"Crazy Like Us"
The origins and causes of mental diseases are two things that have been deeply studied by psychologists and neurologists for years. Though most psychologists tend to argue that mental diseases are things that transcend culture, such that specific neurological deficiencies or other disorders must have specific responses, Ethan Watters shows that that is probably a fallacy in his book “Crazy Like Us.” “Crazy Like Us” examines four places and their cultures, those places being Hong Kong, Sri Lanka, Zanzibar, and Japan. This book examines how these different cultures express mental disorders and how that expression differs from the rest of the world’s. What makes this book unique is that, for most of the cultures, it looks at how Western influences changed how these cultures expressed their mental distress. In other words, this book says that psychological disease is affected not only by problems in the brain, but also by culture, and by showing examples of why that is, Watters is redefining the ideas of how the brain works.
The first disease that Watters studies is anorexia in Hong Kong. Anorexia is largely defined as a disease in which girls, and occasionally boys, starve themselves because they believe that they are fat, even when that is not the case (3; 17). In Hong Kong, however, girls who were anorexic did not actually feel overweight at all (3; 17). As with the main woman being studied, Jiao, it is not so much that they want to starve themselves, they just don't actually feel any hunger-something that Americans are reported to feel despite their wiliness to starve themselves(3; 18). Additionally, though Americans starve themselves consciously without wanting treatment, the people in Hong Kong actually tended to grasp how terrible their situation was and took the steps required to get better (3; 27). To them, anorexia is more like having an impossible lump in the throat (3; 27). Finally, as in the case of Jiao, the anorexics in Hong Kong, unlike Americans, are not middle class perfectionists that are feeling the pressure to be better, but are generally in poverty and underachievers (3; 16). And yet despite all of these differences in their type of anorexia, both of these groups have the same result: they starve.
Watters explains that the reason for why they display the same disease in such different ways is because of culture. In America, striving to be thin is seen as important goal, so the disease makes sense there, but in Hong Kong, this was not the case, since heavier women were more valued (3; 22). The reason for anorexia was not as obvious, but a man named Dr. Lee, who dangerously tried to starve himself in order to find out a reason for anorexia, found an explanation that could actually apply to both cultures: starving yourself is a way of establishing control, and the high that it gives you leads to a sense of superiority (3; 23). This is something that both cultures value, and it would make sense that someone impoverished, like Jiao, would manifest her stress in an eating disorder that would have given her a ‘superiority high.’ These days, however, anorexia in Hong Kong is now defined more by the American standard. Interestingly enough, anorexia was once a rare disease, but after the death of Charlene Hsu Chi-yung, a girl who starved herself in order to be thin, the awareness of anorexia went up, and as a result, more and more people started to become anorexic (3; 41). As I stated earlier, all of these people had stress, but when they discovered the American form anorexia as an outlet, they became anorexic. With the growth of this idea of American anorexia, pop stars and teens started to starve themselves (3; 44) and the Hong Kong idea of anorexia all but disappeared. The American version even managed to change how anorexic people thought about themselves, and psychiatrists in Hong Kong started to believe that anorexia could be best explained by the symptoms that the Western world described. And because of that, the idea of anorexia in Hong Kong was forever changed.
As for Sri Lanka, the Western world fully expected Sri Lankans to show signs of PTSD after the devastating tsunami (3; 68). Depression and anger, among other negative emotions, were considered the only appropriate emotions to feel after something so traumatic, but the Sri Lankans did not readily express them, and to the westerners, this meant that they were in denial (3; 76). As with the case in Hong Kong, the people of Sri Lanka were clearly stressed, especially by the massive tsunami, but their methods for expressing it were completely different because of their different culture and value system. To Americans, the amount of devastation that the tsunami caused is unusual, but Sri Lankans, unfortunately, are familiar with poverty and devastation, so they are able to deal with it better and give it a more positive meaning (3; 88). Furthermore, Sri Lanka is heavily influenced by Buddhism and Hinduism, and those religions believe that pain and suffering are a necessary part of life, and that enduring though them will lead to a brighter rebirth (3; 89). They look at life differently, even to the extent where the greatest promise a mother could make to her son was not that they would be safe, but that they would die together (3; 93). Therefore, they do not feel the emotional trauma that westerners tend to feel when something like a tsunami happens.
Interestingly enough, according to Watters, Sri Lankans express their distress more in the form of physical symptoms (3; 91). People who lost family members complained about back pain rather than the symptoms of depression (3; 91). This changed, however, when the psychologists from the west decided to come and ‘help’ the Sri Lankans so that they could deal with the PTSD they weren’t expressing, because to the west, they appeared to be bottling up all of their emotions (3; 76) and were in denial. These psychiatrists went to educate the Sri Lankans in the appropriate symptoms of PTSD, telling them that they should feel distress, anger, and depression (3; 106). As a result, some in Sri Lanka, especially children, are beginning to feel PTSD, and as one person expresses, it is hard to know if they are making it into a subconscious problem, such that they are fooling themselves into playing a role because they are told that that is how it has to be (3; 122). Because of this, many Sri Lankan psychiatrists are being told how to deal with PTSD as westerners know it, and not how the Sri Lankans see it, preventing them from helping the Sri Lankans and their own symptoms. As a result, it seems likely that this new notion will end up sparking violence, because that is the reaction that they are taught to have for PTSD (3; 125).
