The Mind In The World: Mental Illness, Culture, And Why America May Not Know Best

In the latest issue of the NYT Magazine, Ethan Watters points out that Americans feel we wrote the book on mental illness. But conceptions of psychological suffering vary greatly across cultures — and ours isn't necessarily the best one.

Watters mentions several illnesses common in other countries but unheard of here, like koro, which many Psych 1 graduates will recognize as afflicted men's "debilitating certainty that their genitals are retracting into their bodies." Such illness are classed in the DSM-IV as "culture-bound syndromes," relegated to pages 845-849. Watters writes, "Western mental-health practitioners often prefer to believe that the 844 pages of the DSM-IV prior to the inclusion of culture-bound syndromes describe real disorders of the mind, illnesses with symptomatology and outcomes relatively unaffected by shifting cultural beliefs." But really, the idea that only other people's illnesses are culture-bound is just another form of the ethnocentric belief that only foreigners have culture in the first place. Says Watters, "what cross-cultural psychiatrists and anthropologists have to tell us is that all mental illnesses, including depression, P.T.S.D. and even schizophrenia, can be every bit as influenced by cultural beliefs and expectations today as hysterical-leg paralysis or the vapors [...] or any other mental illness ever experienced in the history of human madness." And maybe we should listen.

Watters does provide an interesting account of the spread of Western-style anorexia in Hong Kong, which apparently mushroomed after the Hong Kong media began quoting the DSM. But he's not interested in the facile claim that Americans are injecting our toxic worldview into other, purer peoples. Rather, he shows how different cultures have different modes of thinking about mental illness, and how these modes influence not just the treatment of disorders, but sufferers' subjective experience.

Especially interesting is Watters's discussion of schizophrenia. He writes that schizophrenic patients in the US and Europe are actually much more likely to relapse than sufferers elsewhere, despite "the best technology, the cutting-edge medicines and the best-financed academic and private-research institutions." To find out why, anthropologist Juli McGruder studied schizophrenia sufferers and their families in Zanzibar. Watters writes,

She watched family members use saffron paste to write phrases from the Koran on the rims of drinking bowls so the ill person could literally imbibe the holy words. The spirit-possession beliefs had other unexpected benefits. Critically, the story allowed the person with schizophrenia a cleaner bill of health when the illness went into remission. 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 as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity.

It's obviously difficult to measure mental disorder and treatment across cultures — Watters himself points out that "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." But as McGruder's Zanzibar research shows, different groups have different ways of dealing with psychological disturbance, and our American methods may not be the be-all and end-all. In fact, our highly medicalized view of mental illness, with its emphasis on defects and imbalances in the brain, may in some cases actually preclude the kind of reintegration McGruder found.

There's no doubt that American medicine, be it drugs or talk therapy, has helped many mental illness sufferers. However, that doesn't necessarily mean that our methods deserve exportation, or that we understand the ills of other cultures as well as we may understand our own. It's popular in America to judge others by our standards — to speak, for instance, of overbearing immigrant parents or of foreign families who "just don't understand" the true nature of depression. But the mind exists in relation to the minds around it, and to their values, customs, and beliefs, and we have no reason to believe that our minds are somehow pure. If anything, we might question whether our highly individual approach to diagnosing and treating mental illness, in which we attach a diagnosis to a single brain and often attempt to treat it in isolation, is creating more sufferers rather than fewer. Not everyone benefits from interpersonal or family therapy, but we might benefit as a culture from the recognition that we are a culture, and that our cultural mores and standards and hopes and fears affect all of us in ways that are profoundly interconnected.

The Americanization Of Mental Illness [NYT Magazine]
Youth Now Have More Mental Health Issues [AP, via MSNBC]