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Crazy Like Us: The Globalization of the American Psyche
It is well known that American culture is a dominant force at home and abroad; our exportation of everything from movies to junk food is a well-documented phenomenon. But is it possible America's most troubling impact on the globalizing world has yet to be accounted for? In Crazy Like Us , Ethan Watters reveals that the most devastating consequence of the spread of American culture has not been our golden arches or our bomb craters but our bulldozing of the human psyche We are in the process of homogenizing the way the world goes mad. America has been the world leader in generating new mental health treatments and modern theories of the human psyche. We export our psychopharmaceuticals packaged with the certainty that our biomedical knowledge will relieve the suffering and stigma of mental illness. We categorize disorders, thereby defining mental illness and health, and then parade these seemingly scientific certainties in front of the world. The blowback from these efforts is just now coming to It turns out that we have not only been changing the way the world talks about and treats mental illness -- we have been changing the mental illnesses themselves. For millennia, local beliefs in different cultures have shaped the experience of mental illness into endless varieties. Crazy Like Us documents how American interventions have discounted and worked to change those indigenous beliefs, often at a dizzying rate. Over the last decades, mental illnesses popularized in America have been spreading across the globe with the speed of contagious diseases. Watters travels from China to Tanzania to bring home the unsettling conclusion that the virus is As we introduce Americanized ways of treating mental illnesses, we are in fact spreading the diseases. In post-tsunami Sri Lanka, Watters reports on the Western trauma counselors who, in their rush to help, inadvertently trampled local expressions of grief, suffering, and healing. In Hong Kong, he retraces the last steps of the teenager whose death sparked an epidemic of the American version of anorexia nervosa. Watters reveals the truth about a multi-million-dollar campaign by one of the world's biggest drug companies to change the Japanese experience of depression -- literally marketing the disease along with the drug. But this book is not just about the damage we've caused in faraway places. Looking at our impact on the psyches of people in other cultures is a gut check, a way of forcing ourselves to take a fresh look at our own beliefs about mental health and healing. When we examine our assumptions from a farther shore, we begin to understand how our own culture constantly shapes and sometimes creates the mental illnesses of our time. By setting aside our role as the world's therapist, we may come to accept that we have as much to learn from other cultures' beliefs about the mind as we have to teach.
320 pages, Hardcover
First published December 7, 2009
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About the author
Ethan Watters
6Ìýbooks51ÌýfollowersEthan Watters is a free lance journalist whose work has appeared in the New York Times Magazine, Discover, Men's Journal, Spin, Details, and Wired. A frequent contributor to NPR, Watters' work appeared in the 2007 and 2008 Best American Science and Nature Writing. He co-founded the San Francisco Writers Grotto, a work space for local artists. He lives in San Francisco with his wife and children.
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Displaying 1 - 30 of 447 reviews
September 16, 2016
A wonderful book for those interested in how culture influences mental health. Ethan Watters crafts a strong argument against how the western world's imperialism dismisses other people's diverse lived experiences, medicalizing their struggles in ways that do more harm than good. He writes in-depth about four compelling case examples: the rise of anorexia in Hong Kong, the wave that brought PTSD to Sri Lanka, the shifting nature of schizophrenia in Zanzibar, and the mega-marketing of depression in Japan. Watters advocates that we should question our assumptions about mental illness and learn to accept the different ways internal issues manifest. Instead of shoving pills and diagnoses down everyone's throats, we should strive for a more understanding, nuanced approach.
As a queer Asian American and as an aspiring psychologist, I loved this book's focus on diversity. Too often psychologists examine human behavior and mental processes while ignoring issues of culture and social justice, which both play a huge part in everyone's psychological processes. Just one example: why do we think eating disorder rates have risen so much, even when beauty ideals have existed for so long? The answer may include biological and psychological reasons, but we should take into account how we condition women to have maladaptive relationships with food, how our society determines the "appropriate" mental illnesses for each gender (e.g., eating disorders for women, antisocial personality disorder for men, etc.) Watters writes with conviction and his commitment to and research about the intersection of mental illness and culture breathes fresh air into an often whitewashed field.
A few suggestions for improvement: highlighting more solutions, speaking with those on all sides of the issue, and focusing on the quality work that has been done in cross-cultural psychology. Watters takes a polemic stance, which makes his writing fiercer, but he could have dedicated more space to providing possible strategies for spreading cultural understanding (e.g., collaboration, diversifying those in the field of psychology, etc.) I wish he had spoken to more researchers on both sides of the issue: those in pharmaceutical companies as well as those who do fabulous work in cross-cultural psychology. He interviews an array of knowledgeable subjects, as well as those on the ground of these foreign countries, but a more holistic integration of sources could have paved the way for increased compassion and teamwork in the field overall.
Overall, I recommend Crazy Like Us to anyone interested in mental illness, imperialism, and culture in different countries. I hope this book can help start a much-needed conversation in how to diversify mental health so we can provide quality psychological services to those from underrepresented backgrounds.
As a queer Asian American and as an aspiring psychologist, I loved this book's focus on diversity. Too often psychologists examine human behavior and mental processes while ignoring issues of culture and social justice, which both play a huge part in everyone's psychological processes. Just one example: why do we think eating disorder rates have risen so much, even when beauty ideals have existed for so long? The answer may include biological and psychological reasons, but we should take into account how we condition women to have maladaptive relationships with food, how our society determines the "appropriate" mental illnesses for each gender (e.g., eating disorders for women, antisocial personality disorder for men, etc.) Watters writes with conviction and his commitment to and research about the intersection of mental illness and culture breathes fresh air into an often whitewashed field.
A few suggestions for improvement: highlighting more solutions, speaking with those on all sides of the issue, and focusing on the quality work that has been done in cross-cultural psychology. Watters takes a polemic stance, which makes his writing fiercer, but he could have dedicated more space to providing possible strategies for spreading cultural understanding (e.g., collaboration, diversifying those in the field of psychology, etc.) I wish he had spoken to more researchers on both sides of the issue: those in pharmaceutical companies as well as those who do fabulous work in cross-cultural psychology. He interviews an array of knowledgeable subjects, as well as those on the ground of these foreign countries, but a more holistic integration of sources could have paved the way for increased compassion and teamwork in the field overall.
Overall, I recommend Crazy Like Us to anyone interested in mental illness, imperialism, and culture in different countries. I hope this book can help start a much-needed conversation in how to diversify mental health so we can provide quality psychological services to those from underrepresented backgrounds.
January 27, 2011
Well, this was certainly interesting. From studying anthropology to working in international public health to studying psych nursing, this is right up my alley. I appreciate some of what he is trying to say, in that transcultural treatment options are often not adequately tailored to each new specific culture. To some degree, I also believe that mental illness is culturally determined, or at least expressed in the particular symptom pool of a time and place. But I also have seen that medication can work wonders and that community remedies are not always helpful. I talked to a Kenyan colleague who worked in mental health here and in Kenya and asked him about his experience with mental health care in Kenya. I asked what types of programs and structures exist. He told me that people with schizophrenia have a huge burden and live on the streets. We know that historically all over the world people with schizophrenia have been killed and tortured, declared spiritually ill by their cultures, not always the revered shamans Watters finds. In the US, many people believe vaccines cause autism, a culturally defined belief that results in children dying unnecessarily.
In my own experience working on a pilot program for cognitive behavioral therapy for orphaned children in Tanzania, we found that there were good local community programs (similar to western models, actually) but there simply were not enough resources to accommodate the orphaned population. Now it may be possible that these children aren't actually bothered by the things we measured: death of a parent, witnessing violence, receiving abuse, hunger, overburdened caregivers (i.e. that we were imposing non-relevant western definitions of "trauma") but I highly doubt it. We know at least anecdotally that these children have less education, lower economic status and often end up in sex work, but, hey, maybe that's a western idea of a bad life. My point here is my struggle with anthropology. At what point do you put theory aside and intervene? In any decent intervention you work with the population to adjust it, but you will never fit every piece. Does that mean we should never act?
The third point is that Watters is quite invested in traditional medicine in ways that the recipients might not be. In my early travels I would be frustrated that people didn't value what I valued about their culture and wanted to Americanize with TVs, cars, and *gasp* clean water. I think it is actually more paternalistic to require a culture to conform to a static definition of "traditional". It is not my job to curate cultural value outside of my own experience. Often requests for western health care, including mental health come from the populations themselves.
Final thought-provoking bit: At the very end of a harsh rant agains it, he mentions that his wife is an American psychiatrist. WTF??
PS. re: Pharma. Lifestyle drugs can be creepy (Viagra and such), the patents can be infuriating, but, hello, antibiotics? vaccines? anti-retrovirals? insulin? birth control? and in my experience SSRIs, increase lifespan and quality of life exponentially.
