"What I'm Reading" Wednesday

How's that for a silly blog title? I wonder if I'll get a book review up here every Wednesday. That's my intention, but we all know about paving that proverbial road.

I've been reading a fascinating book the last 2 weeks or so; Crazy Like Us: The Globalization of the American Psyche by Ethan Watters (Simon & Schuster, 2010.) I had seen this book in the library several times before I finally checked it out. I was a little reluctant to read it because I had the idea it might be sort of anti-American, you know? "Those crazy Americans, they are making the whole world crazy too." But it still seemed to call to me from the shelf, so I thought I'd give it a chance. I'm very glad I did. The book is a fascinating examination of mental illness and how societies diagnose it, view it, and treat it. In our science-driven, technologically advanced society here in the USA, our view of mental illness is that of a disease, physiological in origin and therefore medically treatable. However, studies show that there are many aspects of mental illness that are culturally dictated, both in manifestation (symptoms), duration, and outcome. The author looked at four specific illnesses and anecdotally contrasted either their prevalence, symptoms, treatments, or outcomes between the USA and another culture. First, he talked about anorexia in Hong Kong. Before the mid-1990's, there were virtually no reported cases of anorexia in Hong Kong. After noticing this, a particular psychiatrist looked a little deeper and discovered that the condition he believed to be anorexia actually did exist, but it's symptoms differed enough from the American version of anorexia that it did not fall within the diagnostic criteria, and therefore wasn't considered to be anorexia. The American Psychiatric Association publishes a book, The Diagnostic and Statistical Manual of Mental Disorders, (or the DSM), which has essentially become the worldwide standard of mental illness identification and diagnosis. But Hong Kong's version of this disease didn't include some key symptoms, for example "intense fear of becoming obese, even when underweight" and disturbed self-image, like claiming to "feel fat when emaciated." The Hong Kong psychiatrist found the cultural expression of anorexia, although it included severe control of food intake resulting in physical emaciation, did not include issues with body perception, but rather more culturally recognized physical discomfort issues like being unable to swallow. Because the Chinese have a strong cultural tradition of mental distress manifesting itself in physical sensations, the symptoms of anorexia were expressed that way, but since they did not fit the American textbook symptoms, were not recognized as anorexia. This is the main point the book makes throughout it's four case studies: that symptoms of a mental illness may differ worldwide, but the globalization of the American culture makes it difficult to recognize. In the same way, there are culturally driven treatments and responses that are effective in their place that are being ignored or tossed aside because they, too, do not fit the American mold as appropriate. In the mid 1990's, the importation of American culture into Hong Kong apparently reached a tipping point of sorts, and the Americanized version of anorexia, with it's full complement of American symptoms, showed up in force. Anorexia became rampant, manifesting itself in numbers that led some mental health experts to believe that not only were those who might have had the Chinese version of the illness becoming ill, but also many young girls who likely would have found other ways to express their social or personal distress had not anorexia been in the media so much. It seems that popularization of illness in terms of general knowledge lead to a popularization of illness in terms of frequency as well. In other word, just seeing a condition in the news leads a significant number of people to "get" it.
Other chapters of the book included: a look at PTSD in Sri Lanka (post 2004 tsunami) and how cultural traditions of dealing with mental stress by keeping silent (based on Sri Lankan belief system) rather than talking about it (American treatment technique) can be as effective; a look at how schizophrenia sufferers actually have better outcomes in Zanzibar than in industrialized countries like the US; and how the recent massive rise in diagnosis of depression in Japan has actually been driven not by American views of the disease, but by the marketing machinations of big PHARMA.
The book was fascinating, and not really an indictment of American mental health system per se, but more a caution regarding the wholesale exportation of American culture throughout the world without observation of or regard to local and cultural practices that may actually be more effective. Mr. Watters concludes, "With little appreciation of these (cultural) 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 we rethink our generosity."