I've read and enjoyed a couple of books by jourmalist Ethan Watters, both co-written with sociology professor Richard Ofshe. The first was Making Monsters: False Memories, Psychotherapy, and Sexual Hysteria, one of the best studies of the whole therapy-driven sexual/ritual abuse scare of the Eighties and Nineties. The second was Therapy's Delusions, a critique of Freud in and the whole plethora of psychotherapies that came in his wake. Now he's written a new book, on his own, Crazy Like Us: The Globalization of the American Psyche, so naturally I'm interested. He has a longish essay adapted from the book in the NYT, The Americanisation of Mental Illness.
In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.
That is until recently.
For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.
Well...I don't know. The relative variation in the way mental illness manifests itself in different cultures is a fairly commonplace observation. We no longer see those hysterical women who crowded Freud's waiting roon in 1890s Vienna, for instance. And anorexia, as we all know, has exploded recently for reasons which no one fully understands, but you'd be unlikely to come up with an explanation that didn't include the modern obsession with diet, and absurdly thin fashion models; ie a Western lifestyle. But can you really squeeze all this into the old "cultural imperialism" template?
What about autism? That's another - well, mental illness?..affliction?..however you care to classify it - which has suddenly come into prominence in the West. When autistic children are identified elsewhere, is this then a problem, an imposition of Western hegemony or somesuch?...or is it rather that a previously unidentified syndrome has now been noted, and that previously mysterious behaviour has been made more explicable, with the concomitant expectation that we can start to learn how to deal with it. The rest of the world can, with luck, benefit from advances in understanding based on (Western) science.
The brief discussion of schizophrenia is interesting. It does seem to be a universal of all cultures, but no one, unfortunately, can claim that our treatment of schizophrenics in the West is any kind of success. As part of his argument, Watters notes that schizophrenics tend to do better outside the industrialised world. He suggests, plausibly, that in societies where there's a belief in possession by spirits, schizophrenics going through a relatively healthy period are welcomed back into society because they're seen as now being free from those spirits, and therefore just like everybody else. That is, the schizophrenia is seen as something external to them. With the Western medical model, they're still labelled as schizophrenic, though the illness may be in remission. They're still stigmatised. There's also the related point that the stress on personal autonomy, that particularly American belief in making your own way and taking responsibility for your own fate, doesn't sit well with a sympathetic appreciation of the plight of the mentally ill.
Well, yes..but what do you do with that information? It's not as though we should now be promoting a theory of spirit possession as the best way to understand schizophrenia. Treat the mentally ill with greater consideration and sympathy? Of course, but that's not as grand or eye-catching as putting it in terms of...yes, yet again, it's all down to the evils of modern US-style culture.
So, certainly worth a read, but I'm not sure I'm persuaded.
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