Nov 01

“Crazy Like Us” By Ethan Watters: Mental Health Globally

American journalist Ethan Watters, in his book Crazy Like Us, argues that American psychiatry is launched on a campaign of world domination, as cultures all over the world have their mental lives distorted and traditional ways of coping eroded by the spread of DSM categories, and the conceptual and clinical repertoire that comes with it. Dominic Murphy

The full title of the above-cited book is Crazy Like Us: The Globalization of the American Psyche (2010). In the words of its author (in The New York Times): “We may indeed be far along in homogenizing the way the world goes mad.” And this is neither a good thing nor appropriate.

Some of the reviews offer other ways to rephrase his thesis:

Boston Globe:

Americans are a generous people. We donate riches to needy countries. We send our troops abroad. We have exported some of history’s most influential cultural, scientific, and social inventions: democracy, fast food, and Britney Spears.

Whether that generosity is helpful to other nations is another question. And so it goes with mental health.

Publishers Weekly: “If you thought McDonald’s and strip malls were the ugliest of America’s cultural exports, think again.”

In its book description, publisher Simon & Schuster suggests a change of course: “By setting aside our role as the world’s therapist, we may come to accept that we have as much to learn from other cultures’ beliefs about the mind as we have to teach.”

An excerpt from the opening of Crazy Like Us shows some of the significant ways, in addition to the American-bred DSM‘s far-ranging influence, in which the U.S. has been “the world’s therapist”:

American researchers and organizations run the premier scholarly journals and host top conferences in the fields of psychology and psychiatry. Western universities train the world’s most influential clinicians and academics. Western drug companies dole out the funds for research and spend billions marketing medications for mental illnesses. Western-trained traumatologists rush in wherever war or natural disasters strike to deliver ‘psychological first aid,’ bringing with them their assumptions about how the mind becomes broken and how it is best healed.

More from Publishers Weekly about the author’s argument that Americans’ way of doing psych business often doesn’t translate well to other cultures:

In this well-traveled, deeply reported book, Watters takes readers from Hong Kong to Zanzibar, to Tsunami ravaged Sri Lanka, to illustrate how distinctly American psychological disorders have played in far-off locales, and how Western treatments, from experimental, unproven drugs to talk therapy, have clashed with local customs, understandings and religions. While the book emphasizes anthropological findings at the occasional expense of medical context, and at times skitters into a broad indictment of drug companies and Western science, Watters builds a powerful case.

Shelf Awareness elaborates on two striking examples from Crazy Like Us:

Watters’s report on mental health practitioners arriving in Sri Lanka after the 2004 tsunami with very little understanding of the country and culture is particularly disturbing. The generally accepted Western course for effective healing from PTSD is to process the trauma experience with the help of a trained therapist. Watters views the wholesale application of Western treatments in Sri Lanka (without taking account of the culture and recent brutal 30-year-long civil war) as having been a monumental waste of energy and resources.

That well-intentioned failure is still not as disconcerting as the story Watters has to tell about GlaxoSmithKline (manufacturers of Paxil) in Japan. ‘The psychiatric category of depression was not a widespread public concern, and the capacity to experience great sadness was considered not a burden but a mark of strength and distinction,’ Watters writes of Japanese beliefs before 2000. Despite Japanese thinking to the contrary, GlaxoSmithKline saw a huge potential market for Paxil and mounted a massive marketing campaign that combined savvy marketing and questionable scientific research. That campaign eventually bulldozered cultural resistance and long-held beliefs–by 2008, GlaxoSmithKline was selling $1 billion of Paxil annually in Japan.