The export of mental illness concepts

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Author Ethan Watters argues that America has exported its ideas of mental health, and mental illness, sometimes to the detriment of other countries. In his book Crazy Like Us, he contends that mental disorders have a strong cultural component that is often ignored by Western psychiatrists. Marco Werman talks with Watters and you can share your ideas about this topic with Watters in our Science Forum.

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MARCO WERMAN:  We’re joined now by journalist and author Ethan Waters.  His new book is called Crazy Like Us, the Globalization of the American Psyche.  Ethan Waters, you argue that other cultures have their own ways of dealing with mental illness and those can be as good, sometimes better, than western diagnoses and treatment.  So what is your take on the story we just heard?

ETHAN WATERS:  Well it’s difficult to know because without knowing a great deal about those individual cases, it’s hard to say what would have been best for those people.  But if you take a global look at this, take for instance a look at the World Health Organization studies on outcomes of schizophrenia around the world, I do think it challenges a premise that was in that story that suggested that these people would necessarily be better if they were left in the west.  And the results of that World Health Organization study done over decades, multi-cultured studies, suggests that indeed, schizophrenics in the developed world do better than schizophrenics in the developed countries and in the west.  So often times, there is something going on in these cultures that we, I think, under-appreciate that has a remarkable ameliorative effect on even illnesses as severe as schizophrenia.

WERMAN: Now you contend that Americans are forcing their ideas of mental health on the rest of the world.  But isn’t the western understanding of the mind, a scientific objective approach that transcends culture.

WATERS: I don’t think it is.  Every generation of psychiatrists believes they they’ve finally got past cultural influence.  But mental illness and the expression of mental health are always shaped by culture.  You can look across time and you can see every period and every era there is a way to express mental illness.  Scientists refer to this as the symptom pool and each culture has it’s now symptom pool and each period in history has its own symptom pool by which the person learned those symptoms.  In one period it might be symptoms of anorexia, in another period it might be depression, in another period it might be anxiety.  And in this moment in history, the west I believe globalizing ideas about the mind and also beliefs about what are the valid psychiatric symptoms such that we’re homogenizing the way the world goes mad.

WERMAN: Give us an example of that.

WATERS: Well I went to Hong Kong and spent a lot of time with a psychiatrist named Sing Lee there who documented the rise of anorexia in the middle 1990′s of Hong Kong.  This was a very nervous time for Hong Kong.  This was after Tiananmen Square on the mainland.  Families were being broken up.  And there was a great amount of, as Sing Lee says, a general loading of psychopathology in the population.  Into that moment in history, a young woman who was clearly an anorexic died on a downtown Hong Kong street and suddenly the culture was very interested in this disorder.  And flooding into Hong Kong on this very nervous moment in time was the western knowledge about anorexia and western experts saying, dictating basically, what this disease was.  It was only after that moment in time when there was this sudden understanding of anorexia did you see indeed a rise of the disease.

WERMAN: Are you saying that before the nineties there weren’t any presentations of anorexia nervosa in Hong Kong?

WATERS: They were extremely rare.  Sing Lee was studying one in a million anorexics in Hong Kong and he was discovering that they weren’t like American anorexics in a lot of ways.  They didn’t, for instance, have fat phobia.  They didn’t have body dismorphia.  They often came from poor populations on the outskirts of cities and he was trying to find out what this particular rare form of anorexia was at the moment in time when suddenly the earth shifted underneath him.  Suddenly there was an influx of this American form of anorexia.  And I believe that had partly to do with how American experts came in and began to explain to Hong Kong who is at risk, what this disease was, and what it meant.

WERMAN: I guess I’m having a hard time getting my head around the idea that other cultures and nations would essentially adopt American mental illnesses, or diagnoses of mental illness, when, as you argue in your book, they’ve got their own mental illnesses.

WATERS: That’s true, but every culture, including ours, the new mental illness that comes down the line, the new kids are now cutting, or there is a suicide spike.  We are fascinated as a culture by the new mental illness and that’s true of cultures around the world.  And it’s also true that other cultures around the world looked to the west for innovation.  They looked to the west for technology and they looked at the west for modern drug treatments.  They expect innovation from the west.  And so when a newspaper reporter in Hong Kong has to explain what anorexia is, it makes perfect sense for them to look to a western expert.  So it’s not just us forcing these ideas on the rest of the world, it’s the rest of the world literally reaching out and asking for this information from us, because they expect it.

WERMAN: Now even before I let you go, I should tell our listeners that you’ll be taking their questions online.  You’re the guest in our world science forum through next week.  And you listeners can join the online discussion with Ethan Waters.  Go to the world dot org slash science.  Journalist Ethan Waters, author of the book Crazy Like Us, the Globalization of the American psyche.  He joined us from San Francisco, thank you very much Ethan.

WATERS: It’s been a pleasure.

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