The term brain fag, coined by Nigerian students, refers to a condition first reported in 1959 by Prince among this population. (36> Since then the brain fag syndrome has been recognized in many Nigerian students at home and abroad, and also in students of other African countries who are exposed to the acculturative stress of a Western-type education system emphasizing theoretical book knowledge, quite different from the practical know-how and tribal lore acquired through oral traditions by older generations in Africa. Nevertheless, the older generations expect their students to achieve academic and socio-economic success in modern society and these parental expectations are increasing the emotional pressure on the students. The clinical picture of brain fag is characterized by a variety of symptoms: (36> bothering sensations on or in the head and body, especially aches, burning, and crawling; eye trouble and visual disturbances, especially blurred vision and tears when reading; impaired concentration, difficulty in comprehending and retaining learning material in written or oral presentation; feelings of general weakness, dizzy spells, and daytime fatigue. Depressed mood states are reactive to academic failure and not preceding or underlying this syndrome. It is noteworthy that subnormal intelligence, malnutrition, or physical disease do not account for the brain fag symptoms which are also seen at educational institutions in Europe and North America among African students in satisfactory nutritional and health conditions. The brain fag syndrome is categorically different from the general study stress and examination crises experienced by students from Western or Asian cultures, with their centuries of literary tradition and education systems based on reading and writing, and on memorizing texts for formal examinations. The brain fag syndrome is also clinically different in so far as the mere effort of reading may trigger the symptoms, some of which are quite typical and do not usually occur in Western students under stress, such as the burning heat feeling and the sensation of crawling as if caused by insects on, or by worms under, the skin. The latter are, of course, common reality in tropical Africa; they also play a role as supposedly sick-making agents in folk aetiological concepts of nervous and mental disorders. (ICD-10, F43.0, ?F43.2; DSM-IV, ?309.9)
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