Purpose The purpose of this assignment is to reflect on the new information presented in this book. ?It is meant to increase your awareness and critical thinking about the experience
The purpose of this assignment is to reflect on the new information presented in this book. It is meant to increase your awareness and critical thinking about the experience and treatment of common psychological disorders in the US and around the world.
Reading to Critically Evaluate
Please read the Introduction to Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters. Please note, you are being asked to read the Introduction, not Chapter 1!
You are encouraged to ask questions of the reading as you read, make notes of areas of confusion, surprise, or disagreement, and include that in your pa.per.
- Write two paragraphs (minimum of 200 words) in which you identify Watter's main thesis in the Introduction and discuss your overall thoughts and reactions to the main thesis.
- Write a one-paragraph response (minimum of 100 words) to ONE of the following questions listed below.
- Include two quotes from the chapter that stood out to you. Include the page number or time stamps where your quotes can be found.
Questions (choose only one)
- What do you think are the cultural beliefs and stories Americans might use to understand mental illness?
- How do you react to the idea that a major motivator for universal disease categories is that drug companies stand to make billions off drugs to cure them? (page 4)
Full points for the assignment will be earned when all 3 portions of the assignment are met. Two-paragraph (minimum of 200 words) general reaction (6pts), one-paragraph response (minimum of 100 words) to question (2pts), two quotes with page numbers/time stamps (2pts). Check out the rubric!
ALSO BY ETHAN WATTERS
A Generation Redefines Friendship,
Family, and Commitment WITH RICHARD OFSHE
False Memories, Psychotherapy, and Sexual Hysteria
THE GLOBALIZATION OF
THE AMERICAN PSYCHE
A Division of Simon & Schuster, Inc.
1230 Avenue of the Americas
New York, NY 10020
Copyright © 2010 by Ethan Watters
All rights reserved, including the right to reproduce this book or
portions thereof in any form whatsoever. For information address
Free Press Subsidiary Rights Department, 1230 Avenue of the Americas, New
York, NY 10020
First Free Press hardcover edition January 2010
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Manufactured in the United States of America
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Library of Congress Cataloging-in-Publication Data
Crazy like us: the globalization of the American psyche / Ethan Watters.
1. Mental illness—Cross-cultural studies. 2. Psychology, Pathological—
Cross-cultural studies. 3. Irish—Race identity. 4. Mental illness—
United States. 5. Globalization—Psychological aspects. 6. Psychiatric
epidemiology. I. Title.
ISBN 978-1-4165-8719-4 (ebook) For my mother, Mary Pulliam Watters
The Rise of Anorexia in Hong Kong
The Wave That Brought PTSD to Sri Lanka
The Shifting Mask of Schizophrenia in Zanzibar
The Mega-Marketing of Depression in Japan
The Global Economic Crisis and the Future of Mental Illness
To travel internationally is to become increasingly unnerved
by the way American culture pervades the world. We cringe
at the new indoor Mlimani shopping mall in Dar es Salaam,
Tanzania. We shake our heads at the sight of a McDonald’s
on Tiananmen Square or a Nike factory in Malaysia. The
visual landscape of the world has become depressingly
familiar. For Americans the old joke has become bizarrely
true: wherever we go, there we are.
We have the uneasy feeling that our influence over the
rest of the world is coming at a great cost: loss of the
world’s diversity and complexity. For all our self-
incrimination, however, we have yet to face our most
disturbing effect on the rest of the world. Our golden arches
do not represent our most troubling impact on other
cultures; rather, it is how we are flattening the landscape of
the human psyche itself. We are engaged in the grand
project of Americanizing the world’s understanding of the
This might seem like an impossible claim to back up, as
such a change would be happening inside the conscious and
unconscious thoughts of more than six billion people. But
there are telltale signs that have recently become
unmistakable. Particularly telling are the changing
manifestations of mental illnesses around the world. In the
past two decades, for instance, eating disorders have risen
in Hong Kong and are now spreading to inland China. Post-
traumatic stress disorder (PTSD) has become the common
diagnosis, the lingua franca of human suffering, following
wars and natural disasters. In addition, a particularly
Americanized version of depression is on the rise in
countries across the world.
What is the pathogen that has led to these outbreaks and
epidemics? On what currents do these illnesses travel?
The premise of this book is that the virus is us.
Over the past thirty years, we Americans have been
industriously exporting our ideas about mental illness. Our
definitions and treatments have become the international
standards. Although this has often been done with the best
of intentions, we’ve failed to foresee the full impact of these
efforts. It turns out that how a people in a culture think
about mental illnesses—how they categorize and prioritize
the symptoms, attempt to heal them, and set expectations
for their course and outcome—influences the diseases
themselves. In teaching the rest of the world to think like us,
we have been, for better and worse, homogenizing the way
the world goes mad.
