The Americanization of Mental Illness
January 13, 2010 7:10 PM   Subscribe

"We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness. We may indeed be far along in homogenizing the way the world goes mad." Ethan Watters examines the growing evidence that some mental illnesses are cultural phenomena that can be exported.

This theory is not necessarily unprecedented, as many geographically distinct (and completely fascinating) mental illnesses are known in the form of the (somewhat patronizingly-named) culture-bound syndromes, and which are normally treated in Western society as incidents of mass hysteria. For example, among them is the popular koro or penis panic, which you have probably heard of before, most often as the butt of a joke. But would you think the same of dissociative amnesia, which was apparently not observed before 1800?
posted by dubitoergosum (66 comments total) 48 users marked this as a favorite
 
I'm looking forward to weaponized culture-bound syndromes. That's going to be awesome.
posted by b1tr0t at 7:13 PM on January 13, 2010 [2 favorites]


It's not surprising to me that many mental illnesses are the result of the numerous socially accepted ways we fuck each other up.

I hope we see more studies of this nature.
posted by polyhedron at 7:25 PM on January 13, 2010 [3 favorites]


I'm looking forward to weaponized culture-bound syndromes. That's going to be awesome.

Do you feel lucky?
posted by weapons-grade pandemonium at 7:34 PM on January 13, 2010 [6 favorites]


It must be frustrating to think you're going crazy in a way that's unique to you, only to find out that it's been done before. I think we should at least allow our madmen to feel creatively insane.
posted by empath at 7:40 PM on January 13, 2010 [7 favorites]


Wow, that was even easier than paging languagehat.
posted by b1tr0t at 7:44 PM on January 13, 2010


My own hysteria obsesses on Metafilter suddenly and without explanation shrinking into complete oblivion; accompanied by ever-accelerating bandwidth charges.

Call me crazy.
posted by PareidoliaticBoy at 7:44 PM on January 13, 2010


(Great job on your first post!)
posted by Ian A.T. at 7:57 PM on January 13, 2010 [1 favorite]


I would like to publicly thank empath for being the first person to get my whole life.
posted by cjorgensen at 8:01 PM on January 13, 2010


This is going turn turn into forcing some aboriginal person who walks everywhere to take OCD meds because he's compulsively putting one foot in front of another.

"I mean, walking everywhere? You must be mad!"

I think I've found the plot to The Gods Must Be Crazy IV - Crazy for Meds.
posted by chambers at 8:10 PM on January 13, 2010 [2 favorites]


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.

This statement is so amusingly bizarre that it's hard to forget that it's not a parody of progressive, post-colonial thinking.

As someone who has lived for a good part of my life in a non-Western country, I must say this is a great post, by the way.
posted by KokuRyu at 8:14 PM on January 13, 2010 [1 favorite]


This post is giving me the vapors.
posted by StickyCarpet at 8:27 PM on January 13, 2010 [4 favorites]


My favorite culture-bound syndrome that I still remember from Abnormal Psychology 201: Pibloktoq, where you take off your clothes and run around in the snow naked. Appears exclusively in Eskimo societies living within the Arctic Circle.
posted by sharkfu at 8:32 PM on January 13, 2010 [3 favorites]


Great, thoughtful post on this, thanks. I was wondering when and how Watters' book would appear here. I really like this guy's thesis about "The Globalization of the American Psyche;" it makes sense and from what I've heard of him in interviews so far he seems to have supported it well with evidence. Different cultures do conceptualize "mental illness" in different ways, and the relentless push for profit-taking from psychoactive drugs definitely seems to be shaping the way the world thinks about "sickness" of the mind. It's an argument that's been made strongly and often in the United States, so extending it to the rest of the world makes perfect sense, with the added complexity of cross-cultural differences being rapidly and thoughtlessly pushed aside in the name of profit. Saying that doesn't deny the reality of chemically-based illness, but does put the brakes on the over-medicalization of different cultural and mental states, at least a little bit.

I'm really glad this book appeared right now.
posted by mediareport at 8:38 PM on January 13, 2010 [2 favorites]


I have always thought that depression, social anxiety disorder, ADD and similar 'mental illnesses' that have cropped up mostly in the 20th century are not old diseases that have only recently been formally diagnosed, but natural, healthy, human reactions to a world which is completely at odds with the environment in which we evolved to exist.

So, as the mechanisms, institutions, corporations, etc of the modern, developed world metastasize and spread and colonize the rest of the planet, it's only natural that humans in those places will respond similarly to the new environment in which they find themselves.