In my own experience working on a pilot program for cognitive behavioral therapy for orphaned children in Tanzania, we found that there were good local community programs (similar to western models, actually) but there simply were not enough resources to accommodate the orphaned population. Now it may be possible that these children aren't actually bothered by the things we measured: death of a parent, witnessing violence, receiving abuse, hunger, overburdened caregivers (i.e. that we were imposing non-relevant western definitions of "trauma") but I highly doubt it. We know at least anecdotally that these children have less education, lower economic status and often end up in sex work, but, hey, maybe that's a western idea of a bad life. My point here is my struggle with anthropology. At what point do you put theory aside and intervene? In any decent intervention you work with the population to adjust it, but you will never fit every piece. Does that mean we should never act?
The third point is that Watters is quite invested in traditional medicine in ways that the recipients might not be. In my early travels I would be frustrated that people didn't value what I valued about their culture and wanted to Americanize with TVs, cars, and *gasp* clean water. I think it is actually more paternalistic to require a culture to conform to a static definition of "traditional". It is not my job to curate cultural value outside of my own experience. Often requests for western health care, including mental health come from the populations themselves.
Final thought-provoking bit: At the very end of a harsh rant agains it, he mentions that his wife is an American psychiatrist. WTF??
PS. re: Pharma. Lifestyle drugs can be creepy (Viagra and such), the patents can be infuriating, but, hello, antibiotics? vaccines? anti-retrovirals? insulin? birth control? and in my experience SSRIs, increase lifespan and quality of life exponentially.
January 30, 2011
Kudos to my friends on goodreads who feel inspired enough to write full-fledged reviews; I simply can't muster the energy.
However, this book enraged me in a way few do and I feel compelled to share at least some of my thoughts. Watters caught my attention with the pot-shots he threw at the DSM in the NYT magazine earlier this year and I approached the book with cautious optimism. "Crazy Like Us" follows along the same lines as his initial article, providing four examples of what anyone who has ever taken a multicultural counseling course could tell you: culture bound syndromes exist. Watters does not explain the syndromes, reveal how mental health practices in these countries deal with these cases, etc. Rather, he spends about 200 pages belaboring the point that the good intentions of the West and the dreaded DSM are severely misguided. True enough. Yet, Watters writing is near histrionic and the constant hyperbole is tough to take with a straight-face ("We erase this diversity at out own peril").
The problem with this book and others like it (ie. journalists writing about mental health) is that they do not fundamentally speak the same language and make sweeping generalizations with the anecdotal evidence they happen to muster up. An n of 1 proves nothing except that confirmatory bias exists.
However, this book enraged me in a way few do and I feel compelled to share at least some of my thoughts. Watters caught my attention with the pot-shots he threw at the DSM in the NYT magazine earlier this year and I approached the book with cautious optimism. "Crazy Like Us" follows along the same lines as his initial article, providing four examples of what anyone who has ever taken a multicultural counseling course could tell you: culture bound syndromes exist. Watters does not explain the syndromes, reveal how mental health practices in these countries deal with these cases, etc. Rather, he spends about 200 pages belaboring the point that the good intentions of the West and the dreaded DSM are severely misguided. True enough. Yet, Watters writing is near histrionic and the constant hyperbole is tough to take with a straight-face ("We erase this diversity at out own peril").
The problem with this book and others like it (ie. journalists writing about mental health) is that they do not fundamentally speak the same language and make sweeping generalizations with the anecdotal evidence they happen to muster up. An n of 1 proves nothing except that confirmatory bias exists.
March 1, 2024
A fascinating and important book, though there were places where I wanted more.
The author’s thesis is that mental illness is far more culture-bound than western psychologists acknowledge, and that blithely exporting western (specifically American) models of mental illness and health around the world can be useless and often detrimental. This is especially true when our own house is not in order: compared to physical health, our understanding of mental health runs far behind. The science is still very much evolving (we’re still at the level of diagnosing symptoms as illnesses, where physical health was in the 18th century), and not as reliably as one would hope, given drug companies� dominance over the research. And aspects of western society may make us more vulnerable to mental illness in the first place.
There are only four chapters so I’ll discuss them in turn, for those who may not read the book yourselves:
1. Anorexia in Hong Kong
Up until the 1990s, anorexia was not only extremely rare in Hong Kong, it presented nothing like the stereotypical western model. While still mostly affecting distressed women, they were not teenagers, not high achievers, did not have body dysmorphia or interest in losing weight, and reported untraceable physical causes (lump in the throat, painful digestion, etc.) for their inability to eat. Interestingly, the same was true in the U.S. in the early 19th century. Watters traces the history of anorexia through 19th century hysteria, which had all sorts of weird symptoms—convulsions, paralysis, day blindness—until hysterics as a group seemed to settle on anorexia as an expression of their distress. This phenomenon is quite common, in which something enters the “symptom pool� and then is unconsciously picked up by suffering people.
The risk, then, is that we misunderstand how we are exporting anorexia: not through western beauty standards—not everywhere that prizes thinness has an anorexia problem—but through the very consciousness-raising meant to help sufferers. Indeed, this seems to have happened in Hong Kong: after one highly publicized case, western pop-cultural ideas about anorexia were everywhere, and anorexia itself then spiked. Likewise, in the UK, bulimia spiked both when people suspected Princess Di had it, and when she announced that she had it.
What More I Wanted: It’s hard to tease out whether something is being diagnosed more because awareness is bringing already-suffering people in for treatment, or because awareness is causing people to manifest these symptoms, then come in for treatment. The author makes the valid point that severe anorexia would be a strange thing for doctors to miss if it was in fact widespread (and a western-trained doctor who returned to Hong Kong in the 80s actively sought out anorexics, and found very few). But I was left wondering how the equivalent distress was expressed before anorexia. And also, what is the right amount of awareness, getting help to the people who need it without increasing the problem?
Also Consider: , on culture-bound syndromes and how psychosomatic symptoms can be contagious.
2. PTSD in Sri Lanka
PTSD is a buzzword in the U.S. these days, which can make us evangelical about it. When a tsunami hit Sri Lanka in 2004, western psychologists appeared in droves, in a massive and poorly-managed mental health intervention. “Treatments� for expected future trauma responses involved things like “debriefing� people in groups of 25, with a facilitator unfamiliar with the language and culture, and despite the fact that post-incident debriefs have been shown to be detrimental even in the west, increasing later symptoms. Other “treatments� boiled down to “showing up� and “witnessing� people’s pain, while the locals were more interested in practical support (unlike the groups providing food and shelter, however, the mental health crowd wasn’t asking people what they thought they needed). Still other providers were in fact conducting research, which was often unclear to their subjects, who thought giving the right answers would get them access to practical help.
The larger problem is that trauma, too, manifests differently by culture—that’s also true in the West, where symptoms have shifted over time (WWI shell shock included tics and paralysis; American Civil War soldiers reported chest aches and the perception of a weak heartbeat). So checklists of common western symptoms may be inapplicable to another culture. And, too, resilience is different. Every culture has its own ways of managing suffering and trauma, which may not work like ours (but probably aren’t worse than “debriefing�!). And of course, there’s a difference between experiencing post-traumatic stress, and having a disorder, when what defines a disorder is mismatch with your environment. Hypervigilance for instance is adaptive.
What More I Wanted: This is probably the most dated section of the book (published in 2010). Not because it’s bad—in fact I think anyone with anything to do with trauma should read it—but because PTSD is so huge in the U.S. that there’s been a lot of research since. The book doesn’t address how it shapes the brain, which doesn’t mean Watters is wrong—brains interact with culture—but studying that cross-culturally could tell us much more. I also would have liked to see discussion of the cross-cultural prevalence of “classic� PTSD symptoms around intrusive memories.
Also Consider: , about how emotional experiences are shaped by culture.
3. Schizophrenia in Tanzania
A well-known 25-year study, completed in the 1990s, showed that people with schizophrenia often do better long-term in less developed, less industrialized countries. Western psychology is eager to push a biomedical (“it’s a brain disease�) understanding of mental illness on everyone, in part out of the belief that this reduces stigma. Unfortunately, it actually does the opposite. People who believe that someone’s distress results from life experiences, or even from a spiritual malady or possession in societies where this is an accepted part of life, are more accepting and less afraid of the suffering person. Across cultures, the brain disease model increases stigma, perhaps by creating the impression that it is an immutable part of the person.
