Crazy Like Us Book Review
The introduction and conclusion of this book discuss the overarching theme of how Western culture and beliefs are impacting the view of certain mental illnesses in world cultures. The book explains how other cultures' beliefs about mental illness are being changed by Western medicine. The globalization of Western medicine is ridding cultures of their own specific view on illnesses, and influencing them to adopt the beliefs of Western medicine. This book illustrates how these cultures' views are being changed and how the world is losing its diversity in cultural beliefs regarding mental illness. Cultures are instead adopting the Western view as the only view, which in turn is eliminating the way culture influences illness.
The first chapter of Crazy Like Us reviews the increasing prevalence of anorexia in Hong Kong. Watters dives into the history of anorexia in China, and discovers the big differences between those with anorexia in China versus those with anorexia in the United States. He notes that Chinese sufferers do not fear gaining weight or getting fat, which is one of the main symptoms of anorexia for those in the U.S. Watters shows how anorexia used to develop and be experienced in China, and how it was almost a different disease in itself because of the traditional cultural beliefs regarding its symptoms and potential causes. Lastly, this chapter discusses how anorexia is increasing in China, and how this anorexia is much similar to the Western view of anorexia. The Western media influence in China has impacted the women there, and the Western version of anorexia has replaced the historic version of anorexia in rapidly increasing numbers.
The second chapter of this book discusses the aftermath of a tsunami in Sri Lanka and the development of PTSD for those who experienced it. After the tsunami hit, Western trauma counselors and researchers poured into the country to try and help those affected, predicting that PTSD case numbers would skyrocket following the disaster. They trained locals to help with the counseling, but also seemed to ignore that other cultures can react differently to trauma. Watters illustrates how Sri Lankans reacted differently to the trauma than what was expected of them; they reported having physical pain and ailments, and lacked the expected psychological turmoil of feelings of anxiety and fear. Watters concluded that cultures experience traumatic events differently and that the Western expectation of disease presentation and development is not always accurate.
Chapter three focuses on schizophrenia in Zanzibar. The studies of Juli McGruder with families who were impacted by schizophrenia in Zanzibar illustrate the cultural differences in beliefs surrounding schizophrenia in Zanzibar versus U.S. beliefs. McGruder described how the families of those diagnosed react and treat the schizophrenic family member. Watters focuses on how the families believed in a religious cause for their family member's suffering, and how they lacked the stigma that surrounds schizophrenia that is observed in the U.S., ultimately resulting in a better disease outcome for the schizophrenic. Additionally, Watters illustrates that different cultural contexts of the disease impact how it is viewed and stigmatized; also discussed are the varying emotions amongst the family and schizophrenic which impact the disease progression and presentation.
The last chapter of Crazy Like Us focuses on depression in Japan. The chapter focuses on the rise of depression and suicide in Japan, as well as the rising drug market targeted at treating depression in Japan. Watters discusses how depression has changed in Japan; feelings of sadness and grief were once seen as a natural part of life and character, but are now seen as mental illness. Japanese psychiatry and the public did not identify depression as an illness, but Western drug marketing campaigns begin to appear, influence, and change the Japanese's cultural view on these feelings of sadness, and depression begins to be an illness in their culture. Because of this, a rise in depression has been seen in Japan, as well as an increased influence on the treatment of it by Western pharmaceutical companies.
The social stress paradigm can be seen many times throughout this book. As stated in lecture, the stress paradigm states that stressors in life can lead to physiological stress in the body, which in turn can lead to feelings of psychological distress. Stressors are any events or experiences that are seen as threatening, challenging, or harmful to an individual. These stressors can lead to physiological changes in the body like decreased immune function, high blood pressure, and disturbed sleep. Distress is a result of the physiological changes a person experiences, and is the feeling of being anxious, sad, or suffering. In short, unexpected events in life can disrupt and alter normal physical and mental health.
This social stress paradigm was illustrated in the chapter regarding anorexia in Hong Kong. A patient who had developed anorexia described that following a breakup, she began feeling a pressure/blockage in her throat that returned daily, causing her to become unable to eat (27). This demonstrates the social stress paradigm because the breakup, which was the stressor, led to this patient experiencing physical changes in her body, which ultimately led to her becoming anorexic because she was unable to eat as a result of these physical changes. The breakup also led to this patient experiencing distress because of the breakup and the anorexia diagnosis that followed. Therefore, the breakup stressor led to her becoming ill as a result of the physiological and mental changes that occurred.