It's not people that are sick, but our culture. And just like cattle raised in factory farms, pumped full of steroids and antibiotics in order to keep them alive long enough to extract every bit of value we can, we'll be downing stimulants, anti-depressants and steroids in order to stay alive and functioning in the giant factory farm that we call the modern world.

We are all livestock.
posted by empath at 8:47 PM on January 13, 2010 [71 favorites]


I totally hope penis panic makes it to the US. I have a saved google news search for it set up for the day when it shows up on our shores.
posted by rr at 8:55 PM on January 13, 2010 [2 favorites]


It's a two-way street, you know. How else to explain the collective breakdown among conservative republicans other than as a case of large-scale, cargo-cult syndrome?
posted by felix betachat at 8:57 PM on January 13, 2010 [4 favorites]


(and btw, i think anti-depressants and ADD medication should be non-prescription)
posted by empath at 9:05 PM on January 13, 2010 [1 favorite]


I totally hope penis panic makes it to the US. I have a saved google news search for it set up for the day when it shows up on our shores.

Only fair.

We convince them they have to spend every Sunday in church (in order to not burn in hellfire) rather than having a nice day out or a nice day in, and they convince us that we have to go around with 5lb weights padlocked to our genitalia.

Can we not talk up that particular meme any further? As it is, I have to do a 'check' every five minutes, and I don't thing sebastienbailard jr. can take another 5lb just yet.
posted by sebastienbailard at 9:10 PM on January 13, 2010 [1 favorite]


This is a fascinating article, thank you for posting it-- the passages on schizophrenia were especially eye-opening.
posted by jokeefe at 9:10 PM on January 13, 2010


I used to work as an Spanish-language interpreter here in the US. Used to love getting cases of Mal de Ojo. And sustos, oh how I loved sustos.
posted by jsavimbi at 9:19 PM on January 13, 2010 [1 favorite]


some mental illnesses are cultural phenomena that can be exported.

Or, possibly, only the CIA has really perfect mind-reading.
posted by GuyZero at 9:28 PM on January 13, 2010


I have always thought that depression, social anxiety disorder, ADD and similar 'mental illnesses' that have cropped up mostly in the 20th century are not old diseases that have only recently been formally diagnosed, but natural, healthy, human reactions to a world which is completely at odds with the environment in which we evolved to exist.

Well, there are literally millions of examples of why you're totally wrong, if not billions. Just one: there's a scholarly book called "Lincoln's Melancholy." Hmmm, wonder what they meant by "melancholy?" Then there's tens of thousands of years of "demonic possession." Huh, I wonder what was actually up with those people?

Clinical depression and schizophrenia are "healthy" in the same way that cancer is healthy*. Or is cancer an "illness" too?

*sorry for this tired-ass metaphor, but it's a good one.
posted by drjimmy11 at 9:31 PM on January 13, 2010 [7 favorites]


Not everyone agrees with Watters. Here's an especially pointed rejoinder from a very smart science journalist.
posted by twsf at 9:32 PM on January 13, 2010 [6 favorites]


I'm going to ignore DSM-style culture bound syndromes here, which seem to be considered a hot mess even within the psychiatric community, and focus on more 'conventional' diseases like depression or panic disorder.

There's a substitution that many commenters here are making between psychiatric illnesses and their behavioral manifestations which leaves me uncomfortable. It's the manifestations, in most examples given, that are culturally bound, but not necessarily the syndromes themselves. The classic example given in med schools is that Chinese sufferers from depression tend not to recognize a change in mood, but instead report persistent bodily aches and pains: supposedly, psychological explanations are not strong concepts in Chinese society. This, however, is not to say that there's no underlying disturbance or that the etiology of the disturbance necessarily differs by culture: these somatizing patients are often helped by treatments for depression. Depression, anxiety disorders, OCD, schizophrenia: I believe that these are real entities no matter which culture you observe.

I have always thought that depression, social anxiety disorder, ADD and similar 'mental illnesses' that have cropped up mostly in the 20th century are not old diseases that have only recently been formally diagnosed, but natural, healthy, human reactions to a world which is completely at odds with the environment in which we evolved to exist.

I will disagree, while kind of agreeing. The current way that most chronic diseases are conceived of is as a 'multi-hit model': the manifestation of disease is a consequence of multiple distinct sources. In cancer, this would be multiple mutations, for example to both copies of a tumor suppressor gene, each copy getting affected at a different time. Environmental stress is almost certainly one of the 'hits' in most psychiatric diseases, along with underlying genetic and neurological organization and contributory or protective cognitive strategies. That said, even if I accept 'natural', 'healthy' seems wrong as these disorders seem to me to be on their face maladaptive; also, I don't necessarily accept that the premodern state is one that is substantially less stressful than the modern one.

