Book review: Crazy Like Us

‘Cultures become particularly vulnerable to new beliefs about the mind and madness particularly during times of social anxiety or discord’, notes Ethan Watters in this compelling book. Watters sees social discord as making cultures ‘vulnerable’ to new beliefs, rather than simply ‘receptive’, and this sentence captures both the depth of insight in Crazy Like Us and its main theme – that sees the spread of Western ideas about mental illness as a form of psychological imperialism.

‘Imperialism’ is perhaps too strong a word, as Watters is neither overtly political nor tiresomely polemic in his analysis, which results in one of the most engaging, accessible and well-researched non-academic books about culture and mental illness available. But in summing up he does tend towards suggesting that Western ideas about the disordered mind are imposed on other cultures, when occasionally there are more subtle stories in the details.

Not unlike the adoption of Western music and fashions by young people in traditional cultures, the shift toward new ideas is as often driven by local enthusiasm for concepts of wealth and sophistication as by deliberate outside forces. The book gives several examples of how changes occur by a combination of the two, as, for example, aggressive drug company campaigns to market the Western concept of depression to the public in Japan relied on the fact that these ideas had been already adopted by Japanese psychiatrists, many of whom trained in Europe and America.

Watters discusses culture as a powerful determinant of how we express psychological distress and mental illness. This influence is not always positive, and the book notes how Western models of mental illness may be detrimental over traditional ideas of coping, for example by silence or even spirit possession. The clearest example is how disasters and emergencies often draw in well-meaning ‘experts’ who clumsily apply Western concepts of psychological trauma and pathologise local reactions that may be psychological helpful but don’t fit the model.

I was left with a few minor quibbles, including the reliance on World Health Organisation data on how schizophrenia outcomes in developing countries are better than in developed countries, when more recent work has shown that there is so much variation between countries that this generalisation really means very little. These, however, remain minor concerns in the overall scheme of things. The book is not an academic tome and the approach is narrative, but Watters has clearly mastered the scientific research where it counts. As an introduction to (and perhaps even a revelation of) how culture and mental illness are intertwined, you are unlikely to find a more engaging and thought-provoking book.

This review was originally published in The Psychologist and you can read it online here.

It’s worth noting the book is available in both a US edition and a UK edition which seem to differ only in the subtitle.

Link to Crazy Like Us companion site.

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