The Americanization of Mental Illness

Until recently, people went mad in culturally specific ways -- running amok in Malaysia, partial paralysis in Victorian Europe, raving under the full moon in medieval Europe ("lunacy"). Over the past few decades it seems that crazy people the world over have changed their behavior, and now they conform to the categories of the DSM-IV even in rural India. Or at least that how doctors diagnose them and newspapers describe them; it is always hard to know what severely impaired people experience themselves. Long article on this by Ethan Watters in the NY Times, from which I derive this tidbit on how self-starving has changed in Hong Kong:

Western ideas did not simply obscure the understanding of anorexia in Hong Kong; they also may have changed the expression of the illness itself. As the general public and the region’s mental-health professionals came to understand the American diagnosis of anorexia, the presentation of the illness in Lee’s patient population appeared to transform into the more virulent American standard. Lee once saw two or three anorexic patients a year; by the end of the 1990s he was seeing that many new cases each month. That increase sparked another series of media reports. “Children as Young as 10 Starving Themselves as Eating Ailments Rise,” announced a headline in one daily newspaper. By the late 1990s, Lee’s studies reported that between 3 and 10 percent of young women in Hong Kong showed disordered eating behavior. In contrast to Lee’s earlier patients, these women most often cited fat phobia as the single most important reason for their self-starvation. By 2007 about 90 percent of the anorexics Lee treated reported fat phobia. New patients appeared to be increasingly conforming their experience of anorexia to the Western version of the disease.

The point is not that mental illnessses are not real; the point is that how they are experienced by both doctors and patients depends a great deal on how they are understood. If you are raised to believe that obsessive thoughts represent the assaults of a demon, you will experience your obsessive thoughts differently and fight against them differently than if you believe they are the result of childhood trauma, or a neurotransmitter imbalance. It seems that some teenage girls and young women starve themselves to death in a variety of cultures. In medieval Europe they experienced their food revulsion as a longing for heaven and some are now venerated as saints. Today they speak of their horror of being fat. I don't believe we really understand the underlying causes of this syndrome, but I suspect the brain circuitry involved is very similar.