Another example of the social stress paradigm was illustrated in the Sri Lankans following the tsunami. Not only was the tsunami a stressor, but the devastation that followed was also. Tens of thousands lost family members, their homes, and belongings. These stressors resulted in many Sri Lankans developing PTSD. They reported experiencing physiological disturbances, including chest pains and joint pain (91). In addition, the disruption to many of their social networks because of deaths or people having to move away to start over resulted in distress and PTSD. This illustrates the social stress paradigm, because the devastation from the tsunami (the stressor) resulted in physiological changes like pain and discomfort, as well as the psychological disturbances of distress and anxiety. As a result of the tsunami and the damage it did to many Sri Lankans' lives, PTSD became a growing diagnosis in the country.
In the chapter about depression in Japan, the narrative about Oshima's suicide is yet another example of the social stress paradigm (214-218). Oshima began his new job shortly after the stocks crashed in Japan, creating a frenzy in the financial markets. In order to keep his boss happy and also keep his job, Oshima had to put in an extreme amount of overtime hours. Eventually after months of doing this, Oshima began exhibiting declining physical and psychological health. Shortly after, he committed suicide. This is a representation of the social stress paradigm because his job and its requirements became a major stressor, which led to a decline in Oshima's mental and physical health. He developed depression and ultimately took his own life because of it. The stressors he experienced at work negatively impacted his health, leading to the development of depression and distress, as well as physiological illness.
The effects of culture were commonly seen throughout this book. Culture is the shared beliefs that a society has, and can vary between time periods and places. Crazy Like Us particularly focuses on how culture shapes illness. According to lecture, culture affects what illness is, how it's experienced, what the symptoms may be, and also the treatment and attitudes towards it. This is the major basis behind social construction of illness, with culture having a major part in shaping the illnesses that different societies experience.
One effect of culture that was illustrated was in the chapter about Japan. The traditional Japanese version of depression differed from the Western version. It differed so much so, that they did not even have a word that directly translated to the English word for depression. The Japanese culture did not see feelings of sadness, anxiety, and melancholy as a sign of mental illness, but rather believed that those were normal feelings to be felt throughout life and in their culture, as well as helped to build character. The Western view of depression is very different from this, and has the belief that these feelings are not normal and are symptoms of psychological disturbance. In addition, the Japanese believe depression has more of an outward, external meaning, while Americans believe it is related more to internal feelings (210). These cultural differences impact how this disease was originally diagnosed and treated in this country, and explain why the Western version of depression was not widely accepted early on.
Sri Lankans and PTSD also demonstrated the effect of culture. Many of the Western therapists and counselors who came to assist after the tsunami were puzzled by the lack of psychological turmoil the Sri Lankans appeared to be in, and also by the lack of benefit their counseling had. This was because of how the Sri Lankans react to terrible events which is very different from how Western people would react to the same situation. Because these people had experienced war, poverty, and many other hardships, their culture evolved to enable them to react less devastatingly to traumatic events. PTSD was an illness that was not common amongst these people because of the beliefs their culture had towards life's troubles, as well as how to deal with and move past them. Sri Lankans rely on their religious beliefs and traditions, alongside their strong cultural beliefs in social connectedness, to heal themselves from any illness or psychological distress they may experience (89). This in turn enabled them to not experience PTSD in the way they were expected to, or even at all. Because of these culturally specific reactions to traumatic events, the Western beliefs of PTSD and how to treat it proved to be ineffective or caused more harm than good with the Sri Lankan people.
Watters claims appear to be very based in fact with a good deal of evidence. He could strengthen his claims about cultural differences in disease by having more examples from more regions around the world. For example, Mexico has a cultural belief surrounding the Evil Eye, and how disease can be brought upon someone because of the actions of another person towards them. He seemed to focus on countries in Asia and Africa, and I feel he could strengthen his argument by looking to other regions of the world that Western views of illness and disease have impacted. There are many other demographic groups that the author's assertions could be applied to. Cultures all around the world, and even in the United States, have their own beliefs about disease and how to treat it. Because of this, Watters could gain even more evidence to support his claims if he is able to look into more cultures.
Watters suggests that we should question the biomedical cause for illness and also the globalization of this belief. Although other cultures have their own beliefs about disease, that does not discount that the biomedical model of mental illness and physical illness has been beneficial to Western cultures and other cultures around the world. There are benefits for cultures having their own beliefs regarding mental illness, but understanding the biomedical model for these illnesses may help other societies better understand the illness itself, alongside their cultural beliefs. If a person does not believe they are suffering from a mental illness then it would not be beneficial to try and influence them otherwise. However, those who are suffering from mental illness and do not understand its cause or how to treat it could benefit from the biomedical model and the treatments that have been made because of it. Because of this, Watters should not argue that Western influence has not been beneficial in other cultures. Illness is socially constructed, but culture changes with time and place, so new ideas about illness like the biomedical model could be beneficial for other cultures.
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