Exporting mental illness

Here’s a fascinating article by Ethan Watters in the New York Times about how mental illness is being exported from the West to other parts of the world:

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world… 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.

Mental health professionals tend to overlook the cultural component of mental illness. That can be a problem, since imposing the same set of symptoms and treatments on people in completely different cultures ignores some very important factors:

Whatever the trigger… the ill individual and those around him invariably rely on cultural beliefs and stories to understand what is happening. Those stories, whether they tell of spirit possession, semen loss or serotonin depletion, predict and shape the course of the illness in dramatic and often counterintuitive ways… This does not mean that these illnesses and the pain associated with them are not real, or that sufferers deliberately shape their symptoms to fit a certain cultural niche. It means that a mental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions — the idiosyncratic cultural trappings — of the mind that is its host.

Another interesting point in the article is how differences in the concept of the ‘self’ varies across cultures. In the West, a healthy self is associated with being independent, resourceful, active, and accountable. Many traditional and non-western cultures, however, regard the self as “inseparable from your role in your kinship group, intertwined with the story of your ancestry and permeable to the spirit world.” Such differences don’t just change the way we understand mental illness, but they remind us that treatment must consider where a patient finds his identity, worth, and meaning:

“Western mental-health discourse introduces core components of Western culture, including a theory of human nature, a definition of personhood, a sense of time and memory and a source of moral authority. None of this is universal,” Derek Summerfield of the Institute of Psychiatry in London observes. He has also written: “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. . . . There is no one definitive psychology.”

It’s a good read. Highly recommended.