U.S. exports its mental illnesses

Ethan Watters

TEXT OF INTERVIEW

Kai Ryssdal: Almost any place you go in this world you can find a little slice of America. Because we export virtually every part of our culture -- television and movies, fashion, music and food. In his new book, "Crazy Like Us," author Ethan Watters makes the case that we export our mental illnesses, too. Ethan, welcome to the program.

ETHAN WATTERS: Thank you so much for having me.

Ryssdal: Mental illness seems a very personal thing, I guess, to be exporting to other countries. How does that work?

WATTERS: Well, it's interesting, cultures shape the experience of mental illness. Whether you talk about depression, or something like PTSD, how we think about it, and how we treat it actually shapes the experience itself. So when we, as the globalizing culture in America, export our notions of mental illness in terms of how we treat it, and how we think about it, we are inadvertently shaping those illnesses as well. And what we are doing by exporting our notions of mental illness around the world is we're homogenizing the way the world goes mad.

Ryssdal: And it's your theory that it's the drug companies that are doing this.

WATTERS: Certainly that is one of the key forces. In the book I tell the story of how GlaxoSmithKline took Paxil to Japan at the beginning of the century. They began to gather this knowledge about how to change Japan's notions of depressions. They even enlisted some of these cross-cultural psychiatrists who understand how culture shapes mental illness. They enlisted them in the process. And they taught them to change that idea of states of melancholy can be almost transcendent states of being into this idea that states of melancholy were a mental illness. And bam, they had a tremendous market for their drug. And they're now selling a billion dollars worth of Paxil a year.

Ryssdal: This is kind of a bald thing to say, but if you try to remain value neutral about this, it makes economic sense for these drugs companies, some of which are American, some of which are British, some of which are European, makes sense for them to try to explore other markets, right?

WATTERS: Oh absolutely. And you know the book documents how these executives of these companies talk about the evolution of other cultures. So they talk about China being 10 years behind Japan, and Japan being five years behind America, and they become very good at going from culture to culture, changing notions of sadness, for instance, into ideas of depression. And they assume that we're at the head of the evolutionary tree and that other cultures need to become more like us.

Ryssdal: You know, you note fairly early on in this book that it's the American psychiatric and mental health community that actually, literally, writes the book on mental illnesses that are used around the world. The DSM, it's called.

WATTERS: Yeah, the DSM, the current edition is the DSM-IV. And it's an enormously influential book in the world of psychiatry, and people think of it as sort of the field guide to the human psyche. Unfortunately, what cross-cultural psychiatrists and medical anthropologists have to say about this is that these are actually culturally shaped illnesses that you find in the DSM. And that those don't apply to everywhere in the world. And the trick is if you go to another culture with the DSM, and you're looking only for the symptoms, say with post-traumatic stress disorder, you're likely to find a cluster of those symptoms, but it keeps you from looking at the broad spectrum of, say, a psychological reaction to trauma.

Ryssdal: I was struck to read that your wife is a psychiatrist.

WATTERS: My wife is a very good psychiatrist. So I'm not in a blanket way against the use of these drugs. Certainly to the extent that they can relieve suffering, they should not be denied to the rest of the world. My case is that we need to understand the cultural ideas that come with them, the ideas of the human self, the ideas that shape these expressions of these illnesses, and understand that we can perhaps share our medical knowledge without imposing our cultural ideas about the human mind. Because we erase the diversity of the world's understanding of the mind I think to our peril.

Ryssdal: Ethan Watters. His new book is called "Crazy Like Us: The Globalization of the American Psyche." Ethan, thanks a lot.

WATTERS: Thanks for having me.

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