Our topic for this week is Culture and Mental Illness.  Our aim is to consider the ways in which culture influences and shapes the very idea of mental illness and the also the way culture conditions the way particular mental illnesses express themselves. 

Start  with the way culture shapes the very idea of what counts as a mental illness.  Take the case of koro.   Koro is mental disorder, characterized by a debilitating fear that that one’s genitals are retracting into ones body and that once they are fully retracted you will die.   You don’t find many instances of in Western societies.   But Southwest Asia koro epidemics have been known to break out.   There was such an epidemic in 1984-85 in Guangdong, China.  And between 997 and 2003 in several different West African nations,  there were local outbreaks of koro-like panics.   Koro seems to be at least partly based on a set of culturally specific beliefs about sexuality.   Most koro sufferers appear to be immature, younger men, who lack self-confidence, who engage in a lot of auto-erotic activity, and who suffer extreme guilt and anxiety as a consequence.  Culturally conditioned views about sexuality seem to play an important role in causing  their guilt and anxiety to express themselves in a certain way.

One could think that it makes little sense to call koro a mental disease at all.  Koro seems very much like a form of culturally conditioned fear or panic or something.  But is that enough to make it a mental disease?   A mental illness, one might think,  is is something that happens to you because your brain goes haywire in a certain way  -- like in schizophrenia, for example.   A mental disease isn’t something that happens to you because you have weird beliefs.   Indeed, if you look up koro in the Diagnostic and Statistical Manual – the book that covers all mental health disorders for both children and adults --  you will find koro listed there.  But you’ll find it listed toward the back of the book --  with what are called  “culture-bound syndromes.”   That’s a way of recognizing koro and its cousins, like amok, which was once prevalent in Maylasia,  or zar, which occurs mostly in the Middle East,  are real things – sort of.   But it’s also a way of saying that they are not quite your garden variety mental disorders,  more or less directly rooted in the physiology of the brain 

 But  this isn’t to suggest that only certainly weird and exotic conditions are shaped and influenced by culture.  Take schizophrenia. Though there is some disagreement about what exactly Schizophrenia consists in, nobody would deny that schizophrenia is something real and something really devastating.   And it occurs everywhere, not just in this or that culture.  But even a disease as “transcultural” as schizophrenia seems to be culturally and socially conditioned in certain ways.     Schizophrenics often suffer from various kinds of delusions.  And  it wouldn’t be at all surprising if the content of those delusions were keenly sensitive to locally culturally  shaped beliefs and practices.

On the other hand, we need to be careful here too not to overstate the case for actual cultural variations in the way mental illnesses express themselves.  Just like with everything else in our the rapidly globalizing economy, there are forces that threaten homogenize away cultural differences --  including cultural differences in the way we experience, treat, and understand mental illness.  In fact, this week’s guest is Ethan Watters author of Crazy Like Us: The Globalization of the American Psyche.  He argues that the American Psychiatric establishment is, in effect, changing the way mental illness is experienced, treated, and understood, around the globe. Is the rising hegemony of the American model of mental illness noticed by Watters  a good thing or a bad thing?  Does it represent scientific progress or a kind of cultural imperialism?    Would it be better to let a thousand cultural flowers bloom in the treatment, understanding, and experience of mental illness?  Those are just some of the questions we hope to address.