America's Contagious Craziness

How the US exports its mental illnesses globally

I was just about to head to bed late last night when my pal Kale Zelden texted me raving about the 2010 book Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters. Watters, a San Francisco-based science journalist, writes about how and why American models of mental health conquer the world, to the world’s detriment. I downloaded the book on Kindle, and stayed up till three a.m. reading it. You’re about to see why.

I’ve written in this space about how living outside the United States for an extended time has given me fresh perspective on my native land, and its influence in the world. The decadence of the US is starker seen from the perspective of a country (Hungary) that hasn’t lost its mind. That I could have predicted. What I did not foresee is what this experience has taught me about how powerful the US is in terms of exporting its culture to the rest of the world. I thought I had a pretty good sense of it, but I did not. We Americans really are making the world crazy like us.

Watters, whose journalism focuses on mental health, means it in a narrower way. He writes:

To travel internationally is to become increasingly unnerved by the way American culture pervades the world. … We have the uneasy feeling that our influence over the rest of the world is coming at a great cost: loss of the world’s diversity and complexity. For all our self-incrimination, however, we have yet to face our most disturbing effect on the rest of the world. Our golden arches do not represent our most troubling impact on other cultures; rather, it is how we are flattening the landscape of the human psyche itself. We are engaged in the grand project of Americanizing the world’s understanding of the human mind.

Here’s his thesis:

The premise of this book is that the virus is us. Over the past thirty years, we Americans have been industriously exporting our ideas about mental illness. Our definitions and treatments have become the international standards. Although this has often been done with the best of intentions, we’ve failed to foresee the full impact of these efforts. It turns out that how a people in a culture think about mental illnesses—how they categorize and prioritize the symptoms, attempt to heal them, and set expectations for their course and outcome—influences the diseases themselves. In teaching the rest of the world to think like us, we have been, for better and worse, homogenizing the way the world goes mad.

What does this mean? It’s not just about brains and bodies:

Behind the promotion of Western ideas of mental health and healing lies a variety of cultural assumptions about human nature itself. Westerners share, for instance, beliefs about what type of life event is likely to make one psychologically traumatized, and we agree that venting emotions by talking is more healthy than stoic silence. We are certain that humans are innately fragile and should consider many emotional experiences as illnesses that require professional intervention. We’re confident that our biomedical approach to mental illness will reduce stigma for the sufferer and that our drugs are the best that science has to offer. We promise people in other cultures that mental health (and a modern style of self-awareness) can be found by throwing off traditional social roles and engaging in individualistic quests of introspection. These Western ideas of the mind are proving as seductive to the rest of the world as fast food and rap music, and we are spreading them with speed and vigor.

The truth, though, according to anthropologists and cross-cultural researchers, is that mental illness cannot be separated from culture. Whether its cause is trauma, anxiety, chemical imbalances, or some combination of these, the mind depends on culture to explain what is happening to it. Watters is convinced that the power of American culture — in its domination of global science, media, and mass entertainment — is leading to the extermination of human mental and cultural diversity, and its replacement with a dysfunctional American model of the human person, and the human mind.

In other words, Watters is writing about what would later be called the WEIRD phenomenon: the idea that we in the West are far outliers on normative human psychological experience, but don’t realize it because nearly all the work in psychology has been done in the West, on Western subjects. What we think of as universal is actually just Western. But — and this is a big but — the psyche is so malleable that by exporting the Western model of the psyche, we are changing the world in measurable ways.

Evidence shows that some mental illnesses only start showing up at scale when they are publicly identified, and talked about in the media. The basic idea is not that these mental illnesses are fake. It’s rather that culture sends a signal to people that internal distress can be expressed in certain ways. Watters doesn’t mention this, but the psychiatrist Iain McGilchrist has written about how we have scant record of what we call schizophrenia until the late modern age. It emerged as an artifact of the deep civilizational crack-up the West has been living through since the late 19th century. McGilchrist, citing the work of academic psychiatrist Louis Sass, says that aspects of the disorder we call schizophrenia manifests in much modern art (see here for a short video précis). The idea, then, is that mental illness can be an outward, culturally-determined sign of an inward disordered state. Again, it’s not that diagnosed schizophrenics are faking it, but rather that their profound inner psychic distress may be expressing itself through the illness, because for whatever reason, it has become the model in a particular culture through which this kind of distress may emerge.