I don't have any evidence for this, but I would tend to prefer a 'mixed traits' model for the high population prevalence of affective disorders. Even in our 'natural' environment, there may be an evolutionary advantage to have population members with higher anxiety levels, say for watching the village walls at night, which compensates for the less frequent disadvantage of a community member who is disabled due to panic disorder. That is, it may be to our evolutionarily desirable to have a fraction of us who feel shitty or anxious or spazzy.
posted by monocyte at 9:35 PM on January 13, 2010 [21 favorites]


There's a substitution that many commenters here are making between psychiatric illnesses and their behavioral manifestations which leaves me uncomfortable

I can see your point (and you expressed it rather well), but at the same time (and I know you are not disagreeing with this) I found the following observation from the pretty significant:

Many traditional cultures regard the self in different terms — as inseparable from your role in your kinship group, intertwined with the story of your ancestry and permeable to the spirit world.

From the Western point of view, while there may be acknowledgement that there other cultures that have other ways of experiencing and interpreting the world (although Western culture has the best method of interpretation), I don't think there's any real understanding of how culture can affect the whole concept of "self", and the significance that different experiences of self can have on psychology and psychiatry across cultures.

I've been looking around for writing that investigates this, and while the article linked to in this post may have its flaws, I'm glad to have the chance to read it and to follow this discussion here.
posted by KokuRyu at 9:46 PM on January 13, 2010 [3 favorites]


From twsf's link:

Watters makes some important observations. The death of a girl from anorexia on a Hong Kong street in 1994 led to an explosion of anorexia diagnoses there. For Watters, this is a bad thing. In Watters’s analysis, anorexia is a uniquely American illness that replaced “indigenous forms of mental illness” in Hong Kong. But there is another explanation: Anorexia was widely prevalent in Hong Kong but went unrecognized and untreated until the public death of the young girl. I don’t know whether that’s correct; but Watters doesn’t even raise the question.
posted by KokuRyu at 9:53 PM on January 13, 2010


The author of twsf's link needs a basic refresher course in medical anthropology. It's not necessarily a "return to superstition" to acknowledge that cultural constructions of meaning around mental illness can be useful - and even healing - oustide of a strict Western scientific context.

Seriously, dude needs a basic refresher course.
posted by mediareport at 9:59 PM on January 13, 2010 [3 favorites]


Monocyte, you have made a good point about the difference between the manifestation of an illness and the underlying illness itself. But even in these more "conventional" cases, it is interesting that the apparent symptoms differ from place to place, and likely for non-genetic reasons. I think this cultural variability points to a more complicated relationship between neurological function and psychiatric disease than some strictly mechanistically-inclined people might have you believe. We after all accept that the placebo effect is real, and that many mental disorders can be treated through talk therapy, so it does not seem unreasonable to me to consider that how you think about a mental illness--and by extension how your culture thinks about it--can have an effect on how you experience it.
posted by dubitoergosum at 10:12 PM on January 13, 2010 [1 favorite]


Well, there are literally millions of examples of why you're totally wrong, if not billions. Just one: there's a scholarly book called "Lincoln's Melancholy." Hmmm, wonder what they meant by "melancholy?" Then there's tens of thousands of years of "demonic possession." Huh, I wonder what was actually up with those people?

I'll exclude acute suicidal depression (and other mental states that are obviously disturbed), but not Lincoln's melancholy, since he did, in fact, live in the industrial era. Obviously, people are different, and some people tend to be melancholy, but that does not make them mentally ill, nor would I characterize Lincoln's melancholy as a disease -- and in fact, I'm not sure Lincoln would have been Lincoln without it. I don't see how you can consider a personal attribute that's so tied in with one of the greatest Americans that have ever lived a maladaptive trait.

I just don't see the need to pathologize the normal range of human emotion. Lots of people wish they could be happier. Lots of people respond positively to psycho-active drugs that makes them happier. That doesn't necessarily mean they had a disease. If you think about all the people you know who are on anti-depressants or who take them -- what percentage of them would you honestly say are 'mentally ill'? I don't begrudge anybody taking them at all, I think probably more people should take drugs that make them happier, smarter, more attentive, etc.

I realize that this is a subject that people have strongly held opinions about, particularly when they have personal or family experience with depression. Particularly when questions of sickness and disease have an impact on how people are treated by others, and what access they have to help, etc. To me, it's more of a question of philosophy and what a disease is. I just think it's more realistic to be honest about what it is, and treat it as something that (for the most part) was in the normal range of human behavior which has, because of changes in society, become maladaptive.

