“Help! My Lanj*ao Is Shrinking!” The Koro Epidemic in Singapore: A Crisis in Masculinity

 

What two independent cases of mass genital shrinking tell us about masculinity in Southeast Asia.

Written by Voon Jung, Edited by Ashley Chin

 

A Series of Bizarre Incidents

On 29 October 1967,Koro Study Team. ‘The Koro “Epidemic” in Singapore’. Singapore Medical Journal 10, no. 4 (December 1969): 234–42. Singaporean men abruptly began clutching their groins, seized by a sudden panic that their genitals were irrevocably retracting into their bodies. This trickle of cases soon turned into a torrent, with daily cases at the Singapore General Hospital peaking at 97 on 3 November. The total caseload amounted to 469, with the vast majority of the afflicted (97%) being male. While the general populace initially believed the source of contagion to be pork contaminated by a swine flu vaccine, authorities issued repeated reassurances that this was not the case, instead proposing psychological factors for the outbreak. The public debunking of the vaccine theory was apparently enough to curb the epidemic, with case numbers dropping by half just a day after the Singapore Medical Association’s public announcement.Koro Study Team. ‘The Koro “Epidemic” in Singapore’. Singapore Medical Journal 10, no. 4 (December 1969): 234–42.

Meanwhile, nine years later, Thais near the Thai-Laotian borderJilek, Wolfgang G., and Louise Jilek-Aall. ‘The Metamorphosis of “Culture-Bound” Syndromes’. Social Science & Medicine 21, no. 2 (January 1985): 205–10. https://doi.org/10.1016/0277-9536(85)90090-5. began to exhibit the same strange fear of genital retraction and imminent death. Much like the 1967 Singapore outbreak, the 1976 Thailand outbreak blamed contaminated foodstuffs; however, this time the alleged contamination was not some overlooked faulty vaccine but the fear and paranoia of a region adjacent to conflict and war. There, disease toll soared to over 2,000 cases.

These symptoms of penile (and occasionally labial) shrinkage,Edwards, James. ‘Indigenous Koro, A Genital Retraction Syndrome of Insular Southeast Asia: A Critical Review’. Culture, Medicine, and Psychiatry 8 (1984): 1–24. when combined with feelings of imminent doom, characterise the psychosomatic syndrome known in Mandarin Chinese as suo yang (缩阳, meaning the shrinking of masculinity) or koro in Southeast Asia (more specifically in what is now Malaysia and Indonesia). The existence of a specific word to describe the condition indicates its prevalence in precolonial maritime Southeast Asia. It is worth noting as well that colonial scholars of the condition like van Wulfften PaltheEdwards, James. ‘Indigenous Koro, A Genital Retraction Syndrome of Insular Southeast Asia: A Critical Review’. Culture, Medicine, and Psychiatry 8 (1984): 1–24. observed koro in terms of individual cases, attributing the phenomenon to individual lapses into psychosis. Large-scale epidemics seen in Singapore and Thailand, however, pose a greater challenge in understanding: how can these two epidemics in different countries and situations appear nearly a decade apart but with the exact same psychosomatic symptoms? Are these outbreaks really nothing more than a unique form of food poisoning? Or is there a social cause?

Social Ills in Bodily Form

One solution to this dilemma is to reframe the way we see illness. At the point of writing, much of the world lives under the shadow of the most severe influenza pandemic in living memory.Petersen, Eskild, Marion Koopmans, Unyeong Go, Davidson H Hamer, Nicola Petrosillo, Francesco Castelli, Marete Storgaard, Sulien Al Khalili, and Lone Simonsen. ‘Comparing SARS-CoV-2 with SARS-CoV and Influenza Pandemics’. The Lancet Infectious Diseases 20 (August 2020): 238–44. https://doi.org/https://doi.org/10.1016/ S1473-3099(20)30484-9. The world in 2020 was transfixed over previously-niche medical issues, from January’s fixation over coronavirus transmissibilityImai, Natsuko, Anne Cori, Ilaria Dorigatti, Marc Baguelin, Christl Donnelly, Steven Riley, and Neil Ferguson. ‘Report 3 – Transmissibility of 2019-NCoV’. Imperial College London. Accessed 3 January 2021. http://www.imperial.ac.uk/medicine/departments/school-public-health/infectious-disease-epidemiology/mrc-global-infectious-disease-analysis/covid-19/report-3-transmissibility-of-covid-19/. to December’s fevered enthusiasm over vaccine rollout. This has been the way we think for decades, and barring a paradigm shift, will be (mostly for the better) the way we think for decades or even centuries to come. In our minds, the very idea of illness is thought of solely in terms of biology, chemistry, and other empirical sciences—a concept loosely tied to what French sociologist Michel Foucault termed the medical gaze.Misselbrook, David. ‘Foucault’. The British Journal of General Practice 63, no. 611 (June 2013): 312. https://doi.org/10.3399/bjgp13X668249. This process, Foucault argued, served as an instrument of biopower and hence social control. By rendering conditions as illnesses, the medical gaze provides “numerous and diverse techniques … achieving the subjugation of bodies and the control of populations.”Foucault, Michel. The History of Sexuality. 1^st American Ed. (New York: Pantheon Books, 1978), 140. Socially, however, illnesses and especially mass “hysteria” events/“folk illnesses” can be viewed as resistance and response against enforced social change.

