American madness

The New York Times has a thought-provoking article on culture and mental illness, arguing that the American view of the disordered mind has been exported around the world and has influenced how other cultures actually experience mental distress.

It’s probably worth saying that none of the examples are solely ‘American’, although clearly it has had a huge influence our ideas about mental illness, despite being reined in on several occasions. Indeed, if mental illness had been truly Americanised, we’d all be living in a Freudian world by now.

However, the main thrust of the article to highlight the importance of culture in the shaping of mental illness:

In the end, what cross-cultural psychiatrists and anthropologists have to tell us is that all mental illnesses, including depression, P.T.S.D. and even schizophrenia, can be every bit as influenced by cultural beliefs and expectations today as hysterical-leg paralysis or the vapors or zar or any other mental illness ever experienced in the history of human madness. 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.

The essay has some important points (although with a few minor errors – for example, zar is not a Middle Eastern condition – but the name for a group of spirits which are believed to possess people and can lead to both helpful and disordered states) but you can it’s trying to walk a thin line between outlining the influence of culture on mental illness and avoiding suggesting that mental illness is nothing but the product of culture.

With this in mind, some of the explanations are a little one-dimensional: ‘expressed emotion’ accounts for differences in how patients with schizophrenia manage across cultures, Western-style anorexia appeared in Hong Kong due to the popularisation of the American diagnostic criteria, and so on, when the actual explanations are likely to be more complex and involve a range of biological, medical and social factors (Neuroanthropology has a really good take on this and I recommend their commentary).

I am hoping that this is because the article is taken from a much larger book which explores this topic in more detail, but as a quick introduction to some ideas about how out beliefs about illness can shape how we experience the illness itself, it is a good read.

UPDATE: I’ve just noticed Somatosphere also have a good discussion of the article that’s well worth checking out.

Link to NYT on ‘The Americanization of Mental Illness’.
Link to excellent Neuroanthropology culture.

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