Mental health cure isn’t available with a pill

My following book review appeared in yesterday’s Sydney Sun Herald:

Crazy Like Us
Ethan Watters
Scribe, $35

About one in five adult Australians will experience mental illness at some point.

In the US, about 27 per cent of people aged 18 and older suffer from a mental disorder each year.

These are startling figures that are constantly rising and show both a growing acceptance of mental illness in our societies and a medical profession happy to prescribe pills to lessen the load. Billions of dollars are spent globally but there is little evidence that mental illness is decreasing in frequency or intensity.

The problem is that the West has convinced itself that it has the answers to manage mental conditions and should offer these “solutions” to the globe. “We are engaged in the grand project of Americanising the world’s understanding of the human mind,” writes journalist Ethan Watters in this fascinating book on the dark side of a contemporary affliction.

His thesis is that multinational drug companies “have an incentive to promote universal disease categories because they can make fortunes selling the drugs that purport to cure those illnesses”.

But this work isn’t simply hundreds of pages bashing drug companies. The author takes the issue much further, arguing for far greater cultural sensitivity by researchers, anthropologists, psychiatrists, human-rights activists and non-governmental organisations when working in countries that don’t subscribe to Western roles and attitudes.

An easy, quick fix for mental issues is seductive and Western practitioners are busy spreading the word across the globe. Watters examines four societies – Zanzibar, Hong Kong, Sri Lanka and Japan – and finds a confused population often desperate for mental nirvana. But are they losing cultural diversity in the process by being given so-called solutions that may work in Los Angeles but not necessarily in Zanzibar City?

The most fascinating chapter examines Sri Lanka after the 2004 Boxing Day tsunami. The east coast was devastated, families were destroyed and entire towns were washed away. Watters profiles the actions of the executive director of the New Jersey Association of Mental Health Agencies, Debra Wentz, who spent the first hours and days working tirelessly to help as many victims as possible. She soon wanted to raise money to bring American trauma experts to train local counsellors to diagnose and treat post-traumatic stress disorder (PTSD).

Watters painstakingly explains the well-meaning but naive effort of wanting to impose Western ways of addressing psychological trauma: “The idea that people from different cultures might have fundamentally different psychological reactions to a traumatic event is hard for Americans to grasp. The human body’s visceral reaction to trauma – adrenalin, fear and the fight-or-flight response – is so primal that we assume that the after-effects of such events would also be the same everywhere … Western traumatologists have developed a set of beliefs about how best to heal from the psychological effects of trauma … Against a growing body of evidence, traumatologists assume these ideas to be universally true.”

Both cultural ignorance and Western arrogance are detailed by Watters. When children affected by the tsunami in Sri Lanka wanted to return to school after the event, a counsellor told the BBC that they were “clearly in denial”.

The parochialism worsened. Numerous reports emerged of mental health workers who didn’t speak the local language or understand local culture simply getting in the way of effective community work.

Western drug firms such as Pfizer were fast off the mark, keen to join the PTSD parade. Disaster exploitation for financial gain, something articulated in Naomi Klein’s The Shock Doctrine, was rampant. There’s nothing like chaos to generate huge income for shareholders, far removed from the scene of the crime. A director of the World Health Organisation’s mental health initiative in Sri Lanka, John Mahoney, told a journalist that his group “found one organisation just handing out antidepressants to people”.

Watters summarises the fundamental fault at the heart of Western post-imperialist do-gooding, dressed up as human-rights outreach: “It is the psychiatric equivalent of handing out blankets to sick natives without considering the pathogens that hide deep in the fabric.”

This isn’t a book that advocates isolationism or avoidance of international disaster relief. Watters questions the ever-growing industry of Western miracle cures for a brain we humans barely understand.

Humility and cross-cultural understanding won’t kill us when entering societies that have thrived long before Westerners came on the scene.