‘THE
AMERICANIZATION
OF MENTAL ILLNESS’
Ethan Watters, New York Times
Magazine, 1/10/2010
MEDICALIZATION FROM WEST TO EAST
“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.
A-N BEFORE 1994
 Dr. Sing Lee, at the Chinese University of Hong Kong, began
documenting a culturally specific form of A-N in late 80s
and early 90s
Complaints were typically somatic (bloated stomachs)
Most of his patients did not intentionally diet, no
obesophobia
1994 - CHARLENE'S COLLAPSE ON
HONG KONG STREET
to explain Charlene's case reporters copied out of
western diagnostic manuals (i.e., DSM)
reports affected expression and prevalence
 used to see 2-3 patients/yr, now saw that many in month
 presented with fat phobia
 new patients appeared to be increasingly conforming
their experience of anorexia to the Western version of
the disease
DIAGNOSTIC AND STATISTICAL
MANUAL OF MENTAL DISORDERS (DSM)
 DSM: published by the American Psychiatric Association,
provides common language and standard criteria for the
classification of mental disorders
 Used in the US and around the world by clinicians, researchers, regulatory agencies,
health insurance companies, drug makers and policy makers
 “In the view of some Western mental-health practitioners,
confident in the scientific basis of their field, mental health
disorders are unaffected by culture, universal to humans
everywhere….In this view, the DSM is a field guide to the world’s
psyche, and applying it around the world represents simply the
brave march of scientific knowledge."
BUT DOES THE “BRAIN DISEASE”
BELIEF ACTUALLY REDUCE STIGMA?
 Prof. Sheila Mehta conducted an experiment comparing
effects of “psychosocial” vs “disease” explanations for
mental illness on stigma
 The belief –the “disease” explanation—that was assumed to
decrease stigma actually increased it
HIGH EXPRESSED EMOTION
 High Expressed Emotion: Collection of reactions including
criticism, hostility and emotional overinvolvement (like
overprotectiveness or constant intrusiveness in the patient’s
life)
 In one study, 67 % of white American families w/
schizophrenic family member were rated “high EE”
 Among British families, 48 %
 Among Mexican families, 41 %
 Among Indian families 23 %
IS THERE ONE DEFINITIVE PSYCHOLOGY?
The ideas we export often have at their heart a
particularly American brand of hyperintrospection — a
penchant for “psychologizing” daily existence.
“The problem is the overall thrust that comes from
being at the heart of the one globalizing culture. It is as
if one version of human nature is being presented as
definitive, and one set of ideas about pain and
suffering…”