Joseph Westermeyer, head of psychiatry at the University of Oklahoma, states that a culturally bound syndrome is defined as "certain trance-like disturbances [that] occur with unusual frequencies in certain societies".
[5] In addition, Dr. Richard Castillo, as quoted by Dr. C. George Boeree, believes that amok (with very similar symptoms to grisi siknis), pibloktoq, latah, "falling out", "indisposition", and the "fits" are all related to impulse control disorders, and thus are associated with trichotillomania, compulsive gambling, pyromania, and kleptomania in Western medicine.
[9] Dissociative fugue is distinguished by impulsive travel and amnesia, identity uncertainty, stress, and impediment to normal social function, all of which must not be influenced by substance intake.
[10] Edgardo Ruiz, PhD at the University of Pittsburgh argues that grisi siknis does not correlate with Western scientific cultural perspectives, and the cross-cultural translation of symptoms is an inaccurate device wherewith to understand the disease.
[1] When epidemic outbreaks of the disease occur, the Miskito hold that it is the result of an imbalance with spirits, says Nicola Ross, a reporter for The Walrus magazine,[11] which predicament they believe to be caused by a dilman or evil sorcerer.
[1] Dr. Ronald C. Simons, professor emeritus of psychiatry and anthropology at Michigan State University, as quoted by Nicola Ross in The Walrus magazine, upholds this argument, proposing that grisi siknis is caused by poverty and stress among the Miskito.
[11] Dr. Wolfgang Jilek, of the University of Columbia’s psychiatry department, also quoted by Ross in The Walrus, calls culturally bound syndromes "real" despite a general lack of evidence for organic causes.
[11] Susan Kellogg, Associate Professor and Chair of the History Department at the University of Houston, says that grisi siknis is the result of the cultural "physical and emotional stresses" that Miskito women endure.
[12] Shlomo Ariel, co-director of the Integrative Psychotherapy Center in Ramat Gan, Israel, says that such disorders are the product of the culture, delineates acceptable coping mechanisms for dealing with external or internal changes.
[13] Grisi siknis can be considered a ritualized behavior associated with the adolescent to adult transition among the Miskito, says Mark Jamieson, professor of social anthropology at the University of Manchester.
[13] Miskito girls express transitional sexuality through the syndrome while maintaining social purity, with the culture holding the victims blameless for their actions while attacked by the disease.
[1] While Western medicine typically has no effect on those afflicted with the disease, the remedies of Miskito herbalists or witch doctors are often successful in curing grisi siknis.
[1] Cases of grisi siknis were registered in Nicaragua in March 2009 in Puerto Cabezas and Siuna where many students of the National Institute of Technology and other schools, suffered attacks.