Recontextualising (or rather decontextualising) mass “psychological” illness does in fact have rich precedent, both in the case of koro and other related episodes. For instance, we can examine anthropologist Ong Aihwa’s workOng, Aihwa. ‘The Production of Possession: Spirits and the Multinational Corporation in Malaysia’. American Ethnologist 15, no. 1 (February 1988): 28–42. https://doi.org/10.1525/ae.1988.15.1.02a00030. on the possession of female workers in Malaysian factories by spirits. Ong first characterises spirits and spirit possession as deeply associated with boundaries—demarcating morality, human, and nature. In the context of the great social upheaval of the 1970s–1980s, tens of thousands of Malaysian women joined low paying and often gruelling work on conglomerate factory floors. The factories were not just a violation of moral spaces (which, according to Ong, “displaces”Ong, Aihwa. ‘The Production of Possession: Spirits and the Multinational Corporation in Malaysia’. American Ethnologist 15, no. 1 (February 1988): 28–42. https://doi.org/10.1525/ae.1988.15.1.02a00030. the spirits previously housed in sites like graveyards, rocks, hills, and trees), but also moral values and bodily sanctity. Workers, faced with the alienness of “international-style” toilets and menstruation products, used the toilet facilities in fear. These violations were not merely passive; Ong found that management often policed and interrogated about their going to the toilet. Ironically, despite such alleged concerns about their workers’ private affairs, sexual harassment was reported as well. These conditions, according to the workers, angered the spirits and caused manifestations in toilets, break and prayer rooms, and sometimes even equipment. These represented, respectively, violations in the bodily sanctity of female workers (toilets), violations of their values (prayer rooms), and their economic exploitation (equipment). In Ong’s words, “spirit imagery gave symbolic configuration to the workers’ fear and protest over social conditions in the factories.”Ong, Aihwa. ‘The Production of Possession: Spirits and the Multinational Corporation in Malaysia’. American Ethnologist 15, no. 1 (February 1988): 28–42. https://doi.org/10.1525/ae.1988.15.1.02a00030. In a way rather reminiscent of the Narrator in Charlotte Perkins Gilman’s The Yellow Wallpaper, the concerns of these women were spun by the presiding patriarchal management team as merely female psychosis and hysteria (this time flavoured by both misogyny and Orientalist notions of Asian backwardness).

Ong’s research was hence about trying to break away from the medical gaze and its clinical explanations of undernourishment and psychological factors. Instead, Ong treated these manifestations as social responses and bound by social contexts. In doing so, spirit possession is reframed as resistance, a more rounded and, dare I say, convincing solution. If we similarly reframe the koro epidemics, what interesting conclusions can we draw?

Search for a Cause

If spirit possession in Malaysian factories is a social response to the enforced breaking of social, bodily, and natural boundaries, what then are the koro epidemics a response to? Perhaps a prevailing social crisis of some kind? After all, both regions at the time of their respective epidemics were going through tremendous amounts of social stress. Singapore in 1967, for instance, was undergoing a difficult transition towards fully governing statehood. Henry Murphy, another transcultural/comparative psychiatrist, attributed Singapore’s existential fears to racial tensions between Singapore’s Chinese and Malay communities, and even the hasty withdrawal of the British military garrison,Murphy, Henry Brian Megget. Comparative Psychiatry: The International and Intercultural Distribution of Mental Illness. Monographien Aus Dem Gesamtgebiete Der Psychiatrie 28. Berlin: Springer, 1982. all of which came together to pose an existential threat to Singaporeans themselves. This theme resonates in the Thai epidemic as well. Thailand of the ’70s was the setting of simmering conflict: the Communist insurgency was in full swing, reaching its zenith of nearly 14,000 armed insurgents in 1978Thomas, M. Ladd. ‘Communist Insurgency in Thailand: Factors Contributing to Its Decline’. Asian Affairs: An American Review 13, no. 1 (March 1986): 17–26. https://doi.org/10.1080/00927678.1986.10553659. (only a year after the koro epidemic). It seems then that koro can simply be attributed to societal stress.

