January 14, 2010

Everyone Goes Crazy In A Different Way, As Long As That Way Is The Same

confused chinese.jpg
"yeah, everyone in America is so fake"

The NYT writes The Americanization of Mental Illness:

In some circles, it is easy to make friends with a rousing rant about the McDonald's near Tiananmen Square, the Nike factory in Malaysia or the latest blowback from our political or military interventions abroad. For all our self-recrimination, however, we may have yet to face one of the most remarkable effects of American-led globalization. We have for many years been busily engaged in a grand project of Americanizing the world's understanding of mental health and illness.

The article cites the experiences of a Chinese psychiatrist in the 1990s who tried to explain the culture specific ramifications and meaning of anorexia in Chinese patient:  not a fear of being fat, but a vague feeling of GI distress.  This was some unconscious manifestation, a somatoform disorder.

Then a woman passed out and died from anorexia on a subway:

In trying to explain what happened to Charlene, local reporters often simply copied out of American diagnostic manuals. The mental-health experts quoted in the Hong Kong papers and magazines confidently reported that anorexia in Hong Kong was the same disorder that appeared in the United States and Europe.

What happened next seemed to surprise the psychiatrist: not only did anorexia rates start to  rise, but no longer was it due to the vague GI distress.  These new anorexics specifically cited "fat phobia" as the core. 

Western ideas did not simply obscure the understanding of anorexia in Hong Kong; they also may have changed the expression of the illness itself.
Dr. Lee surmised that because the language to describe anorexia came from America, then

When there is a cultural atmosphere in which professionals, the media, schools, doctors, psychologists all recognize and endorse and talk about and publicize eating disorders, then people can be triggered to consciously or unconsciously pick eating-disorder pathology as a way to express that conflict.

There are two points to ponder: first, what are we to do with the genetic basis if the incidence of a disorder jumps so suddenly?

Second, and more importantly: if Chinese people are being nudged into developing western style diseases because they are being bombarded with western psychiatric descriptions, then what do you think happens to western people? 

That feeling you have is what Sartre called nausea.  Seroquel won't help.


The article, through Dr. Lee, blames the usual suspects:

Mental-health professionals in the West create official categories of mental diseases and promote them in a diagnostic manual that has become the worldwide standard. American researchers and institutions run most of the premier scholarly journals and host top conferences. Western drug companies dole out large sums for research and spend billions marketing medications for mental illnesses... Taken together this is a juggernaut that Lee sees little chance of stopping.

In this case the problem isn't psychiatry, it is the popularization of psychiatry: it is the press, it is the media. She didn't read the DSM, she read the newspaper (and magazines and TV and...)  They're not simply popularizing western psychiatry, either-- they're popularizing western culture.  It's a safe bet that "local reporters" are going to be more westernized than "locals."  But reporters have a forum, so they get to determine the narrative.  The "local reporters" in China basically did what the American press does: "here's what we think happened.  Hit Print.  There, now it's true."

When Google threatens to pull out of China, it isn't because of human rights violations.  It's a battle for who will describe the universe.  NB: Google will win.


The article describes an experiment that could be called, "You rise to the level of your diminished expectations."

A subject tried to silently train a second person to press some buttons in a specific order.  He is told that the second person had a psychiatric disorder either due to "life events" or to a "brain disease."  The only feedback they could give was to administer a very mild shock, or a very big shock, when the second person got the pattern wrong.

When the subject was told that the second person had a psychiatric disorder due to life events, they got the mild shock.  When it was due to a brain disease, they got the big shocks.  If there is already something wrong with their brain, the subject figured he had to make things obvious.

The point of this example was to illustrate that other cultures may end up stigmatizing the mentally ill if they begin to incorporate the Western idea that these are strictly brain diseases.  Too late: incorporating the western idea was what gave them the disease in the first place.  Seroquel won't help that either.


"You have a background in genetics.  How can you flippantly say that ideas are causing psychopathology?"

The interaction of genes of risk with other genes that we have not yet identified-- say, an insulin receptor or the size of your pancreas or your ability to fight a flu infection-- that we wouldn't even think is relevant, may be quite relevant.  Most of our psychiatric genes of risk are risks only in certain environments.  That may seem obvious, but consider that a person with schizophrenia, in which the mind has difficulty with reality, may be even more ill when their reality is actually less real: a Chinese teen in China saturated with western images. Perhaps if he never turned on the TV, he never would have developed the symptoms (or they would have been less.)   The Japanese hikikomori phenomenon may be an example.

Go back to the story of the Chinese anorexic woman who died.  The article doesn't point put the obvious: she had already been infected by the west.  Her name was Charlene.

Certainly I don't hate the west; but when you dip your feet into someone else's culture without the accompanying mental and social infrastructure that goes with it, well, you're going to get anorexia.  Or something.