The Americanization of Mental Illness

Introduction

(1) Americans, particularly those who are left-leaning and college-educated, express concern about the nation's interventions in other cultures. It has become common to criticize American cultural imperialism through references such as the fast-food chain McDonald’s near Tiananmen Square or Nike's factory presence in Malaysia. However, amidst all this self-critical perspective, a significant yet often overlooked phenomenon has emerged: the Americanization of global perceptions of mental health and illness. The trend points towards a homogenization of how mental illness is understood worldwide.

The Impact of American-led Globalization

(2) This unsettling notion arises from new investigations conducted by a collective of anthropologists and cross-cultural psychiatrists. These experts maintain that mental illnesses do not function as distinct entities, like a virus, but rather are shaped by the cultural context of particular times and places. Research indicates that the form, prevalence, and experiences of mental illness have historically varied across cultures. For instance:

In certain Southeast Asian cultures, men may experience 'amok,' characterized by violent rage followed by amnesia.
Another condition in this region is known as 'koro,' where men fear that their genitals are retracting into their bodies.
Meanwhile, in the Middle East, 'zar' relates to spirit possession, manifesting as dissociative episodes filled with laughter and singing.

(3) This cultural variation extends across time as well. Philosopher Ian Hacking, in his work "Mad Travelers," documents historical phenomena such as the 1890s fugue state, where European men would walk long distances in a trance-like state with no memory of their identities. Additionally, he refers to the hysteria that afflicted many middle-class women in the late 19th century, illustrating various spatiotemporal cultural contexts surrounding mental distress.

Cultural Symptom Repertoires

(4) Edward Shorter, a medical historian, introduces the concept of a “symptom repertoire,” suggesting that different eras possess varying physical symptoms available for psychological conflict expression. For example:

Symptoms such as convulsions or leg pain may have been more prevalent in past epochs.
In later periods, abdominal pain and false body weight perceptions may become more common symptoms for conveying psychological distress.

(5) The professionals addressing mental illness—be they doctors, shamans, or priests—play a role in determining which symptoms are recognized as legitimate at any given time, thus reflecting the influence of prevailing cultural and scientific paradigms.

Western Influence in Mental Health

(6) For over a generation, there has been a concerted effort by Western nations to disseminate their mental health paradigms globally, grounded in scientific belief that these understandings reflect the biologically based nature of psychological suffering. (7) However, while promoting this perspective, the West has inadvertently exported its symptom repertoire, thereby altering not only treatment methods but also the manifestations of mental illness across diverse cultures. Disorders such as depression and post-traumatic stress disorder are spreading widely, becoming the universal language of human suffering, supplanting indigenous interpretations of mental health.

Case Study: Anorexia in Hong Kong

(8) Psychiatrist Dr. Sing Lee documented a culturally specific form of anorexia nervosa in Hong Kong during the late 20th century. Distinct from American presentations of anorexia, his patients did not engage in intentional dieting nor predominantly express fear of fat; their complaints were largely somatic, often articulating discomfort with feelings of bloating.

(9) This understanding changed dramatically following a tragic event in 1994 when Charlene Hsu Chi-Ying, a teenager suffering from anorexia, died on a street in Hong Kong. This event grabbed media attention and led to the mimicking of American diagnostic criteria in local publications.

Transformation of Anorexia Presentation

(10) Following Charlene’s death, the conceptualization of anorexia in Hong Kong underwent a profound shift, with local experts adopting definitions from Western diagnostic manuals. Dr. Lee, who once observed a few new cases annually, soon saw the numbers rise dramatically to several new cases monthly by the late 1990s.

(11) By 2007, approximately 90 percent of Lee's patients reported fat phobia as their driving concern, contrasting sharply with the earlier expression of anorexia related to somatic symptoms.

The Role of Culture in Mental Illness

(12) Dr. Lee emphasized the need to note how the expectations and beliefs of individuals suffering from mental health issues influence their experiences. He noted, “Culture shapes the way general psychopathology is going to be translated partially or completely into specific psychopathology.” The contemporary cultural atmosphere can trigger individuals to adopt mental health pathologies aligned with prevalent discourse when there is widespread acknowledgment and discussion of disorders like eating disorders.

(13) Globalization exacerbates this phenomenon, facilitating the cross-border transference of symptom repertoires. Dr. Lee, trained in Western countries, recognizes the overarching influence of Western perspectives on mental illness. (14) In the U.S. and the West, official categories for mental diseases are established and propagated through influential diagnostic manuals, which have become globally recognized standards.

