AMOK

763.

AMOK

       Amok or running amok is another syndrome first described in Malaya, but also found in many other parts of the world, for example in the Philippines, in Africa, in the Caribbean, in Tierra del Fuego, etc. The "going berserk" of the old Vikings was probably similar to running amok. It used to be common in Malaya until the beginning of this century. According to van Wilfften Palthe, [151] it was observed with regularity among the patients of the old Batavia Hospital until the old building was replaced by a modern structure and until modern medical care was instituted in 1914. Since then, amok has become rare among hospital patients. Van Wilfften Palthe claims that he has never observed or heard about a case of amok among the many Malaysians living in European countries.
       In the early days of American occupation of the Philippines, a number of American soldiers became victims of amok Moros, a Moslem tribe. When the Moros' level of education was raised, amok disappeared. Maguigad [102] claims that amok is still quite frequent in the Philippines. It also appears to be fairly common among the Papuans of New Guinea under the name of "Neginegi" or "Lulu," and in Melanesia.
       The "Puerto Rican Syndrome," or Mal de Pelea is, in my opinion, similar to amok, although the outcome is usually less gruesome. As in amok, the patient withdraws at first and gets into a brooding mood. All of a sudden and without any re-cognizable provocation, he becomes violent and strikes out at anyone near him. [43]
       According to Zaguirre [159] and Kline, [74] the premorbid personality is impulsive, emotionally hyper-reactive, according to other authors schizoid [schizophrenic – jmmahoney]. However, the psychodynamic interpretation is probably the same. The patient's attempt at conflict-solution by repressing his hostility is failing. He makes a last desperate attempt by withdrawing within himself. According to Maguigad, amok derives from the Malayan word "amoq," which means engaging in furious battle. It is a life or death battle against a feeling of complete disintegration. I have sometimes sensed this feeling in a patient who from a catatonic stupor suddenly switched to catatonic excitement. It is a last-ditch attempt at survival against the inner forces which are about to disintegrate him.
       The Bantus express this idea in their belief that a person destined to die may escape death by killing someone else in his stead.
       In other words, the amok patient externalizes his desperate need to destroy the death-bringing inner conflict by killing other persons. The most violent cases of amok seem to occur in cultures which demand repression of hostility, as in Malaya, Bandung, and the Philippines. In Puerto Rico, violence is more acceptable, and, in fact, expected of males under certain circumstances. The investment of energy in the repression of hostility is not large and therefore the violence - once repression fails - is of a lesser degree. [43]
       The multiple acts occasionally committed in Western countries by persons with a schizoid personality resemble the clinical picture of running amok and may be due to similar psychodynamic mechanisms. These acts have been the subject of several novels by authors like Camus and D'Annunzio.

[ Johannes M. Meth, Exotic Psychiatric Syndromes/Functional Psychoses and Related Conditions, Chapter 32, pp. 729-730, in American Handbook of Psychiatry, Second Edition, Volume Three, Adult Clinical Psychiatry - Basic Books, Inc., Publishers, New York, 1974. ]