If we're going to talk about curing depression, ADD, etc, I think what we're really talking about is eugenics and transhumanism, and while I'm in not necessarily against it, we should be aware of what we're doing.
posted by empath at 10:21 PM on January 13, 2010 [4 favorites]


>: I have always thought that depression, social anxiety disorder, ADD and similar 'mental illnesses' that have cropped up mostly in the 20th century are not old diseases that have only recently been formally diagnosed, but natural, healthy, human reactions to a world which is completely at odds with the environment in which we evolved to exist.

This. Right here. It's right on.
posted by dunkadunc at 10:22 PM on January 13, 2010 [1 favorite]


Excellent post

I search long and hard for ideas that most sites call ..........
That is their disfunction but they control the servers just like metafilter.
I may buy a server farm.. what 5 mil . can do 8% of my liquid.

America and rome.. there is much comparison.
the 'pres' is the new caeser.

Jesus bless him LOL
posted by Joachim at 10:26 PM on January 13, 2010


Mental illness

K here are the ones i IMPOSE ON MYSELF.
Ataraxy
Aspergers /emote
Paranoid delusion
flyrage

A man of many colors before i start on US fuckery of the worlds human population
posted by Joachim at 10:33 PM on January 13, 2010


Let's think about it this way. If you're in a hunter/gatherer society, what does depression mean? What does ADD mean? What does even paranoia mean?

Cancer means cancer no matter where you are, but I'd suggest that depression would be a meaningless term in a society without 9 to 5 jobs.
posted by empath at 10:34 PM on January 13, 2010 [4 favorites]


The classic example given in med schools is that Chinese sufferers from depression tend not to recognize a change in mood, but instead report persistent bodily aches and pains: supposedly, psychological explanations are not strong concepts in Chinese society.

I hear this all the time, but it goes against my experience of interacting with actual Chinese people. Maybe it was true 50 years ago. Does anybody have any links to the actual research behind this assertion?
posted by afu at 10:34 PM on January 13, 2010


That goes against my experience with Chinese people too-- depression comes out as disgruntlement , self destructive behavior (gambling, drugs) and sometimes suicide. Kind of like everyone else. Well, maybe not the disgruntlement part.
posted by wuwei at 10:56 PM on January 13, 2010


The article twsf posted had one good point (which KokoRyu quoted) but the rest is pretty blatant mischaracterization of the Watters piece, which I found fascinating. And I almost stopped reading after the author threw out "postmodern" just dripping with disdain in the first paragraph; I am so sick of people using that term (without really understanding its genealogy or range of meanings) as some blanket insult term for "stuff I disagree with and want to characterize as snooty bullshit."
posted by Saxon Kane at 11:03 PM on January 13, 2010 [5 favorites]


From the article: Of course, to the extent that our modern psychopharmacological drugs can relieve suffering, they should not be denied to the rest of the world.

WTF does that mean? "Of course they should not be denied to the rest of the world." What shouldn't be? "our modern psychopharmacological drugs"?...to the extent that they can relieve suffering? This is a meaningless sentence and the article has many of these in addition to statements that suggest profound insight but never deliver.

Our "...modern psychopharmacological drugs" also produce many severe side effects like suicide, kidney failure, diabetes, liver failure, loss of emotion and libido, etc., but yeah, they do stop the "hallucinations" and "paranoia".

This is an Inuit story. By Western definition, most would consider him schizophrenic. Within his culture, he is a shaman.
posted by Mike Buechel at 11:21 PM on January 13, 2010 [2 favorites]


I have always thought that depression, social anxiety disorder, ADD and similar 'mental illnesses' that have cropped up mostly in the 20th century are not old diseases that have only recently been formally diagnosed, but natural, healthy, human reactions to a world which is completely at odds with the environment in which we evolved to exist.

I swear I would have half the disorders in the DSM if I had to worry about lions eating me and whether or not I would make it through the winter in my little cave and if there would be enough food when I went out hunting.

But I guess I'll never know.
I'm assuming that's what meant by the "environment in which we evolved to exist".
posted by Defenestrator at 12:12 AM on January 14, 2010


I think the worst part about exporting our mental illness's is the fact that we characterize them as an experience without value. I know some people who have done really well by embracing what is valuable in the experience called mental illness. esp. schizophrenics.

I swear I would have half the disorders in the DSM if I had to worry about lions eating me and whether or not I would make it through the winter in my little cave and if there would be enough food when I went out hunting.

I am not really sure which myth is more valid, the short, brutish existence of primitive man or the noble savage. But I do believe that if you were put into that position, your choice would be to get over it, function with it, or die. Either way, your problem is solved.
posted by psycho-alchemy at 1:46 AM on January 14, 2010 [2 favorites]


I'm assuming that's what meant by the "environment in which we evolved to exist".

