Sam Raeburn, Infectious Psycopathy

Infectious Psycopathy
The late 1980’s saw the birth of what would later become a revolution in pharmaceuticals, Prozac. What was soon dubbed a ‘miracle drug’ not only created a new market, but turned that market into a $10+ billion dollar per year juggernaut. Prozac itself became the best selling drug in America by the late 1990’s, and yet was only the beginning of the revolution. Anti-depressants are now the second leading drug sold yearly in the United States behind only heart medications. Now-a-days, new prescription drugs are emerging almost monthly, offering cures for everything from ‘Restless leg syndrome’ to ‘Avoidant Personality Disorder’. Anti-depressants gave birth to not only a whole market of prescription drugs (one that appeals to patients rather than doctors) but their own niche within that market with the increased sophistication in, and sale of SSRI’s (Selective Serotonin Reuptake Inhibitors, which inhibit the receptors in neurons that re-absorb serotonin, therefore increasing the serotonin levels in the brain without adding any excess or synthetic serotonin to the system). These are the modern anti-depressants which are used to treat varying forms of depression, personality disorders, and even insomnia. The economic triumphs of these drug companies and our knowledge of modern psychological pathologies are not limited to the United States anymore, as seen in the transformation of a virtually non-existent Japanese anti-depressant market to a billion dollar market seemingly over night. This paper intends to outline the idea that there exists a very real danger of overconfidence in our (American/Western) knowledge of and treatment methods for psychiatric disorders. Coupled with this are the dangers provided through the symbiotic relationship that has developed between the drug companies and the psychological community. (Watters)

Ethan Watters is an author who has written several books. His latest entitled Crazy Like Us : The Globalization of the American Psyche speaks directly to the impact of the American Psychiatric community interacting with the global community. He outlines four main examples of differences between our own culture’s views and treatments of disorders and those of other cultures, and through these examples brings to light a few basic yet very counterintuitive and startling suggestions. The primary of these is that psychiatric disorders are not global, or at least the expression of them is not global. In fact, the nature of expression of many disorders varies widely between locations, both geographic and in time. As Watters explains in his book,
“The diversity that can be found across cultures can be seen across time as well. Because the troubled mind has been perceived in terms of diverse religious, scientific, and social beliefs of discrete cultures, the forms of madness from one place and time in history often look remarkably different from the forms of madness in another. These differing forms of mental illness can sometimes appear and disappear within a generation. In his book Mad Travelers Ian Hacking documents the fleeting appearance in Victorian Europe of a fugue state in which young men would walk in a trance for hundreds of miles. Symptoms of mental illnesses are the lightning in the zeitgeist, the product of culture and belief in specific times and specific places. That thousands of upper-class women in the mid-nineteenth century couldn't get out of bed due to the onset of hysterical leg paralysis gives us a visceral understanding of the restrictions set on women's social roles at the time.” (Excerpt from Crazy Like Us, taken from ‘Is the Rest of the World Crazy Like Us?’ Npr.com)
These startling examples reinforce the concept that the unconscious mind adheres to whatever societal norms are prevalent in the culture at that time when expressing a mental disturbance or unrest. This suggests that the outward expression of a disorder will vary over time and location depending on the surroundings of the individual, a concept being proven in increasing amounts with the prescription drug fad. This is demonstrated in the example of depression in Japan. (Watters)

Japan is a culture far removed from our own. Eastern cultures are dominated by a collectivist view of society, whereas in Western culture we have individualistic societies. Moreover, Japanese culture has a particular emphasis on the role of sadness. In opposition of even a normal collectivist view, the Japanese believe sadness, melancholy, and mourning are all vital psychological states. Many Japanese heroes and fabled figures demonstrate substantial melancholy and sadness, and the idea of a melancholy-embracing individual is glamorized in the ideal Japanese societal member. The idea of depression was embraced in 20th century Japan, but only as an end-of-the-spectrum condition. It would seem safe to assume improbability in a 1,000 year old culture changing one of it’s core beliefs so rapidly on account of internal forces, and that assumption would be correct. It was an external force that so swiftly changed the views of an entire culture’s psyche, the West. More specifically, it was the West’s knowledge and opinions of the human psyche. (Watters)
As the pharmaceutical explosion began in America, companies began searching for new markets. In his interview with Oppenheimer, Watters notes how frequently he heard stories of the pressure Japanese psychiatrists were put under by major pharmaceutical companies. One doctor told him “We were like very cheap prostitutes”(Watters). In particular, the company GlaxoSmithKline (heretofore to be referred to as GSK) is mentioned as being the main facilitator of depression medications as well as information on the psychiatric disease. GSK was the first company to branch into the Japanese market as the common view at the time was that due to the cultural significance of melancholy in Japanese culture, an attempt at selling antidepressants would be futile. Ignoring this notion, GSK began doing in depth research, gleaning as much information as possible from the top Cross-Cultural Psychologists, on the spread of ideas, cultural norms, and mental illness between cultures. The tactic worked and over a period of only a few years, the rate of diagnosed depression skyrocketed in Japan. The social mores of the culture have been shifted, a large-scale example of the dangers of pharmaceutical companies. (Watters)