(15) As a result, the intricacies of individual cultural experiences are often lost as Western categories supersede local understandings. It questions whether anorexia would have rapidly integrated into Hong Kong's cultural framework without the Western model.

The Western Medical Model and Stigma

(16) The notion that Western mental health paradigms shape the expressions of mental illness in disparate cultures receives little attention in professional discussions. Many believe the scientific rigor of Western approaches allows them to transcend cultural influences. (17) Current advancements—such as neuroimaging techniques and genetics—further bolster this confidence.

(18) Modern practitioners tend to view past psychiatric practices with disdain, presuming that cultural biases led to misguided understandings of mental illness, while they regard the DSM-IV as primarily an instruction manual for universally applicable psychological conditions.

(19) The widespread assumption in the West posits that mental disorders, such as those recorded in the earlier DSM definitions, are cultural constants, existing beyond the domain of cultural shifts. (20) Consequently, this perspective undermines how the narrative and cultural context of a disorder can shape professional diagnoses and the experiences of those affected.

Common Psychological Triggers

(21) Although mental illnesses can stem from various universal causes—like trauma and biochemical imbalances—the interpretation of these illnesses remains deeply influenced by cultural narratives and expectations. Various mental conditions, such as depression and schizophrenia, persist as susceptible to cultural interpretations, illustrating that understanding these conditions necessitates higher contextual awareness of the host culture's narratives, meanings, and prejudices.

Consequences of Exporting Western Mental Models

(22) The propagation of Western biomedical knowledge was intended to enhance global mental health literacy. Over the past fifty years, cultures globally have become more familiar with Western concepts of mental disorders. (23) The aim was to distance mental illness from supernatural narratives and stigma, to depict it as a biological ailment beyond personal control. However, the actual effects of framing mental illness within a biomedical framework may increase stigma.

Research Findings on Stigmatization

(24) In 1997, Sheila Mehta from Auburn University Montgomery conducted an experiment to determine how psycho-social and biomedical explanations affected attitudes towards individuals with mental illness. Participants were led to believe their partner in an experimental task had a mental illness due to either psychological trauma or a biological disease.

(25) Mehta's findings indicated that those who received the “brain disease” explanation reacted more harshly with increased severity in their feedback. (26) She concluded that the biomedical narrative subtly promotes a perception of individuals with mental illness as fundamentally broken and distinct from the rest of society.

Global Trends Following Western Models

(27) Outside of controlled studies, a parallel phenomenon occurs globally, indicating a push towards a biomedical framing of mental health. Across cultures, people increasingly attribute mental illness to chemical imbalances and genetic factors. (28) Despite the global shift towards biomedical models, the stigmatization of mental illness persists and, in many cases, has worsened.

Describing Schizophrenia Through Cultural Lenses

(33) Schizophrenia presents a telling example of the cultural influences on mental health. Recent studies indicate that individuals with schizophrenia in developing countries tend to show improved long-term outcomes compared to those in industrialized contexts. (34) These findings are puzzling given that advanced medical technology is more accessible in wealthier nations.

Case Study: Zanzibar

(35) Anthropologist Juli McGruder's work in Zanzibar explored the perspectives surrounding schizophrenia, finding that local cultural beliefs regarding spirit possession often provide supportive interventions for individuals. (36) Rather than being stigmatized, these culturally grounded beliefs involve the community in care provisions, embracing those suffering from mental distress.

(37) McGruder identified ways these practices help manage symptoms and prevent isolation, allowing individuals to remain integral members of their communities.

The Complexity of Mental Illness Interactions

(38) Interactions around mental illness are complex; emotional responses from family are linked to higher relapse rates among individuals diagnosed with schizophrenia. In one study, around 67% of white American families exhibited “high expressed emotion” (EE) traits towards their mentally ill members.

(39) This means that American families often express higher levels of criticism, reflecting a notable cultural understanding of personal responsibility that may differ from other traditions. (40) Thus, Americans often apply individualistic frameworks to their understanding of mental illness.

Global Perspectives and Outcomes of Mental Illness

(41) Contrastingly, cultures with more interconnected views might foster better support structures for individuals facing mental illness by maintaining lower EE levels, emphasizing the communal identity over individualism.

(42) Although psychopharmacological advancements should be accessible globally, they should not obscure the underlying cultural paradigms shaping mental experiences.

The Cultural Context of Mental Illness

(43) Cross-cultural observations reveal that the Western conception of mental illness incorporates specific cultural assumptions regarding human nature, event attribution, and emotional expression. The narratives shaped by these assumptions may be regarded as universally valid despite their cultural specificity.