Alexander Kobulnicky

Last week, the New York Times Magazine ran an article by Ethan Waters about the export of American classifications of mental illness to the rest of the world, and the displacement of native classifications. Although he wants us to agree that indigenous concepts of mental illness are worth preserving, the article is handicapped by the author’s refusal to describe most of these diseases; he says

…illnesses found only in other cultures are often treated like carnival sideshows. Koro, amok and the like can be found far back in the American diagnostic manual (DSM-IV, Pages 845-849) under the heading “culture-bound syndromes.” Given the attention they get, they might as well be labeled “Psychiatric Exotica: Two Bits a Gander.”

And so we are unable to learn that koro is also known as “genital retraction syndrome,” a form of panic attack in which victims believe that their penises are retracting into their bodies, usually by means of witchcraft. Injuries are often seen in victims attempting to keep their penises extended by main force, or by mob action against the accused witches.

Waters’ implicit assumption is that it would be a shame if koro and similar diseases were to fade away, replaced perhaps by American-style panic attacks. It’s hard to say what the people of Ghana, who beat 12 sorcerers to death for penis theft a decade ago, would lose by the switch, or whether Malaysians who suffer from amok, a disease characterized by the sufferer attempting to “kill or seriously injure anyone he encounters,” wouldn’t do better to adopt American ideas of sociopathy. He does mention that culture influences the way humans experience otherwise universal mental illnesses, but never really follows through on that: If American insanity is edging out Tanzanian insanity, that must be because American culture is edging out Tanzanian culture to some degree. And that’s okay! American culture is okay, and even if our civilization’s understanding of mental illness is different from an indigenous understanding, it’s hard to argue that it’s worse.

Later in the article, to bolster his view that the DSM-IV is bad for our health, he describes the different experiences of schizophrenics in America and Tanzania. In short, Tanzanian schizophrenics have a better prognosis because Tanzanians view schizophrenia as mere possession by spirits, while Americans view it as a dreadful, incurable brain disease, treatable only with medication and intensive therapy.

Left unsaid is that the Western view is right. Schizophrenia isn’t possession by spirits. There are no spirits. Schizophrenia is a dreadful and incurable brain disease, and even if viewing it in that light is bad for our collective prognosis as a society, then there’s not much we can do: If the shoe fits, wear it. To encourage Tanzanians to maintain wrong beliefs about the causes of mental illness for their own good is condescending and ultimately hopeless.

In conclusion, he says

“No one would suggest that we withhold our medical advances from other countries, but it’s perhaps past time to admit that even our most remarkable scientific leaps in understanding the brain haven’t yet created the sorts of cultural stories from which humans take comfort and meaning. When these scientific advances are translated into popular belief and cultural stories, they are often stripped of the complexity of the science and become comically insubstantial narratives. Take for instance this Web site text advertising the antidepressant Paxil: ‘Just as a cake recipe requires you to use flour, sugar and baking powder in the right amounts, your brain needs a fine chemical balance in order to perform at its best.’ The Western mind, endlessly analyzed by generations of theorists and researchers, has now been reduced to a batter of chemicals we carry around in the mixing bowl of our skulls.”

I can’t deny that “a batter of chemicals” lacks the whodunit appeal of “spirits did it!”, but speaking as (I hope) a typical American, I draw a lot of comfort from the mixing bowl analogy. If a cake has too little baking powder, just add more. Fixing a cake recipe might not be a satisfying narrative, but it’s easy and it usually works. If your schizophrenia is caused by a chemical imbalance, you can always take Clozapine. But if you’re possessed by spirits, who are you gonna call?