The quandary in pharmaceuticals stems from paradox of treatment vs. research. Most simply put, pharmaceutical manufacturers produce treatments for ailments. These treatments are quite profitable, as seen in the multi-billion dollar yearly market of prescription drugs. The treatments produced by the companies are designed around knowledge obtained through research. Research in itself is a money losing proposition, hence the constant need for grants, loans, or donations to fund research projects across fields and disciplines. It then stands to be said that in order for a product to be at it’s maximum effectiveness, it requires sufficient research supporting and molding it’s formation. The better the research, one could argue, the better the product. In the interests of furthering their profit margins, drug companies are continually researching and inventing new methods, products, and even definitions of ailments. Though this form of funded research with, for all intensive purposes, unlimited monetary assets offers new possibilities in the realm of investigation, it lends itself to pressure to both perform and conform to the funding company’s standards. An effect clearly seen in the inflation of many figures given out by drug companies in regards to effectiveness, and the less than full disclosure on topics such as side effects, health risks, and long-term damage. In the early 2000’s the success rate for leading antidepressants were reported as high as 50%, a figure now known to be drastically overestimated. Most empirical evidence has put the success rate much closer to one in ten rather than one in two. These forms of money-motivated truth bending are akin to the pressure felt by Japanese psychological experts during the introduction of GSK’s western version of treatment and well being. A researcher is understandably enticed by the idea of continued funding in exchange for ‘fluffed’ results, especially when the alternative option is a much more bleak retraction of financial aid. Even the most well-intentioned researcher could easily rationalize the less-than-truths peddled by the drug companies in exchange for a continued chance to make a real difference through new research findings. Hypothetical findings only feasible through continued large-scale financing by the company they lie for. (Waters; Is)

Another area Watters investigates is the treatment of Post-Traumatic Stress Disorder, or PTSD. He contrasts the Western view of PTSD with the view and treatment of PTSD in Sri Lanka. Sri Lanka is another collectivist society. To ask an American how they are doing evokes an egocentric response, “I am ok,” or “I’m having a rough day,” are common examples. In sharp contrast, a Sri Lankan would undoubtedly describe their internal feelings in a socio centric manor (i.e. a Sri Lankan individual would say they are being a positive or negative asset to the society). This becomes especially important in the West’s view of PTSD. After the tsunami that wrecked much of Southeast Asia’s coastline, emergency aid was sent from the West to alleviate the struggles of the indigenous people. Along with troops, food, water, supplies, doctors, and nurses, came mental health professionals, and their westernized treatment methods. Methods based upon the assumptions and norms of a society drastically different than that of the people these professionals were attempting to help. PTSD first received major recognition after the Vietnam War. Thousands of young men were returning from a war like no other war before it. Not only was the jungle warfare of a new paradigm than previously encountered by American forces, but the political influence and lack of a clear goal evident throughout the war brought serious psychological turmoil to the troops. The combination of these factors lead to a crack in the previously concrete belief those soldiers had in their country, leaders, and cause. This disturbance in psychological continuity caused many veterans to lose a grip on reality. This phenomenon was, at the time, still in the form of a social narrative Watters explains; meaning the issue at hand was projected outwards onto society in a form of disappointment and uncertainty. Current views on PTSD have evolved into a personal narrative, centering around specific instances of an individuals experiences and their effect on the persons psyche. This is another clear example of the evolution of mental disorders, in Western culture, towards egocentrism. This makes the Americanized treatment methods employed in Sri Lanka ineffective at best. The current views on PTSD see the most effective treatment as time away from society. This time is used by the individual for self-reflection and therapy. Sri Lankan people do not see their mental distress as an internal problem, but rather as their ineffectiveness in society. The western solution therefore is counterproductive to the Sri Lankan individual. Their removal from society only augments the already existing problem in their mind. (Watters)

