Note by HealthWrights staff
A number of important points are made in this fine review of Ethan Watters' book: That our simplistic, reductionist ideas about “mental health” are perhaps disease producing. That when big multinationals get into the act, profit trumps all other concerns and values. That diversity is connected to health. The number of people in prisons plus the number of people in mental hospitals provides a good indication of the general health of a society. By this criteria we should not be exporting our culture. Rather we should be learning from those who have a more holistic and humanistic understanding of mental health.
From Karen Franklin's Blog on forensic psychology and criminology, In The News.
A successful virus is adaptive. It evolves as needed to survive and colonize new hosts. By this definition, contemporary American psychiatry is a very successful virus. Exploiting cracks that emerge in times of cultural transition, it exports DSM depression to Japan and posttraumatic stress disorder to Sri Lanka.
Journalist Ethan Watters masterfully evokes the heady admixture of moral certainty and profit motive that drives U.S. clinicians and pharmaceutical companies as they evangelically push Western psychiatry around the globe. On the ground in Sri Lanka following the tsunami, for example, hordes of Western counselors hit the ground running, aggressively competing for access to a native population "clearly in denial" about the extent of their trauma. Backing up the foot soldiers are corporations like Pfizer, eager to market the antidepressant Zoloft to a virgin population.
Watters has done his homework. Each of his four examples of DSM-style disorders being introduced around the world is rich in historical and cultural context. Despite their divergences, each successful expansion hinges on the mutual faith of both the colonizers and the colonized that Western approaches represent the pillar of scientific progress.
It is ironic that Americans are so smugly assured of the superiority of our cultural beliefs and practices, in the face of mounting evidence to the contrary. Do we really want others to emulate a country with skyrocketing levels of emotional distress, where jails and prisons are the primary sites of mental health care? Does our simplistic cultural metaphor of mental illness as a "chemical imbalance, " with human minds reduced to "a batter of chemicals we carry around in the mixing bowls of our skulls," represent true enlightenment?
Our implicit condescension is made explicit if we imagine the converse, one of Watters' interview subjects points out: "Imagine our reaction if Mozambicans flew over after 9/11 and began telling survivors that they needed to engage in a certain set of rituals in order to sever their relationships with their deceased family members. How would that sit with us?"
Not only is our missionary zeal condescending, it may be harmful. Watters provides evidence to suggest that the "hyperintrospective" and "hyperindividualist" model of Western psychiatry can be destabilizing to time-worn, tried-and-true indigenous healing practices, in some cases even producing the problems we naively believe we are combating.
"What is certain," Watters cautions in his conclusion, "is that in other places in the world, cultural conceptions of the mind remain more intertwined with a variety of religious and cultural beliefs as well as the ecological and social world. They have not yet separated the mind from the body, nor have they disconnected individual mental health from that of the group. With little appreciation of these differences, we continue our efforts to convince the rest of the world to think like us. Given the level of contentment and psychological health our cultural beliefs about the mind have brought us, perhaps it's time that we rethink our generosity."
Perhaps it is already too late to turn back the tide. Thanks to the exportation of Western diet and lifestyle, 19 out of 20 inhabitants of the tiny island of Nauru in the Pacific Islands are now obese. Previously hardy islanders are stroking out in their 20s and 30s. The globalization of the American psyche is more insidious, but perhaps in the end it will prove equally catastrophic.
Reading Crazy Like Us left me with a nightmare image of a homogeneous future world with McDonald's and Starbucks (see my review of Starbucked: A Double Tall Tale of Caffeine, Commerce, and Culture) on every corner, obesity gone wild, and Western psychiatry reigning supreme