Another interesting theory on the different outcomes (borne out by the research of those the author interviewed) is that with schizophrenia even more than other mental illnesses, outcomes are worsened by criticism, judgment and even well-meant obsession with the illness from relatives. Families that just accept improvements and relapses as they come get better results than those who obsess over making the person well or engage in dramatic self-sacrifice, putting pressure on the person and potentially reducing them to their illness. This resigned attitude is far easier to accomplish on Zanzibar, where it fits with a general acceptance of difficulties in life, than in the U.S., where our individualism makes us obsessed with “overcoming� things.
What More I Wanted: In our highly individualistic society, of course I wanted an exploration of the other end of the spectrum! At what point does disengagement from relatives make things worse, rather than better?
Also Consider: , about the importance of meaning in shaping mental illness.
4. Depression in Japan
Drug companies really wanted to market antidepressants in Japan, but to their chagrin, the Japanese didn’t consider themselves depressed. So they engaged in an intensive marketing campaign to convince the Japanese that they were sick, and then sell them medicine. This required overturning Japanese ideas about melancholy, which was considered a perfectly acceptable and even admirable way to be. It also depended on the argument that suicide in Japan results from depression, which is far from clear in a society where suicide has long been considered a valid way to make a social or moral statement.
What the Japanese got out of this was feeling sick, not necessarily followed by getting well. Drug companies� pervasive influence over medical research and the people who do it has allowed them to wildly oversell antidepressants, which outperform placebos in only about 10% of people. Also, all this again involved imposing a western view of what depression looks like: in other cultures, the equivalent involves largely physical symptoms. (According to a depressed person I asked, physical symptoms happen in the U.S. too, but doctors consider them unimportant. Which in turn perhaps pushes depressed people into expressing—and experiencing—the symptoms that get recognition in our culture.)
What More I Wanted: More on the connection or lack thereof between depression and suicide in Japan.
Also Consider: , also a critical look at depression outside the drug-company model.
--
In sum, obviously I found this book fascinating and important. That said, I did find it a bit weak in a couple of areas: I wanted it to delve more into our societal expectations that cause things to be labeled “disorders� at all, from ADHD to grief (yes, “prolonged grief disorder� is in the DSM). So much of this is inconvenient for our society, but a perfectly normal way for humans to be. Also, in the end the author shies away from value statements or comparisons, opining simply that diversity in mental health is valuable for its own sake, like different kinds of butterflies. Surely, when we are talking about human suffering, the question should be if other cultures� models are better: if not for everyone, at least for them. But all that said, it’s an important topic regardless, and I’d recommend the book (as well as those listed above). If nothing else, it will inspire some of the perspective and humility that we’re clearly lacking in telling other cultures we know best.
The author’s thesis is that mental illness is far more culture-bound than western psychologists acknowledge, and that blithely exporting western (specifically American) models of mental illness and health around the world can be useless and often detrimental. This is especially true when our own house is not in order: compared to physical health, our understanding of mental health runs far behind. The science is still very much evolving (we’re still at the level of diagnosing symptoms as illnesses, where physical health was in the 18th century), and not as reliably as one would hope, given drug companies� dominance over the research. And aspects of western society may make us more vulnerable to mental illness in the first place.
There are only four chapters so I’ll discuss them in turn, for those who may not read the book yourselves:
1. Anorexia in Hong Kong
Up until the 1990s, anorexia was not only extremely rare in Hong Kong, it presented nothing like the stereotypical western model. While still mostly affecting distressed women, they were not teenagers, not high achievers, did not have body dysmorphia or interest in losing weight, and reported untraceable physical causes (lump in the throat, painful digestion, etc.) for their inability to eat. Interestingly, the same was true in the U.S. in the early 19th century. Watters traces the history of anorexia through 19th century hysteria, which had all sorts of weird symptoms—convulsions, paralysis, day blindness—until hysterics as a group seemed to settle on anorexia as an expression of their distress. This phenomenon is quite common, in which something enters the “symptom pool� and then is unconsciously picked up by suffering people.
The risk, then, is that we misunderstand how we are exporting anorexia: not through western beauty standards—not everywhere that prizes thinness has an anorexia problem—but through the very consciousness-raising meant to help sufferers. Indeed, this seems to have happened in Hong Kong: after one highly publicized case, western pop-cultural ideas about anorexia were everywhere, and anorexia itself then spiked. Likewise, in the UK, bulimia spiked both when people suspected Princess Di had it, and when she announced that she had it.
What More I Wanted: It’s hard to tease out whether something is being diagnosed more because awareness is bringing already-suffering people in for treatment, or because awareness is causing people to manifest these symptoms, then come in for treatment. The author makes the valid point that severe anorexia would be a strange thing for doctors to miss if it was in fact widespread (and a western-trained doctor who returned to Hong Kong in the 80s actively sought out anorexics, and found very few). But I was left wondering how the equivalent distress was expressed before anorexia. And also, what is the right amount of awareness, getting help to the people who need it without increasing the problem?
Also Consider: , on culture-bound syndromes and how psychosomatic symptoms can be contagious.
2. PTSD in Sri Lanka
PTSD is a buzzword in the U.S. these days, which can make us evangelical about it. When a tsunami hit Sri Lanka in 2004, western psychologists appeared in droves, in a massive and poorly-managed mental health intervention. “Treatments� for expected future trauma responses involved things like “debriefing� people in groups of 25, with a facilitator unfamiliar with the language and culture, and despite the fact that post-incident debriefs have been shown to be detrimental even in the west, increasing later symptoms. Other “treatments� boiled down to “showing up� and “witnessing� people’s pain, while the locals were more interested in practical support (unlike the groups providing food and shelter, however, the mental health crowd wasn’t asking people what they thought they needed). Still other providers were in fact conducting research, which was often unclear to their subjects, who thought giving the right answers would get them access to practical help.
The larger problem is that trauma, too, manifests differently by culture—that’s also true in the West, where symptoms have shifted over time (WWI shell shock included tics and paralysis; American Civil War soldiers reported chest aches and the perception of a weak heartbeat). So checklists of common western symptoms may be inapplicable to another culture. And, too, resilience is different. Every culture has its own ways of managing suffering and trauma, which may not work like ours (but probably aren’t worse than “debriefing�!). And of course, there’s a difference between experiencing post-traumatic stress, and having a disorder, when what defines a disorder is mismatch with your environment. Hypervigilance for instance is adaptive.
What More I Wanted: This is probably the most dated section of the book (published in 2010). Not because it’s bad—in fact I think anyone with anything to do with trauma should read it—but because PTSD is so huge in the U.S. that there’s been a lot of research since. The book doesn’t address how it shapes the brain, which doesn’t mean Watters is wrong—brains interact with culture—but studying that cross-culturally could tell us much more. I also would have liked to see discussion of the cross-cultural prevalence of “classic� PTSD symptoms around intrusive memories.
Also Consider: , about how emotional experiences are shaped by culture.
3. Schizophrenia in Tanzania
A well-known 25-year study, completed in the 1990s, showed that people with schizophrenia often do better long-term in less developed, less industrialized countries. Western psychology is eager to push a biomedical (“it’s a brain disease�) understanding of mental illness on everyone, in part out of the belief that this reduces stigma. Unfortunately, it actually does the opposite. People who believe that someone’s distress results from life experiences, or even from a spiritual malady or possession in societies where this is an accepted part of life, are more accepting and less afraid of the suffering person. Across cultures, the brain disease model increases stigma, perhaps by creating the impression that it is an immutable part of the person.
Another interesting theory on the different outcomes (borne out by the research of those the author interviewed) is that with schizophrenia even more than other mental illnesses, outcomes are worsened by criticism, judgment and even well-meant obsession with the illness from relatives. Families that just accept improvements and relapses as they come get better results than those who obsess over making the person well or engage in dramatic self-sacrifice, putting pressure on the person and potentially reducing them to their illness. This resigned attitude is far easier to accomplish on Zanzibar, where it fits with a general acceptance of difficulties in life, than in the U.S., where our individualism makes us obsessed with “overcoming� things.
What More I Wanted: In our highly individualistic society, of course I wanted an exploration of the other end of the spectrum! At what point does disengagement from relatives make things worse, rather than better?
Also Consider: , about the importance of meaning in shaping mental illness.
4. Depression in Japan
Drug companies really wanted to market antidepressants in Japan, but to their chagrin, the Japanese didn’t consider themselves depressed. So they engaged in an intensive marketing campaign to convince the Japanese that they were sick, and then sell them medicine. This required overturning Japanese ideas about melancholy, which was considered a perfectly acceptable and even admirable way to be. It also depended on the argument that suicide in Japan results from depression, which is far from clear in a society where suicide has long been considered a valid way to make a social or moral statement.
