The subject is the Americanization of the world's psyche, how we are "homogenizing the way the world goes mad". As far as I can tell, the issues it raises are as alive and well in the public dialogue as they were when the book made its debut two years ago. Nothing in the interim seems to have changed substantially enough to diminish the import of the book, and so I think it is as worth reading today as it was two years ago.
Emotional suffering is nothing new to mankind, but expressions of it differ from place to place and age to age. Watters' introduction gives a brief but enlightening tour of the diverse manifestations of mental illness in various places and periods of history, painting a picture of great cultural diversity and sometimes rapid changes in manifestations of mental illness as madness seeks to find a fitting expression within each cultural narrative.
"Because the troubled mind has been perceived in terms of diverse religious, scientific, and social beliefs of discrete cultures, the forms of madness from one place and time in history often look remarkably different from the forms of madness in another. These differing forms of mental illness can sometimes appear and disappear within a generation.... Symptoms of mental illness are the lightning in the zeitgeist, the product of culture and belief in specific times and specific places. That thousands of upper-class women in the mid-nineteenth century couldn't get out of bed due to the onset of hysterical leg paralysis gives us a visceral understanding of the restrictions set on women's social roles at the time.
"But with the increasing speed of globalization, something has changed. The remarkable diversity once seen among different cultures' conceptions of madness is rapidly disappearing. A few mental illnesses identified and popularized in the United States - depression, post-traumatic stress disorder, and anorexia among them - now appear to be spreading across cultural boundaries and around the world with the speed of contagious diseases. Indigenous forms of mental illness and healing are being bulldozed by disease categories and treatments made in the U.S.A." (p. 3)As America once flooded the earth with missionaries hoping to save humanity, we are now with like evangelistic fervor inundating the planet with our mental health theories, tests, diagnoses, therapies, pharmaceuticals, and professionals, confident that we are best equipped to confront the rest of the world's mental health traumas. Eager to ease suffering, hoping to enlighten the ignorant, sensing at times the opportunity for profit, confident of the superiority of its understanding and methods, the American psycho-pharmaceutical complex has unwittingly (and sometimes not) shipped its own versions of mental illness around the globe. American-style mental illness has gone viral.
Watters traveled the world documenting the ways in which American-style psychoses are being insinuated into places where they had never been and foreign anguish is being squeezed into the mold of American mental illness diagnoses. He notes the new problems our western involvement introduces which these societies' indigenous coping mechanisms are unequipped to handle. As cases in point, Watters focuses on four mental illnesses in four different countries: anorexia in Hong Kong, PTSD (Post Traumatic Stress Disorder) in Sri Lanka, schizophrenia in Zanzibar, and depression in Japan.
In the cases of Hong Kong, Sri Lanka, and Japan, the mental illnesses in question did not exist in their "American" expressions prior to American/Western involvement. Anorexia in Hong Kong was previously rare and a disorder mainly of the love-lorn, having nothing to do with a distorted body-image. Prior to the influx of Western mental health professionals following the 2004 tsunami, Sri Lanka was "a population...that seldom needed outside encouragement or counseling to get back on its feet even after the most punishing hardships" (pg.88) which at that time included a recent earthquake and civil war. In Japan, the rise of western-style depression can be traced to the "marketing campaign of GlaxoSmithKline and other SSRI makers" (p. 199).
The matter of schizophrenia in Zanzibar has a different feel. In this case the disease had long appeared in that culture, as it has all around the world. It was interesting to learn that the delusions and hallucinations of schizophrenics around the world reflect the fears, religions, and obsessions of their specific cultures - which put me in mind stories I've heard of disturbed individuals lining their homes or their hats with tin-foil to protect them from the secret spy rays being beamed at them by their perceived enemies - stories which ooze with Cold War/McArthy era paranoia. Schizophrenics are not entirely divorced from their reality and culture. In is research Watters found that the disease varies from place to place not only in its expressions, but in its prevalence and severity, and, even more striking, he found that:
"...people with schizophrenia in developing countries appear to do better over time than those living in industrialized nations...the regions of the world with the most resources to devote to the illness - the best technology, the cutting-edge medicines, and the best financed academic and private research insititutions - had the most troubled and socially marginalized patients." (p. 137-138)What most surprised me in the discussion of schizophrenia was the impact the western "medical model of mental illness" (viewing mental illness as a chemical imbalance, brain disease, etc.) has in the places where it is adopted. The common thinking has been that diagnosing schizophrenia and other mental problems as "diseases" will benefit the sufferers by de-stigmatizing them. Unfortunately, the results have been shown to be exactly the opposite. Studies show that where the disease model is well-accepted the stigma is increased not decreased:
"The problem, it appears, is that the biomedical or genetic narrative about an illness such as schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal compared to one made ill through life events."In fact, studies show that people treat sufferers worse when they believe them to have a mental illness than when they believe them to be suffering emotionally as a result of painful experiences. And so we find another case of western methods making matters worse rather than better.