Yeah, and the problem is it's naive primitivist bullshit, basically. Species development doesn't stop at some magic snapshot in time that starry-eyed romatics declare the perfect point of human harmony.

And cancer, incidentally, was most likely meaningless to at least early Maori, since with an typical lifespan in the 30s, it's unlikely to have existed for them as a major problem.
posted by rodgerd at 1:52 AM on January 14, 2010 [1 favorite]


I realize that this is a subject that people have strongly held opinions about, particularly when they have personal or family experience with depression. Particularly when questions of sickness and disease have an impact on how people are treated by others, and what access they have to help, etc. To me, it's more of a question of philosophy and what a disease is.

Empath, as a matter of curiosity, do you have any personal experience of depression?

I ask because, in my experience, people who are suffering from depression themselves often say that their symptoms are a natural reaction to a messed up society; and people who have no direct experience of depression often do not realise how powerfully present, abnormal and identifiable it can be - for a start, they often assume that it merely means feeling apathetic or down. Sometimes it does, but it often has a quality of ferocity or self-righteousness and bitterness that can come as a surprise to those who haven't experienced it.

Please understand that I am neither calling you depressed, nor suggesting that you are ignorant! It's more that I want to understand where you're coming from...
posted by lucien_reeve at 1:57 AM on January 14, 2010 [4 favorites]


So, I'm about halfway through the New York Times article. Thus far it seems to be avoiding any examination of, what I suppose we could call, the meta-psychology. Maybe psychologists are not studying this either, but if mental illness is in large percentage based on one's culture, mental illness is still using the same machinery as a starting point. This implies to me that there'd be larger classifications, a bigger picture, than what's been studied to this point (this may be ignorance on my part).

Also, the first half of it is written almost entirely from the point-of-view of one Hong Kong research doctor and his experiences over two decades; specifically his one study going to publication as anorexia nervosa came to his island's shores. To me that just looked like a dimensional problem, as in taking a step up and seeing that, yes, there were different conscious and unconscious symptoms, but both Western and Eastern patients shared the major (and dangerous) symptom of not eating to the point of starvation.
posted by Captaintripps at 5:06 AM on January 14, 2010 [1 favorite]


Ocherdraco mailed me an awesome book by two British epidemiologists called The Spirit Level: Why Greater Equality Makes Societies Stronger which argues that mental health disorders and addiction along with a number of other social fabric corroders is a result of increased inequality, and that it's not so much that the US is exporting its mental illness to other nations, but its extremely caustic way of life as a whole. They have just a crushing amount of evidence to support their thesis, uncanny correlations across like a million different variables, that greater inequality and divisiveness exacerbates a really broad spectrum of social ills.
posted by The Straightener at 5:21 AM on January 14, 2010 [9 favorites]


Maybe this will be mean that common humanity will become more common.
posted by litleozy at 5:38 AM on January 14, 2010


I have always thought that depression, social anxiety disorder, ADD and similar 'mental illnesses' that have cropped up mostly in the 20th century are not old diseases that have only recently been formally diagnosed, but natural, healthy, human reactions to a world which is completely at odds with the environment in which we evolved to exist.

So, as the mechanisms, institutions, corporations, etc of the modern, developed world metastasize and spread and colonize the rest of the planet, it's only natural that humans in those places will respond similarly to the new environment in which they find themselves.


Without totally disagreeing with your analysis, the point of the article goes against what you're saying because it shows that depression, social anxiety disorder and ADD are culture specific. The idea of the article, as I understand it, is that conflicts within a person's psyche are going to be expressed within a society's 'accepted' forms of mental illness (“Culture shapes the way general psychopathology is going to be translated partially or completely into specific psychopathology”).

So while internal conflict may be a necessary consquence of our impulses being repressed by our environment*, how this conflict is expressed is not universal. In which case it is not the development of a society that popularises depression, but the spread of depression as a concept, as a way of expressing internal conflict. Experiencing repression may be inevitable, but the ways of expressing it aren't.


*not a new idea in itself; it was discussed under the concept of 'bad conscience' in Nietzsche's "On the Genealogy of Morality" in 1887.
posted by litleozy at 5:57 AM on January 14, 2010 [3 favorites]


I read the article a few days ago, thought of posting it here, but didn't get around to it. I wish there had been more emphasis on big pharm. That industry has a major vested interest in promoting its products. Can we call it DSM/ big pharm imperialism, perhaps?
posted by mareli at 7:37 AM on January 14, 2010 [1 favorite]


empath: I just don't see the need to pathologize the normal range of human emotion. Lots of people wish they could be happier. Lots of people respond positively to psycho-active drugs that makes them happier.

