Cultural Globalization and Mental Illnesses

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Despite the biotechnological advances which have substantially improved the overall health status in developing countries worldwide, an increase has been observed in mental illness incidence rate in low income societies. According to the statistics provided by the World Health Organization (2010), five of the ten leading causes of Disability-Adjusted Life Years (DALYs) for 15 to 44-year olds are mental illnesses or self-injuries. The paradoxical increase in the rate of mental illnesses worldwide can be looked at in the context of intensified globalization and its influence on cultures and societies. The implications and consequences of cultural globalization are highly controversial in nature. Certain adverse effects of cultural globalization such as loss of identity, merger of cultures, and the takeover of global brands over the subtle cultural forces are the aspects that have been studied the most. However, the indirect effects of cultural globalization go far beyond affecting the growth of mental illnesses worldwide: from increasing depression and anxiety, to eating and post-traumatic disorders. Some ways cultural globalization affects mental health include the shaping and dissemination of psychological knowledge itself and the alteration of people’s self-perception, values, and priorities through global media and global branding.

To understand each of these aspects, an essential notion to consider is homogenization; a process by which people of the world are incorporated into a single world society. On one hand, homogenization is mostly attributed to the strong forces of capitalism; consumerism, enhancement of multinational, transnational corporations and global brands. On the other hand, it is aided by the rapidly developing information and communication technologies .

Homogenization could be narrowed to be simply “Westernization” or even “Americanization”. According to Steger (2013), we are witnessing the rise of an “increasingly homogenized popular culture” heavily influenced by the Western world; ideals, values, and culture. Canadian Ex-Prime Minister Kim Campbell in her turn observes that “images of America are so pervasive in this global village that it is almost as if instead of the world immigrating to America, America has migrated to the world, allowing people to aspire to be Americans even in distant countries”. As a result of the increasing prevalence of western values, many people from indigenous cultures experience acculturation, a complex process by which behaviors and attitudes in a particular group are altered toward the dominant group because of the exposure to a cultural system which is considerably different (Barth, F. 1998).

On one hand, as American values are gaining increased popularity, people tend to see these values as progressive, modern, and worth emulating, which highly affects people’s behavior, self-perception, and cognition. On the other hand, the more “westernized” the world becomes, the more people’s understanding of mental health and illness becomes shared and universal. Logically, increased awareness and actions should lead to a reduction in vulnerability and aid treatment. The more rapidly brain sciences and technologies develop in the western world, the more emphasis is put on the biological nature of mental illnesses and the universalized approach to treatments. However, there is some evidence indicating that these illnesses are at least partly psychosocial in nature, and neither the diagnosis nor the treatment is universal; they vary across cultures, societies, and individuals.

As research conducted by Bhugra and Mastogianni (2004) demonstrates, there is considerable evidence suggesting that cultural background affects the experience and expression of mental illnesses: it is likely to determine whether the illnesses will be experienced in psychological, emotional, or physical terms. Cultural identity denotes the internalized self-definition resulting from the person’s selective, developmentally mediated incorporation of values, beliefs, history, and customs from those available in that person’s native environment. For instance, the research revealed that Asian patients tend to appear with mainly somatic complaints and are less willing to express depressive ideas. People from traditional cultures may not distinguish between the emotions of anxiety, irritability and depression because they tend to express distress in somatic ways. Even the term “depression” is absent from certain languages, and the feeling of guilt varies in frequency and intensity across cultures.

As a matter of fact, unique mental illnesses, called culture-bound syndromes exist, which, once again, prove the role of the sociocultural context. Culture-bound syndromes are illness phenomena that are restricted to a particular cultural context. Some examples include acute episodes of psychosis and violence such as amok (Malaysia) or syndromes with prominent anxiety such as shin-byung (Korea), or koro (Malaysia). These syndromes derive their significance from their cultural context and do not necessarily match the illness categories of Western nosology. However, there has been a tendency within the field of Western psychiatry to interpret these syndromes as exotic appearances of underlying universal disorders rather than as culturally particular syndromes.

A prominent psychiatrist and researcher, Dr. Sing Lee, has been observing the Westernization of mental illnesses for a decade. In the early 1990s, he documented a rare and culturally specific form of anorexia nervosa in Hong Kong. Unlike American anorexics, most of his patients neither intentionally dieted nor expressed a fear of fatness. The complaints of Lee’s patients were typically somaticized; they mostly complained of having bloated stomachs. Lee was trying to understand this indigenous variation of anorexia and find out the rareness of the disease when suddenly the public understanding and interpretation of anorexia shifted. The death of an anorexic teenage girl collapsed on a street caught the attention of the media with catchy headings, such as “Anorexia Made Her All Skin and Bones”, and “Schoolgirl Falls on Ground, Dead” (Watters, 2010).

Attempting to explain the story of the girl, local reporters turned to the American psychiatric diagnostic manual. The mental-health experts ubiquitously reported that anorexia in Hong Kong was essentially the same disorder as in the U.S. and Europe. The transfer of knowledge about the nature of anorexia, including the ways and reasons of its manifestation and the risk factors went solely in one direction: from West to East.

