In the early 1990s, Dr. Sing Lee began to see mental illnesses behave the way they’re not supposed to.
A practicing psychiatrist and researcher at the Chinese University of Hong Kong, Lee was studying anorexia in China – where it displayed virtually none of the symptoms of the disease in the West. His patients didn’t diet, or fear becoming fat: instead, they said their stomachs felt constantly bloated.
Then, in 1994, an anorexic teenage girl collapsed and died on a Hong Kong street. The death caught big media attention, and the Chinese language newspapers and TV covered it. They went to western experts to describe the illness, and naturally those experts quoted from the DSM (the Diagnostic and Statistical Manual, now in its fourth edition): they said anorexia involves deliberate dieting and fear of obesity.
Almost immediately, people around Hong Kong began exhibiting those symptoms – symptoms that had never before existed in a Chinese country – instead of the symptoms of anorexia that Dr. Lee had previously seen. Those symptoms had been indigenous to the culture, but not as well known – and almost overnight they disappeared to be replaced by the same “mental illness” made famous by American teenagers and celebrities.
By the late 1990s, three in ten women in Hong Kong reported symptoms of an American style eating disorder.
This story, reported recently in the New York Times Magazine in a feature called “The Americanization of Mental Illness” draws a startling conclusion: a transfer of “understanding” of mental illness is moving from West to East, and this actually changes the nature of the “illness” people experience. If Hong Kong in the 80s had a DSM (Diagnostic and Statistical Manual for psychiatry), it’s entry for “anorexia” would now be completely wrong. But Hong Kong doesn’t – and so instead our “official” description of anorexia has become standard in just a few years.
As Times writer Ethan Watters says:
“Mental-health professionals in the West, and in the United States in particular, create official categories of mental diseases and promote them in a diagnostic manual that has become the worldwide standard. American researchers and institutions run most of the premier scholarly journals and host top conferences in the fields of psychology and psychiatry. Western drug companies dole out large sums for research and spend billions marketing medications for mental illnesses. In addition, Western-trained traumatologists often rush in where war or natural disasters strike to deliver “psychological first aid,” bringing with them their assumptions about how the mind becomes broken by horrible events and how it is best healed. Taken together this is a juggernaut.”
According to Alan Vaughan, a practicing clinical psychologist, Jungian psychoanalyst and the director of Saybrook’s program in Consciousness and Spirituality in the Graduate College of Psychology and Humanistic Studies, this story actually has a great deal of historical precedent. Because behind these western ideas of mental illness are deliberate actors – such as pharmaceutical companies – who stand to profit from this change in culture. And this is hardly the first time that western actors have tried to change indigenous cultures for profit. It may be under the guise of mental illness, but make no mistake: this is neo colonial Western cultural hegemony. .
“This is an offshoot of colonialism, European expansionism, of the 15th and 16th centuries, and it creates many of the same kinds of problems,” Vaughan says. “What we in the west call a bi-polar disorder might be called a form of spirit possession among the Yoruba of Nigeria. Some may say that’s ridiculous, but what’s important to understand is that Nigerian culture has ways to address those symptoms, and they’re effective. As part of my cross cultural doctoral research,I remember visiting a clinic run by Dr. Lambo, a Nigerian psychiatrist just outside of the major city of Ibadan, Nigeria. What was quite nice about the treatment interventions is that there was a mix of western medicine and traditional medicine at the clinic, so that the psychiatrist conferred with the local shaman, and the family did much of the treatment. The family lived with the patient or came every day bringing and preparing the food and taking care of them and being part of the discussion of their family member’s ailing spirit, so there was continuity between the home environment and the healing environment that was very beneficial to the healing process.”
While the DSM, has empirical value as an evolving catalog of European and American mental disorders, it recognizes no such protocol, nor does it have any way to address the spectrum of culturally specific symptoms in a way that is meaningful in the indigenous cultures. The result, Vaughan says, is that we are “creating” new symptoms that the culture has no traditional way to handle, while devaluing and ostracizing the effective healing methods they’ve built up over time, in the way that colonial Christianity devalued indigenous religions. This causes a psychological dislocation . We’re creating more problems than we’re solving.
However, says Vaughan, that’s happened with psychology before – in the west. Before the bio-medical model of “mental illness” could conquer the globe, it conquered America. It was never, and is not, self-evident that a “mental illness” has the same set of symptoms and responds well to drugs – or that mental illness has any meaning as a concept separate from culture.
Take a look at your television: you’ll see a bevy of advertisements for psychotropic medications promising to cure a specific set of symptoms for depression or anxiety. The potential side effects of the medications can cause a host of new physical and mental problems for the user – but nobody’s spending big money to promote the often more effective options of therapy or depth analysis: the pharmaceutical companies that pay for the products and the commercials are driving treatments in the west as much as they are in the rest of the world.
While medications can be useful with curative talk therapies for individuals, couples, and families, they do not address the etiology of the problems in modern culture.
“Is this model even good for America?” Vaughan asks. “That’s the first question we should ask. It’s pretty clear that even no one here is really satisfied with the model we’re exporting, and that the market the drug companies have created inside the United States has had harmful consequences even here. This isn’t just an issue for the rest of the world to deal with: America needs to be more introspective about what mental health is and how to address it. That’s the first, and most important, step in stopping this process where we develop material ‘treatments’ and then export them to the world without any real studies or ethical considerations.”