Now personally, I think one of the limits to this sort of discussion is that we use terminology for mood disorders that just coincidentally aligns with "normal" emotional states. Getting butterflies in your belly before giving a presentation is anxiety. Feeling like there are ants crawling under your skin and wanting to put a bullet in your brain to escape a completely irrational fear because you bounced a check is an anxiety disorder. Feeling bummed because you had to work late is sad. Feeling lethargic and hopeless for weeks at a time for no reasonable or rational cause is depression.

And likewise, treatment has not a fucking thing to do about being happy. (It's a nice side effect when it happens.) It's about managing the more extreme symptoms in such a way that we can feel frustrated, sad, or angry without doing something drastic like eating a bullet.
posted by KirkJobSluder at 8:20 AM on January 14, 2010 [10 favorites]


Feeling like there are ants crawling under your skin and wanting to put a bullet in your brain to escape a completely irrational fear because you bounced a check is an anxiety disorder.

Yeah, my question here, is in the absence of things like bounced checks, how would that manifest?
posted by empath at 8:23 AM on January 14, 2010 [1 favorite]


Which, I don't see a problem with acknowledging that something may be both a disorder worthy of treatment, and at the extreme edges of normal human variation. My seasonal hay fever for example is an overreaction of my immune system with likely multiple causal factors. Few people politicize the use of antihistamines and analgesics to manage the symptoms of hay fever.
posted by KirkJobSluder at 8:25 AM on January 14, 2010 [1 favorite]


empath: Yeah, my question here, is in the absence of things like bounced checks, how would that manifest?

Well, here you are not seeing the forest for the trees. The underlying issue is that a relatively innocuous stressor results in a radical and disproportionate fight-or-flight reflex combined with disordered thinking that greatly exaggerates the consequences of the stress.

Now certainly, you can make the case that the individual stressors might be culture and context specific. My grandmother had an ugly delusional break over a pair of misplaced underwear that led to the entirely sincere but batshit crazy idea that my sister had drug-fueled lesbian orgies while my Grandmother was in the hospital. I find Poe's "Tell-Tale Heart" shockingly familiar in spite of being over a century old.

I also don't buy the notion that a disorder must be universal in order to be legitimate. Black lung disease and carpal tunnel syndrome are entirely real occupational risks.
posted by KirkJobSluder at 8:40 AM on January 14, 2010 [1 favorite]


I find Poe's "Tell-Tale Heart" shockingly familiar in spite of being over a century old.

I've always thought that Dostoevsky was fundamentally concerned with mental illness, alcoholism, and other compulsive disorders like gambling, it's just so pervasive in everything he wrote. I think he saw mental illness in his world on the order of magnitude that we see it in ours, today.
posted by The Straightener at 9:19 AM on January 14, 2010 [2 favorites]


hey jsavimbi, Mal de ojo I get. But what are sustos? I assume it's not a mere startle?
posted by toodleydoodley at 10:15 AM on January 14, 2010


I have always thought that depression, social anxiety disorder, ADD and similar 'mental illnesses' that have cropped up mostly in the 20th century are not old diseases that have only recently been formally diagnosed, but natural, healthy, human reactions to a world which is completely at odds with the environment in which we evolved to exist.

So, as the mechanisms, institutions, corporations, etc of the modern, developed world metastasize and spread and colonize the rest of the planet, it's only natural that humans in those places will respond similarly to the new environment in which they find themselves.

It's not people that are sick, but our culture. And just like cattle raised in factory farms, pumped full of steroids and antibiotics in order to keep them alive long enough to extract every bit of value we can, we'll be downing stimulants, anti-depressants and steroids in order to stay alive and functioning in the giant factory farm that we call the modern world.

We are all livestock.
posted by empath


This. Totally.

Why? See this.
or
this
posted by kaiseki at 11:16 AM on January 14, 2010


But what are sustos? I assume it's not a mere startle?

Susto is when you get startled so bad that your soul escapes from your body, leaving you subject to all sorts of symptoms until you can get a curandero to cram it back in.
posted by infinitywaltz at 11:46 AM on January 14, 2010 [1 favorite]


I absolutely agree with KirkJobSluder and can easily imagine that, while underlying chemical-based biology is the same here and now as it was then or elsewhere, the triggers and manifestations will undeniably be different. It's sort of a false truism that disorders have some sort of cause. When a man takes a gun and kills his wife and children, then turns the gun on himself (a uniquely Western manifestation of some disorders, I believe), we hurry to come up with all the reasons he could do such an action. But KJS is right - The underlying issue is that a relatively innocuous stressor results in a radical and disproportionate fight-or-flight reflex combined with disordered thinking that greatly exaggerates the consequences of the stress.