What the Japanese got out of this was feeling sick, not necessarily followed by getting well. Drug companies� pervasive influence over medical research and the people who do it has allowed them to wildly oversell antidepressants, which outperform placebos in only about 10% of people. Also, all this again involved imposing a western view of what depression looks like: in other cultures, the equivalent involves largely physical symptoms. (According to a depressed person I asked, physical symptoms happen in the U.S. too, but doctors consider them unimportant. Which in turn perhaps pushes depressed people into expressing—and experiencing—the symptoms that get recognition in our culture.)
What More I Wanted: More on the connection or lack thereof between depression and suicide in Japan.
Also Consider: , also a critical look at depression outside the drug-company model.
--
In sum, obviously I found this book fascinating and important. That said, I did find it a bit weak in a couple of areas: I wanted it to delve more into our societal expectations that cause things to be labeled “disorders� at all, from ADHD to grief (yes, “prolonged grief disorder� is in the DSM). So much of this is inconvenient for our society, but a perfectly normal way for humans to be. Also, in the end the author shies away from value statements or comparisons, opining simply that diversity in mental health is valuable for its own sake, like different kinds of butterflies. Surely, when we are talking about human suffering, the question should be if other cultures� models are better: if not for everyone, at least for them. But all that said, it’s an important topic regardless, and I’d recommend the book (as well as those listed above). If nothing else, it will inspire some of the perspective and humility that we’re clearly lacking in telling other cultures we know best.
September 19, 2018
Neil's anthropology textbook had an amazing article adapted from this.
I really really want to read this, and to read more anthropology.
.....
Done. Now I want to read more by this author, too.
What I really like is that he emphasizes reportage, leaving the interpretations mostly to us. The data seems sound to me (and you who have been reading my reviews know that I pay attention) and the obvious conclusion seems justified. And so I agree with Watters that this is an important issue and that this book needs to be read. Western ideas about mental health are not the only ones, and often not the most helpful ones, either. No matter the good intentions of activists on missions, if they try to fight the cultural traditions of patients and families, they are most likely doing more harm than good.
Even in the west, listen more to your own body and spirit than to your doctor, who is probably partially informed by sneaky campaigns on the part of drug companies. Only you know what you really need for most mental illnesses and even for many other conditions.
That is to say, be sceptical of both SSRIs and of St. John's Wort. Of surgery and of acupuncture. Etc.
Anyway, back to the book. "There is currently no scientific consensus that depression is linked to serotonin deficiency or that SSRIs restore the brain's normal 'balance' ... [SSRIs] broadly alter brain chemistry" and actually have only been shown to help, more than placebo, adult males. One study showed that teens were "five times more likely... [to experience] serious side effects (including hospitalization and suicide attempts)."
And the makers of Paxil are pushing this Western cultural story of depression on the Japanese people.
In Zanzibar, the author spent time learning about the traditional cultural stories that were understood about people with schizophrenia and learning about how families coped with caring for a mentally ill family member. Unlike in the West, they don't talk about brain chemistry. And Watters quotes , who also points out that we don't talk about 'brain chemistry' when we refer to *healthy* people and emotions. The cultural story of the brain chemistry narrative is at least as "unappealing and dehumanizing" to many as was the idea that the person with a mental illness should be able to get better by applying willpower or should 'just snap out of it.'
Particularly harmful are the practices that those Western aid workers who were interested in PTSD brought to Sri Lanka after the tsunami of 2004. "Imagine our reaction," said Ken Miller, "if Mozambican [traumatologists] flew over after 9/11 and began telling survivors that the needed to engage in a certain set of rituals in order to sever their relationships with their deceased family members. How would that sit with us? Would that make sense?" .... After all, it's not like the civil war in Sri Lanka hadn't given the citizens plenty of experience in dealing with trauma already....
What may be most ironic is that the development of PTSD as a diagnosis came out of a politically agendized exploration of how Vietnam vets had a unique experience. "These psychoanalysts and veterans had no intention of carving out a diagnosis that could be applied to all victims of terrifying events, or even all soldiers who experience battle.... these veterans felt upset because they had been 'used, deceived, and betrayed.'" After all, we already could talk about 'shell shock,' 'debility syndrome,' and other related ideas from previous wars.
In a way the first exploration was the most startling to me. I've always wondered about Anorexia and other food disorders, not being able to even consider fasting myself, and Watters makes it very clear that 'fat phobia' is a cultural story about something much deeper that tends to trouble girls and young women. Putting a few pounds on fashion models would not be a cure-all.
On the whole the book is not only important, but it's both infuriating and sad because it's probably too late to protect other traditions from Western, particularly American, interpretations of mental illness. But it's also just plain *fascinating.* Very accessible and satisfying.
Know that the issues of book are somewhat personal to me, and therefore some of what I've said above is actually extrapolated and not actually directly in Watters' book. Still, I've no doubt that my interpretations are valid and that we would not say that I did him a disservice.
Obviously my five-star rating indicates that I highly recommend this to anyone the least bit interested in psychology, health, globalization, and even to educators and first responders in diverse communities.
I really really want to read this, and to read more anthropology.
.....
Done. Now I want to read more by this author, too.
What I really like is that he emphasizes reportage, leaving the interpretations mostly to us. The data seems sound to me (and you who have been reading my reviews know that I pay attention) and the obvious conclusion seems justified. And so I agree with Watters that this is an important issue and that this book needs to be read. Western ideas about mental health are not the only ones, and often not the most helpful ones, either. No matter the good intentions of activists on missions, if they try to fight the cultural traditions of patients and families, they are most likely doing more harm than good.
Even in the west, listen more to your own body and spirit than to your doctor, who is probably partially informed by sneaky campaigns on the part of drug companies. Only you know what you really need for most mental illnesses and even for many other conditions.
That is to say, be sceptical of both SSRIs and of St. John's Wort. Of surgery and of acupuncture. Etc.
Anyway, back to the book. "There is currently no scientific consensus that depression is linked to serotonin deficiency or that SSRIs restore the brain's normal 'balance' ... [SSRIs] broadly alter brain chemistry" and actually have only been shown to help, more than placebo, adult males. One study showed that teens were "five times more likely... [to experience] serious side effects (including hospitalization and suicide attempts)."
And the makers of Paxil are pushing this Western cultural story of depression on the Japanese people.
In Zanzibar, the author spent time learning about the traditional cultural stories that were understood about people with schizophrenia and learning about how families coped with caring for a mentally ill family member. Unlike in the West, they don't talk about brain chemistry. And Watters quotes , who also points out that we don't talk about 'brain chemistry' when we refer to *healthy* people and emotions. The cultural story of the brain chemistry narrative is at least as "unappealing and dehumanizing" to many as was the idea that the person with a mental illness should be able to get better by applying willpower or should 'just snap out of it.'
Particularly harmful are the practices that those Western aid workers who were interested in PTSD brought to Sri Lanka after the tsunami of 2004. "Imagine our reaction," said Ken Miller, "if Mozambican [traumatologists] flew over after 9/11 and began telling survivors that the needed to engage in a certain set of rituals in order to sever their relationships with their deceased family members. How would that sit with us? Would that make sense?" .... After all, it's not like the civil war in Sri Lanka hadn't given the citizens plenty of experience in dealing with trauma already....
What may be most ironic is that the development of PTSD as a diagnosis came out of a politically agendized exploration of how Vietnam vets had a unique experience. "These psychoanalysts and veterans had no intention of carving out a diagnosis that could be applied to all victims of terrifying events, or even all soldiers who experience battle.... these veterans felt upset because they had been 'used, deceived, and betrayed.'" After all, we already could talk about 'shell shock,' 'debility syndrome,' and other related ideas from previous wars.
In a way the first exploration was the most startling to me. I've always wondered about Anorexia and other food disorders, not being able to even consider fasting myself, and Watters makes it very clear that 'fat phobia' is a cultural story about something much deeper that tends to trouble girls and young women. Putting a few pounds on fashion models would not be a cure-all.
On the whole the book is not only important, but it's both infuriating and sad because it's probably too late to protect other traditions from Western, particularly American, interpretations of mental illness. But it's also just plain *fascinating.* Very accessible and satisfying.
Know that the issues of book are somewhat personal to me, and therefore some of what I've said above is actually extrapolated and not actually directly in Watters' book. Still, I've no doubt that my interpretations are valid and that we would not say that I did him a disservice.
Obviously my five-star rating indicates that I highly recommend this to anyone the least bit interested in psychology, health, globalization, and even to educators and first responders in diverse communities.
January 26, 2011
I read a lot of books about psychology and mental illness, but this book took what I already knew to a new level. It discusses four different illnesses in four different cultures: anorexia in Hong Kong, schizophrenia in Zanzibar, PTSD in Sri Lanka, and Depression in Japan.
