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

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]