In the very first paragraph, the author has already rejected the idea that the cause of mental homogenization may be physical or corporate homogenization. It's not necessary to teach anyone to think like us if we've already taught them to act like us.
posted by muddgirl at 12:33 PM on January 14, 2010


We are all livestock.

Someone's been listening to Radiohead!
posted by speicus at 5:52 PM on January 14, 2010


I just don't see the need to pathologize the normal range of human emotion.

I'm sure there are some health insurance executives who would be glad to agree with you on that. I also suspect you may not have experienced depression, since it involves trimming the more pleasant end of the range out and replacing it with more of the less pleasant end. Seething rage the best part of your day? Why would you want to "patholigize" that? Isn't seething rage just part of the normal range of human emotion?
posted by Jimmy Havok at 9:18 PM on January 14, 2010


That Inuit guy was not much like any schizophrenic people I have known, except when their symptoms are under control by medications. In particular, he told a story with a clear narrative. A weird story, but it was coherent for the 5 minutes that I watched. Did he freak out later?
posted by Hello Dad, I'm in Jail at 12:04 AM on January 15, 2010


And likewise, treatment has not a fucking thing to do about being happy. (It's a nice side effect when it happens.) It's about managing the more extreme symptoms in such a way that we can feel frustrated, sad, or angry without doing something drastic like eating a bullet.

"I do not doubt that it would be easier for fate to take away your suffering than it would for me. But you will see for yourself that much has been gained if we succeed in turning your hysterical misery into common unhappiness." - Freud
posted by phrontist at 1:41 AM on January 15, 2010


I'm sure there are some health insurance executives who would be glad to agree with you on that. I also suspect you may not have experienced depression, since it involves trimming the more pleasant end of the range out and replacing it with more of the less pleasant end.

According to the armchair therapists in this thread, I either must be depressed or I have never experienced depression.
posted by empath at 9:34 AM on January 15, 2010


empath: Well, when you drop a turd in the punchbowl like: "I just don't see the need to pathologize the normal range of human emotion. Lots of people wish they could be happier." It's pretty clear that you are about as qualified to talk about mental illness as an anti-vacc homeopath is in talking about immunology.
posted by KirkJobSluder at 10:25 AM on January 15, 2010 [2 favorites]


That Inuit guy was not much like any schizophrenic people I have known, except when their symptoms are under control by medications. In particular, he told a story with a clear narrative. A weird story, but it was coherent for the 5 minutes that I watched. Did he freak out later?

I think this is one of Watters' points. Culture affects both the manifestation and the severity of psychological disorders. Schizophrenia is a prime example of that.

One of the biggest points for me is on the matter of reintegration. I really liked Anna N.'s post on the article at Jezebel (and the ensuing comments thread also had a lot of good points).

Just from my personal experience carrying a bipolar diagnosis, I have found the treatment to be very isolating sometimes. You see the person who is "unwell," make the diagnosis, prescribe the treatment and until they are "well" then they are officially Other. Rather than being embraced by the community we are pushed out of it until we can "be normal." You lose many of the community tools that could help you to recover faster and stay well longer: your job or purpose in life, your family, your friends, the normal use of your body (due to side effects). There is so much cultural pressure in America not to "fail at life," and whatever keeps you from being a productive citizen is a failure.

If you do recover (thanks to the medication/therapy which I do not mean to denigrate) it's not like you are welcomed back with open arms. Now you have to pick up all the pieces, mostly alone, with everyone keeping a wary eye. You're "sick" now, and being "sick" is more than just being depressed or anxious. From the article:

The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events.

It doesn't surprise me that mental health stigma has actually increased rather than decreased. On the one hand, it's important to get the word out that the mentally afflicted person is not "bad" in some way, or refusing to control themselves. On the other hand, the disease paradigm causes many people to see you as a fail. In reality, I submit that depression, anxiety, paranoia, etc. can be transitory and even understandable responses.

Besides keeping the sick individual in the social group, the religious beliefs in Zanzibar also allowed for a type of calmness and acquiescence in the face of the illness that she had rarely witnessed in the West.


This is just very important, so very important. We need community, to still be touched, to be a part of things, to be respected. Peace and calm, the attitude that "this is an understandable part of life." Not for everyone else to blow up and get emotional or treat us like we're suddenly outsiders. Not an interrupted girl, but a girl with a "thing" right now.

