Mental illness and the concept of mental health are not new.
They have existed as long as we have. There exist accounts from as early as the
third century CE of the confinement of mentally ill people in Syrian Catholic churches.
Institutional care for the mentally ill can be traced back as early as the
1400s, and the first psychiatric hospital in North America opened in 1773 in
the colony of Virginia1.
One would think that this history, along with the later
development of effective pharmacological and psychosocial interventions for a
range of conditions, might have resulted in the recognition that mental
disorders were a public health priority. This, unfortunately, is not true. The
key impetus for the emergence of the field of global mental health did not come
until the publication of the World Development Report 1993. This report
featured the initial findings of the Global Burden of Disease study, the first
study to use DALYs to measure the global burden of disease. Much to the
surprise of many people, computation with DALYs showed that approximately 8% of
the global burden of disease was due to mental health problems2. Several other publications
followed, culminating with the publication of the Lancet series on global mental
health in September 2007. Only then was the global mental health movement
officially launched.
In the eight years since the Lancet series, the field has
experienced a surge of attention, research, and public support. One of the most
interesting, and most controversial, pieces of literature to come out of this
surge is the 2010 New York Times piece by Ethan Watters entitled “The
Americanization of Mental Illness.” In the piece, Watters suggests that a kind
of psychiatric-cultural imperialism has been foisted on other countries and
cultures by “the West.” Specifically, Watters claims that, “For more than a
generation now, we in the West have aggressively spread of our modern knowledge
of mental illness around the world… There is not 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 cultures3.”
Though the Watters thesis has its merits, it is also shallow
and simplistic in many of its assumptions and conclusions. I
found it hard to agree completely in light of several unfounded claims. In
discussing anorexia in Hong Kong, for example, Watters fails to consider
alternative explanations for the rise in “westernized” anorexia presentation.
Could it perhaps be attributed to better understanding and recognition of a
disorder that had not been fully studied or appreciated in the past?
Considering the history of PTSD in the United States, wherein clinical
presentation has been described for centuries, while the diagnosis has been
clarified and categorized only recently (the 1980s)4, this is
certainly possible. Additionally, I found Watters’ claim that a biological
interpretation of mental illness results in harsher treatment of the mentally
ill shortsighted. Were those thought to have a biological determinant of
disease really treated more harshly, or were they treated like someone without
a mental illness? It is important to consider this control (or lack thereof) in
analyzing his claim.
The rise of the global mental health movement has greatly
helped to publicize, personify, and reduce global suffering due to mental
illness. It has also, however, shown the limitations of the current approach to
global mental health care. There is thus an urgent need for continuing
research, in low-/middle-income and high-income countries alike, that addresses
the questions of etiology, treatment, and cultural variations that scholars
such as Watters have brought to light.
References
- Cohen, A., Patel, V., and Minas, H. (2014). A brief history of global mental health. In V. Patel, H. Minas, A. Cohen, and M. Prince (Ed.), Global Mental Health: Principles and Practice (pp. 3-26). New York: Oxford University Press.
- World Bank. (1993). World development 1993: Investing in health. New York: Oxford University Press.
- Watters, E. (2010, Jan 8). The Americanization of mental illness. The New York Times. Retrieved from http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html
- Friedman, M.J. (2013). History of PTSD in veterans: Civil War to DSM-5. Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/history-of-ptsd-vets.asp