A third comparison is shown through Watters investigation of schizophrenia in Zanzibar. Zanzibar is collectivist society within the third world country of Tanzania. Like most other aspects of life in an underdeveloped society, the psycho-social sciences are far behind those of their industrialized, Western counterparts. The common treatment of schizophrenia in Zanzibar is based on their belief in spiritual possession. It is an embraced belief throughout the society that ancestral spirits can overtake a person and cause the erratic behavior we classify as schizophrenia. While all research and modern science would essentially debunk this belief, it is the treatment of the believed ailment that is so surprising in its success, a success not reliant on the ideals the treatment is formulated around, but instead by the secondary benefits of the treatment method. Whereas in western psycho medical fields one would isolate an individual with schizophrenia, working on the patients problems in a one-on-one or small group therapy setting, the method in Zanzibar is to surround them with the other members of their village or social group. The complete lack of a stigma surrounding the disorder is, in itself, a dramatic difference from Western society. The community comes together around the afflicted to collectively aid in the healing process. This form of treatment boasts not only higher success rates of treatment, but lower rates of reoccurrence in those once afflicted. (Watters)

The very nature of psychology itself should deter an overly confident attitude in what is ‘known’. When thought about against the backdrop of other human knowledge, the field of psychology is a fledgling. Mathematics, philosophy, biology, chemistry, and even physics far predate psychology. Psychology is therefore apt to follow much in the same manner of those topics before it, albeit in an accelerated fashion. Already, several schools of thought have come to prominence and passed in psychology’s brief history. With every new piece of information presented to us comes another conflicting aspect of the human mind. It’s now understood that there is both a nature and nurture element to every aspect of a person’s personality, it just varies as to how much of an effect each element has. The Diagnostic Statistic Manual, the bible for Western psychologists, is soon coming out with it’s fifth edition. This alone shows the evolution of the field in the past 58 years. Each new edition removes old definitions and disorders altogether, defines newly formed disorders, and sharpens definitions of existing disorders as knowledge of them increases. It is an exercise in arrogance to believe that our current definitions warrant the invasion of cultures with our knowledge, presenting them as absolute fact and changing societal norms and customs whose age is five to twenty times the existence of the entire field of modern psychology. (Waters; Is; Crazy)

Psychology as a field needs to become more responsive to differences between cultures and time periods. The narcissistic view of western science from the viewpoint of western scientists must be dealt with in order for the field to become more effective and adaptive to different circumstances. Further research into the root causes of disorders, rather than the blatantly observable manifestations of the disorders, is a necessity to the advancement of the field. This research must be unbiased to be truly reliable and progressive, leading into the necessity for government or non-profit funding. A true separation between the research firms and drug companies must occur in order for this to happen.

Though some many aspects of psychological pathology are consistent across cultures and through generations, there are many superficial traits of these pathologies that can vary greatly. Even more important are the societal opinions, views, and stigmas associated with the disorder that vary by culture. The cognition a member of an individualistic society has in regards to schizophrenia differs drastically from that of an individual from a collectivist society. In order for the field of psychology to fully transform into a diagnostic science, it must be removed from the motif of the western culture it was primarily contrived in. Only in this way can the true causes, meanings, and cures for psychological maladies be revealed. The dangers of ignoring these warning signs and trends could become extremely detrimental. The infectiousness of the individualistic self-view has already done notable damage to several cultures, and there stands only a handful of cultures and peoples unaffected by western influence. Humans have an underlying idea that everyone at their core is basically the same. As members of the western society, it’s time to realize that everyone being the same doesn’t mean everyone is like us, and act accordingly. (Watters; Is)














Works Cited
Watters, Ethan. Interviewed by Todd Oppenheimer; Berkley Arts and Letters. 2/4/10
http://fora.tv/2010/02/04/Ethan_Watters_The_Globalization_of_the_American_Psyche#chapter_02

“Is the Rest of the World Crazy Like Us?” NPR.com, 1/2/10

“Crazy like Us” Gilsdorf, Ethan, Psychology Today 2/9/10;
http://www.psychologytoday.com/blog/geek-pride/201002/crazy-us