nejs, pre nitue ejaculations and hypochondriasis. Allthe patients were either from low or average socio- economic status. Majority of the patients attributed ...
Indian J. Psychiat. (1984), 26(1), 76—78 D H A T S Y N D R O M E : T H E P H E N O M E N O L O G Y OF A C U L T U R E B O U N D S E X N E U R O S I S OF T H E O R I E N T P. B . B E H E R E S M . D . G. S. NATRAJ", M . D . , D. P. M . SUMMARY Indian Dhat syndrome which is symptom complex most commonly seen in younger group oi patients in between 16 to 23 yeirs of age. These pitients present with whitish discharge with urine (patients believe it to be semen). This is associated most commonly with impotency, marked anxiety, general weaknejs, pre n i t u e ejaculations and hypochondriasis. A l l t h e patients were either from low or average socioeconomic status. Majority of the patients attributed masturbation as a causative factor for this problem.
T h e culture b o u n d syndromes are well known in the field of psychiarty. Some involve sexual potency and genitalia. 'Dhat Syndrome' is also a cultural b o u n d sex neurosis of the orient (Wig, 1960; Neki, 1973). T h e origin of ' D h a t ' has come from the Sanskrit word ' D h a t u ' , m e a n i n g the elixir which constitutes the body (Sushruta Samhita, 1938). In ages known ancient Indian literature, seven types of D h a t u s are described. Semen is considered as the most important D h a t u a m o n g all. These D h a t u s d e t e r m i n e the bodily immunity or susceptibility to the m a n i festatation oi' disease (Sharma & Das, 1977). Gharak Samhita (Ancient Indian literature) describes the disorders of D h a tus viz. Shukrameha (Spermaturia) in which patient passes semen resembling urir.e or urine mixed with semen, Sitameha (Phosphaturia) in which patient gets frequent micturition which is exceedingly sweet and cold, and Suklameha, where the patient passes urine having white colour like that of pasted floor. T h e D h a t u has been given so m u c h i m p o r t a n c e in Indian culture t h a t it becomes synonyms with semen.
Indian D h a t syndrome is a clinical condition in which p a t i e n t is preoccupied with excessive loss of semen by n o c t u r n a l emissions a n d this leads to severe anxiety, hypochondriasis, lack of concentration, bodily weakness a n d is often associated with sexual impotency (Wig, 1960: Neki, 1973). Singh (1983) recently in a study reported depression in 5 2 % of cases of D h a t Syndrome. In t h e present study our main focus is on t h e phenomenology of D h a t syndrome.
METHODOLOGY: T h e study was conducted in d e p a r t m e n t of Psychiatry, Institute of Medical Sciences, V a r a n a s i . All consecutive patients, who a t t e n d e d psychiatry outdoor either directly or referred from the skin or medicine outdoors with main complaint of ' D h a t ' discharge were included in the study. A semistructured proforma was used to assess the patients. T h e proforma included besides identification d a t a , other socio-demographic characteristics of patients and details of D h a t discharge. Proforma also included symptoms (Verbatim), duration, frequency, associated problems (Viz. impotency, marital -
1. Lecturer. Deptt. of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi 22100j. 2. Psychiatrist, Mental Hospital, Dharwar (Karnataka).
77
DHAT SYNDROME : T H E P H E N O M E N O L O G Y O F A C U L T U R E
disharmony, p r e m a t u r e ejaculation, weakness, other problems), causative factoi in patients opinion (masturbation, coitus during menses, p r e - m a r i t a l or extra m a r i tal sexual relations, homosexuality, heterosexual experiences with prostitutes). I t also included t h e patients a t t i t u d e t o wards D h a t . AIMSj: T h e a i m of the present study is to evaluate t h e phenomenology of I n d i a n Dhat syndrome.
to o n e m o n t h , the distribution was 23 ( 4 6 % ) , 23 (46%) a i l d 4 ( 8 % ) respectively. A large group of patients i.e. 37 (74%) viewed that D h a t is whitish discharge with u r i n e , 3 ( 6 % ) viewed it a s night emission, a n d only 10 (20%) viewed it as b o t h . Associated problems in these patients were impotency in 13 ( 2 6 % ) , p r e m a t u r e ejaculation in 11 ( 2 2 % ) , bodily weakness in 34 ( 6 8 % ) , anxiety in 19 ( 3 8 % ) , hypochondriasis in 23 (46%) while 5 (10%) patients h a v e n o associated problems (Table 2).
