‘THE AMERICANIZATION OF MENTAL ILLNESS’ Ethan Watters, New York Times Magazine, 1/10/2010

MEDICALIZATION FROM WEST TO EAST

“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.

A-N BEFORE 1994

Dr. Sing Lee, at the Chinese University of Hong Kong, began documenting a culturally specific form of A-N in late 80s and early 90s

Complaints were typically somatic (bloated stomachs)

Most of his patients did not intentionally diet, no obesophobia

1994 - CHARLENE'S COLLAPSE ON HONG KONG STREET

to explain Charlene's case reporters copied out of western diagnostic manuals (i.e., DSM)

reports affected expression and prevalence used to see 2-3 patients/yr, now saw that

many in month presented with fat phobia new patients appeared to be increasingly

conforming their experience of anorexia to the Western version of the disease

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM) DSM: published by the American Psychiatric

Association, provides common language and standard criteria for the classification of mental disorders

Used in the US and around the world by clinicians, researchers, regulatory agencies, health insurance companies, drug makers and policy makers

“In the view of some Western mental-health practitioners, confident in the scientific basis of their field, mental health disorders are unaffected by culture, universal to humans everywhere….In this view, the DSM is a field guide to the world’s psyche, and applying it around the world represents simply the brave march of scientific knowledge."

BUT DOES THE “BRAIN DISEASE” BELIEF ACTUALLY REDUCE STIGMA? Prof. Sheila Mehta conducted an experiment

comparing effects of “psychosocial” vs “disease” explanations for mental illness on stigma

The belief –the “disease” explanation—that was assumed to decrease stigma actually increased it

HIGH EXPRESSED EMOTION

High Expressed Emotion: Collection of reactions including criticism, hostility and emotional overinvolvement (like overprotectiveness or constant intrusiveness in the patient’s life)

In one study, 67 % of white American families w/ schizophrenic family member were rated “high EE” Among British families, 48 % Among Mexican families, 41 % Among Indian families 23 %

IS THERE ONE DEFINITIVE PSYCHOLOGY?

The ideas we export often have at their heart a particularly American brand of hyperintrospection — a penchant for “psychologizing” daily existence.

“The problem is the overall thrust that comes from being at the heart of the one globalizing culture. It is as if one version of human nature is being presented as definitive, and one set of ideas about pain and suffering…”