There is now a remarkable body of research that suggests
that mental illnesses are not, as sometimes assumed,
spread evenly around the globe. They have appeared in
different cultures in endlessly complex and unique forms.
Indonesian men have been known to experience amok, in
which a minor social insult launches an extended period of
brooding punctuated by an episode of murderous rage.
Southeastern Asian males sometimes suffer from koro, the
debilitating certainty that their genitals are retracting into
their body. Across the Fertile Crescent of the Middle East
there is zar, a mental illness related to spirit possession that
brings forth dissociative episodes of crying, laughing,
shouting, and singing.
The diversity that can be found across cultures can be
seen across time as well. Because the troubled mind has
been perceived in terms of diverse religious, scientific, and
social beliefs of discrete cultures, the forms of madness
from one place and time in history often look remarkably
different from the forms of madness in another. These
differing forms of mental illness can sometimes appear and
disappear within a generation. In his book Mad Travelers, Ian
Hacking documents the fleeting appearance in Victorian
Europe of a fugue state in which young men would walk in a
trance for hundreds of miles. Symptoms of mental illnesses
are the lightning in the zeitgeist, the product of culture and
belief in specific times and specific places. That thousands
of upper-class women in the mid-nineteenth century
couldn’t get out of bed due to the onset of hysterical leg
paralysis gives us a visceral understanding of the
restrictions set on women’s social roles at the time.
But with the increasing speed of globalization, something
has changed. The remarkable diversity once seen among
different cultures’ conceptions of madness is rapidly
disappearing. A few mental illnesses identified and
popularized in the United States—depression, post-
traumatic stress disorder, and anorexia among them—now
appear to be spreading across cultural boundaries and
around the world with the speed of contagious diseases.
Indigenous forms of mental illness and healing are being
bulldozed by disease categories and treatments made in the
There is no doubt that the Western mental health
profession has had a remarkable global influence over the
meaning and treatment of mental illness. Mental health
professionals trained in the West, and in the United States in
particular, create the official categories of mental diseases.
The American Psychiatric Association’s Diagnostic and
Statistical Manual of Mental Disorders, the DSM (the “bible”
of the profession, as it is sometimes called), has become the
worldwide standard. In addition American researchers and
organizations run the premier scholarly journals and host
top conferences in the fields of psychology and psychiatry.
Western universities train the world’s most influential
clinicians and academics. Western drug companies dole out
the funds for research and spend billions marketing
medications for mental illnesses. Western-trained
traumatologists rush in wherever war or natural disasters
strike to deliver “psychological first aid,” bringing with them
their assumptions about how the mind becomes broken and
how it is best healed.
These ideas and practices represent much more than the
symptom lists that describe these conditions. Behind the
promotion of Western ideas of mental health and healing
lies a variety of cultural assumptions about human nature
itself. Westerners share, for instance, beliefs about what
type of life event is likely to make one psychologically
traumatized, and we agree that venting emotions by talking
is more healthy than stoic silence. We are certain that
humans are innately fragile and should consider many
emotional experiences as illnesses that require professional
intervention. We’re confident that our biomedical approach
to mental illness will reduce stigma for the sufferer and that
our drugs are the best that science has to offer. We promise
people in other cultures that mental health (and a modern
style of self-awareness) can be found by throwing off
traditional social roles and engaging in individualistic quests
of introspection. These Western ideas of the mind are
proving as seductive to the rest of the world as fast food
and rap music, and we are spreading them with speed and
What motivates us in this global effort to convince the
world to think like us? There are several answers to this
question, but one of them is quite simple: drug company
profits. These multibillion-dollar conglomerates have an
incentive to promote universal disease categories because
they can make fortunes selling the drugs that purport to
cure those illnesses.
Other reasons are more complex. Many modern mental
health practitioners and researchers believe that the
science behind our drugs, our illness categories, and our
theories of the mind have put the field beyond the influence
of constantly shifting cultural trends and beliefs. After all,
we now have machines that can literally watch the mind at
work. We can change the chemistry of the brain in a variety
of ways and examine DNA sequences for abnormalities. For
a generation now we have proudly promoted the biomedical
notion of mental illness: the idea that these diseases should
be understood clinically and scientifically, like physical
illnesses. The assumption is that these remarkable scientific
advances have allowed modern-day practitioners to avoid
the biases and mistakes of their predecessors.
