Overall I was only moderately interested in the book’s thesis that we are globalizing American concepts of mental health. With the exception of the genuinely interesting anorexia chapter, the depression/PTSD/schizophrenia chapter all showed societies with pre-existing recognizable versions of these disorders. America got really interested in and heavily medicalized these disorders in the mid-20th century, and now these other societies are getting really interested in and heavily medicalizing them. People who like calling things “colonialist” should call this colonialist, and people who like debating whether or not things are colonialist should debate it, but I’m not sure how much extra we can learn about mental health here.
I was more interested in a sort of sub-thesis that kept recurring under the surface: does naming and pointing to a mental health problem make it worse? This was clearest in Hong Kong, where a seemingly very low base rate of anorexia exploded as soon as people started launching mental health awareness campaigns saying that it was a common and important disease (as had apparently happened before in Victorian Europe and 70s/80s America). But it also showed up in the section on how increasing awareness of PTSD seems to be associated with more PTSD, and how debriefing trauma victims about how they might get PTSD makes them more likely to get it. And it was clearest in the short aside about the epidemic of neurasthenia in Japan after experts suggested that having neurasthenia might be cool, which remitted once those experts said it was actually cringe. A full treatment of this theory would go through the bizarre history of conversion disorder, multiple personality disorder, and various mass hysterias, tying it into some of the fad diagnoses of our own day. I might write this at some point.
Of course, the null hypothesis is that there are lots of people suffering in silence until people raise awareness of and destigmatize a mental illness, after which they break their silence, admit they have a problem, and seek treatment. I am slightly skeptical of this, because a lot of mental health problems are hard to suffer in silence - if nothing else, anorexia results in hospitalizations once a patient’s body weight becomes incompatible with healthy life. Still, this is an important counterargument, and one that I hope people do more research into.
This book is about cultures that respond to mental disease very differently than we do, so I find myself imagining a culture that holds Mental Health Unawareness Campaigns. Every so often, they go around burning books about mental illness and cancelling anyone who talks about them. If they must refer to psychiatric symptoms in public, they either use a complicated system of taboos (like Sri Lankans) or maximally vague terms like “an attack of nerves” (like Zanzibaris). Whenever there is a major natural disaster, top experts and doctors go on television reassuring everyone that PTSD is fake and they will not get it. Whenever there’s a recession or something, psychiatrists tell the public that they definitely won’t get depressed, since “depression” only applies to cases much more severe than theirs, and if they feel really sad about losing all their money then that’s just a perfectly normal emotion under the circumstances.
Writer - Critic - Poet - Editor