Crazy like us: America's exporting of mental health

The quake reminded me of a recent thing I read:

http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?ref=magazine
http://www.kqed.org/epArchive/R201001110900

This journalist studied how America is exporting our "scientific" views on mental health to the rest of the world, and not always for the better. After the big Asian tsunami, a bunch of "white, upper-middle class" trauma counselors went to Sri Lanka and Aceh to console the locals. The author said that it's the purest form of American hubris to think that comfortable, complacent suburbanites can explain grief to poor people who have lived with war for decades. I know they mean well, but it is somewhat ridiculous. And I'm sure they will try again in Haiti.

Other highlights from his book:

- The author's main thesis is that America is exporting its views on mental health to the world, and actually homogenizing the way humans approach the subject. This is troubling because (1) the American way has its share of flaws and (2) the supplanting of older, local, EFFECTIVE beliefs on the psyche with modern American science has negative consequences, and also results in a loss of precious cultural knowledge. Instead, he thinks we should learn more and teach less, and cherry-pick what works best in various situations instead of completely relying on the American way. Like how herbal and Eastern medicine are popular when Western medicine fails, we should consider alternative approaches to mental health too.

- Clinical depression was very rarely diagnosed in Japan before the year 2000. People just dealt with their sadness privately, and didn't consider it a preventable disease. But then Glaxo-Smith-Kline wanted to sell more of their anti-depressants to the #2 economy, and started a major media campaign to Japanese doctors and such. Now Japanese consume over $1B/year in anti-depressants, yet suicides, happiness indices, and such are not any better.

- Anorexia was very rarely diagnosed in Hong Kong (and when it was, the symptoms were different than Ameican anorexia), but then there was a well-publicized death of an emaciated young woman in 1994. After that, curious media sources wanted to research the disease, and consulted the American psychological reference DSM-IV. By explaining what anorexia was (in the Western view at least), it got many women thinking that that they were afflicted. Eating disorder cases rose over 1000% by 1999, with 3-10% of young women showing some manifestations, this time perfectly in lock-step with the American definition.

- Strangely, with all our resources, "compassion", and science, a 30-year global WHO study showed that schizophrenics have a much lower relapse rate outside of the US and Western Europe, even in very poor nations with no available drug treatments. They attribute this mostly to culture: other "primitive" nations believe in superstitions suggesting that mental disease is not the patient's fault (evil spirits, curse, etc.), and in fact the community has a duty to support the sufferer and drive out the evil. Wheres in the West, we believe in the self-made man, and we believe that we are fully in control of our bodies. If we are sick in the head and not getting better, then we're not trying hard enough. So hovering, meddling relatives often judge and pressure schizos to improve. They think it helps, but it actually increases the chance of relapse. So the author is not saying that we should dismiss science and believe in demonic possession, but the ends can justify the means. If it works better (and costs a lot less) for them, then maybe their way has some value.

- You've all heard of those prison experiments where a subject will hurt a stranger (or thinks he/she is) under various stimuli. Researchers set up a study where a subject would administer a test on a person with mental illness either caused by genetics or by childhood trauma. If the ill person faltered, the subject would have the option to apply an electric shock of varying magnitude. It turns out subjects shocked the "genetically ill" patients harder than the "childhood trauma" ones. Science has tried to uncover genetic causes for various mental illnesses (but hasn't done a very good job so far). They believe that it will reduce the stigma of mental health if the causes are shown to be out of the patient's control. Like homosexuality is not a choice, but just nature. Well, the electric shock study showed that people are actually less compassionate to the mentally ill if they think their condition is genetic rather than social. So are we doing more harm than good?

- Manifestations of mental stress are very local and culturally dependent. Southeast Asia has a syndrome called "amok" (hence the term "run amok") where a young male will go on a violent rage and not remember anything. Victorian England saw many women exhibit "dead legs" and fear of paralysis when actually there was nothing wrong with their legs. This was possibly their subconscious responding to cultural pressures making women into fragile, inferior dolls to be kept by men. I wonder if modern American afflictions (PTSD, bipolar, ADHD, OCD, obesity, the list goes on and on!) are also our subconscious lashing out at social pressures that we can't deal with. We claim we are tough and we can deal, but obviously it's not the case. It's easy to say that it's just genetic and then pop a pill to fix it, instead of carefully examine possible cultural causes of these behaviors. Why is it that US soldiers are experiencing PTSD more frequently than foreign fighters in much nastier warfare situations? Maybe over-eating is a response to all the fast food media and rebelling against the health craze. Maybe ADHD is just bad parenting and a glut of distracting stimuli for youth. Maybe OCD cleanliness and home beautification are the result of all the germophobic paranoia in the mainstream, and the "house porn" on HGTV and such.