The west and other cultures often have different symptoms for disorders, but it is often the different treatments that can change the way a certain disease progresses. A perfect example of this is how schizophrenia differs between those in the west and those in Zanzibar (3; 127). It’s a bit surprising, but when it comes to schizophrenia, those in developing countries often do better than those in the developed ones (3; 128). Though both of the groups tend to have the same symptoms of hearing voices, it is the people in developing countries that relapse the least and ‘get over’ the disease the best (3; 153). The reason for this is due to people in the west not being able to properly accept their relative’s disease and people in Zanzibar being willing to do so. Suffering, such as having a family member with this disease, is considered a gift given by God, and only those who are thought to be strong must endure it. In a way, it’s a compliment (3; 155). On the other hand, westerners tend to run too high on emotion when a family member is schizophrenic. The families of the schizophrenics would often criticize them or act hostile, or would often want to be pitied or thanked for their own sacrifices (3; 153). This stress on the schizophrenic person prevents them from successfully recovering. The way the culture of Zanzibar approaches the idea of schizophrenia is healthier. The west assumes that schizophrenics have brains that are ‘broken’ (3; 173), which means that people can never recover from the disease; Zanzibar does not take this approach, people are never considered broken. The idea of brokenness, or some kind of chemical imbalance or ‘wrongness’ is considered dehumanizing (3; 177). As with Sri Lanka, the introduction of the western ideas makes it harder for these people to recover (3; 179). When they think of the disease as being a spirit, one that can be expelled and not be there as a constant biological disorder, they recover more easily than those in the west, whether it be through ritual or prayer (3; 185).
Depression, or at least depression as a disease, was not known to the Japanese until the introduction of it from western culture (3; 187). The Japanese were certainly able to feel sadness, but having a frequently occurring disease that involved depression was unheard of; Japan tended to think of sadness as a respectable trait. Nevertheless, western drug markets wanted to figure out how to sell to Japan, so as a result, they tried to figure out how to sell the condition of depression (3; 193). For example, in Japan, suicide is seen as something people do for honor and respect. The west however, sees it as a sign of depression (3; 205) and by perpetuating this idea, they tried to indicate that Japan, because of its high suicide rate, must be extremely depressed. What tended to depress the Japanese and the west, however, were very different, as seen through word association experiments (3; 209). Americans tend to associate depression with things like moodiness and erratic emotions, where as the Japanese associate it with things like disease or exams. In other words, the Americans see depression as an internal problem and the Japanese see it as an external problem (3; 210). Therefore, western drug companies tried to express it as something internal, they wanted this form of emotion to be something that everyone would feel so that they could sell drugs based on that feeling (3; 212). As they influenced Japan with this idea, more and more people became chronically depressed, to the point where it became overwhelming to the Japanese therapists, who never experienced people coming in to say that they were chronically depressed before. With the introduction of drugs that could change or improve one’s mood for anyone experiencing depression-like symptoms (3; 226), depression actually went up, and the amount of depressed increased every month (3; 227). The west managed to create chronic depression in Japan, something that did not seem to exist there before.
As Watters is showing, genes and hormones are not the only thing that affects the individual, but life-experiences and culture can affect them as well (1). Each culture sets up a list of behavioral expectations, and based on those expectations, people are supposed to live up to a set of standards (2). They express diseases in a certain way because that is what they are told are the appropriate responses (2). The constant influence of our surroundings forms our ideas of how we should act in certain situations, such as when we are distressed (1). It is not always something we think about consciously, because cultural standards are something that have been taught since birth. It is something that is deeply etched into the society, even to the point where it is in the language. In Japan, for example, the word for depression did not exist as we understand it, it had to be coined (3; 209). Clearly there are several possible outputs-the forms diseases take-for the same disorder. There isn’t just one right answer (1). Therefore, culture heavily influences how our brain forms (2) and develops, which in turn creates the individual.
As Watters shows, with the introduction of the western ideas of how mental diseases should be expressed, the expectations changed. People were told to express their problems and stresses in different forms, and because of that, they, for the most part, lost their old form of expression and developed the western version. Again, in Japan, the Japanese only had the word ‘yuutsu,’ which means gloominess, in order to express the idea of depression. The term to describe medical depression was created and modified after the introduction of western ideas (3; 209). A change in language signifies a change in culture. The environment that people were thrown into changed, and because of that, so did their language, culture, and diseases. They were told that a different output was required for their disorder, so without realizing it, they modified it in order to meet societies’ new expectations.
Personally speaking, I think that Watters makes a very convincing argument, and one that I have never thought about before. Before this class and before this book I was very firm in the idea that certain disorders, brain disorders included, had very specific symptoms. “Crazy Like Us” showed me that that is not the case; culture is just as important as genetics when it comes to mental disorders. It also made me realize that the west should not promote its ideas about mental health as vigorously as it is, because that itself is creating disease. Rather than that method, psychiatrists should learn how to treat mental diseases within the context of their own cultures. I believe that this would promote better mental health for all. Finally, I would recommend this book to anyone who is interested in culture and its relation to mental diseases. It is not only an easy read, but it is also full of information, and more importantly, is an interesting book.
1) Biology 202 Spring 2010 Notes, on the Serendip Website, http:// serendip.brynmawr.edu/exchange/courses/bio202/s10/notes2; accessed 6 May 2010
2) McDermott, R., & Varenne, H. (1995). Culture as Disability. Anthropology and Education Quarterly, 26, 323-348.
3) Watters, E. (2010). Crazy Like Us. New York, NY: Free Press.