Western Madnesses Displace Indigenous Kinds?

Ethan WattersThe New York Times has published an interesting essay by Ethan Watters claiming that the spread of Western psychiatry has paradoxically spread characteristically Western kinds of mental illness to other parts of the world where they were rarely seen before.

The essay is adapted from Watters forthcoming book, Crazy Like Us: The Globalization of the American Psyche.

According to Watters,

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.

The article discusses, in particular, the example of how anorexia rose markedly in prevalence after a highly publicized case in Hong Kong. By contrast, characteristically southeast Asian conditions like amok (“an episode of murderous rage followed by amnesia”) and koro (the debilitating certainty that their genitals are retracting into their bodies) are relegated to to minor descriptions as “culture bound syndromes” at the back of the American Diagnostic and Statistical Manual (DSM). Culture-bound they may be, but Watters’ point is that anorexia may well have been just as culture-bound (Western) if not for the international influence of the American Psychiatric Association and its DSM.

One of the intentions of the biomedical assumption of the DSM is that, if mental illnesses are really just physical illnesses, then they will lose the social stigma often associated with them. Watters relates the research of an Auburn U. professor that showed, by contrast, that “we may actually treat people more harshly when their [mental] problem is described in [physical] disease terms.”

One of the cross-cultural epidemiological is why people with have (what we would call) schizophrenia have so much lower a relapse rate outside of the Western world that they do within it. One U. Puget Sound anthropologist, Juli McGruder, has noted that in Zanzibar, for instance, such individuals are “coaxed with food and goods, feted with song and dance. They are placated, settled, reduced in malfeasance.” McGruder saw this approach in many small acts of kindness…. An ill individual enjoying a time of relative mental health could, at least temporarily, retake his or her responsibilities in the kinship group. Since the illness was seen [by the local community] as the work of outside forces [evil spirits], it was understood as an affliction for the sufferer but not as an identity.”

About Christopher Green

Professor of Psychology at York University (Toronto). Former editor of the Journal of the History of the Behavioral Sciences. Creator of the "Classics in the History of Psychology" website and of the "This Week in the History of Psychology" podcast series.