Contagious Mental Health

Lynne says:

I ran into an article not long ago in The New York Times, The Americanization of Mental Illness by Ethan Watters, based on his forthcoming book, Crazy Like Us: The Globalization of the American Psyche, discussing how the American way of mental illness being exported along with other American products such as rock n’ roll, Coca Cola, and anorexia.

The classic case of Western media-induced anorexia happened on the Polynesian island of Fiji, where eating disorders were unknown for 3,000 years until television became available in 1995. A 1999 New York Times article describes what Dr. Ann E. Becker, director of research at the Harvard Eating Disorders Center of Harvard Medical School, found when she investigated shifts in body image and eating practices in Fiji over a three-year period.

Before 1995, Dr. Becker said, there was little talk of dieting in Fiji. ”The idea of calories was very foreign to them.” But in the 1998 survey, 69 percent said that at some time they had been on a diet. In fact, preliminary data suggest more teen-age girls in Fiji diet than their American counterparts.
Study Finds TV Alters Fiji Girls’ View of Body By Erica Goode, May 20, 1999

Oddly enough the idea of viral mental illness set me to thinking about some unusual toys I played with as a child. My father was a psychologist who administered psychological tests for schools, government agencies and mental institutions before he gave that up to go into military and aerospace research.

He had a cupboard full of old psychological tests that he never used, and when I got old enough not to mess them up, he would let me take them out and play with them. I think by then his worldview was that these tests were indeed games, so why shouldn’t I play with them.

It’s been nearly 50 years since I last picked these up but I still remember how beautiful the Rorschach ink blots were. They were large, thick cardboard about six by nine inches and not just black and white, but with almost three-dimensional gray shadings, and colorful red, blue, green orange and pink swirls.

Another test was the TAT or Thematic Apperception Test, again pictures on even larger cards. Each drawing showed a little scene that you were supposed to tell a story about–good training for a novelist, although that was hardly anyone’s plan for me at the time.

The creepiest test was the Szondi test–no, not Zombie test, it was named after Hungarian psychiatrist Lipot Szondi (1893-1986). This test consisted of four sheets of mug shots, 48 pictures of mental patients taken in the late 1800s to early 1900s. As my father explained it, if you got on a bus and there was an empty seat next to each of these people, who would you sit next to?

Szondi lived into the 1980s and I don’t know if he ever changed his diagnostic definitions, but the eight diagnoses the Szondi test used were: homosexual, sadistic, epileptic, hysteric, catatonic, paranoiac, schizophrenic, depressive and manic.

Just that list gives you an idea of how ideas about what constitutes mental illness have changed just in America.

The Watters New York Times article that started my whole trip down memory lane talks about mental illnesses that once were common and now are rarely if ever seen, such as hysterical paralysis. He reports a contagious anorexia phenomenon in Hong Kong, and goes into a fascinating digression on how one culture’s treatment of schizophrenia as spirit possession actually leads to fewer relapses than the Western diagnosis and drug treatment

An internet search away from the Watters article was an equally absorbing commentary by Greg Downey at Downey suggests that export of mental health can also be motivated by:

[P]ure mercenary impulses, as drug companies try to persuade new markets that the individuals need their products, suffering as they do from disorders of which they were previously unaware. Here, the idea that it’s just the beliefs about illness held by therapists and authorities obscures the naked greed that goes into public relations campaigns designed to produce disorder.

He cites the case of GlaxoSmithKline’s fostering of depression in Japan, where the concept of depression (and thus treatment with their product) was unknown until 1999. The manufacturer of Paxil was forbidden by Japanese law to advertise directly to customers, so they embarked on a series of “educational” ads telling consumers: “Depression is a disease that anyone can get. It can be cured by medicine. Early detection is important.”

So, as Dr. Phil would say, “How’s that working for GlaxoSmithKline?”

Pretty well, alas! A 2007 Boston Globe article reports that depression and the drugs to treat it have taken solid root in Japan.

8 thoughts on “Contagious Mental Health

  1. Holy shit, that’s the most fascinating article I have ever read in my entire life. Your summary sounded a little as if it were strangely offensive at times (“What do you mean television causes anorexia???”), but I’m glad I decided to read it anyway.

