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.
It's a provocative but incomplete analysis, in my opinion. Yes, manifestations of mental illness are shaped by local norms and culture. Yes, people are presenting with combinations of symptoms that suggest Western-style depression and schizophrenia in places where those combinations of symptoms have been unrecognized in the past. And yes, Big Pharma has been aggressive in promoting the diagnosis of disorders for which it sells treatments, in the West and around the globe. But Watters makes a number of logical leaps which I find questionable.
For one thing, he ignores a fundamental, chicken-and-egg question as to what has caused the spread of Western psychiatric diagnoses to the non-Western world. According to Watters, Western psychiatry is to blame. But isn't it just as possible that the spread of Western culture during the globalization of the past half-century created the conditions necessary for the emergence of Western-style mental disorders? Yes, citizens of various Third World countries may have only recently begun presenting with the symptoms of Western-style depression, but couldn't that be just as much a result of the Westernization of Third World cultures as the hegemony of Western psychiatry? Western business practices, Western books, Hollywood TV and movies.... Isn't it possible that Western cultural hegemony has created breeding grounds for Western mental illness where before there were none? If in my town there were suddenly a McDonald's and a big agribusiness operation where once there were a local market and family farmland, I know I for one would probably be depressed.
And then there's the question of why Western-style symptom clusters haven't been prevalent in much of the world until recently. Yes, anorexia nervosa was rarely diagnosed in Hong Kong until the 1990s. But is that because nobody in Hong Kong ever suffered from anorexia nervosa before? Or is it because local culture in Hong Kong stigmatized those who exhibit the symptoms of that disorder? Or maybe because people in that culture lacked the language to describe anorexia nervosa? Watters never addresses these possibilities. Indeed, he makes the assumption that because anorexia wasn't traditionally diagnosed in Hong Kong, it didn't exist there -- that people began manifesting with anorexia only after the local mental-health industry became familiar with the disorder's array of symptoms.
I know from first-hand experience that one can present with a given cluster of symptoms with no prior guidance from doctors or the broader culture. I went more than five years with the symptoms of panic disorder -- heart palpitations, hyperventilation, derealization, the feeling of being about to die -- before I stumbled upon the panic disorder diagnosis, in a newspaper ad for a mental health clinic specializing in anxiety disorders. My cluster of symptoms developed before I'd ever heard of panic disorder. (This was in the 1980s, just a few years after the panic disorder diagnosis became "official" with the publication of the DSM-III, and well before panic disorder began showing up on Oprah and Maury and in The Sopranos and Analyze This.) That newspaper ad didn't create my symptom cluster; it just gave a name to something that was turning my life upside-down, but which I had no way of knowing how to fight. That changed once I read that ad. We may not be able to diagnose panic disorder with the same precision and accuracy as we can diagnose a broken bone or a torn ligament -- there's no x-ray or MRI that will show panic disorder, at least not yet -- but by no means does that mean that the panic disorder diagnosis is illegitimate.
Finally, and perhaps most importantly, is it necessarily a bad thing that doctors are diagnosing PTSD, schizophrenia, depression, or whatnot where they would not have done so before? Watters seems to assume that it is: Western psychiatry is a "juggernaut" that we have "little chance of stopping." But is Western psychiatry the force for ill that Watters thinks it is? If so, he certainly doesn't provide sufficient evidence to support his case.
I agree that we should question the products, practices, and motivations of Big Pharma and Western psychiatry. But I wonder whether Watters's analysis throws out the baby (the potential benefits of Western diagnoses and treatments) with the bathwater (the potential harm caused by same). Especially given the possibility that Western mental illness diagnoses might result in the successful treatment of patients suffering from forms of mental pain that traditional diagnoses miss or traditional treatments fail to address: If it relieves people's anguish, who gives a crap whether it's a Western diagnosis or treatment or not?
