Crazy Like Us: How Globalization Affects Mental Illness

• How a culture thinks about mental illness, 
• how they categorize and prioritize symptoms, 
• attempt to heal them, 
• and set expectations for their course and outcome-influences the disease s themselves. 

In teaching the rest of the world to think like us, we have been, for better or for worse, homogenizing the way that we go mad.

We also change the way that "disease" is defined and therefore treated.

Indigenous forms of mental illness are being bulldozed by disease categories and treatment made in the USA

DSM (Manual of Mental Disorders)-bible of the profession

Biomedical approach will reduce the stigma of mental illness and that our drugs of the best we can offer. We are certain that by throwing off traditional social roles and engaging in individualistic quests for introspection they will be more mentally healthy.


ETHNIC PSYCHOSES

• amok (extended period of brooding and murderous rage)
• koro (S. Asia -genitals are retracting into their bodies)
• zar  (spirit possession bringing about dissociative episodes)

WHAT ARE OUR MOTIVATIONS?

• drug company profits
• the science behind our drugs and illness categories and theories of mind have put the field beyond the influence of constantly shifting cultural trends and beliefs

BUT: The experience of mental illness cannot be separated from culture, whatever the cause, we rely on cultural beliefs and stories to understand what is happening.

• influence is always local and intimate
• we should WORRY ABOUT THE LOSS OF THIS DIVERSITY OF VISION in exactly the same way that we worry about the loss of biological diversity in nature.
• modes of healing and culturally specific beliefs about how to achieve mental health can be lost to humanity.

Examples:

(1) The Arrival of Anorexia in Hong Kong

THE IDEAS BEHIND FEMALE BODY IMAGE IN HONG KONG

• young women worshipped in some contexts for their attractiveness
• in other situations vilified 
• Chinese anorexia was unlike that found in the West. CHARACTERISTICS:
• no fear of fatness did not see themselves as overweight (body dysmorphia)
• connected to failed or unrequited relationships
• little stigma in China surrounding larger body shapes
• larger shapes and ability to eat is to have "luck"
• later onset of puberty compared to the West
• girls spoke of their desire to get back to their normal body weight
• refusal to eat attributed to:
• bloating, blockages in throat or digestion, feeling of fullness in stomach
• feeling of no appetite
• from poor families and the lower achievers in school
• no hint of moral superiority often found in anorexics in the West.

YIN YANG & CHI

traditional diagnosis is that there is a blockage of Qi

GLOBAL SPREAD

• Lee knew that he had to understand anorexia at two different levels
• why women began the behavior of self-starvation
• what happened to their mind and body as the regimen of starvation gained momentum in their daily life.
• feeling of hyper-alertness and sense of mastery over the body
• feeling superior to others who were ruled by their need for food
• getting on a train even if it was going in the wrong direction
• Origins in Victorian Culture
• HYSTERIA (part of popular magazines and popular culture)
• Epidemics of vomiting 
• refusal of food
• self-starvation
• 1873: received formal recognition in medical community (hysterical anorexia)

Does the naming of a disorder allow doctors to suddenly recognize and report what they had previously overlooked? Or is there an interplay between the codification of a new mental illness and the sudden appearance of those symptoms in the general population?

• What are illnesses like Anorexia?
• unconscious mind trying to speak in  a language of emotional distress that will be understood in its time and place (culture)
• symptom is a distillations of emotions translated into a culturally recognized signal of suffering
• patient is unconsciously striving for recognition and legitimization of internal distress-drawn to symptoms which will achieve that ends.
• why naming an illness is perilous
• ILLNESS NEGOTIATION-patients and doctors  create a CULTURAL FEEDBACK LOOP that further establishes the legitimacy of a new symptom and provide scientific validation for it.
• illnesses become widespread after they have an agreed upon cultural expression
• MENTAL ILLNESSES DO NOT EXIST INDEPENDENT OF SOCIAL AND HISTORICAL CONTEXT

 Chinese

• historically looked to bodily sensations to indicate psychological distress (somaticizing)
• no cartesian distinction between mind and body
• ADOLESCENTS are most vulnerable to "catching" these disorders...they are most consumers of Western pop culture
• thinness is not highly valued traditionally

WESTERN ASSUMPTIONS in Hong Kong media coverage

• anorexia is a threat to young women who are prone to anxiety or depression or facing problems in school or with their families
• severe food restriction in young women should be read as a cry for help
• shifting ideas about thinness and beauty are also contributing
• fat phobia and a distorted body image defined the illness
•  usually attacks the most promising young women
• well to do families
• PROBLEM: many of these Western assumptions had little meaning for most of the anorexics Lee saw in his practice
• biomedical categories IMPERIL ILLNESS NEGOTIATION and curtail local healing opportunities
• as symptoms became known, it became ever more likely that a teenager would try food restriction as a method of communicating internal distress (fashionable)
• SHOULD HEAR COMPLEX TRUTHS instead of adopting these assumptions -women's voices are being drowned out by Western narratives about the power of fashion, dieting and pop culture
• DSM and Western categories of disease have gained dominance
• POPULAR WRITERS as the carriers of a disease!!!!
• glamorize disease
• elevate the social role of the sufferer
• create fashionable expressions of angst

(2) PTSD after the Tsunami in Bali
Assumption: the psychological reaction to horrible events is fundamentally the same around the world.

• a victim processes a traumatic event as a function of what it means drawn from their society and culture and this shapes how they seek help and their expectation of recovery

(3) Depression in Japan