The Americanization of Mental Health Care

Crazy Like Us: The Globalization of the American Psyche

By Ethan Watters

Scribe Publication (2010)

Book Review

This book concerns the imposition of American mental health standards across the entire world, including indigenous and Third World cultures. According to Watters, this approach assumes human beings suffer from universal emotional disturbances that are unaffected by cultural beliefs and should be treated “scientifically” like medical conditions. It also advocates the best way to achieve “mental health” is to throw off traditional cultural and social roles and engage in individualist introspection like Americans do.

Watters divides the book into five sections: the first concerns the global commodification of anorexia, the second the global commodification of post traumatic stress disorder; the third the distinctly different presentation, management and outcome of schizophrenia in Zanzibar and other African countries; and the the fourth the corporate marketing of “clinical depression” and serotonin reuptake inhibitors (SSRIs) in Japan.

Part 1 mainly looks at the changing presentation of anorexia nervosa since the first case report in 1823. Back then anorexics were low income with somatic fixations of fullness and pain in the upper abdomen. During the 19th century, distressed middle class women were more likely to present psychiatrists with psychosomatic conditions, such as hysterical blindness or paralysis.

Owing to a complex  process Watters refers to as “symptom negotiation,” women presented with these conditions because psychiatrists recognized them as symptomatic of emotional distress. After World War II, it became more acceptable for women to acknowledge feelings of depression and anxiety and and diagnoses of hysteria became exceedingly rare.

Rare in Hong Kong prior to 2000, anorexia diagnoses followed the original European pattern and were limited to low income women complaining of abdominal discomfort. Thanks to the growing influence of Western media, more recently Hong Kong anorexics present a more Western pattern involving distorted body image and a fatal obsession to be as thin as glamorous Western models and movie stars.

Part 2 mainly looks at the army of Western traumatologists who have descended on every global trauma side since the 2005 tsunami in Sri Lanka. The result has been rowing evidence that, contrary to popular belief, early psychological intervention does not prevent the development of later PTSD. Watters is critical of professionals who fail to recognize that PTSD is a distinctly American and individualist way of suffering for  society that has almost completely lost natural social mechanisms for coping with tragedy.

Part 3 looks at the the tendency in Zanzibar (and other African countries) to regard symptoms of schizophrenia* as evidence of spirit possession. The effect of this approach is to keep the so-called “schizophrenic” within their natural social group, rather than excommunicating them, as occurs in the West. This consistently results in a far better treatment outcome.

Overall African societies are more tolerant of community members who display psychotic symptoms. In African societies an external locus of control leads people translates into the common belief that people can control their problems only with support. In contrast most Western societies favor an internal locus of control, which tends to blame individual patients for their problems.

Part 4 looks at the big spike in suicides (more than 30,000 per year) in Japan during their brutal 1990s recession. Traditionally Japanese culture has long supported the philosophical belief that suicide is a perfectly sane and legitimate act of personal will. However thanks to a massive marketing campaign Glaxo Smith Klein (manufacturer of the SSRI Paxil), the Japanese were trained to link suicidal thoughts and personal suffering with clinical depression and seek Paxil prescriptions.

This, despite three decades of outcome studies showing Paxil is no better than placebo in alleviating depression and increases suicide risk in adolescents.

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*Schizophrenia is a condition characterized by delusions, hallucinations, disorganized speech or behavior and flat affect.

How Advertising Hurts Women

Killing Us Softly 3

Jean Kilbourne (2000)

Film Review

Killing Us Softly 3 is the third Jean Kilbourne documentary on the advertising industry’s destructive effect on women. It updates Killing Us Softly (1979) and Still Killing us Softly (1987). It’s presented in lecture format, illustrated by dozens of ad images.

The majority of Americans deny being influenced by advertising. Kilbourne challenges this. Modern advertising deliberately targets the unconscious. Ads are everywhere, continuously surrounding us with unconscious messaging about values and attitudes, as well as products.

Advertising has a massive impact on the way women think about themselves and the way they are viewed in society. The number one message pounded home by the ad industry is that women should be judged by the way they look. The expectation is flawlessness (young, thin, white and perfectly proportioned and groomed). Important secondary messages are the hard work it takes to look that way and that women who don’t measure up should feel guilty and ashamed. Sex is used to sell everything. Kilbourne is particularly concerned about the sexualization of children and teenagers in ads deliberately modeled after child pornography.

Only 5% of women have a model’s tall thin body type, with the narrow hips, long legs small breasts (unless they’re enhanced) favored by the fashion industry. This body type is based on genetic inheritance and can’t be achieved by diet, exercise or surgery, no matter how hard the advertising industry tries to persuade us otherwise. Often models are airbrushed to appear thinner and more flawless than they really are.

This constant emphasis on an unachievable ideal also negatively impacts the way men feel about real women, who are pear shaped. In addition, the objectification of women (ie their portrayal as sex objects) is directly linked to increased violence towards women. Viewing people as objects rather than human beings makes it easier to commit violence against them (and is used in military training).

The problem is aggravated by a growing tendency to eroticize violence and male dominance in advertising imagery.

Killing Us Softly 4, produced in 2010, isn’t available on YouTube for copyright reasons. It can be viewed for free on trutubetv (an uncensored noncorporate alternative to YouTube now that it’s been taken over by Google).

Killing US Softly 4 repeats most of the same ad images as number 3 but puts more emphasis on upsurge of appearance medicine (plastic and laser surgery, botox injections, etc). It also bemoans the introduction of size 0 and size 00 clothing, the pressure this places on models to starve themselves and the rise of eating disorders in the industry. Anna Carolina Reston was still modeling in 2009 when she died of anorexia nervosa.