Crazy Like Us: Homogenizing How We Go Mad

I’m reading Ethan Watters exposé Crazy Like Us where he postulates that the most devastating consequence of the global spread of American culture is not the obesity epidemic or bomb craters but the destruction of the human psyche itself. We are on track to homogenize the paths to mental illnesses, giving them a distinctly American tang.

As Watters writes, Westerners are confident that our biomedical approach to mental illness will reduce stigma. Our drugs are the best that science has to offer. Mental illness should be understood scientifically, like physical illnesses. Under the guise of progress, we promise people of other cultures that happiness can be found by throwing off traditional social roles and engaging in individualistic quests of introspection.

So, what motivates us in this global effort to make the world think like us? The complex answer is that our health professionals believe that the science behind our drugs, theories of the mind, and illness categories have elevated the field beyond the influence of constantly shifting cultural trends. We’re the guardians of hard science. A more sinister answer also springs to mind – drug company profits. By promoting universal disease categories fortunes can be made by selling the cures.

In one of four case studies, Watters describes how the pharmaceutical giant GlaxoSmithKline embarked on a carefully orchestrated campaign in Japan in the early 2000’s to create a market for their antidepressant Paxil. Consulting with cultural scholars, GSK changed the meaning of depression, which went from being a serious debilitating illness to a simple “cold of the soul” as they called it, one that was widespread and could be medicated away. The Japanese flocked to their doctors after seeing television ads and Paxil sales soared. Was GSK making people happier by tapping into a previously underdiagnosed condition, or where they in fact creating a new categorization, what the philosopher Ian Hacking refers to as the “making up of people”? 

Crazy Like Us has a chapter on schizophrenia which I found to be the most interesting for two reasons – first off because I’m schizophrenic myself, and further, because it heavily emphasized the cultural variations of the disease. Something approximating schizophrenia can be found in populations from all around the world, but cross-cultural studies indicate that they show enough variations that purely genetic and biological causes (as emphasized by Western hard science, especially since the advent of brain scans) fall short in fully explaining the disease.

The main difference between cultures lie in the delusions and hallucinations that schizophrenics experience. These reflect the phobias and fascinations that are culture-specific. Delusional guilt and hearing the voice of God typically occurs in the West, and in the United States where celebrity, wealth, and power are popular fetishes, people suffer delusions of grandeur. This is rare in rural South-East Asia where it’s frowned upon to strive for personal status.

Of course, in order to believe that the CIA is beaming microwaves into your dental fillings, you have to be familiar with the CIA, modern dentistry, and electromagnetic rays permeating our bodies, so it makes sense that delusions would be culture-specific. Yet, research suggests that culture and social setting play a deeper role. People living in urban settings in the Western world are significantly more prone to developing schizophrenia than people living in rural areas, even when you take poverty, drug abuse, and migration out of the equation. Some city neighborhoods produce so many schizophrenics that scientists are raising questions about environmental pathogens being the culpit. The diathesis-stress model theorises that biological factors make one vulnerable, but that it’s the stress in the environment that sets off the illness.

What’s also interesting is an epidemiologial finding – that schizophrenics in developing countries appear to do better over time than people in industrialized nations. A World Health Organization study that ran over 25 years starting in the 1960s in a dozen sites in the world showed that people with the illness in India, Columbia, and Nigeria suffered a less severe form than people in the United States, Denmark, and Taiwan. They had longer periods of remission and a higher level of social functioning. It’s a paradox that the regions that devoted the most resources to treating schizophrenia also had the most marginalized patients, and no satisfying explanation for this has been reached. One suggestion is that traditional beliefs in supernatural agents and spirit possession remove the weight of blame. Another is that schizophrenics in developing nations have more opportunity to meaningful work, engaging in child care and gardening, while the modern world simply overwhelms the schizophrenic in heavily industrialized nations with weaker family ties.

Regardless of this, and that we have more than 40 years of evidence which suggests that the biomedical or brain disease belief increases stigma, Western health professionals keep exporting our model of thinking about schizophrenia. We might want to reconsider our interventions in regions that have better outcomes for schizophrenics than we can manage ourselves.