    Now I have yet another reason to oppose this tendency to put a label on everything.

  2. Thanks for the kind words, Tiana, and for reading on after initial hesitation!

    Debbie, I remember reading your review of the Peterson book, was thinking about it when I read the post, and in fact I think of it every time I see a commercial for “overactive bladder”!

    Somewhere in my travels (I can’t for the life of me remember where) I ran across testimony from a former designer of drug trials (maybe I should say a “recovering” designer of drug trials) who said that he was free to do as many studies as he needed to in order to get a positive “better than placebo” result for a drug they wanted to push. The standards for a positive result were incredibly low, and no mention had to be made of the many studies they did that did not show a better-than-placebo result.

    I’m a big fan of placebo medicine, by the way, I think there’s something powerful going on there that needs actual (as opposed to product-marketing-oriented) study. But there’s no profit in it, so I’m not holding my breath on that one.

  3. I read the Watters Times article with some skepticism. In the case of Japan and antidepressants, Japan is a culture in which illness and disability are judged harshly. Conformity is important – “the nail that sticks out gets hit.” It’s easy for me to believe that there are depressed people in Japan who have not been getting treatment and who can be helped with drugs. Hell, in our culture, which in some ways is ready to medicate every condition, there are plenty of people who look upon anti depressants as fake drugs for weaklings who need to pull themselves up by their bootstraps.

  4. Great article. I’m recalling the study of the “Just say no” anti-drug campaign, how it actually spurred on experimental drug use among youths–temptation via fascination of badness.

  5. The diagnosis of mental illness is a different thing from mental illness itself. (That’s how it’s possible for depression to be underdiagnosed and overdiagnosed at the same time–the people doing the diagnosis are looking for something real and prevalent and important; they are just making a lot of mistakes along the way.) Any illness, mental or physical, needs a certain threshold of being known and talked about before it can be diagnosed reliably…but talking about AIDS in the 1980s didn’t create the disease, it just made it possible for doctors to diagnose something they might otherwise not have recognized.

    Anxiety is contagious. I mean, it’s really directly contagious. I may be more sensitive to this kind of contagion than most people, because I have an anxiety disorder…but I think it’s common to find it hard to be calm when talking to frightened people, especially if they are very frightened or if there are a lot of them. This is a problem for police officers and prison guards, who spend so much of their time with people who are angry and/or frightened.

    I haven’t noticed depression being contagious in the same way as anxiety, or PTSD (it’s not the trauma that’s contagious, but people with PTSD can reinforce each other’s triggers), or obsessiveness, or addiction.

  6. I agree, Elizabeth, that some people in Japan suffered from conditions very similar to what we would call depression, long before the drug company set out to “educate” consumers about that label and not coincidentally offer Paxil to “cure” it. I don’t know what options were offered to depressed people by doctors, but I respect the ethics of the law that makes it illegal to advertise drugs to the public. Enforcing conformity is a major cultural trait Japan, but there is quite often a great deal of positive person-to-person support for people going through crisis.

    At the most negative extreme you could say that the Japanese response might be essentially “suck it up and deal–please, just do your best” (gambate kudasai) while the American equivalent would be “take a pill and chill, get with the program.” To my mind the essential nature of the communication is rather similar, although the Japanese equivalent is more personal and the American method is more commercial and medical, involving both medication and a product you can buy.

    That said, I strongly question the morality of a drug company blatantly using advertising to “educate” consumers into using their drugs.

    Adrian, I agree with all your points, and I think the idea of mental illness as “contagious” is probably not a metaphor that can stretch to include every mental problem. However, I think that some of the shaping of mental illness into Western diagnostic manual pigeonholes reminds me at best of the old truism that a person holding a hammer often sees everything as a nail. At worst the idea of shaping mental illness into something that will sell more pills seems immoral.

    I do remain fascinated by the way that cultures change in what forms of mental illness are expressed. The classic example is the Malaysian “amok” episode where a stressed-out man would grab a kris sword and proceed to go on a killing spree until being brought down by other citizens with swords. Essentially it was a form of “suicide by cop” with local, armed civilians being the unofficial cops. It began to wane when victims were captured by police and brought to trial. Now it’s extremely rare.

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