Of greatest interest to me, as someone who was at one time diagnosed and medicated for depression, was the discussion of depression in Japan. The surprises here for me were two-fold: first, the heavy hand of the pharmaceutical industry in promoting the American model of depression in order to create a market for their product (In Japan "depression" had little in common with its Western counterpart, and what we would call depression was not originally viewed as a bad thing.); second, the absence of "scientific consensus that depression is linked to serotonin deficiency or that SSRIs restore the brain's normal 'balance' of this neurotransmitter."
"To date, no lower levels of serotonin or 'imbalance' of neurotransmitter have been demonstrated in depressed patients. The American Psychiatric Press Textbook of Clinical Psychiatry states simply, "Additional experience has not confirmed the monoamine [of which serotonin is a subgroup] depletion hypothesis.'
SSRI's don't bring a patient's brain chemistry back into balance, but rather broadly alter brain chemistry. Although that change may sometimes help a depressed patient, the idea that SSRIs restore a natural balance of serotonin is a theory without evidence. Put another way, this idea is more of a culturally shared story than a scientific fact..."Reading those words, I remembered how little the anti-depressant I had taken had helped me, and how hellish the withdrawal had been when I discontinued it. I found it difficult not to feel as though I had been sold a bill of goods. And, sadly, I continue to hear this "chemical imbalance" narrative repeated in almost every discussion of depression I hear.*
As it turns out America is rather unique in viewing depression as a medical problem. "Feelings and symptoms that an American doctor might categorize as depression are often viewed in other cultures as something of a 'moral compass,' prompting both the individual and the group to search for the source of the social, spiritual, or moral discord. By applying a one-size-fits-all notion of depression around the world...we run the risk of obscuring the social meaning and response the experience might be indicating." (p. 196) In other words, in other cultures emotional suffering is understood as having meaning and moral import. When we reduce emotional anguish to the level of chemical processes, we dehumanize the sufferer and invalidate the social and moral aspect of whatever tragedy is causing their pain.
"The ideas we export to other cultures often have at their heart a particularly American brand of hyperintrospection and hyperindividualism.... that have encouraged us to separate the health of the individual from the health of the group. Even the fascinating biomedical scientific research into the workings of the brain has, on a cultural level, further removed our understanding of the mind from the social and natural world it navigates. On its website advertising its antidepressant, one drug company illustrates how far this reductive thinking has gone: 'Just as a cake recipe requires you to use flour, sugar, and baking powder in the right amounts, your brain needs a fine chemical balance in order to perform at its best.' The Western mind, endlessly parsed by generations of philosophers, theorist, and researchers, has now been reduced to a batter of chemicals we carry around in the mixing bowl of our skulls." (p. 254, emphasis mine)I share Watters' over-arching concern, but not only for the sake of the rest of the world, which we are rapidly converting. I feel we've done ourselves a disservice in the way we treat mental disorders right here at home.
I heartily recommend Crazy Like Us to anyone affected in any way by Western mental health practices. It is not only informative, it is riveting. You will walk away with a broader perspective, and, if you're like me, a renewed sense of respect for the emotional suffering of the world.
* I heard the following assertion regarding SSRIs recently in a rather disturbing (to me) discussion on the treatment of depression: "...if we go back to Prozac, and we go back to an era when the people used to talk about depression in terms of this chemical in the brain called Serotonin, right. Everybody, oh, your Serotonin is low, that's why you're depressed. And that turned out not to be the case, or it was not nearly that simple, that depression was simply a lack of Serotonin." The subject of the full discussion is a certain party drug which has been found to curb depression quickly in some people. You may listen to the interview or read the transcript here.