The idea that Western psychiatry has imperialistically exported its syndromes is well established in anthropological discourse. Among psychiatrists the notion remains controversial, as many hold the view that culture may shape psychiatric disease presentation, but underlying disorders remain the same.
This provocative book by journalist Ethan Watters is an exploration of the anthropological viewpoint, arguing that alongside the globalisation of American culture there has also been an Americanisation, often through the influence of DSM–IV, of the understanding and treatment of mental distress, which is changing the very nature of mental illness abroad.
Watters's argument takes shape by way of case studies. He examines the emergence of anorexia in Hong Kong, the treatment of post-tsunami psychological distress in Sri Lanka and the increased diagnosing of depression in Japan, finding that scant consideration was given in these cases to the appropriateness of applying an American model of distress to a non-Western society. A common theme is that of foreign ‘experts’ introducing their knowledge to a population that is seen as psychologically primitive. The book calls this primitiveness into question, especially when examining schizophrenia treatment in Tanzania, where outcomes are considerably better than in America.
Some of Watters’ targets provide rich focus for discussion. In Sri Lanka in particular the book's account of rival research groups scheming to recruit to their own specific brand of post-traumatic therapy is alarming and the concerns raised reflect those held by many psychiatrists. The chapter on depression might be better served by a more in-depth approach. As there is little space given to arguments opposing those this book favours, Crazy Like Us is more polemical than analytical. However, anyone who surmises that Watters has an agenda hostile to psychiatry will be intrigued by an admission that his wife is a psychiatrist.
Some may strongly disagree with this book's challenges to the assumption that Western frameworks can generate a universally valid knowledge base. The focus is on America, but the book is sufficiently universal to interest a European reader. It is worthy of purchase for anyone, psychiatrist or lay reader alike, interested in the disagreements between anthropology and psychiatry.
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