OBSERVATIONS :
TABLE 2.
Fifty consecutive p a t i e n t s were i n terviewed w h o a t t e n d e d psychiatry outdoor, with complaints of ' D h a t ' discharge. Among these there were 34 ( 6 8 % ) in age group of 16—-25 years. T w e n t y six (52%) patients were m a r r i e d while 24 ( 4 8 % ) were u n m a r r i e d (Table I ) . According to their Socio-economic status, TABLE-1.
Age
Problems
Married
Single
Total
13 (26)
Pre-Mature Ejaculation
11 (22)
Bodily Weakness
34 (68)
Anxiety
19 (38)
Hypochondriasis
23 (46)
problems
5 (10)
(%)
16—25
16
18
34(68)
26—35
8
5
13(26)
36—45
2
1
3( 6)
26
24
Total
Patients (%)
Impotency
No Age
Associated problems
50
21 (42%) were from low, 29 ( 5 8 % ) from average a n d n o n e from high socio economic status. Interestingly 23 (46%) were students b y occupation, 14 ( 2 8 % ) had agriculture as their main occuptation, 10 were clerks a n d 3 belonged to professional group. Five (10%) patients had duration of illness less than 3 m o n t h s , 11 (22%) h a d 3 m o n t h s to 1 year a n d majority of t h e patients i.e. 34 (68%) having more than 1 year. Patients were categorized according to frequency of D h a t discharge into daily, once in a week a n d once in a fortnight
T h e causative factors as reported b y p a t i e n t were m a s t u r b a t i o n — 2 6 ( 5 2 % ) , p r e - m a r i t a l sexual relation-—-8 (16%) a n d extra m a r i t a l sexual relation—7 ( 1 4 % ) patients (TabIe-3). When their attitudes TABLE 3.
Causative factors
Factors
Masturbation
Patients (%)
26 (52)
Pre-Marital Relation
8 (16)
Extra-Marital Relation
7 (14)
Nil
14 (28)
were studied we found that 44 ( 8 8 % ) felt it as semen with u r i n e , 2 (4%) viewed it as semen a n d phosphate both, while 2
P. B. BEHERE AND G. S. NATRAJ
78
(4%) gave some other views and 2 (4%) didn't respond (Table-4).
Semen
44 (88)
Semen+ P 0 4
2 (4)
Others
2 (4)
(66%) patients completely recorvered in 1 year follow up. 11 (22%) showed improvement (some of hyponchondriae and somatic pre occupation were persistent in less intensity) while 6 (12%) patients remained same. Due to poor follow up subsequently it is difficult to say whether these 22% of patients (who showed improvement) remained same or deteriorated.
Not responded
2 (4)
REFERENGES
TABLE 4. Patients' attitude Attitude
Patients (%)
Regarding treatment seeking pattern 25 (50%) patients contacted quacks (so called sex specialists) for the first time. 15(30%) consulted skin and veneral disease specialist, while 10 (20%) consulted a general practitioner. TREATMENT AND O U T C O M E S :
We have treated these patients with minor tranquillisers and verbal reassurance. We have tried to explain about misconception regarding sex, wliich these patients were having. Similarly we have tried to remove the misconception about the semen loss. The subjects were told about the harmless effect of semen loss (nocturnal emission). They were informed about misconception regarding masturbation. 33
CHARAK SAMHITA, (1949). Shree Gulab Kunuverba Ayurvedic Society. Jamnagar, India. MALHOTRA, H . K. AND W I G , N . N . (1975). Dhat Syndrome. A cultural bound sex neurosis of the orient. Archives of Sexual Behaviour, 4, 519. NAKARA, B. R . S. (1971). A psycho social study of male potency disorders. Mimeographed M . D. thesis, Postgraduate Institute of Medical Education and Research, Chandigarh, India. N B K I , J . S. (1973). Psychiatry in South east Asia. Brit. J . Psychiat., 123. 256. SHARMA, R . K . AND DAS, B. (1977). Charak Samhita. Volume 2, Chowkhamba Sanskrit Series Office, Varanasi. SHUSHRUTA SAMHITA (1938). (Ed.) Vaidya Yadavji Tikamji Acharya. Nirnaya Sagar Press, Bombay, India. SINGH, G. (1983). Dhat syndrome revisited. Paper presented at 35th Annual conference of Indian Psychiatric Society at Bombay. W I G , N . N . (1960). Problems of mental health in India. J . Clin. S o c . Med. College, Lucknow. India, 17.