One of the fascinating premises promoted by this book is that when Western psychologists describe a typical western mental illness to another culture, their incidence of that illness morph into a version closer to ours. I don't want to give too much away, but I've always been fascinated by the existence of culturally-specific mental illnesses (like koro and amok and hysterical leg paralysis), and this presentation of our own culturally-specific mental illnesses flipped everything around. I genuinely felt my mind broadened.
The only other book I've read on this subject is The Culture of Our Discontent, but I think this book is better. I liked that Watters chose four distinct subjects to cover, and covered them in depth. I also felt that he managed to say "we don't know as much as we think we know" without getting too much into "simple, primitive people have all the answers."
One of the fascinating premises promoted by this book is that when Western psychologists describe a typical western mental illness to another culture, their incidence of that illness morph into a version closer to ours. I don't want to give too much away, but I've always been fascinated by the existence of culturally-specific mental illnesses (like koro and amok and hysterical leg paralysis), and this presentation of our own culturally-specific mental illnesses flipped everything around. I genuinely felt my mind broadened.
The only other book I've read on this subject is The Culture of Our Discontent, but I think this book is better. I liked that Watters chose four distinct subjects to cover, and covered them in depth. I also felt that he managed to say "we don't know as much as we think we know" without getting too much into "simple, primitive people have all the answers."
November 30, 2016
‘Crazy Like Us� is the most fascinating book I’ve ever read about mental illness, and probably one of the best books I’ve read this year. I thought it would be a tough read, but found myself utterly caught up. The writing is precise, thoughtful, humane, and erudite. Watters� thesis is that Western notions of mental illness are being exported to Africa and Asia, for intertwined reasons of profit and philanthropy, and this is changing the very nature of mental illness in the countries concerned. The book provides convincing evidence to support this thesis through four in-depth case studies. Each focuses on a particular geographical location, cultural milieu, and category of mental illness. Although I found all four deeply compelling, I think the most powerful concerned PTSD in Sri Lanka. After the catastrophic tsunami in 2004, a range of organisations and individuals descended upon the country to try and treat the tsunami survivors for PTSD. However, as the book explains, this demonstrated the culturally mediated nature of trauma and its treatment, as well as the neocolonialist arrogance of well-meaning medical practitioners with zero local knowledge. As Watters puts it:
Through these case studies, Watters makes deeply thought-provoking points about the culturally mediated nature of mental illness. Over the decades and centuries, mental distress has always existed but evolved in form. As I gathered from (which I also highly recommend), the categorisation of depression and anxiety as different disorders only came about when drugs were developed to treat their symptoms. Watters also points out that the categorisation of mental illness as biological in nature, an imbalance in the individual brain rather than having a social context, increases rather than reduces stigma. The current argument is that situating mental illness in the biological realm gives it the same status as physical illness - which is likewise stigmatised! Watters cites research suggesting that emphasis on mental problems as physical disorders leads to greater fear and aversion towards the mentally ill than emphasis on social and experiential factors. This of course links neatly to the wider individualism in Western culture, which frames mental illness as purely a personal problem, rather than a reaction to circumstances or society.
Another case study in the book examines anorexia in Hong Kong and reads very interestingly with the excellent novel . Yet another investigates in Zanzibar the reasons for a persistent research finding, which I hadn’t previously come across, that those diagnosed with schizophrenia in developing countries have a significantly better prognosis than those in the developed world. The last damningly narrates how big pharma companies created a new concept of depression in order to sell SSRIs in Japan. This sheds striking light on how Japanese notions of mental illness, and in particular suicide, were very different to those of the West before GlaxoSmithKline got involved. The concluding chapter considers the future of mental illness and the DSM-V, which was in preparation at the time Watters was writing. It reminded me of this amazing review of the final DSM-V as if it was a dystopian novel: .
'Crazy Like Us' ends as strongly as it began, with this statement:
I highly recommend this book, whatever your experience of mental illness, or lack thereof. It asks very important yet rarely posed questions about the psychological toll of cultural homogenisation.
Often these campaigns seemed to imply that the psychological consequences of trauma were similar to a newly discovered disease, and that local populations were utterly unaware of what happens to the human mind after terrible events. The implicit assumption often left anthropologists shaking their heads in disbelief. It takes a wilful blindness to believe that other cultures lack a meaningful framework for understanding the human response to trauma.
“Most of the disasters in the world happen outside the West,� says Arthur Kleinman, a medical anthropologist from Harvard University. “Yet we come in and we pathologise their reactions. We say, ‘You don’t know how to live with the situation.� We take their cultural narratives away from them and impose ours. It’s a terrible example of dehumanising people.�
Once one comprehends the cultural differences in psychological reactions to trauma, the efforts of the Western traumologists who rush into disaster zones on a few days� notice begin to look somewhat absurd. To drive this point home, [psychology professor Ken] Miller asked me to consider the scenario reversed. “Imagine our reaction,� he said, “if Mozambicans flew over after 9/11 and began telling survivors that they needed to engage in a certain set of rituals in order to sever their relationships with their deceased family members. How would that sit with us? Would that make sense?�
Through these case studies, Watters makes deeply thought-provoking points about the culturally mediated nature of mental illness. Over the decades and centuries, mental distress has always existed but evolved in form. As I gathered from (which I also highly recommend), the categorisation of depression and anxiety as different disorders only came about when drugs were developed to treat their symptoms. Watters also points out that the categorisation of mental illness as biological in nature, an imbalance in the individual brain rather than having a social context, increases rather than reduces stigma. The current argument is that situating mental illness in the biological realm gives it the same status as physical illness - which is likewise stigmatised! Watters cites research suggesting that emphasis on mental problems as physical disorders leads to greater fear and aversion towards the mentally ill than emphasis on social and experiential factors. This of course links neatly to the wider individualism in Western culture, which frames mental illness as purely a personal problem, rather than a reaction to circumstances or society.
Another case study in the book examines anorexia in Hong Kong and reads very interestingly with the excellent novel . Yet another investigates in Zanzibar the reasons for a persistent research finding, which I hadn’t previously come across, that those diagnosed with schizophrenia in developing countries have a significantly better prognosis than those in the developed world. The last damningly narrates how big pharma companies created a new concept of depression in order to sell SSRIs in Japan. This sheds striking light on how Japanese notions of mental illness, and in particular suicide, were very different to those of the West before GlaxoSmithKline got involved. The concluding chapter considers the future of mental illness and the DSM-V, which was in preparation at the time Watters was writing. It reminded me of this amazing review of the final DSM-V as if it was a dystopian novel: .
'Crazy Like Us' ends as strongly as it began, with this statement:
If the irony isn’t already obvious, let me make it clear: offering the latest Western mental health theories in an attempt to ameliorate the psychological distress caused by globalisation is not a solution; it is a part of the problem. By undermining both local beliefs about healing and culturally created conceptions of the self, we are speeding along the disorientating changes that are at the very heart of much of the world’s mental distress. [...] I have tried to avoid making the cliched argument that other, more traditional cultures have it right when it comes to treating mental illness. All cultures struggle with these intractable diseases with varying degrees of compassion and cruelty, equanimity and fear. My point is not that they necessarily have it right - only that they have it different.
I highly recommend this book, whatever your experience of mental illness, or lack thereof. It asks very important yet rarely posed questions about the psychological toll of cultural homogenisation.
November 20, 2022
‘Yet we come in and we pathologize their reactions…We take their cultural narrative away from them and impose ours. It’s a terrible example of dehumanizing people�
Ethan Watters provides a very insightful look into how western notions of psychology have plagued cultures on a concerning, global level. His work with researchers of various mental illnesses gives overt criticism to how the value of diversity in cultural mindsets and communities are increasingly neglected as the dominant western world- devoid of spiritual and communal influences in their sciences- is becoming the central model for diagnosing and treating patients with cognitive ‘disorders�.
This consequently has caused not only disputes within wider ethnic and religious circles but also impacted growing inner conflicts within individuals and their perception of cultural behaviours/characteristics.
I thoroughly enjoyed this read. I feel as though the author stated even the most concealed influences of domineering western assumptions, also establishing the disregarded views on various mental/emotional states through the eyes of distinct cultures before the intervention of modern western psychiatry.
Also just from a reading experience, I appreciate the way this book was written. The debate was well articulated with a steady flow to it, at no point did I find it tedious.
Good writing put together with an interesting subject is always a W, so I recommend you add it to your lists :)
Ethan Watters provides a very insightful look into how western notions of psychology have plagued cultures on a concerning, global level. His work with researchers of various mental illnesses gives overt criticism to how the value of diversity in cultural mindsets and communities are increasingly neglected as the dominant western world- devoid of spiritual and communal influences in their sciences- is becoming the central model for diagnosing and treating patients with cognitive ‘disorders�.
