Book Review

Crazy like us: the globalization of the American Psyche

By Ethan Watters

2010, Free Press

Forget junk food, forget obesity – the most devastating health-related export from the USA is psychiatry, according to Ethan Watters. 

From depression in Japan to schizophrenia in Zanzibar (two of the topics given chapters in the book), American definitions, diagnoses and – overwhelmingly – treatments are swamping the world and changing the way we look at mental health. And not for the better.

Dr Rupert Whitaker, from the House Partnership, finds this an important book: ‘Watters explores the links between culture and mental illness, raising awareness of the commercial underbelly of western psychiatry.’

‘Mental illness has become a commodity, with all the different conditions, and the treatments the pharmaceutical companies have developed to match them – they’re all packaged, branded and marketed like any other consumer product, and exported round the world for sale.’

It’s a form of American cultural imperialism, and imposes inappropriate diagnoses and interventions on other cultures, creating more trouble than it alleviates. ‘The book tells us to be wary of research,’ says Rupert Whitaker, ‘especially research supported by the pharmaceutical industry. We should be skeptical and critical, because research does not necessarily reveal what it’s said to reveal, and the questions asked by research are not necessarily the ‘right’ ones. The basic purpose is to sell pills.’

In one example, Sri Lanka after the tsunami of 2005, Watters reports how an influx of Western trauma counsellors unwittingly managed to crush local culturally-bound expressions of grief, and interfered with healing.

In Hong Kong, he discovers an epidemic of US-style anorexia nervosa. – and elsewhere he reveals how the industry succeeds in marketing new pathologies alongside the drugs to treat them.

He explains it by describing how our cultural (Western) fascination with a disease, or a syndrome, or a 'disorder', leads to sometimes huge publicity being granted to it – and, lo and behold, many new sufferers are then discovered. Watters says this attention actually creates an increase in the incidence of the same disease – not a comfortable or popular idea among professionals or health educators, who don’t want to be seen as ‘transmitters’ of the condition they’re trying to eradicate. The whole process is nurtured by the psychiatric and pharmaceutical industries – because where there’s 'mental disorder', there’s money. Lots of it.

He’s especially convincing on the whole phenomenon of anorexia, and eating disorders generally – and describes how these conditions have become attractive, and that the work of eating disorder experts might actually be counterproductive. 

It’s a shocking, awareness-raising account, with plenty of supportive and highly convincing evidence, accessible and rewarding to any general reader with an interest in mental health.