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Crazy Like Us

Western ideas can strip away local beliefs

Americans are a generous people. We donate riches to needy countries. We send our troops abroad. We have exported some of history’s most influential cultural, scientific, and social inventions: democracy, fast food, and Britney Spears.

Whether that generosity is helpful to other nations is another question. And so it goes with mental health. According to Ethan Watters in “Crazy Like Us: The Globalization of the American Psyche,’’ the American way of perceiving and treating mental illness has quickly and ruthlessly become the worldwide way.

What is lost are local customs, beliefs, and practices that worked fine before the invention of antidepressants and antipsychotics. For example, people who suffer from schizophrenia in some developing nations tend to cope better than those in industrialized nations armed with “Diagnostic and Statistical Manual of Mental Disorders’’ diagnoses. Why? In East Africa, for example, traditional beliefs in spirit possession help families accept schizophrenia and reduce social stigma. But Western ideas have “the effect of stripping away the local beliefs’’ that in practice can make people feel better.

Watters, who wrote “Urban Tribes,’’ an examination of the “never-married’’ generation, and “Making Monsters,’’ an indictment of the false memory movement, blends scholarship, journalism, and travel reportage to unearth this hidden story of good intentions in the mental health profession gone awry.

“Crazy Like Us’’ is both groundbreaking and shocking. By focusing on four countries and four disorders - anorexia in Hong Kong; post traumatic stress disorder in post-tsunami Sri Lanka; schizophrenia in Zanzibar, Tanzania; and depression in Japan - Watters shows how American mental health professionals and pharmaceutical companies, sometimes accidentally, sometimes insidiously, have actually hastened the spread of some Western disorders.

The opening section on anorexia is the most eye-opening and establishes the book’s thesis. Watters focuses on Dr. Sing Lee, a researcher bent on discovering why in the 1990s, increasing numbers of women in Hong Kong began unconsciously expressing their “mental distress’’ as anorexia nervosa. Sensational media stories and the swift spread of Western diagnoses, Watters argues, were “not only changing the way patients and doctors talked about the disorder - [they were] changing the disease experience itself.’’ Watters astutely draws parallels to the rise of hysteria among Victoria era women plagued by internal strife. Like the fits, paralysis, and blindness exhibited by the sufferers of hysteria, for troubled modern Chinese women, starving themselves began entering the “symptom pool’’ of the disorder. Thus began “the feedback loop by which the disease goes forward and claims new victims.’’

As an aside, Watters notes that cases of hysteria fell as knowledge of the symptoms and the symptoms themselves became more commonplace, thereby losing some power to communicate the emotional pain of the sufferer. He suggests that eating disorders may someday similarly decline if we can find a way to diffuse “the meaning we give to them.’’ The ways America has colonized the foreign mind can be more deliberate. Or worse: driven by greed, as in the example of GlaxoSmithKline and other drug makers, which fund and influence favorable medical studies, wine and dine experts, and attempt to shape attitudes about depression in order to sell treatments in the lucrative Japanese market. GlaxoSmithKline, for instance, has succeeded wildly: From effectively zero market share in 2000, sales of the firm’s Paxil in Japan topped $1 billion in 2008.

For mental heath volunteers who rushed to Sri Lanka to counsel victims after the 2004 tsunami, it was case of big hearts colliding with naivety. Cultural differences were ignored; workers assumed that Sri Lankans would automatically express checklist symptoms for PTSD like New Yorkers after 9/11. The blunder resulted in often pathetic outcomes, such as bands of counselors competing for the affections of traumatized children.

Watters writes skillfully. His tone is measured, but you can see Watters struggling for a consistent voice and style. Is this lay scholarship (the nearly three dozen pages of sources are impressive) or first person travelogue? The “I’’ wavers in and out. Zanzibar is the most personal section. Sri Lanka feels the most distant, seemingly reported largely from library research and phone conversations; the section could have benefited from in-country reporting and more follow-up now that five years have passed since the tsunami. One could criticize the inconsistent methodology, or see the various approaches as creative tacks into a tricky subject matter.

Watters never fully unleashes his indignation, either. One might wish for a little more passion, particularly in the Sri Lanka and Japan chapters. But “Crazy Like Us’’ isn’t outright investigative journalism; the book is thoughtful, contextualized reportage of a disturbing if not entirely surprising trend.

The situation presented in “Crazy Like Us’’ is akin to the disappearing Amazon. “The remarkable diversity once seen among different cultures’ conceptions of madness,’’ Watters writes, “is rapidly disappearing.’’ Whether Watters’ book will be sand in the engines of the bulldozers remains to be seen. At least it proves the West, despite its best intentions, does not possess all the answers.

Ethan Gilsdorf, author of “Fantasy Freaks and Gaming Geeks: An Epic Quest for Reality Among Role Players, Online Gamers, and Other Dwellers of Imaginary Realms.’’ More info at