"Crazy Like Us" America's Influence on World Psychiatry
According to author Ethan Watters, the US is exporting more than Nike shoes and McDonald's food. In his new book, Crazy like Us: the Globalization of the American Psyche and in an interview with NPR, he shares an interesting perceptive on the American influence.
According to him, "we are flattening the landscape of the human psyche itself. We are engaged in the grand project of Americanizing the world's understanding of the human mind."
He worries that when we define a set of symptoms as a disorder - be it depression, anorexia, post-traumatic stress, even schizophrenia - we're defining those symptoms for the rest of the world as well. While he admits that sharing health knowledge is usually a good thing, his studies have led to a concern that not only are we disrupting cultural variations in healing, but we're actually spreading mental illness.
Depression in Japan
For a long time pharmaceutical companies had thought of Japan as untouchable when it came to the sale of anti-depressants - not because there were no sad people there, but because they had no cultural notion of "depression". To them the symptoms of this disorder were a normal part of the human experience - until Paxil came along.
Alongside a team of Japanese cultural experts, Paxil surmounted this mental health hurdle, essentially by selling not only their prescription medication, but the condition it was treating! Until the new millennium, selective serotonin reuptake inhibitors (SSRIs) were non-existent there. Today their sale makes billions of dollars each year.
Still, Watters feels that Americans, for the most part, are spreading our understanding with the best of intentions. Our motivation is to help, but we have an unfortunate tendency to view ourselves as the be-all and end-all of medical knowledge.
In an NPR interview, host Rebecca Roberts asks, "So, this is moving a cultural definition of what is normal and what needs treatment, and also introducing the notion that the best treatment is a pharmaceutical intervention."
"That's exactly right. Those two things go hand in hand in terms of how the drug companies look to the rest of the world. And interestingly enough, they talk about the evolution of these countries. So they talk about Japan as being five years behind America and China being 10 years behind Japan, but at the head of the evolutionary scale is always America. They're trying to move other countries along to become like America, how we think about depression, how we treat it, how we prescribe for it the head of the evolutionary tree is always us." Watters replies.
The Western, American Expert
To make matters even more difficult, we've done such a good job of convincing the world that we are the last authority, even the psychiatrists that visit other countries, determined to respect cultural differences and avoid imposing American beliefs, have trouble avoiding the stereotype of the western, American expert with the most advanced knowledge.
One American caller on the NPR interview had moved to Saudi Arabia after her psychiatrist husband was asked to train young psychiatrists there. In her nine years living there, she too noticed this effect.
"I lived among the people, and I got to know how they just deal with everyday life. I came to respect and see as somewhat liberating their narrative style, I guess, of explaining things, and their incorporating of the ups and downs of life as just something of value and not something to be afraid of but, oh, you know, if you're down, then oh, there could be some value in that they respected the Western models that had come in a little bit too unquestioningly, and some maybe don't respect their own models, think maybe anything coming from the West has to be better. So I think that it's good to remind people, no, what you have has value. What's coming in could have some value. Let's see how we can incorporate these and make them a very good, healthy blend."
Schizophrenia in Zanzibar
Another prime example is of a more serious illness...schizophrenia in Zanzibar. In this particular area, the idea of spirit possession is very prevalent, and those with schizophrenia are believed to be afflicted. Yet, this belief brings acceptance of the schizophrenic, and keeps them closely tied to their community. They lead a good life and with the support of friends and family. In their view, a spirit possession is like the result of a traumatic experience. It can negatively affect the person, but over time it can be left behind and effects will be less and less.
In Zanzibar, the idea that they are suffering from a disordered brain instead of a spirit possession, is actually detrimental to schizophrenics. They view people with brain disorders as almost another species - they assume they are dangerous and want to distance themselves for them, leaving the schizophrenic to their own devices.
Says Watters, "I'm not a believer in spirit possession, but I do believe that mental illness exists as a biomedical fact in the human brain, but I can also recognize that cultural stories make a difference, and the cultural story we tell ourselves about the scientific truth of mental illness might not always be the one that is the most helpful."
But there's more to the story.
Not only is there the subjective nature of health and illness from culture to culture, but from generation to generation as well. Roberts observes, "it certainly seems from the evidence in your book that there are times when talking about mental illness encourages mental illness."
Watters explains, "Or it encourages a particular expression of that mental illness... in any given generation there is a way to express internal distress.. that does change over time; and indeed the reason it changes is oftentimes because healers change their beliefs about the human mind. And so they think of the mind as working this way, they predict certain notions, and the population responds to that...his is not a matter of faking a symptom. This is the unconscious mind trying to figure out how to express itself, and it looks for oftentimes very subtle cultural cues... if you look across time -say, for instance, to Victorian England, hysteria was the form of illness of the time. You had thousands of women with leg paralysis and hysterical blindness and convulsions, the 1960s and '70s, we had anxiety. Come the 1980s and '90s, depression became the key narrative for how we talked about our general distress... So these things actually change fairly quickly. However, within one moment in time, it's often very difficult to see what those cues are and where they exist. When we exist within one culture, it's like being a swimmer outside of sight of land - you can't really tell the currents you're in."
The American Health Narrative
So what is the narrative story that defines the American view of health today? A big part of our viewpoint, according to Watters, is our ego. When you do cross-cultural studies about egocentric versus sociocentric versions of the self, it turns out to be true that Americans are more egocentric. They believe that the self exists within the human mind. And that just might sound commonsensical to an American, but there are other notions where the self exists as part of a social group more than an individual self.
One caller, from Keho, Australia illustrated this difference as she compared traditional American therapy, alone in a room with your psychiatrist - to methods in Keho which occur outside as a day-long ceremony, in the presence of friends and family. It's not that we're cold or selfish, it's just that success in our culture requires us to think independently.
In fact, statistics prove that Americans are consistently one of the most generous countries around. Our hearts are in the right place, but we don't always realize how our actions come across. For example, when Sri Lanka experienced a devastating tsunami, many Americans wanted to help, and that includes the mental health community -psychiatrists, talk-field therapists, Scientologists, EMDR therapists, ect. They each came with their own variation of the America idea of healing - most without any idea of the Sri Lankan culture, language, war-torn history, or their personal beliefs including those about death. These people meant well, but imagine things the other way around.
Says Watters, "what if Sri Lankan shamen came over to New York after 9/11 and began knocking on doors of the people who had family members die in 9/11 to tell them the appropriate ways to heal? That would seem bizarre to us and utterly culturally insensitive. But as Americans with this idea that we have the most advanced knowledge, it makes perfect sense for us to go and do that in another culture."
A Culture-Sensitive Approach to Healing
As more research confirms this, Mr. Watters has been pleased to see how receptive mental health professionals are to the idea. Their goal is to help people the best they can and incorporating the idea of cultural variation in to their own practice, will only increase their effectiveness in that goal. However, this is not to say what we have shouldn't be shared. Says Watters, "...you know, there are valuable drugs to be had that help the mentally ill, they should certainly not be denied to the rest of the world."
His advice to the mental health professionals and pharmaceutical companies?
We should make sure when we promote them as scientific, the science behind them is solid, helpful, and won't trample on cultural beliefs...