Though a good starting point, the simple idea of societal stress is not enough to explain the specificity of koro as an illness. Psychosomatic/social syndromes are by no means rare in Southeast Asia. Why have patients not been afflicted with something closer to their own folkloric traditions, as in the examples of the Malaysian spirit possessions? Why not a more generic social illness like latahBakker, Mirte J., J. Gert van Dijk, Astuti Pramono, Sri Sutarni, and Marina A.J. Tijssen. ‘Latah: An Indonesian Startle Syndrome: Latah’. Movement Disorders 28, no. 3 (March 2013): 370–79. https://doi.org/10.1002/mds.25280.(a response to shock with symptoms more akin to a psychotic break)? Perhaps the key to understanding koro, much like Malaysian factory spirit possessions, lies in the explicitly gendered nature of the illness. After all, koro is most defined by penile retraction.

Early koro research attributed the cultural causes of koro down to “Yin-Yang imbalance”Buckle, Chris, Y.M. Lisa Chuah, Calvin S.L. Fones, and Albert H.C. Wong. ‘A Conceptual History of Koro’. Transcultural Psychiatry 44, no. 1 (March 2007): 27–43. https://doi.org/10.1177/1363461507074967, 37., or more specifically a weakness in masculinity. The need for a balance between yin (denoting coolness or femininity) and yang (denoting energy, heat, and masculinity) is a key tenet in both Traditional Chinese Medicine and Chinese philosophy.Jiang, Xinyan. ‘Chinese Dialectical Thinking—the Yin Yang Model’. Philosophy Compass 8, no. 5 (2013): 438–46. https://doi.org/https://doi.org/10.1111/phc3.12035.  Jilek and Jilek-Aall identified this trend in the Thai epidemic as well. While the majority of the afflicted did not have knowledge about these Chinese concepts (very few of the Chinese population in Northeastern Thailand were afflicted during the pandemic), the threat they reacted to was similar—the fear of “genocidal extermination … threatening the survival of one’s ethnic group by attacking its procreative ability.”Jilek, Wolfgang G., and Louise Jilek-Aall. ‘The Metamorphosis of “Culture-Bound” Syndromes’. Social Science & Medicine 21, no. 2 (January 1985): 205–10. https://doi.org/10.1016/0277-9536(85)90090-5. Clearly, it seems the nature of koro is masculine, but what of the social situations that necessitated a specifically masculine response?

Crisis in Masculinity

I hypothesise that the crises on hand were actually masculine in nature to begin with. In response to the withdrawal of the British garrison, the Singapore Parliament passed the Enlistment Act in March 1967, with its first batch enlisting into military training in August 1967. Societal resistance to this change was indicated by violent protests.‘13 Are Held after Anti Call-up Demonstrations in S’pore’. The Straits Times. 28 March 1967. What the Enlistment Act entailed was that the vast majority of young men and teenagers in Singapore was placed under State control, their masculinity effectively replaced with state-enforced hegemonic masculinity.Lowe, John. ‘Masculinizing National Service: The Cultural Reproduction of Masculinities and Militarization of Male Citizenship in Singapore’. Journal of Gender Studies 28, no. 6 (18 August 2019): 687–98. https://doi.org/10.1080/09589236.2019.1604329. Boys are taught one specific mode of what it means to be a man—namely that they needed to possess “self-discipline, physical strength, virility, heterosexuality, competitivity, endurance, and emotional suppression.”Lowe, John. ‘Masculinizing National Service: The Cultural Reproduction of Masculinities and Militarization of Male Citizenship in Singapore’. Journal of Gender Studies 28, no. 6 (18 August 2019): 687–98. https://doi.org/10.1080/09589236.2019.1604329. To this effect, masculinities are broken down, rebuilt, and reinforced by the military in an environment that is too often homophobic, aggressive, and violent. For many boys, these military ideals unconsciously become part of their selves.