This consequently has caused not only disputes within wider ethnic and religious circles but also impacted growing inner conflicts within individuals and their perception of cultural behaviours/characteristics.
I thoroughly enjoyed this read. I feel as though the author stated even the most concealed influences of domineering western assumptions, also establishing the disregarded views on various mental/emotional states through the eyes of distinct cultures before the intervention of modern western psychiatry.
Also just from a reading experience, I appreciate the way this book was written. The debate was well articulated with a steady flow to it, at no point did I find it tedious.
Good writing put together with an interesting subject is always a W, so I recommend you add it to your lists :)
June 15, 2024
4� � devoured this within 3 days despite the fact that i was quite busy over the last week. it examines the western imposition of diagnostic categories upon other cultures and its own disregard for indigenous systems of healing and understanding of disordered behaviours, as well as a criticism of the takeover of the field of mental health by big pharma. this is an aspect that has piqued my interest for a long while now and i found that it left me satisfied for the most part, but still managed to leave me more curious about everything discussed.
May 26, 2014
So it's basically pop psychology/anthropology and as such lacks a certain depth. However, this is an interesting and convincing book about the cultural specificity of mental illness and the imperialism of a specifically Western, radically individualist, medical model of mental suffering. I've been pretty persuaded by the idea of symptom pools (that each culture has its own pool of legible ways to express psychic distress, subconsciously taken up by sufferers) since I first read about them in 2007-ish. It's interesting to think about the ways in which speech, "raising awareness" can have material effects. Also, and importantly, this book doesn't fall into the trap of a lot of critics of the medical model of mental health, i.e. denying the materiality of the mind and proclaiming the supremacy of talk therapy (which is of course also a culturally imperialist model of dealing with psychic distress). It doesn't moralise about the choices of individuals trying to navigate their own mental illnesses, or proclaim one experience more "authentic" or less mediated than another. Recommended.
May 10, 2017
In a psychology major's stand point, this book is ridiculously unprofessional. The cases are presented in a misleading way, yet not sure whether it is done intentionally or not. First, the first case presented about the girl from hongkong, is a classical case of Somatization Disorder. I saw TONS of cases like this in mainland China. Second, the main argument is not even logically supported by the distorted cases he presented. Not even close. Of cause mental health issues emerge differently in different culture, because disorders COMMUNICATE differently in different culture. The fact that we talk about mental health issues more and more similarly globally, is because we communicate in a much more similar way than the world used to be. In the end, is the same set of issues, presented differently. Maybe we are erasing the diversity in presenting symptoms, but in my point of view, we are not erasing the diversity in the disorders per se. What I will propose is the exact oppose way of the author propose, that is, figuring out the overall fundamental issues under diverse forms of disorder, and stop blinding yourself with so call "cultural" labels.
December 4, 2024
A very approachable and eye-opening review of the impact of Western concepts of mental health on other cultures and the importance of cultural humility in the field
January 4, 2024
WOW. This book blew my mind. I had never thought about culture largely influencing and shaping the psyche or the colonization and westernization of mental health. This book made me sad and mad at pharmaceutical companies and the arrogance and pervasiveness of western thought, but It also made me marvel at the fluidity and power of the human mind. I thought this was excellently written, accessible, smart, and brought something into my life I had simply never considered. A grand way to start 2024 and a must read!!
March 11, 2021
Is it possible to give a 6 star review on here? I absolutely loved this book. Granted, I have a certain inclination towards books delving into mental health and psychology but this anthropological look at the way the West is exporting their mental health disorders, without any regard to the culture or beliefs of the nation's they are being exported to, was fascinating.
While some very scientific and complex concepts are covered within, Ethan Watters does a fantastic job at making the concepts easily understandably and thoroughly enjoyable, felt very similar to Malcolm Gladwell at times.
While some very scientific and complex concepts are covered within, Ethan Watters does a fantastic job at making the concepts easily understandably and thoroughly enjoyable, felt very similar to Malcolm Gladwell at times.
July 30, 2010
A woman tries to walk across a room, but collapses. Another suddenly goes blind, for no obvious physical reason. Victorian hysteria, clearly a product of a time when women lived highly constricted, repressed lives. A veteran suffering from PTSD, on the other hand: doubtless a real disease, immutable, applicable in all situations and cultures. Not so, says Ethan Watters, who convincingly argues that all mental illnesses are circumscribed and molded by the cultures in which they occur. A person who is distressed will express it by drawing from whatever pool of symptoms is available in his culture–which may well be completely different from what is available in my culture.
In Crazy Like Us: The Globalization of the American Psyche, Ethan Watters, a veteran journalist who presented a scathing indictment of the recovered memory movement in Making Monsters, examines four illnesses in four parts of the world: anorexia in Hong Kong, PTSD in Sri Lanka, schizophrenia in Zanzibar, and depression in Japan.
These four illnesses (and cultures) are quite different from each other, but share something important: none of them looked like the accepted Western clinical definition of the disease. Anorexics in Hong Kong did not believe that they were fat, trauma sufferers in Sri Lanka tended to describe physical symptoms and damage to family relationships rather than psychological problems, schizophrenics in Zanzibar were believed to be possessed by spirits, and in Japan, milder forms of depression were not viewed as an illness that requires treatment.
Watters describes a world far from the definitive-sounding edicts of the DSM (the diagnostical and statistical manual of psychological disorders, the handbook of Western psychology); one in which distress is signaled in an enormous variety of ways. “The simple but mind-bending truth,� the anthropologist Allan Young explains, “is that mental illnesses such as PTSD can be both culturally shaped and utterly real to the sufferer.� This world collides unhappily with the immutable-disease view of much of the Western mental health establishment. (Anne Fadiman’s The Spirit Catches You and You Fall Down makes a good companion read.)
Western mental health professionals increasingly treat patients throughout the world, and are often far less helpful than they believe. A Western-trained therapist, unwilling to consider that a Hong Kong anorexic does not believe herself fat, is unable to hear what the patient is actually saying. This is one problem with the globalization of the DSM. An even larger concern is that in the course of describing an illness, particularly if the description is dispersed widely throughout a culture, therapists may actually create an illness where it did not exist before. The local expressions of mental illness begin to disappear, and the clues that could have been gleaned from them are lost.
Crazy Like Us is not a polemic against Western mental health care: it is clear that competent Western therapists can be very helpful, under the right circumstances. It is equally clear, though, that they can be distinctly unhelpful under the wrong circumstances, when they fail to understand that their definitions are not universal.
This is especially clear in Sri Lanka, as American therapists rush to the scene of the tsunami, insisting that the local population has no understanding of trauma, and no idea how to treat victims. The psychology professor Ken Miller suggests that we consider the opposite scenario, with Mozambicans telling 9/11 survivors which rituals they need to engage in to sever their relationships with deceased family members. That the therapists earnestly believe themselves to be doing good makes these scenes no less disturbing. They explain that large segments of the population will fall victim to PTSD, and that it is not necessary to understand Sri Lankan culture to make this prediction. (There is an obvious connection to Watters� previous work, with echoes of the victim mentality that characterized the recovered memory movement in these PTSD predictions, as well as in the medicalization of very minor depression in Japan. Human beings occupy a large spectrum, from fragility to resilience, and it’s not clear why fragility should be the default option.) These therapists are, of course, wrong: Sri Lankan history is sadly full of tragedy, and Sri Lankans have developed specific and effective methods of coping with it.
In all of these cultures, a shift is underway to a more Western view of the mind. Watters believes that a society is most susceptible to this influence when it is under a great deal of strain: the Chinese takeover in Hong Kong, for instance, or the tsunami in Sri Lanka. These changes do not happen on their own, but tend to be encouraged by outside agencies. The most striking instance of Western intervention that Watters describes is a successful attempt by a consortium of pharmaceutical companies to change the definition of depression in Japan, through an enormous and society-wide campaign. The high regard in which U.S. knowledge is held in much of the world makes such attempts to influence local mental health practices particularly effective–and dangerous.
From the U.S. point of view, the culture-blind promotion of Western ideas on the mind could appear to be a good thing. Shift your vantage point a bit, though, and these efforts look misguided and even harmful. This is a brilliant and genuinely paradigm-shattering book.