This comment from the Jezebel thread was really good.
posted by Danila at 5:05 PM on January 15, 2010 [4 favorites]


There is no question in my mind that some mental illnesses have been selected for. Seasonal affective disorder? Don't feel like eating or doing much of anything during the winter but lying curled up in a fetal position on the fur rug in your tent? You just may survive, where those guys chasing around in the cold after non-existent prey wind up dead. Manic enthusiasm? Everyone knows that the well went dry, but no, this one guy is all psyched about digging down a hundred feet. He and his people survived. As mentioned above, no one sneaks up on an anxious paranoiac.

Some people are just broken, though. Perhaps the cultural adaptations required to care for these people had other social benefits as well.
posted by StickyCarpet at 5:53 PM on January 15, 2010


I'd say that the genetic component of mental illness comes from the survival value of certain traits which in isolation are bearable, but which, as a cluster, become untenable. For example, originality is a positive trait, so a gene that introduces a certain degree of randomness into thought processes is a survival trait. But if there are a half-dozen different genes that can do that, and you happen to get all six of them, your thought processes may be too random to be useful. The same goes for anxiety, or pattern-recognition. Get a cluster of genes that includes several for high anxiety, high pattern-recognition, and high randomness, and you've got a good chance of ending up schizophrenic.
posted by Jimmy Havok at 7:05 PM on January 15, 2010 [1 favorite]


Cancer means cancer no matter where you are, but I'd suggest that depression would be a meaningless term in a society without 9 to 5 jobs.

See, this is just plain wrong. While it could be called Lincoln's melancholy or could be called post-partum depression (which is found in mothers everywhere), there are extremes that become profoundly dysfunctional and ruinous no matter what time or culture you are in. If you simply curl up and refuse to participate in society-- hunter/gatherer, farming, whatever-- for long enough, you are going to cause problems not just to self but to others and eventually you may well be abandoned or expelled.

PTSD-- and other trauma-related syndromes-- also seem to be pretty ahistorical and universal. The thing is, if what caused the trauma doesn't also destroy your social support network and you have a strong one, you'll be less likely to develop it than if the trauma does destroy that because your social support mediates your stress system and what works to prevent and heal PTSD is ultimately social support. So healthy cultures are going to have less PTSD and the idea that people can swoop in to fix it by having you vent to strangers is completely backwards (as the research shows).

Nonetheless, Watters is absolutely right to point out that culture shapes the manifestation of mental illness. Where people miss is when they start claiming that there is no "there there"-- no underlying thing-- like an overactive stress system in PTSD or like the various types of symptoms that always seem to be found in depression-- that takes different shapes in different times and places.

For example, postpartum depression may have evolved as an adaptation to get women to abandon babies who weren't likely to survive-- consistently, it seems most common in women who don't have enough social support and/or who have premature or otherwise seemingly-unhealthy infants. Does that mean that women in hunter/gatherer societies didn't feel "upset" by it? Somehow, I doubt that.

Similarly, schizophrenia that can be tamed by group support and made into the social role of shaman is probably different from that which results in the person being expelled from the group because their behavior is harmful to others.

Sure the DSM is codifying Western versions of these disorders as "default" versions and this is problematic when it undermines indigenous coping (as with sending in PTSD debriefers or hospitalizing schizophrenics rather than helping families support them and keep a role other than "sick" for them). But when cultures are, say, seeing people with bipolar as possessed and stigmatizing the mentally ill, driving them away, incarcerating, even killing them-- well, then introducing the Western view is helpful. This must all have context-- it's silly to keep saying it's all culture or all biology.
posted by Maias at 7:59 PM on January 15, 2010 [2 favorites]


You know, I could see how people could claim that something like Huntington's disorder is expressed differently in different cultures. After all, it's defined mostly by etiology.

But if you want to strongly* and seriously advance the claim that a disorder described by psychiatry manifests itself differently depending on culture, you have to be really careful. These disorders aren't primarily defined by etiology (with weak exceptions r/t ruling out organic disease or drug toxicity). They aren't defined by objective physical findings. They are almost entirely defined by the behaviors exhibited.

Look, if to ancient Babylonians, depression means, not that they suffer disturbances in sleep and appetite, anergia, anhedonia, but that they become easily enraged and buy more lottery tickets, then it's not depression that they're suffering-- it's something else.

This is exactly why the DSM authors found it necessary to include culture-bound disorders. There can be no justification in considering koro (or others) to be a cultural expression of one of these other (presumably universal, but apparently modern and Western) mental illnesses.

* I have to include "strongly" because one could pointlessly claim small differences in intercultural expressions that are no larger than in intracultural expressions.

oh hay also wut is culture really

posted by nathan v at 9:36 PM on January 16, 2010


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