Furthermore, contemporary Singaporean Chinese (which represented 95% of the koro pandemic caseload) ideas of Neo-Confucian masculinity were based on values (the idea of wen 文 or “civility”)Brooke, Mark. ‘Masculinity in Singapore: The Residual Culture of the Chinese Martial Artist’. Sport in Society 20, no. 9 (2 September 2017): 1297–1309. https://doi.org/10.1080/17430437.2017.1284799.—inherently opposed to militarisation. Good men, claimed 1950s Chinese parents, “should never be soldiers.”Wong, Sin-Kiong. ‘Subversion or Protest? Singapore Chinese Student Movements in the 1950s’. American Journal of Chinese Studies 11, no. 2 (2004): 181–204,  183. Resistance to the lawful imposition of hegemonic masculinity can be traced back to the 1954 National Service Riots, where hundreds of secondary to high school–aged students, most of them from Chinese schools, clashed with police over objections to enforced enlistment.‘‘National Service Riots of 1954 | Infopedia’. Accessed 14 January 2021. https://eresources.nlb.gov.sg/infopedia/articles/SIP_1202_2006-07-28.html. In the face of enforced militarisation of its young men, the koro pandemic can then be viewed as a response to a crisis in masculinity caused by an irrevocable, state-enforced change.

While the epidemic in Singapore represented the coerced militarisation of its masculinity, Thai masculinity already emphasised martial prowess, as can be seen via Thai negotiations with Muay Thai and the state. Rites of passage for Thai boys, especially in rural Thailand, involved bouts of Muay Thai, emphasising “victorious conquests of opponents through physical superiority, cunning, wit, mental strength and prowess.”Kitiarsa, Pattana. ‘“Lives of Hunting Dogs”: Muai Thai and the Politics of Thai Masculinities’. South East Asia Research 13, no. 1 (March 2005): 57–90. https://doi.org/10.5367/0000000053693572., 67. Via carefully controlled royal-national narratives, Muay Thai provided a military element inherent to Thai masculinity, linking the physical prowess of Thai men to the strength of the military and the independence to the state.Vail, Peter. ‘Muay Thai: Inventing Tradition for a National Symbol’. Journal of Social Issues in Southeast Asia 29, no. 3 (2014): 509. https://doi.org/10.1355/sj29-3a. The Thai political situation in 1976, a climate especially magnified in the Northeast, was particularly dangerous to this triumvirate. Fears of foreign agents near the Lao border provided an enemy that cannot be seen, much less bested through combat. The return of deposed dictator Thanom Kittikachorn, the resultant protests, brutal crackdown, and military takeover in the capitalStaff, Guardian. ‘Brutal Thai Coup’. the Guardian, 7 October 1976. http://www.theguardian.com/theguardian/1976/oct/07/fromthearchive. meant an internal threat to Thai sovereignty as well. Mired in multiple ongoing threats to Thai sovereignty and their way of life, men in the Northeast could do nothing but watch and suffer. Instead of assigning a separate normative stance on masculinity, circumstances in Thailand culminated to undermine its nature altogether. While it is not known what proved to be the tipping point, the confluence of factors in the region thus proved sufficient to spark off their own koro epidemic.

Re-demarcating Disease

Instances and even epidemics of koro have continued to pop up in places as far from East and Southeast Asia as India and Western Africa.Dzokoto, Vivian Afi, and Glenn Adams. ‘Understanding Genital-Shrinking Epidemics in West Africa: Koro, Juju, or Mass Psychogenic Illness?’ Culture, Medicine and Psychiatry 29, no. 1 (March 2005): 53–78. https://doi.org/10.1007/s11013-005-4623-8. While each location and population has its own peculiarities, an examination of these psychosomatic episodes through the lens of reactions towards masculine crisis might provide interesting and valuable insight. Sometimes, aspects of disease (or whole diseases themselves) fall outside the domain of hospitals, laboratories, and doctors, and can instead be understood best by our friends in the much-maligned arts fields. Whether Foucault was entirely right about the medical establishment, I dare not opine, but I am convinced—and I hope you are too—that the koro epidemics in Southeast Asia can best be explained not by hormonal dysregulation but by the action, interaction, and reaction of social forces and constructs.