Thursday, January 14, 2010

Americanization of Mental Illness

Working with newcomers to the United States provides a very unique view into your own country's impact on the world. Thanks to Rev. Danny Fisher for posting this fascinating article about mental illness and its discontents. The article's author, Ethan Watters, argues that modern, primarily U.S. driven psychology is changing the way mental disorders around the world are both being treated, and how they occur in some cases. He writes:

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.

As a long time supporter and user of alternative forms of medicine, I see parallels in the way "western" medicine has influenced the world. Some of my students, who in their native countries often relied on cultural forms of medicine, now rush to the doctor whenever there's a problem. In some cases, they reject the simple herbals, the shamans they used to trust, or other indigenous approaches, and gulp down pharmaceuticals that fail to address the underlying traumas that are producing the physical symptoms in the first place. Surely, there are times when the allopathic approach is better than traditional methods, but the sometimes wholesale faith I see refugees and immigrants place in this system is painful. Of course, it is no different with many of us who were born here, which is why the Watters' thesis is so compelling to me.

One of the examples Mr. Watters brings up is anorexia in Hong Kong. He follows the work of a dr. Sing Lee, who was researching the disorder during a period of change in the country. Given all the discussion of the media's influence on perceptions of religion lately, notice how the Hong Kong media influenced perceptions of anorexia.

DR. SING LEE, a psychiatrist and researcher at the Chinese University of Hong Kong, watched the Westernization of a mental illness firsthand. In the late 1980s and early 1990s, he was busy documenting a rare and culturally specific form of anorexia nervosa in Hong Kong. Unlike American anorexics, most of his patients did not intentionally diet nor did they express a fear of becoming fat. The complaints of Lee’s patients were typically somatic — they complained most frequently of having bloated stomachs. Lee was trying to understand this indigenous form of anorexia and, at the same time, figure out why the disease remained so rare.

As he was in the midst of publishing his finding that food refusal had a particular expression and meaning in Hong Kong, the public’s understanding of anorexia suddenly shifted. On Nov. 24, 1994, a teenage anorexic girl named Charlene Hsu Chi-Ying collapsed and died on a busy downtown street in Hong Kong. The death caught the attention of the media and was featured prominently in local papers. “Anorexia Made Her All Skin and Bones: Schoolgirl Falls on Ground Dead,” read one headline in a Chinese-language newspaper. “Thinner Than a Yellow Flower, Weight-Loss Book Found in School Bag, Schoolgirl Falls Dead on Street,” reported another Chinese-language paper.

In trying to explain what happened to Charlene, local reporters often simply copied out of American diagnostic manuals. The mental-health experts quoted in the Hong Kong papers and magazines confidently reported that anorexia in Hong Kong was the same disorder that appeared in the United States and Europe. In the wake of Charlene’s death, the transfer of knowledge about the nature of anorexia (including how and why it was manifested and who was at risk) went only one way: from West to East.

Western ideas did not simply obscure the understanding of anorexia in Hong Kong; they also may have changed the expression of the illness itself. As the general public and the region’s mental-health professionals came to understand the American diagnosis of anorexia, the presentation of the illness in Lee’s patient population appeared to transform into the more virulent American standard. Lee once saw two or three anorexic patients a year; by the end of the 1990s he was seeing that many new cases each month.

Now, I'm always a little wary of arguments that state any given influence occurred one way, so the tone of this is too totalizing for my taste. However, there's still something very compelling here, given the shift in case numbers and the way the disorder was approached after the Charlene case.

Maybe some of you are saying "So what? Why does any of this matter?" Well, there are a number of reasons, in my opinion, that make this something worth caring about.

1. The McMental Health Approach

Believing that a single model is the best "medicine" for every mental disorder around the world is the end logic of what's now occurring. Just as the explosion of McDonald's, KFC, and other fast food joints have contributed to the deterioration of indigenous foods all over the world, so too, in time, will indigenous forms of therapy disappear because of the spread of the bio-chemical linked with psychotherapy model to mental disorders.

2. Destruction of Diversity leads to a Destruction of Autonomy

When a single model of anything becomes not only the standard, but the "only true way," any group of people who deviate from that approach face either marginalization or forced conversion. Individual and group autonomy, as well as agency of choice, dwindle under such circumstances. A great part of this is simply from the gradual weakening and even disappearance of the knowledge and forms that made up the systems that are now considered inferior. The struggle of the Dakota Indians in my home state of Minnesota to maintain their language is a perfect example. Nearly everyone who spoke it fluently has died, and only a percentage of Dakota care enough to attempt to learn and preserve that which is remaining. The pressures of modern life make such choices challenging, and those who engage in preserving and practicing forms on the margins often are privileged members of their communities in some ways.

3. The Spread of One View as Gospel Leads to a Failure to See Reality

Buddha warned us constantly to be wary of the views we have attached to. Giving authority to a single view of mental disorders is, and will continue to lead to great mistakes when it comes to assessment of what's happening.

4. Bankrolling Big Pharma

It's hard for me to ignore how wonderful the spread of "Western" psychology is for the pharmaceutical companies. Every reliance on their drugs leads to more. I say this not to completely dismiss their work - some drugs are useful to some people in some cases - but it's so obvious to me that the continued spread of our approach is completely and fully tied to drug companies.

No comments: