forum discussion #14

Going Mad The American Way

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Listen to a story by reporter Laura Starecheski, followed by our interview with Ethan Watters.
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Our guest in the Science Forum is journalist Ethan Watters.

His latest book is Crazy Like Us: The Globalization of the American Psyche.

“America is homogenizing the way the world goes mad,” Watters writes. He contends that Americans are exporting their view of mental illness to the rest of the world.
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Watters says culture influences not only how people deal with mental disorders but how mental disorders manifest themselves. Yet those cultural differences are disappearing as American notions of mental health become popular worldwide.

Some examples Watters cites in his book:

•  Anorexia nervosa, the eating disorder, is now common in countries with no history of the disease.

•  Modern biomedical notions of schizophrenia are replacing the idea of spirit possession in places like Zanzibar.

•  By selling pills for depression, pharmaceutical companies have caused a rise in the diagnosis of depression in Japan.

Bring your thoughts and questions about culture and mental illness to Watters. The discussion is just to the right.

  • Is America’s view of mental health reflective of the nation’s individualistic culture?
  • Have you or a family member been diagnosed with mental illness? Has your ethnic or religious background influenced your response?
  • Would Americans benefit from importing ideas of mental health from other countries?

Additional Resources:


The guest has left this discussion, but feel free to leave your thoughts.

Your Comments

  1. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

    Hi, and welcome to this discussion about globalizing American madness. I’m looking forward to your thoughts and comments. Anybody have a personal experience in the spread of western mental health ideas around the world? Do you think America’s influence over the treatment of mental disorders is a positive trend in the end? Does the West have a corner on the market in the understanding of the human mind?

    I welcome any other thoughts and questions.

    • Ethan,

      Fantastic insight you’re providing. I think the entire “world” of mental illness needs to challenged. Some of the approaches and perspectives are as terrifying as the diseases themselves. We need to continue to think critically about the norm…and keep the discussion alive. A book such as yours definitely achieves both of these.

      Having lived with “mental illness” for over 2 decades now, I’m attempting to spark conversation via my own voice. Perhaps our paths will cross.

      Best wishes to you. And thank you for investing your talents and time on this increasingly complex issue.

      • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

        Thank you Jonathan. Appreciate the thoughts and encouragement.

  2. Kristina Shevory

    I find the premise of your book fascinating and have been wondering how you ever managed to discover that we’re exporting our mental health ideas worldwide.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      The thesis actually came from work I did almost 20 years ago. I was writing about the recovered memory phenomenon — when thousands of women were uncovering what they thought were memories of abuse by satanic cults and displayed the symptoms of what was then called Multiple Personality Disorder. That work drove home the point that I followed up in Crazy Like Us: That mental health healers often shape the beliefs and symptoms of those they treat. Once I started to think about globalization and America’s influence around the world in treating mental illnesses, I was off to the races.

  3. Caroline Paul


    Thanks for your book. very insightful ideas. I was wondering what the reaction has been from psychiatrists here in the US. They regard mental health diagnoses as a science, and very objective while you argue otherwise. Has there been a backlash? I imagine hundreds of psychiatrists wanting to break your kneecaps with their pipes and their heavy DSM manuals.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      Actually the professional reaction to the book has been largely positive. (Fortunate for me because I’m married to a psychiatrist.) Most of the heroes in this book are themselves psychiatrists and mental health healers. Although often critical, Crazy Like Us is not an anti-psychiatry book. I’m simply trying spread the news about some interesting research that hasn’t hit the limelight.

  4. arw1961

    I’ve read you argue that viewing what we call schizophrenia as spirit possession can sometimes be beneficial to the sufferer because it allows others to treat the sufferer as “normal” when the “spirit has gone away.” Does this mean that the western conception of schizophrenia is just another form of superstition — another name for something we really don’t understand? Alternatively, how do you separate the positive aspects of the “spirit possession” narrative from the historical negative aspects such as witch burning?

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      There is a body of scientific research behind our Western conception of the disease that I would not characterize as our own superstition. That said, the bio-medical conception of the disease does also operate as a social belief that influences how people view the ill individual (in the same way as the spirit possession belief does.) So I think it’s important to not just look at the dichotomies of true/false or science/myth and look further at how these differing beliefs influence the experiences of the ill individual and those who care for him or her.

  5. Chris Colin

    Extremely interesting, Ethan. Like Caroline, above, I’m curious about the reaction to the book from the psychiatric community. Also curious how your personal conceptions of your own mind might have shifted during your writing and reporting.

  6. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

    My ideas about these trends have certainly changed over the course of the 20 years I’ve been writing about this area. I was once much more a booster regarding anti-depressants and other drug interventions. While I still feel they have value (and will likely become more effective in the future), the recent revelations regarding the how drug companies have skewed the research surrounding these drugs has shaken my confidence in the system. Charles Grassley’s senate hearings on the subject were a revelation to me as were the writings of psychiatrist David Healy.

  7. Ethan,

    I agree that SOME aspects of mental health awareness and treatment are good to export. Others, not so much. It seems sometimes (I am a high school teacher) that our first stop in treating a mental disorder is to prescribe medication. I believe every psychotropic prescription should require behavioral counseling including group therapy, not just a trip to the psychiatrist.

    Another American (perhaps global) habit that I wouldn’t want to write home about is our penchant for seeing “evil” in such events as school shootings, lone bombers, etc.

    Therefore, I would want to make sure that what we export considers the impact of Big Pharma, psychological counseling and social stigma on the awareness and treatment of mental illness in the world.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      In terms of the forces pushing Western ideas across the globe, the psychopharm companies can’t be matched. In the book, I also question some other exports as well — such as the widely shared assumption that talking about mental illnesses (during counseling or group settings) is universally beneficial. Indeed, in some cultures, stoic silence is the social norm. I’m not saying that they have it right and we have it wrong. Fundamentally, I’m asking the question: Are we sure that our way of addressing and thinking about these illnesses will fit with the cultural understanding and beliefs in other cultures.

      • No, Ethan, I am NOT sure our way of addressing and thinking about these illnesses will fit with the cultural understanding and beliefs in other cultures. Mental health rests on cultural traditions in part, wouldn’t you agree?

      • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

        I do agree with you. e.

  8. Matthew Bonaker

    Mr. Watters: I’m wondering about the title of your work, are you referring to the US, or do you mean you have a Psychiatric Diagnosis? As someone who does have one, I find the choice of terms you use, and also Laura Starecheski, the reporter of that piece, uses, antiquated and shocking, just as the actions of those in the piece. Looking at any group of people and giving the a label as “the mentally ill” to quote Ms. Starecheski, is wrong. That particular phrase implies there is no hope of recovery. It seems to be the same thing as saying “great big fat people that will surely die of heart disease”. I offer the challenge that one more way to help, rather than hurt the recovery of persons with a psychiatric diagnosis is to stop using words like crazy, madness and labeling them as “ill”.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      I did allow myself to use colloquial language in the title and body of the book. I apologize if that has given offense. However, I would say that the underlying point of your post (that the words and narratives we employ have a great impact on the very expression of these illnesses and conditions) is an idea I agree with and explore in great detail in the book. It is, I would say, the central point of the book.

  9. Hi Ethan,

    I listened to you (Chapel Hill, NC public radio) with great interest and couldn’t help thinking about a population I work with, hoarders. I’m a professional organizer and here in the US there is a huge stigma attached to the disorder. We know hoarding exists all over the world, even in very poor countries. I’m curious if you have any knowledge about hoarders and hoarding and how it’s handled outside western mental health communities.

    Can not wait to read your book.

  10. NAMI Advocate

    Just heard your segment on PRI. I would like to thank you for your dedication and research. As a case manager at a Public Mental Health Clinic and as an advocate for people with mental illness, I would like to remind you of the politically correct terminology these days. People aren’t “schizophrenic”, they are people “with schizophrenia”. This is true for all other diagnoses, such as “people with anorexia” and not “anorexics”. The disease does not own them, they are people that have a disease.

    Again I thank you for your research and advocacy.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      You are absolutely correct. Thank you for reminding me.

  11. Deva

    Hi there! I have personal experience with mental illness, and have read books about indigenous cultures, where western doctors have come in and claimed that a tribe’s “shaman” was schizophrenic because they were believed to heal others and see visions that would help the society. This is very interesting to me, and I wonder how much our culture feeds depression by suppressing natural tendencies to pick up on other people’s feelings or thoughts, or connecting to nature in ways that are different from the modern culture. I also read that schizophrenia is significantly more common in first world countries, and I am curious as to why. Is there something about the structure of our society that won’t allow for an alternative perspective? Thank you so much for your time.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      Thanks Deva, You are interested in the very same ideas that have fascinated me for the last couple of years. All of the topics you mention are dealt with in great detail in the book but to respond briefly:
      -Yes there is solid research that suggests the prevalence and course and outcome of schizophrenia differs around the world with better outcomes in developing countries.
      -And yes some have suggested this difference is related to the cultural narratives tied to the illness — narratives such as spirit possession.

      • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

        Note that you don’t have to believe in the reality of spirits to see that spirit possession narratives might (in some places and times) be employed in ways that limit the stigma placed on an ill individual.

  12. Hi, Ethan, I’m reading your book, and enjoying it a lot. I direct MindFreedom International, an independent nonprofit coalition. I’d like to ask you, how you suggest those concerned about the globalization of the worst parts of the psychiatric system — its over-reliance on a medical model, its western-bias, it’s authoritarianism — can work more with survivors of psychiatric abuse. As you may know, most of our members self-identify as individuals who have been harmed by the mental health system (though we are open to the public). How can we all work together on what I consider to be a global emergency: The way the psychiatric industry is targeting literally hundreds of millions of people, without adequate advocacy, information and alternatives? Thanks, David

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters


      Thank you for the question. This is perhaps a good time to point out that I fall in the middle ground regarding the effectiveness of drugs/psychiatry. To the extent that Western drugs are effective I think they should be shared with the rest of the world. But I’m also aware that there are many abuses and misguided treatments that play out for years longer than they should. My goal as a writer has been to document these stories and publicize abuses and missteps where I find them. Sharing these stories is key to changing public opinion. Sometimes it feels like yelling into the void but I believe that simple story telling remains a powerful tool for the disenfranchised.

  13. Dane Rogers

    Hi Ethan,
    I’d like to share a somewhat different take on your thesis in regards to anorexia. Another western export has been our high fat, very rich diet. One result of this abundant calorie supply is the initiation of female menarche at a much earlier age. My sources say average onset of menarche in the U.S. in 1900 was around 16 or 17 but is now 12 and 13. Natures purpose of course is to make use of the calorie resource by speeding reproductive maturity with an intention of expanding the population. However, this early menarche places new emotional burdens on young girls who are not ready to mature. Most cope “successfully” but others, especially those with tendencies toward OCD, can manifest this circumstance as anorexia as my daughter did 6 years ago at age 13.
    Your thoughts?

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      I think that is a very interesting theory and does agree with the observation that anorexia rarely strikes in calorie poor populations. However, anorexia does seem to spike rather quickly (as I write about in my book) and changes in the timing of menarche happen more gradually in a population. I would still want to know what causes the sudden spike.

      I’m sorry to hear that you are dealing with this difficult illness on a personal level and wish you and your daughter the best.

      • Dane Rogers

        Thanks for the reply Ethan. I may need to read your book and see your data about anorexia spiking. That is a very interesting observation that does beg an explanation.
        Thanks again, Dane

  14. Maggie Gurman

    I would just like to piggy back on a couple of previously stated posts about labeling. As a mental health professional, I urge you to refer to individuals with mental illness as such – not as ‘the mentally ill’. There is a body of recent literature on the benefits of psychosocial rehabilitation including changing the verbiage that is so often used by the general public and many in the field, which contributes to the stigma attached to mental illness and does not promote recovery. Your research is fascinating and I find it valuable to the field. However, I also believe that as mental health researcher you have the ethical responsibility to promote recovery in your language in future works. Thanks.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      Thank you for the comment and I will do my best to make this change. My argument is that language, narratives and social belief effect the course of these illnesses and I certainly should be held to account regarding my participation in the creation of these currents.

  15. Lila

    My question pertains to your response to Ms. Starecheski’s piece. You challenge what you saw as a premise in her piece that individuals expatriated to West Africa would have been better off staying in the West. Then you go on to discuss examples from your book that show non-Westerners in their non-Western locations faring worse under Western constructions of mental illness. I’d like to point out that Ms. Starecheski’s piece focused on individuals who presented as mentally ill in the US, so they would have had ample opportunity to “learn” from the Western “symptom pool”. Surely you agree that relative merits of different cultural understandings of mental illness don’t trump individual agency. I was shocked to learn of the individual rights crisis that her story so clearly highlights.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      I actually don’t agree that individual agency trumps cultural understandings. I think that what often has the appearance (and even feeling) of individual agency is often simply an internalizing of cultural understandings and beliefs. I don’t know enough about that individual story to comment on it directly but I do think there is enough evidence to question the premise that an immigrant who is diagnosed with a severe mental illness will do better if he or she says in America.

      I also wonder about the vilification of those who wanted to get that individual back home. There is good evidence that kinship networks are often the most stable for those with illnesses like schizophrenia.

      • Laura Starecheski

        Thank you Ethan et al for this discussion. I’d like to respond to the idea that a person with mental illness would do better in the US. As Dr. Eaton noted, there are abundant mental health care resources in the US. But, availability is different than access. Language barriers, a lack of culturally competent care, economic constraints, and stigma all prevent many immigrants (from many parts of the world) from accessing mental health care. Add to that mix the very important idea that many people do not believe that a hospital is the place to go for mental or emotional problems, and you’ve got a long list of reasons for people to avoid Western psychiatry. I hoped that, among other things, the story would bring up the need for culturally competent mental health care in the US.

      • Laura Starecheski

        Ethan, I also want to respond to the charge of vilification of what you call kinship networks here. Most people with mental illness I’ve interviewed say that strong community support is a matter of survival. But the silence around mental illness in the West African community can lead to further isolation, even within a family or community, whether in the US or in West Africa. (Just as can happen within American families as well, when mental illness becomes something to hide.) Also, this story is about specific cases, but it’s important to acknowledge the incredibly wide range of mental illness experience worldwide, beyond this story, as you do in your book. Generalizing about the outcome of strong kinship networks neglects the variability for which I think you’ve made a strong case.

  16. Concerned

    The public discussion I have read and heard about your work thus far (PRI, NYTimes) deeply scares me for the ways in which I believe it may add to or fuel the pervasive and detrimentally stigmatizing attitudes which surround mental health and mental health disorders. I’ve watched people hear about your work and take it as confirmation of their belief that mental illnesses aren’t real (the beliefs that follow from that one include: if they’re not real, they’re not serious, they’re not treatable, those with them should be able to ‘snap out of it,’ as well as a host of other harmful ideas). I know that this is a simplistic and unfair conclusion for anyone to draw from your work but I am wondering what you can do in the public discussion of it to prevent this from happening.

  17. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

    Well, all I can say is that I’ve tried to be very clear:

    Mental illnesses are real but they are also shaped by our cultural understanding of them. This does not mean that anyone can snap out of them or shake them off. Indeed the addition of culture to the mix makes them more difficult to combat — they shape-shift across time. Anorexia, schizophrenia, depression and other mental disorders destroy lives and are devilishly difficult to combat.

    I would also say that I’ve followed the discussion about my book pretty closely and I haven’t heard people drawing the conclusions you suggest. It makes me sad to think that they would.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      I would add that we will never truly understand mental illnesses (and be able to effectively combat them) unless we understand how cultural beliefs influence their expression.

  18. Dear Mr. Watters,

    Thanks for your book — it’s an excellent example of the power of a rigorously constructed social construction argument. Regarding the dialog between you and the NAMI advocate above: I’ve been manic-depressive for 13 years, and I feel a surge of irritation when people insist that I “have” bipolar disorder. I beg to disagree. This disease acts on the will and the self, and I have suffered uncontrolled symptoms for my entire adult life. It’s not meaningful to try to imagine who I’d be without it. That doesn’t mean that I’m helpless or that the disease is purely biological — if anything, it makes my existential more absurd. In short, don’t apologize for choosing the accurate and grammatically elegant “manic-depressive,” say, over “person with bipolar disorder.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      I think taking personal control of the words and social narratives (to the extent that one can) that describe and shape our experience is important. We engage in a many battles over words and descriptions. Culture is also acting on us at a level more difficult to point to. We are unconsciously shaped by the beliefs and stories of our time. That interaction is harder to identify — or influence — than the choices we make with language.

  19. Jim

    With regards to the PRI report on West African immigrants, I’m surprised that no one has mentioned culture shock. I lived for 8 years in Japan; living in a society so different from one’s own can be very stressful: not only because you don’t have a support network, but because every aspect of life is different. The most simple interactions with one’s neighbors can be a source of severe distress.

    Americans think assimilating into our society is easy, and that people will have an easier life here than they did in their own country. We think our doctors are the best in the world, so when an immigrant has a mental illness, we naturally think they are best off seeing an American psychiatrist. That may be true. Or it may be best if he goes home, away from the stress of life in a foreign land.

    • Jim

      I should add that I’m not trying to downplay the seriousness of mental illness, or the effectiveness of American medicine. I’m only trying to point out that culture shock can be very severe, and is not often acknowledged in our society.

    • Laura Starecheski

      Hi Jim. Thanks for your comment… actually, a lot of people spoke to me about culture shock. (Since the cases in the story referred to severe mental illness, culture shock didn’t make it into the broadcast.) For many West African people, the isolation of life in New York is overwhelming, but working to send money home is the top priority. Dozens of people back home may be depending on their income. The choice to leave would be a difficult one. I met one woman who felt her life in the US was a failure because she couldn’t find work, and her family was depending on her. She and others I met said they “think too much”, referring to what many Americans might call anxiety or depression. But this woman chose to stay. She was too ashamed to return home empty-handed.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      Absolutely, Jim. I had that thought too but failed to mention it in my reaction to the story. Social stress is a well known spark for psychotic breaks. Living in poverty in a foreign land would no doubt be a disorienting and difficult to manage. It would make a great deal of sense that the people who knew this individual thought that he might do better in the culture he understood best.

      • Laura Starecheski

        This brings up an important point about repatriation that didn’t come out in the story– some of those sent home have lived in the US for decades. I think by that point it would be up for debate which culture such a person would understand best, or feel most comfortable in.

  20. I have read your book carefully and written about it extensively on my blog. Thank you for your valuable contribution.

    That said, I wonder if you’ve thought about going beyond the claim that cultural beliefs shape the expression of, and response to, mental illness, and considered that culture may actually play a causal role. There is more than a little evidence in your book to suggest that individualistic, western culture is particularly damaging to mental health. McGruder’s work especially suggests that the importation of nationalism changed the nature of identity in Zanzibar and led to psychotic episodes for Hemed and Kimwana. The question, I guess, comes down to this: Do you believe a biologically real disease can have a cultural cause?

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      Good point. I did walk away from the book wondering the same thing. Does our highly individualist belief regarding the self cause more mental distress than would be found in other cultures with more socio-centric understandings of the self. I believe it probably does. Dr Sing Lee refers to such inchoate stresses as causing a “general loading of psychopathology” in a population but there is no one way for the human mind to express that distress. That’s when our unconscious minds go looking for the language of suffering for our time and place. (The “symptom pool” as Edward Shorter puts it.) This is why mental illnesses often look dramatically different from time to time in history.

      • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

        My hope is to help Americans in particular erase the dichotomy suggested in your last question. Culture can both spark and shape psychopathology but simply because the resulting disorder can appear different in different cultures and different times in history does not make the illness any less “real” than an illness sparked by genetics or a chemical imbalance in the brain.

      • The hypothesis I am working from, which Liah Greenfeld (sociologist and scholar of nationalism) will be exploring in a forthcoming book, is that modern culture actually disrupts the normal functioning of the human mind. Those “individualist beliefs about the self” are not just ideas in our heads, they define the possibilities and structure of our society, and there are serious problems with identity formation which result. While I agree that once cultural beliefs about illness or distress take hold, they become inevitably mixed up in our thoughts and behavior, I don’t believe elaborate delusions, psychosis, or black suicidal depression are explained by our unconscious minds latching onto the available language of suffering. I see no dichotomy; I’m suggesting that culture affects the brain.

      • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

        David I like your ideas and your train of thought. I think we’re mostly in agreement. In my book I emphasized the cultural shaping of mental illness but I also think that culture (and conceptions of the self) can be the cause of those illnesses as well. I’ll keep reading your blog to keep up with your explorations of these ideas.

  21. Scott Denny

    I think this concept has validity, as a dominant power certainly has vast cultural, economic and other critical influences on the world. Not big on the book’s title as “Crazy Like Us” has a kind of cheesy, offputting effect. I would have gone for something like “Exporting Illness”, as i feel the subject deserves a little more weight and intrigue.

  22. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

    Interesting review of Crazy Like Us from India just came out today if anybody is interested.

  23. Reader

    Drugs and pills and the dramatic increase in diagnosis are clearly the work of the pharmaceutical industry in cahoots with pliant, or unscrupulous “doctors”. the world is a sick place, anyone who is not sensitive to it in some way is the sick one. People live in small boxes or cages, especially in the city, totally out of touch with nature, never see the stars or know when the moon is full or new, and work like slaves for 40 or more hours a day or meaningless or banal or violent tasks so they can buy things and watch tv, or be online like me, while their kids are sent to spend time with strangers and learn the dominant culture and nationalistic jingo and that is normal?

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      I think it is difficult for the human mind to look at the whole of modernity and not feel a sense of disconnect. I get that feeling when I fly in over a large city and look out at the miles of houses. But the human being can make meaning and forge deep connections in the most dire conditions. Within this frenetic world, one can still create an intimate social world filled with deep connections to one another and the world we live in.

  24. A.R

    I havent read your book; but the ideas seem interesting and I think its great that you have taken up this very important and humane task of deconstructing mental illness.
    I’ve also had personal experiences with mental illness and somehow this idea of the root cause being a chemical imbalance seemed unconvincing to me.Very recently I’ve been coming across Indian scholarship that critiques western and biomedical notions of mental illness. Dr. Bhargavi Davar is one of them who has written on the subject and is a proponent of psychosocial models of mental illness.She believes that victims of psychosocial disturbances need empathy and a need to tell their stories. They need to be encouraged to develop a personal language (unmedicalised) that will be heard by an empathetic friend circle.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      Many people with mental illness have expressed dissatisfaction with the biomedical narrative. Here’s a quote from a man who was diagnosed with schizophrenia while attending Harvard:

      “I have spent years . . . clinging to the understanding that i was a defective biological unit. . . . This may truly be a valuable perspective for those who observe mental illness, but for me, as a subject, this tree bore only dry and tasteless fruit. . . . I have a chemical imbalance; I really didn’t feel those things. I have a chemical imbalance; I didn’t really experience those things. I have a chemical imbalance; I didn’t really think those things . . . here is an insight! The entire human drama of love, suffering, ecstasy, and joy, just chemistry.”

      • A.R

        ‘the entire human drama of love, suffering,ecstasy and joy,just chemistry’..a very touching quote that strikes at the reductionism of biomedical notions of mental illness..thank you for sharing.

  25. elizabeth

    I found it interesting that the Sudanese community seems to be more accepting of integrating traditional and western treatment of mental illness whereas the us (perhaps with the help of big pharm companies) seems bent on solving everything with a pill. It is frustrating to have to personally fight to get alternative therapies to compliment the numerous scripts that line my dresser drawer. The idea of a chemical imbalance is like the chicken and egg situation. In your studies of ptsd, you must have found that 2 people can go through the same thing and one will come out traumatized while the other will be fine. That leads me to believe that there are chemical pre-dispositions that make some more susceptible to being adversely affected by life events.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      I think most psychiatrist would agree with you. It’s a combination of predisposition and life events that often spark mental illnesses.

  26. elizabeth

    I agree with A.R.’s point that mental illness is *mostly* a psycho-social problem, but the patient is not always aware of the social aspect. The human mind has an amazing way of tucking things away to protect its owner; forcing the social issues to the front of the patient’s mind can have life-threatening consequences. removing stigma and the idea of being ‘defective’ is something that each person has to work on themselves. We cannot change society overnight; we can only work on changing on our own self-image. Lastly, I’m guessing it was your publisher who chose the title? I have yet to read the book, and i’m clearly not current on what’s pc, but like any sub-group, i don’t think it’s appropriate for someone outside of that group to use slang when referring to people w/in said group.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      No it was my title. As a journalist I’m almost always outside the group I’m writing about and I very rarely let the in-group prescribe the words I use. (That said I also strive not to cause needless offense.) As to your first point, my hope is not necessarily to make the case that mental illness is mostly psychosocial or mostly biological (or mostly genetic) but to make the point that these things are integrated in a way that they cannot be easily teased apart. We’ve recently been ignoring the psychosocial aspect of the creation and experience of these illnesses to the detriment of our understanding of them.

      • e™

        interesting. i don’t think the cause/effect of chemistry and events will ever be able to be deciphered, again like the chicken and the egg. the sad thing is that doctors push meds but don’t emphasize any other sort of therapy. we are fortunate in san francisco because there is more of an acceptance of integrating therapies. i currently volunteer to teach at-risk kids to sail. others teach hooping (v. therapeutic), yoga… a myriad of things. imo, this is far better than trial and error with medications on children. or even adults. overall i believe there needs to be a psycho-social-spiritual-physical integration of therapies. one cannot separate mind from body just as one cannot separate chemistry from incident(s). thanks for replying, and congratulations on your success.

  27. Elaine

    I find it odd that Western psychiatry tries so hard to fit mental illness into nice, neat little boxes. Ask any physicist (in my opinion, the greatest scientists around) how all that matter and energy stuff REALLY works, and they’ll tell you they don’t know. And THEY can “prove” an awful lot of what they study. There’s a reason psychiatry is the stepchild of the medical profession. It’s because the practice of it is worse than witchcraft.

    Seems to me that, while it’s clear that there is some scientific support for the “big three” of the mental illness diagnoses (depression, schizophrenia, and manic-depression), and it’s likely true that these illnesses used to be called “possession,” none of that rules out the possibility that there really IS such a thing.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      I agree. Most mental illnesses are still lacking a good understanding of their etiology. I’ve been told that the delay of the DSM-5 has had to do with the hope that genetic or biomedical advances will come up to speed to fill this gap in our knowledge. There is still good reason to have categories — critically so that those studying these disorders know when they are talking about the same thing.

  28. Carole

    I work with recent immigrants(postpartum mothers) from the Middle East (as a health care professional). I screen them for postpartum depression using the mood based Edinburgh Postpartum Depression Scale. I often initially get mystified looks from my patients when I introduce the idea of asking them some questions about how they feel in terms of mood. It seems that psychological well-being tends to be expressed somatically and in terms of spirituality. Nevertheless, after a period of time (I have the good fortune to be able to work with my patients for several months), they often warm to the notion of identifying their moods. They tell me their stories of severe social dislocation, and in so doing, I think find some relief of their often severe distress. Any thoughts?

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      I think your story is interesting but I would wonder why you feel it necessary to move patients from their way of describing the distress (somatic/spiritual) to your way of describing it (feelings/mood)? Is it necessary for your intervention to have them speak your language in this matter? I would also ask: Does the change in the patients language connect to a change in the experiences they are having? What are the consequences of those changes? These are meant as honest questions — not veiled criticisms.

  29. Mary Rutherford

    I heard your radio presentation, and you asked anyone to write to you about their experiences with spirit possession. I have been doing a healing technique called “Soul Retrieval” for over 20 years, and incorporate what I term “depossession” into the healing session. I have had some very specific “entities” come out of people, and they were able to go off their meds for “hearing voices.” I have written a script that I give people to direct the spirit to leave them. I have studied with Peruvian shamans for 17 years, and work as a chiropractor in my “day job”, though I don’t mix them!

    Another thought…I have never considered the people who have “entities” as being mentally ill, though they usually feel like it themselves, until the spirit is removed that is bringing them the crazy thoughts. The spirit of the person who is possessing them brings with it all the thoughts and feelings of the person whose spirit it is. This is quite confusing to the one possessed!

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      Interesting. I wonder if you could step back from your interventions and ask this question: Might your ministrations to these individuals have healing properties regardless of the truth or falsehood of the spirit possession story? Does the story we tell have to be real to be helpful? I’m not a believer in spirit possession myself but I’m fascinated by these questions.

      • I agree that the “story” surrounding the healing is unimportant, and I frequently do not tell the client that I have removed anything that I can describe. As a shaman, I have been trained in communicating with the spirit (that is in the client), but I do not necessarily think it helpful to tell the client about it. Some of my teachers think it is important to engage the consciousness of the client in the healing process, and others think that if you can heal an issue or past trauma without engaging the consciousness, all the better. I have worked both ways, and it seems to vary from person to person.
        When removing the spirit, I have “spirit helpers” that are also in the spirit world, who help bring the “entity” to the other worlds and remove them from the earth where they are stuck.

      • A.R

        Taking off on Ethan’s question on do the stories we tell have to be real ..i’d like to share some ideas from the book ‘Acts of meaning’ by Jerome Bruner.The main focus of the book is the centrality of narratives in human cognition.He touches upon the healing function of the narrative in psychoanalysis.One thing that he points out is that the cause of mental trauma is sometimes the inability of the patient to construct narratives of traumatic events.According to him,the psychoanalyst helps the patient to do so by going over events of his or her past. the reality of the story, according to Bruner,is immaterial as long as the narrative ‘makes sense’ to the patient. So, maybe if soul retrieval fits into the worldview or belief systems of the patient;it may help them heal.

      • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

        I agree with AR’s comments to a point. Having closely followed the recovered memory movement, I can tell you that the truth or falsehood of some therapy-created stories matter a great deal (particularly if they implicate loved ones in satanic child abuse as many recovered memories did). That said I do think that the sense of truth to a story often has meaning above and beyond its historical truth. Donald Spense’s book Narrative and Historical Truth also made that point eloquently.

  30. A.R

    i found this interesting website that critiques the biomedical approach to schizophrenia:

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      I don’t know any thing about this website but I this might be a good point to reiterate that I am not myself “anti-psychiatry.” Indeed the scholars that I profiled in the book (the heroes of the story, if you will) are mostly psychiatrist or mental health providers.

      • A.R

        i am not ‘antipsychiatry’ either but what I thought was interesting is he points to a lack of consensus about definitions of schizophrenia among textbooks of psychiatry as well as practitioners.

      • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

        Right. There is indeed disagreement out there on this issue.

  31. Carole

    My work with postpartum immigrants from the Middle East follows protocols required by the program’s funders, thus I must use a Western tool to assess for postpartum depression. In response to your excellent questions, I do think using a Western screening tool may result in my patients feeling even more social dislocation than they previously were. But I think there are other good effects. She is dislocated from her native country and support system and I cannot replicate that. But discussing moods seems to open the door to her thinking about her issues and framing her story in these terms. I think my patients and I learn a lot from each other. I try to adapt the work to what I learn from my patients as best I can within the protocols imposed. Thank you for your work.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

      That’s all very well said. In my book I’m dealing mostly with examples of western healers in other cultures. I do think you are right that if an immigrant comes to you in this culture you pretty much have to work with the tools you have at hand.

  32. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Ethan Watters

    Thank you all for the thoughtful comments. This will be the end of the discussion in this forum but I hope the ideas in this edition of The World and in Crazy Like Us go on to inspire many more conversations on this topic.

    My best to you all.

    Ethan Watters

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