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America’s Imperial Mental Illness

How U.S. medicine is changing the way the world loses its mind.
How U.S. medicine is changing the way the world loses its mind.

I finally got around to Ethan Watters’s 2010 Crazy Like Us: The Globalization of the American Psyche, an exposé of the exporting of American concepts of mental illness.

Watters writes with justified outrage about the corporations, humanitarian organizations, and mass media which have acted as pushers of both drugs and therapies. He depicts charities descending on post-tsunami Sri Lanka, ignoring local cultural practices and basic needs in order to promote PTSD diagnoses, in a kind of “voluntourism” for grown-ups. The NGOs assumed that their understanding of trauma could be easily transplanted to other cultures, so they sent volunteers who didn’t even speak the local languages. Sri Lankans lacked water and medicine; they got puppet therapy and coping bracelets. Meanwhile Hong Kong media made anorexics into celebrities, leading to an increase of this deadly behavior. And American drug companies used heavily-massaged research and shady advertising practices to turn Japanese melancholy into medicalized, Western-style depression.

Watters has two main explicit insights. First: People in every culture experience trauma and stress, but they find different ways of expressing and understanding their suffering—lending it meaning by embedding it in a narrative—based on the “symptom pools” provided to them by their cultures. When a new disorder enters the cultural “symptom pool,” people in distress will begin to manifest the symptoms of that disorder, whether it’s the day blindness of Victorian hysterics or the body dysmorphia of (some) American anorexics. Shifts in cultural narratives will shift the symptom pool, and thereby change the ways people manifest their suffering. Importantly, cultural narratives also shift how people relieve suffering, if and when they do relieve it. When it comes to mental illness, not only the diseases but the cures are culturally-conditioned.

And second: American media, medical authorities, corporations, and other agents have decided to ignore these cultural differences in favor of promoting a one-size-fits-all model of mental distress. The only cultural narrative they will accept is the American narrative: Distress and suffering are illnesses like any other; human beings are fragile physical vessels, easily broken by trauma but fixable by medication and therapy; other people’s religions and traditions may be nice ornamentation, but the real treatment comes from psychiatrists and drugs; what works in Schenectady will work about as well in Suriname.

Watters exposes the assumptions and blithe overconfidence behind this worldview. He also suggests a deeper, implicit critique of American atomistic culture. The chapter on Sri Lanka shows how Sri Lankans understood trauma as stemming not from individual suffering but from loss of social support; misery could be bearable as long as it had company. This communal culture provided resilience that was often overlooked by the individualistic symptom checklists of American therapists. And the chapter on schizophrenia in Zanzibar emphasizes the isolation of American schizophrenics, the scrutiny to which they’re constantly subjected and the ways in which well-meaning attempts to protect or encourage them actually keep them from rejoining the ordinary social world. Cultural practices in Zanzibar, by contrast, embed the sufferers within their family. By accepting the sufferers’ shifting moods and abilities, their relatives to prove to God their steadfastness and penitence.

After exploring many different approaches to schizophrenia, Watters asks, “Which cultural beliefs tend to exclude the sufferer from the social group and which allow the ill individual to remain part of the group?” American beliefs that schizophrenia is a brain disease, which we might expect to reduce stigma, in fact may increase stigma and separate sufferers from their community. Belief that schizophrenia is caused by spirit possession, which might strike many (not all) Americans as not only stigmatizing but obviously false, in Zanzibari culture actually helps fit sufferers into well-accepted roles and rituals.

Several of the book’s chapters contrast the American fix-it mentality with an older mentality of acceptance of suffering. The PTSD chapter suggests that people are often more resilient than the American worldview would expect (so there’s less to fix in the first place); the chapter on depression in Japan suggests that while there are obvious problems with traditional Japanese romanticism about melancholy and suicide, there are also ways in which pathologizing suffering damages those who suffer.

The fix-it mentality may also fuel Americans’ tendencies to judgmentalism: If most suffering can and should be fixed, then people who perversely persist in suffering are just wallowing. A bootstraps mentality can apply itself to mental health as much as to financial prosperity. Learning to accept suffering might be as necessary for American mental health as learning to live in community—and, in fact, these might be mutually-reinforcing cultural changes, since nothing teaches patience like living with people you can’t slough off.

However, Watters ends the Zanzibar chapter with a sobering exploration of one American researcher’s attempt to apply Zanzibari insights to her own husband’s mental breakdown. Even once she had identified the problems in her own culture’s approach to mental illness, she found it impossible to step outside her culture or take a truly “Zanzibari” approach. My attempt to wring cultural critique out of this book may simply be my own form of American fix-itism. Maybe we can’t be fixed either.

The end of the Zanzibar chapter is an unusually subtle moment for Watters. Mostly he’s a polemicist and a dice-loader, uninterested in alternate readings of the evidence (maybe one Zanzibar family is having a hard time because it’s run by a controlling jerk, not because it’s run by a modernist?) or non-craven reasons that somebody might accept an American narrative of the self. I wish Watters had engaged at all with literary studies like Jonathan Shay’s Achilles in Vietnam: Combat Trauma and the Unmaking of Character, which traces the outlines of PTSD symptoms in the Iliad.

But the limits of Watters’s book are less important than the exposure and criticism of American mental-health meddling.

Eve Tushnet is a TAC contributing editor, blogs at Patheos.com, and is the author of the recently-released book Gay and Catholic: Accepting My Sexuality, Finding Community, Living My Faith.