian cultures, amok is rooted in a deep spiritual belief.[7] Malaysians traditionally believe that amok is caused by the hantu belian,[8] which is an evil tiger spirit that enters one's body and causes the heinous act. As a result of the belief, those in Malay culture tolerate amok and deal with the after-effects with no ill will towards the assailant.[9]

Although commonly used in a colloquial and less violent sense, the phrase is particularly associated with a specific sociopathic culture-bound syndrome in the cultures of Malaysia, Indonesia and Brunei. In a typical case of running amok, an individual (almost always male), having shown no previous sign of anger or any inclination to violence, will acquire a weapon (traditionally a sword or dagger, but possibly any of a variety of weapons) and in a sudden frenzy, will attempt to kill or seriously injure anyone he encounters and himself.[10] Amok typically takes place in a well-populated or crowded area. Amok episodes of this kind normally end with the attacker being killed by bystanders or committing suicide, eliciting theories that amok may be a form of intentional suicide in cultures where suicide is heavily stigmatized.[11] Those who do not commit suicide and are not killed typically lose consciousness, and upon regaining consciousness, claim amnesia.

An early Western description of the practice appears in the journals of British explorer Captain James Cook, who encountered amok firsthand in 1770 during a voyage around the world. Cook writes of individuals behaving in a reckless, violent manner, without cause and "indiscriminately killing and maiming villagers and animals in a frenzied attack."[12]

A widely accepted explanation links amok with male honour (amok by women and children is virtually unknown).[13]Running amok would thus be both a way of escaping the world (since perpetrators were normally killed or committed suicide) and re-establishing one's reputation as a man to be feared and respected.

In 1849, Amok was officially classified as a psychiatric condition based on numerous reports and case studies that showed the majority of individuals who committed amok were, in some sense, mentally ill.[14] "Running amok," is used to refer to the behavior of someone who, in the grip of strong emotion, obtains a weapon, which is usually a gun, and begins attacking people usually ending in the murdering of an innumerable number of people.[15] For about twenty years, this type of behavior has been described as a culture-bound syndrome.[15] As of the DSM-V, the culture-bound syndrome category has been removed, meaning that this particular condition is no longer be categorized as such.[1] Culture-bound syndromes are seen as those conditions that only occur in certain societies whereas standard psychiatric diagnoses are not seen that way regardless if there is some sort of cultural limitation.[1]

Though the DSM-IV does not differentiate between them, observers historically described two forms of amok: beramok and amok. Beramok, considered to be more common, was associated with personal loss and preceded by a period of depression and brooding. Amok, the rarer form, was believed to stem from rage, perceived insult or a vendetta against a person.[9]

Early travelers in Asia sometimes describe a kind of military amok, in which soldiers apparently facing inevitable defeat suddenly burst into a frenzy of violence which so startled their enemies that it either delivered victory or at least ensured what the soldier in that culture considered an honourable death.

This form of amok appears to resemble the Scandinavian Berserker, mal de pelea (Puerto Rico), and iich'aa (Navaho).[20] The Zulu battle trance is another example of the tendency of certain groups to work themselves up into a killing frenzy.

In contemporary Indonesia, the term amok (amuk) generally refers not to individual violence, but to frenzied violence by mobs. Indonesians now commonly use the term 'gelap mata' (literally 'darkened eyes') to refer to individual amok. Laurens van der Post experienced the phenomenon in the East Indies and wrote in 1955:

According to the Encyclopædia Britannica Eleventh Edition, some notable cases have occurred among the Rajputs. In 1634, the eldest son of the raja of Jodhpur ran amok at the court of Shah Jahan, failing in his attack on the emperor, but killing five of his officials. During the 18th century, again, at Hyderabad (Sind), two envoys, sent by the Jodhpur chief in regard to a quarrel between the two states, stabbed the prince and twenty-six of his suite before they themselves fell.[24]

Shortly after Captain Cook's report, anthropologic and psychiatric researchers observed amok in primitive tribes located in the Philippines, Laos, Papua New Guinea, and Puerto Rico. These observers reinforced the belief that cultural factors unique to the primitive tribes caused amok, making culture the accepted explanation for its pathogenesis in these geographically isolated and culturally diverse people. Over the next 2 centuries, occurrences of amok and interest in it as a psychiatric condition waned. The decreasing incidence of amok was attributed to Western civilization's influence on the primitive tribes, thereby eliminating the cultural factors thought to cause the violent behavior. Modern occurrences of amok in the remaining tribes are almost unheard of, and reports in the psychiatric literature ceased around the mid-20th century. Inexplicably, while the frequency of and interest in amok among primitive tribes were decreasing, similar occurrences of violence in industrial societies were increasing. However, since the belief that amok is culturally induced had become deeply entrenched, its connection with modern day episodes of mass violence went unnoticed.

Contemporary descriptions of multiple homicides by individuals are comparable to the case reports of amok. In the majority of contemporary cases, the slayings are sudden and unprovoked and committed by individuals with a history of mental illness. News media, witnesses, and police reports describe the attackers as being odd or angry persons, suggesting personality pathology or a paranoid disorder; or brooding and suffering from an acute loss, indicating a possible depressive disorder. The number of victims in modern episodes is similar to the number in amok despite the fact that handguns and rifles are used in contrast to the Malay swords of 2 centuries ago. The outcome for the attacker is also analogous to amok, being death, suicide, and less commonly, apprehension. The following report demonstrates the resemblance between amok and contemporary violent behavior:

Amok was first classified as a psychiatric condition around 1849 on the basis of anecdotal reports and case studies revealing that most individuals who ran amok were mentally ill. Prior to that time, amok was studied and reported as an anthropological curiosity. Historically, observers described 2 forms of amok, but DSM-IV does not differentiate between them. The more common form, beramok, was associated with a personal loss and preceded by a period of depressed mood and brooding; while the infrequent form, amok, was associated with rage, a perceived insult, or vendetta preceding the attack. Based on these early case reports, beramok is plausibly linked to a depressive or mood disorder, while amok appears to be related to psychosis, personality disorders, or a delusional disorder.

Previous psychiatric investigators also questioned the culture-bound classification of amok, indicating disagreement with the consensus opinion that was developing circa the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Pow Meng Yap,4 a psychiatrist for the Hong Kong Government, wrote in 1951 that amok behavior was preceded by a period of brooding, and if the attacker was not killed in the process, it ended when the individual became exhausted and collapsed (and frequently had amnesia for the event). Yap's description of amok suggests a psychotic type of depressive disorder or a dissociative disorder. By the time of Yap's comments, violent behavior similar to amok had been observed in most countries. For a condition to truly be culture bound, it could not be found in other distinct cultures, and culture must be indispensable to its pathogenesis. This has never been the case with amok, or for that matter, with most other psychiatric conditions.

Jin-Inn Teoh, a professor of psychiatry at the University of Aberdeen in London, reported in 1972 that amok behavior existed in all countries, differing only in the methods and weapons used in the attacks.5 According to Teoh, culture was a modulating factor that determined how amok was manifested, but not whether or not it occurred. The individual's culture and the weapons available naturally influenced the method of the attack. Teoh's report of amok was one of the last in the psychiatric literature. In the subsequent quarter century, the incidence of violent behavior similar to amok has increased dramatically in industrialized countries, surpassing its incidence in primitive cultures. This increase may be the result of better case reporting and heightened public awareness and interest in violence, combined with an increase in the psychopathology responsible for amok. Teoh's findings and the increase in violent behavior in industrialized societies are further evidence against characterizing amok as a culture-bound syndrome. 041b061a72

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