Great article by Ethan Watters in the New York Times last Friday, called The Americanization of Mental Illness, which deals with questions at the heart of cross-cultural philosophy. (Watters also has a book on the subject coming out, and a blog.) The article notes how “mental illness” remains a category far more culture-bound than psychological studies are typically willing to admit. The DSM, American psychologists’ scripture, has a seven-page appendix (pp. 897-903 in the DSM-IV-TR edition) for “culture-bound disorders,” such as amok (a condition in Malaysia where men get violently aggressive and then have amnesia) or pibloktoq (an Inuit condition involving a short burst of extreme excitement followed by seizures and coma). It’s telling that few of the disorders in this section are culture-bound to the United States; and those which are, are quite telling: “ghost sickness” is “frequently observed among members of many American Indian tribes”; locura, nervios and susto are found among Latinos; sangue dormido is found among Cape Verde Islanders and their immigrants to the US; “rootwork” and “spell” are “seen among African Americans and European Americans from the southern United States.” That is, the only “culture-bound disorders” to be found among white Americans are found among those weird Southern hillbillies who live beside black people. Normal white Americans, the kind who live in Cambridge, MA or in Manhattan, don’t get “culture-bound disorders.” Their disorders are just part of the universal human condition.
Or are they? Consider a mental disorder one might expect to find frequently among white Manhattanites: anorexia nervosa. Watters examines the clinical research of Hong Kong psychiatrist Sing Lee. In the late 1980s and early 1990s, Lee examined a number of patients who refused food like anorexics did, but did not see themselves as fat, nor did they diet intentionally. Rather, the patients had “somatic” complaints, feeling that their stomachs were bloated. This rare pattern was the prevailing form of anorexia in Hong Kong – until the Hong Kong media reported a teenage girl dying of anorexia in 1994, and gave context on anorexia out of Western manuals like the DSM. After that, Lee started seeing more anorexic patients appearing – and they followed the Western pattern of believing themselves fat. The “universal medical condition” documented in the DSM had not appeared in Hong Kong until now.
This sort of pattern provides great fodder for the social constructionists in the Western humanities. When one is immersed in the humanities today it’s easy to assume that the default position is a cultural relativism that assumes the absence of cultural universals. But cross the quad to the psychology building, and one can discover a startlingly naïve cultural universalism that confines everything outside Western white experience to a brief appendix.
There are many lessons to be taken from Watters’s article, and I can’t begin to address them all here. The one that stands out for me is Robin Horton’s point that non-Western cultures have a great deal to teach us about psychology and sociology, and not only in the long-literate “great traditions” of South and East Asia. Especially, their supernatural explanations of (what we usually call) mental illness can be far more humane than our medical models. Anthropologist Juli McGruder noted in her studies of Zanzibar: behaviours that the DSM would easily classify as schizophrenia, are classified in Zanzibar as examples of spirit possession, and treated accordingly; and while Zanzibari rituals don’t return the individual to a “normal” state, they nevertheless allow the individual to remain within a caring social environment, and allow a kind of “calmness and acquiescence” (patient endurance, I might call it) in the face of the unusual behaviour.
It’s not hard, then, to see that there’s something very wrong with psychological diagnosis in the West – which becomes psychological diagnosis everywhere, as it gets exported. On the other hand, it’s also worth asking what’s right with it. While the Zanzibaris might have a more effective way of dealing with the behaviours in question, those behaviours do still seem to have something in common with schizophrenia. The case of anorexia is still more intriguing. The behaviour of starving oneself to death is common to thin-obsessed Manhattanites, Hong Kongers complaining of stomach bloat, and the philosopher Simone Weil, who starved herself as an ascetic attempt to transcend the world. Could there not be something these differently interpreted behaviours have in common? If Manhattanites have something to learn from Zanzibaris, surely the reverse can be true as well.