The Americanization of Mental Illness

The New York Times writes that the Americanized view of mental illness, which minimizes locally and culturally defined terms and symptoms in favour of a "melting pot" of universalized, scientifically knowable and defined disorders, has begun to colonize the world:

In any given era, those who minister to the mentally ill -- doctors or shamans or priests —- inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.

That is until recently.

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders —- depression, post-traumatic stress disorder and anorexia among them —- now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.

Privileging an understanding of mental illness as something biologically rooted minimizes a fuller and more nuanced understanding of the disease as it relates to cultural expectations, daily living arrangements, and the way in which a person may express themselves to others. Depending on the social context, such communication may be variously appropriate or inappropriate, recognized or unrecognized, legitimate or illegitimate, normal or bizarre. As the article notes, "a mental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions -— the idiosyncratic cultural trappings -— of the mind that is its host." The importance of culturally-specific understandings of mental illness is detailed in the article, ultimately concluding that "As Western categories for diseases have gained dominance, micro-cultures that shape the illness experiences of individual patients are being discarded.”

Adopting a cross-cultural and locally contingent appreciation of mental illness is a powerful reminder that the bio-medical model, which seeks to locate a specific biological disorder for mental expressions that are innately human, is as likely to confound the opportunities for recovery as it is to support it. And further, that prescribing a pill is no silver bullet or easy solution.

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