Indeed modern-day mental health practitioners often look
back at previous generations of psychiatrists with a mixture
of scorn and pity, wondering how they could have been so
swept away by the cultural beliefs of their time. Theories
surrounding the epidemic of hysterical women in the
Victorian era are now dismissed as cultural artifacts. Even
recent iatrogenic contagions, such as the sudden rise of
multiple personality disorder just fifteen years ago, are
considered ancient history, harmful detours but safely in the
past. Similarly, illnesses found only in other cultures are
often treated like carnival sideshows. Koro and amok and
the like can be found far back in the American diagnostic
manual (DSM-IV, pages 845–849) under the heading
“Culture-Bound Syndromes.” They might as well be labeled
“Psychiatric Exotica: Two Bits a Gander.”
Western mental health practitioners are prone to believe
that, unlike those culturally contrived manifestations of
mental illness, the 844 pages of the DSM-IV prior to the
inclusion of culture-bound syndromes describe real
disorders of the mind, illnesses with symptomatology and
outcomes relatively unaffected by shifting cultural beliefs.
And, the logic goes, if they are unaffected by culture, then
these disorders are surely universal to humans everywhere.
Their application around the world therefore represents
simply the brave march of scientific knowledge.
But the cross-cultural researchers and anthropologists
profiled in this book have a different story to tell. They have
shown that the experience of mental illness cannot be
separated from culture. We can become psychologically
unhinged for many reasons, such as personal trauma, social
upheaval, or a chemical imbalance in our brain. Whatever
the cause, we invariably rely on cultural beliefs and stories
to understand what is happening. Those stories, whether
they tell of spirit possession or serotonin depletion, shape
the experience of the illness in surprisingly dramatic and
often counterintuitive ways. In the end, all mental illnesses,
including such seemingly obvious categories such as
depression, PTSD, and even schizophrenia, are every bit as
shaped and influenced by cultural beliefs and expectations
as hysterical leg paralysis, or the vapors, or zar, or any
other mental illness ever experienced in the history of
The cultural influence on the mind of a mentally ill person
is always a local and intimate phenomenon. So although this
book describes a global trend, it is not told from a global
perspective. In the hopes of keeping the human-scale
impact in sight, I have chosen to tell the stories of four
diseases in four different countries. I picked these tales
because each illustrates how the globalization of Western
beliefs about mental health travel on different currents.
From the island of Zanzibar, where beliefs in spirit
possession are increasingly giving way to biomedical
notions of mental illness, I tell the story of two families
struggling with schizophrenia. To document the rise of
anorexia in Hong Kong, I retrace the last steps of 14-year-old
Charlene Hsu Chi-Ying and show how the publicity
surrounding her death introduced the province to a
particularly Western form of the disease. I deconstruct the
mega-marketing of the antidepressant Paxil in Japan to
illustrate how drug companies often sell the very disease for
which their drug purports to be a cure. The aftermath of the
2004 tsunami in Sri Lanka provides the opportunity to
examine the impact of trauma counselors who rush into
disaster zones armed with the diagnosis of posttraumatic
stress and Western certainties about the impact of trauma
on the human psyche.
At the end of each of these chapters I turn the focus back
to the West, and to the United States in particular. When
viewed from a far shore, the cultural assumptions and
certainties that shape our own beliefs about mental illness
and the human mind often become breathtakingly clear.
From this perspective, it is often our own assumptions about
madness and the self that begin to appear truly strange.
The cross-cultural psychiatrists and anthropologists
featured in this book have convinced me that we are living
at a remarkable moment in human history. At the same time
they’ve been working hard to document the different
cultural understandings of mental illness and health, those
differences have been disappearing before their eyes. I’ve
come to think of them as psychology’s version of botanists
in the rain forest, desperate to document the diversity while
staying only a few steps ahead of the bulldozers.
We should worry about this loss of diversity in the world’s
differing conceptions and treatments of mental illness in
exactly the same way we worry about the loss of biological
diversity in nature. Modes of healing and culturally specific
beliefs about how to achieve mental health can be lost to
humanity with the grim finality of an animal or plant lapsing
into extinction. And like those plants and animals, the
diversity in the human understanding of the mind can
disappear before we’ve truly comprehended its value.
Biologists suggest that within the dense and vital
biodiversity of the rain forest are chemical compounds that
may someday cure modern plagues. Similarly, within the
diversity of different cultural understandings of mental
health and illness may exist knowledge that we cannot
afford to lose. We erase this diversity at our own peril.
The Rise of Anorexia in Hong Kong
Psychiatric theory cannot deny its participation in the social
trajectory of the anorectic discourse, which articulates
personal miseries as much as it does public concerns.
On the morning of my visit to Dr. Sing Lee, China’s
preeminent researcher on eating disorders, I took the
subway a few stops north of downtown Hong Kong to the
Prince of Wales Hospital in the suburb of Shatin. In the clean
and well-lit subway corridors, I passed several large posters
featuring outlandishly slender, bikinied young women
promoting a variety of health care regimens, cellulite-
removing creams, and appetite-suppressant supplements.
