Crazy Like Us: The Globalization of the American Psyche

 

Book, 2010

 

Premise - An exploration of how so-called psychological "diagnoses" present themselves in different cultures around the world, bringing into question the very nature of whether categorical diagnoses for mental health symptoms exist. More concerning yet, the book explores how Westernization of the globe has perhaps brought mental health disorders to various cultures as a sort of symptom contagion, and that our good intentions to teach our ways of life have left the world, mentally and emotionally, worse off.

 

Review - This book is absolutely necessary reading for any mental health professional, particularly those who diagnose their clients. This book calls into question the very existence of categorical psychological diagnoses, and rightfully so. I would hope that for anyone who reads this, their takeaway isn't, "Oh, people from OTHER cultures have other manifestations and we gotta respect that, but at least for Americans the diagnoses are scientifically correct." No. The takeaway is, instead, using global evidence we can realize that psychological diagnoses can be socially constructed, with the understanding that social constructs are incredibly real, valid, and true to someone's experience. The fact that they can be socially constructed though means symptom presentation can change over time and location, with generational examples such as "hysteria" in women, or more modernly anorexia. As the world becomes more globalized and interconnected, especially with the internet, these social constructs can spread.

I think there are a few central ideas. One is that our when our minds and bodies are suffering - that suffering is real. But the way in which our bodies manifest that suffering can change based on our understanding of what's possible. For instance, those without many words for emotions might have somatic manifestations (like children), and those with a specific model of others who have suffered in this way may mimic their symptoms (like seeing other girls starve themselves or cut, makes someone try the same thing). That's not saying that these symptoms are not real - they are 100% real. But they are influenced by environment. And if they are influenced by environment, then they are subject to change.

Another central idea is that the way in which we approach treatment and prevention cannot be standardized, if the disorders themselves are not standardized. The research in which "evidence based" treatment comes from is based on very White populations, generally. And White treatment can not only be unhelpful, sometimes it can be harmful.

And lastly, the evils of White supremacy and capitalism. If it's in America's best interest to standardize treatment (like the pharmaceutical companies - they want depression to look the exact same so they can market their drugs), then it's in America's best interest to standardize disorders - which may mean marketing the symptoms intentionally. 

All of this makes it seem like disorders are entirely socialized without definitive, medical components. That's not true either - the chapter on schizophrenia is evidence of this. There are neurological components to disorders for sure, some more than others, like schizophrenia. But the way in which we conceptualize and treat these symptoms vary so vastly, that the entire presentation and outcome can change.

 

My world was revolutionized by this book and I base so much of my conceptualization of psychological distress from it now.  (97/100)

 

Quote - “Shorter believes that psychosomatic illnesses (such as leg paralysis at the turn of the twentieth century or multiple personality disorder at the turn of the twenty-first) are examples of the unconscious mind attempting to speak in a language of emotional distress that will be understood in its time. People at a given moment in history in need of expressing their psychological suffering have a limited number of symptoms to choose from—a “symptom pool,” as he calls it. When someone unconsciously latches onto a behavior in the symptom pool, he or she is doing so for a very specific reason: the person is taking troubling emotions and internal conflicts that are often indistinct or frustratingly beyond expression and distilling them into a symptom or behavior that is a culturally recognized signal of suffering.” This quote alone REVOLUTIONIZED my thinking

 

What to read for - The entire thing was good and there are only five or so chapters, each of which are really long. Perhaps my favorite chapter was the anorexia one?? But honestly, they're all interesting.

 

If you liked this book, I'd recommend The Man Who Mistook His Wife for a Hat and Other Clinical Tales!

 

Written by Ethan Watters

Published by Free Press