February 15, 2023
“With little appreciation of differences, we continue our efforts to convince the rest of the world to think like us. Given the level of contentment and psychological health our cultural beliefs about the mind have brought us, perhaps it's time that we rethink our generosity.�
October 22, 2023
incredibly disheartening, concerning, and disturbing :D
January 15, 2011
A very readable and very interesting read (I also heard the author in a radio interview you can find here: ). It had never occurred to me that HOW mental illness and distress expresses itself is very tied in to one's culture, so that the same event (a flood, a death, whatever) requires different treatment, ritual, etc depending on one's culture. The USA has pushed western psychiatry's (and psychology's) theories all over the world, but done next to nothing to figure out how much damage it's done to local peoples and their culture. As the book says, "It turns out we have not only been changing the way the world talks about and treats mental illness -- we have been changing the mental illnesses themselves".
This is a book for you if you have any of the following interests:
- social justice (e.g., protection of indigenous and non-dominant western cultures)
- anthropology
- history of and efficacy of western psychiatry
- mental and/or physical health
- history and current events
This is a book for you if you have any of the following interests:
- social justice (e.g., protection of indigenous and non-dominant western cultures)
- anthropology
- history of and efficacy of western psychiatry
- mental and/or physical health
- history and current events
December 19, 2019
This should be required reading for all mental health practitioners. This book presents egregious examples in how a lack of reflexivity/understanding of positionality ultimately harm those we claim to help. It also reinforces the importance of the intertwined nature of mental health and culture, emphasizing the importance of a person-in-environment framework and cultural humility rather than supposed competency. Reading this left me horrified but also not surprised by the, often unintentional, failures of current practice: supplanting local protective factors and resiliency strategies, engaging in hazy ethical violations about research participation when the terms of engagement are unclear, exploiting vulnerable populations in crisis, and profiting off of the globally-assumed superiority of biomedical models that are washed in American ideals of hyperindividualism and introspection. And though this book explored the international implications of this proliferation, these lessons are also very applicable in many communities social workers occupy here in the US.
“Offering the latest Western mental health theories in an attempt to ameliorate the psychological stress caused by globalization is not a solution; it is part of the problem. By undermining both local beliefs about healing and culturally created conceptions of the self, we are speeding along the disorienting changes that are at the very heart of much of the world’s mental distress. It is the psychiatric equivalent of handing out blankets to sick natives without considering the pathogens that hide deep in the fabric� (253).
“Offering the latest Western mental health theories in an attempt to ameliorate the psychological stress caused by globalization is not a solution; it is part of the problem. By undermining both local beliefs about healing and culturally created conceptions of the self, we are speeding along the disorienting changes that are at the very heart of much of the world’s mental distress. It is the psychiatric equivalent of handing out blankets to sick natives without considering the pathogens that hide deep in the fabric� (253).
December 31, 2024
Thought provoking journalistic work examining the way the West (esp American) has been exporting its view of mental heath (and unhealth) to the rest of the world.
The most important thesis: your understanding of human nature (which is culturally informed) not only frames but even determines aspects of how you experience inner turmoil. While Watters writes to caution Western therapists from too quickly exporting their expertise onto other cultures before listening and understanding ( a very needed caution), as a Christian I left this book reflecting on how many forms of mental health problems are essentially symptoms of cultures that are rejecting the biblical understanding of humanity.
I had to put the book down just to process several times. The chapter on anorexia in Hong Kong was paradigm shifting for me. Watters follows several psychiatric researchers (studying HK, or the emergence of anorexia in Victorian England, or in 1980’s West) who argue there are essentially two forms of anorexia—one more rare, but more constant across ages. One more common in particular eras, fostered by a cultural moment that elevates awareness of the disease, which then leads more people to genuinely experience their internal distress through anorexic framework.
The chapter on trauma in Sri Lanka following the 2004 tsunami is a damning indictment of the way the Western view of trauma doesn’t understand human nature, the reality of suffering, or how to equip people for resilience. Instead it is a framework that if adopted actually promotes greater pain and fragility in people’s lives. The hubris of Westerners instructing others on how to process hardship is harming far more than helping. Counselors who have been swept up in the current fad of interpreting most difficulties or hardships as automatically “traumatizing� should pay close attention.
Recommend to anyone involved in counseling or who put a lot of confidence in therapy.
The most important thesis: your understanding of human nature (which is culturally informed) not only frames but even determines aspects of how you experience inner turmoil. While Watters writes to caution Western therapists from too quickly exporting their expertise onto other cultures before listening and understanding ( a very needed caution), as a Christian I left this book reflecting on how many forms of mental health problems are essentially symptoms of cultures that are rejecting the biblical understanding of humanity.
I had to put the book down just to process several times. The chapter on anorexia in Hong Kong was paradigm shifting for me. Watters follows several psychiatric researchers (studying HK, or the emergence of anorexia in Victorian England, or in 1980’s West) who argue there are essentially two forms of anorexia—one more rare, but more constant across ages. One more common in particular eras, fostered by a cultural moment that elevates awareness of the disease, which then leads more people to genuinely experience their internal distress through anorexic framework.
The chapter on trauma in Sri Lanka following the 2004 tsunami is a damning indictment of the way the Western view of trauma doesn’t understand human nature, the reality of suffering, or how to equip people for resilience. Instead it is a framework that if adopted actually promotes greater pain and fragility in people’s lives. The hubris of Westerners instructing others on how to process hardship is harming far more than helping. Counselors who have been swept up in the current fad of interpreting most difficulties or hardships as automatically “traumatizing� should pay close attention.
Recommend to anyone involved in counseling or who put a lot of confidence in therapy.
October 7, 2024
Mixed feelings. The exploration of how the American version of anorexia and PTSD has been exported, to the detriment of other countries, was masterful. The chapter on schizophrenia was so-so. The chapter on SSRI’s made me mad- this is a journalist, not a mental health professional, and he cherry picked data to support his claims just like he accuses pharm companies of doing (which they absolutely do. Not questioning that). I felt like he did a good job avoiding an agenda with the other chapters but lost it on the last one.
January 1, 2022
4.5
Honestly I'm shocked about the things I read in this book. The way the West has colonized their ideas about mental health disgusts me. In addition it also (once again) brought to light how much the pharmaceutical industry influences scientific research on how to treat mental ilness with drugs that may enhance mental problems in stead of lessening them. I'm truly shocked.
I highly recommend reading this if you have any affiliation with mental health
Honestly I'm shocked about the things I read in this book. The way the West has colonized their ideas about mental health disgusts me. In addition it also (once again) brought to light how much the pharmaceutical industry influences scientific research on how to treat mental ilness with drugs that may enhance mental problems in stead of lessening them. I'm truly shocked.
I highly recommend reading this if you have any affiliation with mental health
September 1, 2023
Crazy like us is a book about America’s international influence on mental health. This book covered brief parts of the history of mental health and its stigmas as well as how ideas of mental illness were spread worldwide. Although this book has a clear bias and could use more research, it provided a great foundation of ideas and valuable anecdotes. I would recommend this book because it challenges ideas and presents provoking questions about western ideas on mental health in a time when western medicine is accepted as fact.
December 6, 2024
I found the book fascinating. Watters presents how Western psychiatric models have influenced and globalized mental health. Some highlights from the book include how Western models have changed the perception amd even completely redefined meanings to certain disorders. It also vocalize the lack of cultural context in Western health, and that the lack of understanding can lead to misdiagnosis or ineffective treatment
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December 20, 2022As someone without too much knowledge on psychology, mental health, and the history of mental health, this was SUPER interesting and gave me lots to think about.
Would recommend!
Would recommend!
April 4, 2022
absolute must-read for anyone with any interest in psychology. death to american imperialism
December 28, 2018
Found the uber-bland US basic journalism style difficult at first, but soon that melted away, leaving an engrossing and alarming picture of how different cultures experience mental illness. As Watters points out, none of these experiences is necessarily better or truer than the others, though it inevitably emerges that the Western model � medicalising everything and severing any responsibility from social and economic conditions (the very thought!), and then exporting that model to the rest of the world for profit � is maybe not the healthiest.
May 4, 2023
Ethan Watters book goes through four examples of other cultures experience with mental illness and a demonstration of how illness can be culturally dependent.
He starts with the story of anorexia in Hong Kong and how the manifestation of anorexia was different. The patients' fears are not as tied to a sense of body image but to a sense of power over the body. He describes how Lee, a mental health provider in Hong Kong, starved himself past the point of fatigue and sickness into a feeling of improved mood and hyper-alertness. This condition of eating disorder was extremely rare and difficult to treat in Hong Kong. However, it was overtaken by the spread of our Western image of eating disorder.
