Not a great book, but still useful for understanding certain motivations of the healthcare industry to culturally universalize medical conditions that are anything but universal. Also a good source to illustrate the circularity of many health conditions: how symptoms and conditions are shaped by the expectations of doctor and patient, and how psychological conditions become "contagious" thanks to further expectation shaping by the healthcare industry and the media as it "discovers" a new disease.
Finally, it's always helpful to get regular reminders of how little medical science actually knows. To repurpose the old joke: half of what medical science thinks it knows is wrong, we just don't know which half!
Watters scratches at this idea when he writes "Indeed modern day mental health practitioners often look back at previous generations of psychiatrists with a mixture of scorn and pity, wondering how they could have been so swept away by the cultural beliefs of their time." I've often been struck by the fact that while people of every generation remark on the idiocy of their predecessors, they rarely reach the second-order conclusion, which is to think humbly about which idiocies and mistakes they are committing right now that will be mocked by the generations to follow. This is a weird form of temporal solipsism that seems to plague each generation of medical practitioners.
The author structures the book in long chapters, each exploring a psychological condition that the USA has "exported" to another country: anorexia to China, depression to Japan, etc. Along with the exportation of the condition of course comes the exportation of treatment protocols, preferably daily pharmaceutical meds that can be sold in the billions.
It's worth thinking about the incredible array of incentives to discover new medical conditions, to pathologize, medicalize and publicize them, and to give pills and protocols to people to treat them. Obviously there's money to be made in treatment, but there's glory (immortality, actually) to be had in "discovering" a new disease. The media makes money writing about it--alarmingly, of course--and this further spreads the contagion. And of course many psych diseases, such as they are, occur on a spectrum. Everybody has seen one of those "Do I Have Depression?" quizzes, and, on a bad day, everybody will find themselves checking the requisite six or seven items. "Jeez, it says I'm depressed!" The result is the healthcare industry pathologizes many things it shouldn't.
Notes:
1) How anorexia today parallels almost directly with the Victorian age's "hysteria" as the standard psychiatric condition of young women. It shouldn't surprise us that Victorian age also had its celebrity doctors, just like we have our Dr. Phil and Dr. Oz today.
2) Medical conditions are circular in that they are shaped by the doctor's own ideas about what constitutes real disease. The "shaping" of symptoms. Ultimately serves to disseminate a model of how the patient is to behave and the doctor to respond, and then people follow that model! Or, in other words, "an interplay between the codification of a new mental illness and the sudden appearance of those symptoms in the general population." So, did the condition go unnoticed or under-reported before? Is there a sort of "symptom pool" that people can choose from to express their psychological suffering in a form that is culturally recognized or validated by the healthcare industry? Or is there some connection that we don't understand?
3) With anorexia and Hong Kong, the media hijacks the disease by using a western narrative, assuming that anorexia is due to the sexist or unrealistic presentation of women in media or other doctrinaire feminism-based reasons, when there was absolutely no clinical indication that this was the actual underlying driver of the disease. Thus the media both makes the condition itself contagious and also controls the reasons presumed for its cause!
4) Anorexia as a symptom pool, pre-made in the west and then "imported" into Hong Kong.
5) PTSD in Sri Lanka: an example of western therapists and clinicians "bringing the condition to the place," imposing their disease model and cultural assumptions on the substrate of a totally different culture, and thus producing more of the very condition they want to treat. A weird mix of solipsism and white supremacy and the belief that "we know our disease classifications are accurate for you too, whatever miscellaneous culture you are."
6) Thus we see an absolute clusterf*ck of therapists parachuting in to Sri Lanka doing studies, imposing Western perspectives on people, failing to have context for the language, quality of translators etc, and manufacturing psychological disease from the West out of nothing! Yowza. And when the people themselves differ in their responses or reactions, or deny a condition, the Westerner is always ready with the bulletproof response: "You're in denial. Clearly you have trauma/PTSD/whatever." Or, as the author writes: "Imagine our reaction if Mozambicans flew over after 9/11 and began telling [American] survivors that they needed to engage in a certain set of [Mozambican] rituals in order to sever their relationships with their deceased family members. How would that sit with us? Would that make sense?"
7) Clinician Kate Amatruda as particularly striking example of a researcher who rushed to Sri Lanka "to pick up, pick up The White Man's burden" and impose a type of psychological colonialist indoctrination. One anthropologist quoted in the book unironically cites "the psychologically advanced culture of the United States" when it's our psychologically arrested development that's by far our most salient cultural trait.
9) The evolution of PTSD from a therapy designation specifically for Vietnam veterans into a catch-all therapy process for everyone, regardless of culture. By analogy, this looks a lot like the expansion of blood pressure medicine use from a sample of ultra-hypertensive VA patients to an entire spectrum of patients, many of whom should never be taking these meds.
10) The chapter on schizophrenia in Zanzibar is long-winded, adrift and doesn't quite fit with the book. This chapter is the weakest so far.
11) Depression in Japan: how cultures differ in their explanatory models for depression-like states. Glaxo producing a "seismic shift" in selling depression into the culture of Japan. Large-scale human trials of SSRI drugs, including Zoloft, in Japan had failed to show any positive effects.
12) The depression in Japan chapter is an excellent example that everyone should read about how the healthcare industry can redefine and pathologize normal emotions, normal emotional or physiological states, and thereby create a gigantic new market for drugs from nothing. Further, the influence of the pharmaceutical corporations over prominent scientists and researchers (and media) in Japan should be sobering to any reader.
13) The skewing and shaping of data specifically by drug companies ghost writing scientific papers began as early as the 1950s. It reached generalized practice in the 1990s. Ghost authorship as "the steroid problem" of academia, and Paxil as a profoundly lied-about and misrepresented med.