Cultural imperialism and mental health

Back in the early 1970s, when I was in Namibia, I received a letter from a bunch of psychotherapists in Chicago, saying that they were concerned about the mental health of people in Namibia. They offered to send teams of shrinks as kind of short-tem missionaries to Namibia, to help Namibians to overcome their mental health problems.

It was a kind gesture, and well-meant, and we discussed it for a while, but really could not see that it was a practical project. Eventually I replied to the effect that a team of Western psychotherapists would be about as effective in Namibia as a team of Namibian witchdoctors would be if sent to help with the mental health needs of middle-class suburbanites in Illinois. In either case, they would need to bridge the cultural and language gap before they could be effective, and that could not be done in a few weeks.

I didn’t put it quite as bluntly as that, of course, but that was the gist of it.

A hundred years earlier there was the same problem. Christian missionaries came to Africa from Europe and North America, and they had been inculturated into the worldview of modernity. Yet they came to premodern societies, which had a very different worldview. And one of the areas where the differences in worldview showed up more clearly than anything else was in the cultural interpetation of illness, both physical and mental.

For the next century or so Western missionaries studied the cultures of Africans, and thus, in some ways, laid the foundations for the discipline known as social anthropology or cultural anthropology today. But until fairly recently no one made a cultural study of the worldview of the missionaries themselves. Perhaps significantly, one of the breakthroughs in that area came from, of all places, Chicago. The book to read is Of revelation and revolution: Christianity, colonialism and consciousness by Jean and John Comaroff (Chicago, University of Chicago Press, 1991). Another is Modernity and its malcontents: ritual and power in post-colonial Africa, edited by the Comaroffs.

And then today, hat-tip to An anthropologist and the pearly (white) gatekeepers: Culture Matters, I came across this Exporting American mental illness: Neuroanthropology:

The New York Times Magazine has a great discussion of the effects of the exportation of American ideas about mental illness, titled appropriately, The Americanization of Mental Illness by Ethan Watters, based on his forthcoming book, Crazy Like Us: The Globalization of the American Psyche, coming out this month from Free Press. The article is quite good, offering some intriguing cases, such as the rise of virulent, American-style anorexia nervosa in Hong Kong, the effect of possession beliefs on communities’ reactions to schizophrenia, and how the narrative of mental illness as ‘brain disease’ might actually lead to great stigma as it spreads and replaces local understandings. The article is well worth a read, and I’m looking forward to the book.

One point that is very significant (and was in the back of my mind when I wrote a reply to those Chicago shrinks 40 years ago) is:

One thing I really liked about the New York Times Magazine article, however (and by extension, Watters’ book, I suspect), is that the discussion of ‘culture-bound syndromes’ usually tends to treat other people’s syndromes as ‘culture-bound,’ Western psychological illnesses as not ‘culture-bound.’ Watters’ work points out that Western mental illness is both itself culture-bound and that persuading people to believe in Western-style mental illness can affect the way that psychic disorders manifest.

Another significant point is this:

In Zanzibar, schizophrenics are believed to be suffering from intermittent bouts of spirit possession. To cut to the chase, this belief affects those around them, especially family members, which affects how they treat the individual with the condition: ‘With schizophrenia… symptoms are inevitably entangled in a person’s complex interactions with those around him or her. In fact, researchers have long documented how certain emotional reactions from family members correlate with higher relapse rates for people who have a diagnosis of schizophrenia.’ It turns out that interaction patterns with a person possessed by spirits are actually healthier than those of family members in the West who believe the individual has a ‘mental illness.’ In fact, with US families, the more they try to ‘care’ for the schizophrenic family member, the more they fall into an unproductive interaction pattern with the individual with the illness. The issue is not just the belief, but the emotional quality of family interaction with a suffering individual; treat them one way, and it’s not just that you believe they’re different — the individual actually becomes different.

Another point that Watters does not go in to much is that in premodern African societies many ailments, both “mental” and physical, are attributed to witchcraft, though that is dealt with in the works by Comaroff and Comaroff that I referred to. See also my article on Christian responses to witchcraft and sorcery. This has become complicated by cultural imperialism from a somewhat different quarter, namely the rise of neopaganism among Western people, including a significant number of whites in South Africa. Some of these neopagans are very unhappy with the kind of discourse in which witchcraft is seen to be evil, and have tried, with varying degrees of success, to change the public image of witchcraft into a more favourable one. This has perhaps made some headway in the West. Since modernity became the dominant worldview of the West, most Western people have believed that witchcraft in the evil sense simply does not exist, and that the belief that there were such things as evil witches was a medieval superstition. The Western missionaries who came to Africa in the 19th century were no exceptions to this. They saw it as part of their task to teach Africans that evil witchcraft did not exist. Now some Western neopagans are tending to confuse the issue by saying the same thing, others saying that witchcraft is good after all, and yet others saying that African and European witchcraft are utterly different phenomena. I have dealt with this in more detail in another blog post, Witchcraft: African and European, in case anyone is interested in more details. And in case anyone objects to the term “neopagan” (and I know some people do), I’m not trying to be offensive, but revived Western paganism that has arisen in the milieu of modernity and postmodernity is very different from the paleopaganism of premodern Europe, which tended to be much closer to African paganism in this respect.

If we had sent witchdoctors to Chicago forty years ago, what would they have found? In all probability they would have found a society in which people would simply not not believe that their problems were caused by witchcraft, and the visitors would find that they were helpless to cure such people. And the same would apply, mutatis mutandis, to Western psychotherapists going to Namibia. There might be some cases in which psychiatrists (as opposed to psychotherapists) could do something. As Greg Downey notes, “Some disorders have neurological or neurochemical dynamics that are susceptible, at least in part, to treatment with drugs, so all symptoms may not be so culturally negotiable, although they might still vary in frequency, severity, and trajectory”. But he qualifies this a litte further on by saying Exporting American mental illness: Neuroanthropology:

Without doubt, Western ideas about mental illness are directly affecting expectations of psychic distress around the world; see, for example, Vaughan at Mind Hacks discussing Did Antidepressants Depress Japan?. Here Vaughan highlights another force, one touched on by Watters but not explored; pure mercenary impulses, as drug companies try to persuade new markets that the individuals ‘need’ their products, suffering as they do from disorders of which they were previously unaware. Here, the idea that it’s just the ‘beliefs’ about illness held by therapists and authorities obscures the naked greed that goes into public relations campaigns designed to produced disorder.

There is the question of “spirit-possession” again, and perhaps it is the unclean spirit of laissez-faire capitalism that needs to be exorcised.