Note to self: "crazy like us, the globalization of the american psyche" by Ethan Watters

Notes to self is the place where I write about interesting stuff that I happen to read/watch/listen. It is less about writing a review and rather about recording my thoughts and considerations.

The book is about the use of the American (or western) concept of "mental health" or "psychiatric disorders" in non western contexts. It is divided into 4 case studies, each of them describing the introduction of a particular "disorder" in a particular country. The overall theme is that non-western cultures have their own way to deal with mental illness, and the introduction of the "western" way typically causes great damages.

Anorexia in Hong Kong: a form or anorexia had existed in Hong Kong long before the arrival of the western mental categories. It had very different symptoms and causes from the western one, and a meaning that was close to the local culture. After a highly-publicized death for anorexia, a large prevention/awareness campaign followed. Except, this campaign was targeting anorexia in its western sense. What followed was an epidemic of western-style anorexia. The campaign had effectively added a new element to the pool of symptoms available (within the local culture) to express distress. Interesting "endogeneity" problem in which identifying a disorder creates the disorder - relevant mechanism in mental health.

Schizophrenia in Zanzibar: In many non-western societies, mental health illnesses are not disorders but conditions/individual characteristics. I'm tall, you are short, he likes to strawberries, she likes to shout for no apparent reasons. A "condition" does not imply any guilt - everyone is what he/she is. A "disorder" implies that there is something wrong with the person. A "condition" does not require any cure. A "disorder" needs a cure. 

Before the introduction of the "western" way of thinking about schizophrenia in Zanzibar, families with a schizophrenic member were generally accepting, patient, resigned. After the arrival of the "western" way, families started looking for a cure, being frustrated (implicitly at their schizophrenic family members) for the lack of progress, attaching stigma to the person who is ill. Ultimately, patients were worse off, because  schizophrenia gets worse in emotionally-charged environments.

Question: should we call diseases or disorders only things that actually have a cure? After all, what is the point of calling something a "disorder" rather than a "condition" if there is no cure? I'm thinking about, for example, down syndrome. Also, if tomorrow someone invents a pill to become tall, will being less than 180 cm be considered a disease?

Post Traumatic Stress Disorder (PSTD) in post-tsunami Sri Lanka: first of all, it is striking how none of the most common treatments for PSTD (based, by en large, on "re-experiencing the traumatic experience" shortly after the events) have shown any effectiveness, even in the western world. Despite this, thousand of western "experts" travelled to Sri Lanka after the tsunami to provide PSTD treatment to the people affected, especially children. Except that, in the local culture, (a) mourning and healing is a social process, (b) talking explicitly about a traumatic experience risks generating violence and revenge within the community. Hence, local people were used to talk about their traumatic experience only indirectly, using metaphors. Western experts were, in fact, destabilizing local communities and preventing the process of healing.

Depression in Japan: something similar to "depression" has long existed in Japan. It was something close to "deep melancholy", and was considered with respect. It was not considered a "disease" but rather a condition associated with a particularly sensitive soul. Japan was not a great market for antidepressant.

Therefore, a bunch of pharma companies organized a congress, where they engineered a strategy to "import" western style depression (and its cure) to Japan. They enlisted leading scientists (local and foreign), started a media campaign, convinced the government, massaged data and results. They succeed.