Cultural Psychiatry

The New York Times has an article which exerpts a bunch of stuff from an upcoming book.  While this is always a dicey proposition (generally if an author's argument takes an entire book to make in the first place, trying to explain the whole thing in a single newspaper article is only going to lead to tears) it is already leading to controversy.

"The Americanization of Mental Illness" by Ethan Watters is, as you can tell from the title, another in a long line of articles talking about American cultural imperialism.  Although where Watters stands on the issue is a little unclear.  He seems - from what I could tell from the excerpt - to be taking the stance of cultural relativity.  It isn't good or bad that Western understandings and frameworks for mental illness are spreading across the world; it simply IS.

One thing that should be made clear, which is getting lost in a lot of the online debates about this article, is that Watters is at least at one point taking care to point out that the diseases themselves are not being spread.  It's easy to glance at Watters' article and deduct that he's saying that "Anorexia, depression, schizophrenia, and other mental illnesses are a completely cultural construct," in other words "all in your head" in other words "not a real thing."

I found the most compelling bits about Watters' essay buried deep in the middle, where he makes the point that the way the illness manifests is what is culturally determined.  For example, depression (an imbalance in the brain chemistry) may manifest as lethargy and "everything is gray" here in the United States, but in Asia it may manifest as bitterness or more combative conversational tendencies.

While Watters may well be on to something, and there is an entire branch of anthropology which is dedicated to medical and psychiatric anthropology, I have some serious reservations about some of the things Watters brings up in this article.  For example, as this incisive retort points out, is it that anorexia itself spread to Hong Kong?  Or is it simply that by describing what anorexia was, by giving the disease a name it gave the people of Hong Kong a framework to understand this thing they had seen happening all along?  

This is a common issue with epidemiology, and I'm surprised Watters doesn't address it.  (Maybe it is addressed in the full book itself, but not in this article.)  For example, the autism community has been struggling with trying to determine whether autism itself is on the rise, or if it's simply that autism is more closely monitored, understood, and reported.  The same can be said for Post Traumatic Stress Disorder, which we now know can happen from any of a number of unpleasant events, from being a participant in warfare to having a car accident.

I also dispute Watters' interpretation of a study which found that people partnered with someone with mental illness who described it as a "brain disease" were harder on their partners than if it was described as "due to something that happened to me."  Who's to say the participants weren't simply coddling the "something that happened to me" people, while treating the "brain disease" people just like they would anyone else?  Since it seems that the study was done without a control, it's impossible to say.