Magazine article Psychotherapy Networker

Bookmarks, Psychiatric Imperialism: DSM Goes Global

Magazine article Psychotherapy Networker

Bookmarks, Psychiatric Imperialism: DSM Goes Global

Article excerpt

BookmarksBy Diane Cole

Psychiatric ImperialismDSM goes global

Crazy Like Us: The Globalization of the American Psyche Ethan Watters Free Press. 306pp. ISBN: 9781416587088

In a strongly argued new book, Crazy Like Us: The Globalization of the American Psyche, journalist Ethan Watters presents a disconcerting portrait of the latest incarnation of the Ugly American: as global shrink. Read it at the risk of hating yourself (or your colleagues, or Watters, or American culture and capitalism) in the morning. But don't read it and risk missing what our global cultural blinders may be preventing us from seeing.

Crazy Like Us is a withering indictment of America's role in spreading our own concepts of mental illness around the world--a form of American psychiatric imperialism, you might say. "The virus is us," he contends, and we keep on spreading it. (Whoa! See what I mean about hating yourself?!)

Okay, so does Watters have anything new to tell us beyond leftie America-bashing, which is tedious even for a bleeding-heart liberal like me? The answer is yes, but you have to sift through his political assumptions to find it.

To give Watters his due, he's clearly done his homework, researching the cross-cultural psychology literature and interviewing internationally recognized experts. He's traveled to Hong Kong, Japan, Sri Lanka, and Zanzibar, and uses case histories from each locale to illustrate the ways in which he believes we're "homogenizing the way the world goes mad" by exporting our own culture-bound (and DSM-defined) understanding of mental disorders to non-Western cultures.

The prime culprits are pharmaceutical companies and Western-style marketing campaigns, combined with a worldwide overreliance on and overestimation of American psychiatric know-how. Watters finds that when a country's medical establishment assumes that Western treatments are always superior, traditional healing techniques from those cultures become undervalued and are frequently dismissed.

He begins his whirlwind, state-of-the-world's-mental-health tour in Hong Kong, where in recent years, a steep rise in cases of anorexia and bulimia has seemed to mirror the rapid increase in advertising dollars spent on marketing beauty and diet products with the message that thinner is better. At the same time, ever-higher levels of political uncertainty and economic anxiety began bubbling up as the populace began preparing for the territory's transfer from British control to mainland China's. However, Watters hypothesizes there was another dynamic at work in the proliferation of these cases.

Fifteen years ago, according to Sing Lee, whom Watters identifies as China's leading expert on eating disorders, Hong Kong had far fewer instances of eating disorders, and patients rarely or never voiced conflicts or worries about their body-image. Then, in 1994, a Hong Kong schoolgirl's death from anorexia sparked widespread media reports and warnings about harmful eating disorders. While the media's descriptions of a "fat phobia" fixation on thinness would have sounded familiar to Americans, Watters contends that framing the symptoms in this way was new to Hong Kong. He believes that constant media attention helped create a Western-style eating-disorder epidemic.

In the wake of the schoolgirl's death and the massive attention given to it, the number of Lee's patients began to grow exponentially--all of them reporting obsessive thoughts about body-image. Soon, it was his original patients--those who hadn't expressed anxiety about how their bodies looked--who began to seem "atypical," precisely because they didn't conform to American concepts of the disease. Thus, according to Watters, "Western assumptions about eating disorders were not only steamrolling local variations but also potentially acting as a vector, both spreading these illnesses and shaping their expression."

The suggestion is provocative, yet it seems impossible to tease out the number of cases "spread" by Western assumptions from those originating from the rise of political and economic anxiety that suffused Hong Kong at the time that eating disorders burgeoned. …

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