Second, Watters describes how residents of Sri Lanka coped in very different ways with tragedy and jarring events than their western counterparts, until a tsunami influenced many mental health professionals to come and attempt to treat them as if they experienced it in the same way. "Psychological scarring" was not as present a term according to Watters. Of course, one thing he didn't address in his book was the idea of hardship and mental suffering as a form of currency. Human beings are emotional creatures and prone to reach out to our fellow especially when connected by a sense of empathy. I can't help but wonder if the spread of a more monolithic form of mental disease perhaps creates a more likely response from the global community when considering basic aid. In that sense, a more homogenized cultural template of acceptable manifestations of disease could be rational.
Third, Watters describes Schizophrenia in Zanzibar, here focusing much more on the caretakers responses to the illness around them and how this response ends up interacting with disease. Finally I felt more nuance was added when he asks the researcher if there is something Westerners could learn from the lower emotion response to disease. The take away the researcher gave was basically that culture is so strong that an individual can't overturn it.
Finally, Watters takes to task mega-marketing of depression in Japan in order to sell drugs for depression. This was my least favorite chapter. We almost certainly over-use SSRIs but the lack of faith the author has in the pharmaceutical industry more widely is disconcerting to me.
Ultimately, this was a good introduction to a medical anthropology way of thinking. I found I didn't really have the framework of how to think through some of the ideas brought up and I definitely thought the author seemed to go a little far in the conclusion of some sort of "need" for mental illness diversity or "badness" of homogeneity of negative templates. His criticisms didn't seem completely unfounded either though and did have me considering what connections might exist toward ideas of neurodiversity and destruction of cultures.
Perhaps I will think through this book more and come back to its ideas at some point to better grapple with them.
He starts with the story of anorexia in Hong Kong and how the manifestation of anorexia was different. The patients' fears are not as tied to a sense of body image but to a sense of power over the body. He describes how Lee, a mental health provider in Hong Kong, starved himself past the point of fatigue and sickness into a feeling of improved mood and hyper-alertness. This condition of eating disorder was extremely rare and difficult to treat in Hong Kong. However, it was overtaken by the spread of our Western image of eating disorder.
Second, Watters describes how residents of Sri Lanka coped in very different ways with tragedy and jarring events than their western counterparts, until a tsunami influenced many mental health professionals to come and attempt to treat them as if they experienced it in the same way. "Psychological scarring" was not as present a term according to Watters. Of course, one thing he didn't address in his book was the idea of hardship and mental suffering as a form of currency. Human beings are emotional creatures and prone to reach out to our fellow especially when connected by a sense of empathy. I can't help but wonder if the spread of a more monolithic form of mental disease perhaps creates a more likely response from the global community when considering basic aid. In that sense, a more homogenized cultural template of acceptable manifestations of disease could be rational.
Third, Watters describes Schizophrenia in Zanzibar, here focusing much more on the caretakers responses to the illness around them and how this response ends up interacting with disease. Finally I felt more nuance was added when he asks the researcher if there is something Westerners could learn from the lower emotion response to disease. The take away the researcher gave was basically that culture is so strong that an individual can't overturn it.
Finally, Watters takes to task mega-marketing of depression in Japan in order to sell drugs for depression. This was my least favorite chapter. We almost certainly over-use SSRIs but the lack of faith the author has in the pharmaceutical industry more widely is disconcerting to me.
Ultimately, this was a good introduction to a medical anthropology way of thinking. I found I didn't really have the framework of how to think through some of the ideas brought up and I definitely thought the author seemed to go a little far in the conclusion of some sort of "need" for mental illness diversity or "badness" of homogeneity of negative templates. His criticisms didn't seem completely unfounded either though and did have me considering what connections might exist toward ideas of neurodiversity and destruction of cultures.
Perhaps I will think through this book more and come back to its ideas at some point to better grapple with them.
February 20, 2011
This book offers a fascinating series of accounts of how Western (i.e. American, European) understandings of mental health have and are being exported to cultures throughout the world, often in ways that are profoundly at odds with deep cultural practices and traditions that understand the mind in fundamental different ways. Watters in engaging narrative form, carefully chronicles the rise of anorexia in Tokyo, PTSD in Sri Lanka, schizophrenia in Zanzibar, and depression in Japan. At the heart of Watters' critique is that the Western biomedical account of mental illness is less an indubitable and objective certainty of human biology, and more a powerful cultural narrative that invites both health care professionals and patients to carefully construct a named disease from a prescribed pool of legitimate symptoms. To be clear, Watters is not insensitive to the real mental anguish that many individual genuinely experience, rather his point is to reveal the way in which named diseases are culturally specified, and trade in the currency of narrative and power as supported by science, religion, philosophy, and economics.There are plenty of places in such an account for an author to be overly ambiguous or imprecise in his claims, but I found Watters to be a thoughtful and sophisticated writer that offers a good balance of reporting, commentary, and qualification.
The most stinging critique in this book comes in the final section, wherein Watters documents the way in which major pharmaceutical companies carefully orchestrated a campaign to promote a new understanding of depression in Japan whereby they could market a range of antidepressant medications that promise obscene quantities of money for the companies. Even more so, Watters highlights the way in which academic researchers were often funded and supported by the major pharmaceutical companies to provide research that would positively effect the sales of certain drugs manufactured by the various pharmaceutical companies. As one academic researcher who worked with the drug companies in Japan and then became an outspoken critic remarked, "The strong force of the pharmaceutical industry threatens to turn medicine into a pseudoscience in the same way they have made opinion leaders in the field of Japanese psychiatry into a type of prostitute...We were very cheap prostitutes."
Needless to say Watters has left me with much to think about. I would highly recommend this book to anyone with interests in the formation of cultural narratives, the nature of the mind, health care, or the dynamics globalization. The book is well written, and accessible to a large audience.
The most stinging critique in this book comes in the final section, wherein Watters documents the way in which major pharmaceutical companies carefully orchestrated a campaign to promote a new understanding of depression in Japan whereby they could market a range of antidepressant medications that promise obscene quantities of money for the companies. Even more so, Watters highlights the way in which academic researchers were often funded and supported by the major pharmaceutical companies to provide research that would positively effect the sales of certain drugs manufactured by the various pharmaceutical companies. As one academic researcher who worked with the drug companies in Japan and then became an outspoken critic remarked, "The strong force of the pharmaceutical industry threatens to turn medicine into a pseudoscience in the same way they have made opinion leaders in the field of Japanese psychiatry into a type of prostitute...We were very cheap prostitutes."
Needless to say Watters has left me with much to think about. I would highly recommend this book to anyone with interests in the formation of cultural narratives, the nature of the mind, health care, or the dynamics globalization. The book is well written, and accessible to a large audience.
January 5, 2022
I have a fascination with cross-cultural psychiatry as a whole, and I was very eager to read this book per recommendation of my abnormal psych professor. However, this book was disappointing to me. One of Watters� core theses is that amongst different cultures, there exists knowledge about mental health that we cannot afford to lose. I wholeheartedly agree with this idea. However, Watters goes so far as to argue that biomedical models are totally inadequate for describing mental illness, and the DSM and importation of foreign-educated psychiatrists means total erasure of cultural understandings of mental illness. This assertion is much more challenging and unfair. Watters� criticism of medication as an intervention also lends his arguments an anti-psychiatry bent. Watters examines four different case studies to prove his point: the changing landscape of anorexia diagnoses in Hong Kong and mainland China, the surge of PTSD and trauma counselors into Sri Lanka after a devastating tsunami, the care of people with schizophrenia in Zanzibar, and the introduction and aggressive marketing of paroxetine (Paxil) to Japanese citizens and psychiatrists. There are rich veins of colonialism running through western medicine and psychiatry as a whole, to be sure. Historically, psychiatry and psychology have been used to boost the status of higher-class individuals and disenfranchise women, lower classes, and unique ethnic groups. Psychiatry can also cause deep harm when used carelessly in certain religious and cultural contexts. However, Watters is clearly not a clinician.
To use a tired metaphor, it is absolutely not worth throwing the “baby� of the psychiatric field’s contributions out with the “bathwater� of culturally blind, one size fits all practices. What we need are more researchers, scientists, and clinicians with diverse ethnic and cultural backgrounds- not to dismiss bio-psycho-social theories of mental illness epidemiology outright. We must also examine how stigma continues to manifest across cultural boundaries, and combat it with truthful and accurate information about people who are mentally ill.
To use a tired metaphor, it is absolutely not worth throwing the “baby� of the psychiatric field’s contributions out with the “bathwater� of culturally blind, one size fits all practices. What we need are more researchers, scientists, and clinicians with diverse ethnic and cultural backgrounds- not to dismiss bio-psycho-social theories of mental illness epidemiology outright. We must also examine how stigma continues to manifest across cultural boundaries, and combat it with truthful and accurate information about people who are mentally ill.
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