Emotions and Illnesses

Allison Terlizzi

            The two chapters from Ethan Watters’ book, “Crazy Like Us” explored the globalization of psychological disorders, anorexia nervosa and depression. These disorders have manifested themselves in Western countries, and to understand the ways they are expressed on a global level, we have to look at them without using a Western lens. It is the cultural beliefs, practices, and influences within different social and historical contexts that have led to different psychological characteristics to be expressed in patients with these disorders even if two people across the globe have the same disorder.

            In “The Rise of Anorexia in Hong Kong”, Watters explores Dr. Sing Lee’s experience studying anorexia nervosa in patients in Hong Kong. What he found was that women were starving themselves for different reasons than exist in the West, and the disease also elicited different physiological responses in the body. Often, it occurred in lower class women who were low achievers and did not experience obsessing over food quantities and portions. In addition, they did not feel fear of being fat and losing weight was not a way for them to become more attractive (Watters, 18). For one of his patients named Jiao, she experienced a loss of love in her life, which contributed to the onset of anorexia. Many patients like Jiao experienced “the refusal to eat as a physical symptom: a literal blockage of [their] throats (26)”.

            Dr. Lee also said, “Mental illnesses do not exist independent of social and historical context (35)”. There is no natural history of the disease, but a social history at any time and place. Because anorexia was never declared as a legitimate disorder, there was a lack of research on the disease. There also was not very much public awareness of the disease, leading to its rarity (37). Charlene was another patient he studied who collapsed on the street due to organ failure because of anorexia. Her death symbolized the point in time when the public’s knowledge of the disease and their acceptance of it grew (44).  Lee determined that by 1977, fat phobia had become the most important reason for self-starvation to occur (50). This means there was a noticeable change in the expression of the disease that more closely matched Western expression. Thus, two groups emerged for research: the women with hysteria who had no desire to eat and women who conformed to the Western expression of the disease characterized by fat phobia. Watters says, “the women attracted to the disorder when there is exists a cultural template for the behavior inevitable far outnumber the women who come to food restriction on their own (51)”. This is important because once it had become culturally acceptable to be anorexic, women used the disease to manifest their feelings of unhappiness and anxiety for example, as a sort of vehicle for expression. It had become acceptable and increased in prevalence.

            Ultimately, the Western categories for the disease remain dominant and anorexia is rarely studied outside of this context. Before reading this article, I had assumed that women across the world had been influenced by Western standards of beauty, such as in the case of the Fijian women, and had developed eating disorders because of these same reasons. My main issue with this article is that I felt as though since the women in Hong Kong and American women refuse to eat for two different reasons, can we call their disorder the same name? What I mean by this is, if Chinese women reported the tightening of their esophagus and unsettling stomach which is clearly a physical feeling, and American women reject food because they don’t want to become fat which is an emotional feeling, how are they the same disorder? While anorexia will lead women in both countries to reject food and lose extreme amounts of weight, the causes of this are very different.

            In the chapter, “The Mega-Marketing of Depression in Japan”, Watters starts by discussing Dr. Lawrence Kirmayer’s experience at the International Consensus Group on Depression and Anxiety, a conference in Kyoto in 2000, the purpose of the conference being to find out what scholars knew about how cultures shape the illness experience (190). People in Japan had a completely different conception of what depression is compared to the West, making it unlikely that Japanese people will want to take a drug associated with this disorder. The Japanese describe depression differently than we do, calling it “a mental illness that was as chronic and devastating as schizophrenia (193)”. In order to market drugs to the Japanese, we first must the question of how the culture has shaped the illness itself. Then, through advertising, the public’s attitudes about the disease can be influenced.

            Kirmayer suggested that every culture has a type of experience that is in some way parallel to the Western conception of depression, defined as “a mental state and set of behaviors that relate to a loss of connectedness to others or a decline in social status or personal motivation (194)”. However, all cultures have their own unique expressions, descriptions, and understandings for these mental states (195). For the Japanese, because it wasn’t socially acceptable to have depression, people will be unwilling to categorize themselves as depressed and thus will not take treatment. The frequency of depression began to rise rapidly in Japan over the next few years after this was explained.

            The spread of mental illness in Japan started with neurasthenia, which included symptoms of insomnia, lack of concentration, eye fatigue and the feeling of a heavy pot being on one’s head (204). This disorder carried little social stigma and afflicted the “elites”, so it became trendy to have it. It was also depicted as a symptom of modernization and people who had it were considered to embody modernity. I thought this section of the article was most fascinating because when do we ever look at a mental disorder and consider it to be trendy? Being able to experience the effects of modernity in this case was a “problem” that needs “treatment” and if you have this problem, you are “cool”.

            One of the most surprising and important things about this reading was the discussion of how the Japanese and Americans were not only describing the symptoms of depression, but were feeling the symptoms in different ways. This alludes to the differences between how the Japanese and Americans conceived of the nature of the self.  While Americans experienced the self as isolated within the individual mind, the Japanese conceive of the self as less individualized and more connected, dependent on social and environmental contexts (211). This is a reason for why the symptoms of depression, and what people define depression as, are expressed differently in both cases.

            In the case of Oshimo, who died by hanging himself, the Japanese public remained split on whether suicide was a meaningful act with moral intent, or was an act of someone who was mentally ill (219).  This comes back to the denial of the Japanese to accept mental health disorders as a cause for concern and treatment.

            The Japanese have mega-marketed drugs to treat depression to appeal to people by saying they will become like Americans, but no conclusive scientific data has come out that has proved if these drugs work or not. Has Westernization caused the placebo effect to arise in the Japanese who take these medications because they want to become more modern?