Crazy Like Us: The Globalization of the American Psyche
By Ethan Watters
Free Press, 2010. 306 pgs, $26.00 (hardcover)
Reviewed by Katinka Hooyer (University of Wisconsin-Milwaukee)
Over the last decade, the globalization debate has become as much a part of the public as the academic sphere, with research journalists contributing greatly to the shaping of public opinion. While talk about the effects of fast food and offshore manufacturing can be heard in any Starbucks, less attention has been devoted to the globalization of science, or export of ideas. In Crazy Like Us, Ethan Watters moves beyond a cultural commodities focus to address the homogenization of modern theories and treatments surrounding mental illness. This ‘globalization of the American psyche’, he argues, is the most dangerous of North American exports. We should care because this homogenization of well-being and healing contributes to the loss of diversity of different understandings surrounding mental illness. Comparing this to the loss of biodiversity’s medicinal compounds, Watters’ main concern is that these cultural variations and beliefs about how to achieve mental health may disappear before we can identify their value (p.7).
Essentially a survey of case studies, Watters’ meta-analysis deftly translates the complex work of scholars into accessible narratives, conscientiously weaving in the major anthropological premises on which he bases his argument. First, that illness is culturally shaped and its expressions are socially normative and second, that the creation and universalizing of disease categories shape how mental illness is experienced over time.
Watters spent a year abroad collecting data, travelling from China to Tanzania, relying almost exclusively on the research of anthropologists and transcultural psychiatrists. He chronicles four diseases from four different countries, profiling the work of experts: the rise of anorexia in Hong Kong (Sing Lee, Jenny Ng, Edward Shorter); the introduction of PTSD therapy in post-tsunami Sri Lanka (Gaithri Fernando, Alex Argenti-Pillen); the shifting treatments of schizophrenia in Zanzibar (Juli McGruder); and the mega-marketing of depression in Japan (Lawrence Kirmayer, Kalman Applbaum, David Healy, Junko Kitanaka). Each vignette illustrates the varying ways in which Western ideas of mental illness get infused into local belief systems, and ultimately how they undermine local idioms of distress, strip away peoples’ cultural narratives and beyond just being ineffective, have the real potential of doing harm.
As an example, in the section on trauma counseling in post-tsunami Sri Lanka, Watters focuses on the work of Dr. Gaithri Fernando (p.87). Fernando illustrates that the damage of the tsunami lay in its effects on social relationships (i.e. social isolation, inability to fulfill kinship roles) and should be distinguished from the US, where trauma is identified in the mind of the individual, not in the social realm. Volunteer counselors sweeping in after disasters, whose techniques encourage hyperintrospection and hyperindividualism, are therefore not effective. Pushing this idea of misplaced therapy even further, Watters digs into the pre-tsunami work of Argenti-Pillen (p.108), who documented the use of local customs of euphemistic speech in coping with violence during the ongoing civil war in Sri-Lanka. With the introduction of NGO counseling activities, these customs of using ambiguous speech to promote a delicate social balance were pathologized as avoidance or denial. As a result, local techniques of containing violence were destabilized, essentially contributing to, rather than ending cycles of violence. Present in each section of the book, this narrative move, from ineffectiveness to potential harm and loss of life, leaves the reader questioning the ethics behind such large scale interventions.
This explicit exposure of effects, however, becomes lost in Watters’ cultural diversity argument, which seems a bit superficial and dated considering the rich data he presents. In an era of pharmaceutical transgression and neo-liberal policies – both concerns that are amply acknowledged – Watters might have touched on issues of human rights, local autonomy and corporate accountability. Instead, his rationale for reconsidering the export of our mental health practices hinges on what we can learn from the ‘other’ and the potential ramifications of premature culture loss. The cultural relativism of his conclusion feels a bit disconnected – considering the dearth of evidence exposing the suffering and unconscious application he goes through great lengths to elucidate. “My point is not that they [other cultures] have it right – only that they have it different,” (p.254) feels curiously at odds with the ongoing critique of ‘Western’ ideas and the mission of the book, to take a fresh look at our own beliefs about the mind and health. The implication is that we do not have it right, as illustrated in his closing words: “Given the level of contentment and psychological health our cultural beliefs about the mind have brought us, perhaps it’s time we rethink our generosity,” (p. 255).
To be fair, Crazy Like Us is meant for a general audience and is a great primer for anyone interested in the emerging discipline of global health. It surveys a cross-section of many significant contributions to the field: topics of health inequities in socio-political contexts, effects of (pseudo-) science and technology on local worlds, the interrogation and critique of international health programs and the consequences of new partnerships in international health development.
Though Crazy Like Us may at times seem superficial to those already steeped in the issues of global health and transcultural psychiatry, the book nevertheless may present a model for public anthropology. Watters skillfully weaves ethnographies with social histories of mental illness to elucidate how the creation of disease categories shape our experience. He deals with the inherent complexities of scientific research in a manner that is not overly compromising of detail and he creates a plot with narrative threads that remain true throughout the text. Academics interested in turning tedious research into good stories before reporters get a hold of them, might take note. Because of how he has packaged them, the good questions Watters raises will surely be debated widely.
Katinka Hooyer is a doctoral student in Anthropology at the University of Wisconsin-Milwaukee.