"a particularly American view of the self"

Jacques alerted me to this, then Sarah, then Kristina, and now I'm pleased to say everyone seems to be reading and talking about it:
The Americanization of Mental Illness, NYTimes.com

It's the perfect storm of my interests: mental health and cross cultural issues with some Chinese thrown in as well. (What, no tap dancing?)

I've been interested in Lee's work on anorexia for some time - though what I take from it is further evidence that the underlying brain disorder doesn't involve body image, it exploits it. I don't believe mental illness spreads; I think the form the cognitions take depends on the environment of the sufferer. For example, obsessive compulsive disorder is an underlying brain issue but the particular focus of the sufferer's thinking has to do with their unique experiences and values and that of those around the person.

There are two aspects here: the experience of the sufferer and the interpretation by those around the sufferer. The symptoms are certainly influenced by culture, but the response by those around the patient is far more tied to society's ideas. With eating disorders we're talking about ideas and myths and implications involving every facet of development and social relations and the body - everybody has an opinion. This illness has "meaning" to everyone whether they understand it or not. My work is mainly around changing the way the world outside the patient responds to the patient, and I do see great differences between cultures but also between classes and families and individuals and IT MATTERS.

Americans are held back by certain assumptions we make about how people "should" think about illness, but I think our greater mistake is in assuming that other people are starting in the same place as we are. Guilt and Freud are destination number one for Americans, but that isn't true everywhere. Neither is our terror of ambiguity - we want an answer, on Oprah, fast and fat-free and paid in advance with repentance and apologies. Not everyone needs the same myths busted.

Mental health is an incredibly complex issue even if you remove cultural baggage and assumptions but somewhere in this complexity are some facts, and some fallacies. Perhaps the better question is not whether mental illness differs across cultures but "What myths about this condition are hindering recovery in this culture?" and "What truths about this condition will help this person's family and treatment providers support them best?"

There isn't going to be an American answer to eating disorders or mental illness, nor a Chinese or Bengali one, but that does not mean there are no answers. People may or may not be helped by knowing that their condition is based in the brain, but it is true or it is not. People may not like the ambiguity of there being an environmental aspect to mental illness - it confuses the issue and it is messy - but brains are by design highly sensitive to the environment and don't operate in a black box.


  1. I'd like to add another example to how culture and situation alters symptoms. A hundred years ago, a sufferer of paranoid delusions might think that people were summoning demons to get them. Now, they're more likely to believe that aliens are listening in on their thoughts or that aliens have planted a chip in their brain. The delusions have changed, but the disease is still the same.

    At one time, anorexia had cultural links to religious purity. That doesn't change the disease.


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