The advertisements over the handrails in the subway cars
repeated the offers. The magazines and newspapers being
read by the commuters were filled with similar pitches,
often featuring before and after photos, young women
becoming little more than skin and bones after the offered
treatment. Such products are a huge business in Hong Kong
and increasingly in mainland China. Over the past few years
the beauty industry in Hong Kong (including dieting,
cosmetics, skin care, and fitness) has outspent every other
business sector on advertising. In that week’s issue of the
popular weekly magazine Next, a remarkable 110 of the
publication’s 150 ads were for slimming or beauty products
The reporting and photojournalism that appeared
alongside those ads had a slightly different obsession:
telling tales of young women celebrities. That morning’s
Standard, one of Hong Kong’s English dailies, prominently
reported the recent misadventures of several famous young
women, including Britney Spears, who had that week been
held against her will at the UCLA Medical Center. She had
been “5150ed,” which is the code for a California statute
that allows doctors to hold a patient involuntarily if she is
deemed a danger to herself or others. On the opposing page
was an article about the Japanese pop idol Kumi Koda, who
lost her job as a spokesmodel for Japan’s third largest
cosmetics company, Kose Corp., after making pejorative
comments about the fertility of older women. The cute and
perky 25-year-old had gone on a popular radio show and
given her medical opinion that a “mother’s amniotic fluid
turns rotten once a woman reaches about thirty-five . . . It
The biggest story in The Standard, in fact the front-page
story in every paper in Hong Kong that morning, was a sex
scandal involving a handful of the region’s best-known
female pop stars and a young actor. Hundreds of very
explicit nude photos had been posted on the Internet of
singer Gillian Chung and actresses Bobo Chen and Cecilia
Cheung Pak-chi, among a dozen others. That same week a
humanitarian crisis was erupting along the Gaza-Egyptian
border and a severe snowstorm was sweeping across much
of eastern China, threatening to strand millions of holiday
travelers, yet no other story could compete with this sex
scandal. Everyone, from politicians to op-ed writers, felt the
need to criticize the behavior of the young women. Even
Hong Kong’s Catholic bishop John Tong weighed in on the
subject of celebrity sin and cyber etiquette, saying that it
was important to “keep our minds decent” and “not post or
circulate these pictures.”
Of course it’s not possible to say exactly what these
advertisements, images, and stories of celebrity
misadventures might have been adding up to in the minds
of average adolescent girls in Hong Kong. It didn’t take
much reading between the lines, however, to perceive a
high degree of confusion and ambivalence surrounding the
issues of female body image, sexuality, youth, beauty, and
aging. Young women in some contexts were worshipped for
their attractiveness, while in other situations they were
humiliated and publicly vilified with a vitriol that would be
hard to overstate. Whatever understanding Hong Kong
teenage girls were piecing together about the
postadolescent world from these sources, it is safe to say
that it was not unconflicted.
Given this environment, it would make sense to most
Americans and Europeans that occurrences of anorexia and
bulimia have spiked here in the past fifteen years. Nor
would it likely be a surprise that Gillian Chung, one of those
young celebrities in the sex scandal, had herself battled
bulimia. Most well-educated Westerners understand that
anorexia is sparked by cultural cues, but they often have a
fairly narrow conception of what those cues might be. Most
assume that anorexia, with its attendant fear of fatness and
body dysmorphic disorder, is born of a peculiar modern
fixation with a slender, female body type, and that popular
culture transmits this fetish to young women. As we’ve
exported our obsessions with slender models—our Barbie
dolls and our Kate Moss fashions—it makes sense to us that
eating disorders have followed in their wake.
But although this commonsense cause and effect might
be part of the story, Sing Lee’s research shows that there
have been other, more subtle, cross-cultural forces at work
here. The full story of how anorexia spread from the
American suburbs to Hong Kong is more complex and, in
many ways, more troubling. It turns out that the West may
indeed be culpable for the rise in eating disorders in Asia,
but not for the obvious reasons.
After making my way across Shatin, I found Lee’s small
suite of offices among the labyrinth of midrise buildings that
make up the Prince of Wales Hospital. Introduced by his
assistant, Dr. Lee was younger than I expected. At 49 years
old, he’s had a remarkable output as a scholar despite the
fact that he has split his time between seeing patients at
the public hospital, teaching, and running a mood disorders
center. He admits that at times he has been accused of
being a workaholic. “I do work long hours, but I’ve never
experienced much work stress,” he said to me in what I
would come to know as his characteristic humble manner.
“I’ve wanted to be a psychiatrist since high sch
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