Western ideas not only altered the perception of anorexia in Hong Kong; they also altered the expression of the illness. Once the society and local mental-health professionals came to understand the American diagnosis of anorexia, the presentation of the illness in patients transformed into the western standard and the number of the victims escalated. In contrast to Lee’s former patients, the new ones usually mentioned fat phobia as a reason for self-starvation. New patients appeared to conform their experience of anorexia to the Western symptoms.

According to Lee, an understanding of the ways expectations and beliefs of the mentally ill shape their pathology are missing.

Culture shapes the way general psychopathology is going to be translated into a specific psychopathology. When there is a cultural atmosphere in which professionals, the media, schools, doctors, psychologists all recognize and endorse and talk about and publicize eating disorders, then people can be triggered to consciously or unconsciously pick eating-disorder pathology as a way to express that conflict

An award-winning psychologist, and an expert in post-traumatic disorders, Andrew Solomon (2003), likewise, refers to the impact of culture on the specificity of pathologies and the ways they can be treated.  Summarizing his research and experiments, Solomon writes: “I discovered that depression exists universally, but the ways that it’s understood, treated, conceptualized or even experienced can vary a great deal from culture to culture”

Working with Rwandan people after the genocide, Solomon found out that there was a disconnection between the western and the traditional approaches to treating mental health which caused problems with the effectiveness of the therapies. According to Solomon, “Westerners were optimistically hoping they could heal what had gone wrong, but people who had not been through the genocide could not understand how bad it was, and their attempts to reframe everything were somewhere between offensive and ludicrous”. The Rwandan people felt that the experts working with them were intruding and re-traumatizing them by constantly reminding them of their stories and revitalizing the pain (Leach, 2015).

As a Rwandan man, paraphrased by Solomon, puts it:

Their practice did not involve being outside in the sun where you begin to feel better. There was no music or drumming to get your blood flowing again. There was no sense that everyone had taken the day off so that the entire community could come together to try to lift you up and bring you back to joy. Instead, they would take people into these dingy little rooms and have them sit around for an hour or so and talk about bad things that had happened to them. We had to ask them to leave.

Both the case of anorexia in Hong Kong and the post-traumatic one of Rwanda indicate the impact of homogenization on mental health specialists and the problems caused by a one-way approach to the treatment of mental illnesses. This does not mean that the interference of Western specialists and raising awareness about mental illnesses worldwide are not beneficial at all. As a matter of fact, in numerous cases, like schizophrenia, the symptoms are mainly shared in diverse cultures, and the better understanding of the disease aided its identification and treatment in developing countries greatly. However, despite the dissemination of the psychiatric knowledge and the rapid development of neuroscience and cognitive psychology that tend to concentrate on the biological roots and universality of mental illnesses, the cultural context should not be ignored.

As the increased universalization affects the growth and evolution of mental illnesses worldwide, numerous multinational and transnational corporations and leaders of pharmaceutical industries spot opportunities to take advantage of people’s attraction to western images.

The study conducted by Watters (2010) illustrates the marketing of depression in Japan and its destructive outcomes. Formerly, Japanese psychiatry and popular thinking only acknowledged a severe and rare type of depression that implied institutionalization. However, the efforts of GlaxoSmithKline, the producers of Paxil (an antidepressant), to introduce a new conception of depression to Japan were successful. Medical anthropologists and psychiatrists were invited to luxurious hotels and rewarded for their readiness to share some insights with CEOs and marketing experts. A clever marketing campaign presenting new images of depression was then created. The image of depression that was presented to the Japanese public was deliberately left ambiguous, but it was designed to affect almost everyone, in particular, the youth, and intelligent, successful people. The experience from the Western world suggested that “marketing” diseases leads to much higher revenues than marketing the cures. Ask-your-doctor commercials were everywhere to destigmatize depression and encourage people to take charge of their condition by requesting prescriptions. At that time, in the early 2000s, the evidence in favor of Paxil was inconsiderable, incomplete, and questionable. Adverse side-effects including akathisia (a psychological disorder characterized by a feeling of anxiety, restlessness and a need to be in constant movement), violent behavior and increased risk of suicide had been disregarded. The impact of this promotion was the emergence of new forms of depression in Japan: the suicide rate, especially among young people, rose in line with Paxil sales.

When it comes to psychotropic drugs, not only do the marketing efforts play a crucial role in the rise of related mental illnesses, but also the ways these drugs work depending on culture and ethnic peculiarities. There is evidence suggesting that the pharmacokinetics of various psychotropic medications differs among diverse ethnic groups. In addition, the brain receptor responsivity, the volume of distribution, and the exposure to environmental factors (such as herbal remedies) that alter drug metabolism contribute to the interethnic differences in reaction to psychotropic drugs as well.

To sum up, the interrelation between cultural globalization and mental health creates various chain-reactions and gives a new definition to the concept of increasing mental health issues. Western psychotherapeutic models adopt an ethnocentric orientation toward an individuated self that reflects western notions of selfhood as well as an agenda derived from white, middle-class, male values. On one hand, influencing the ways mental illnesses are homogeneously defined and understood, cultural globalization leads to misdiagnosis and mistreatment of such illnesses. It induces artificial proliferation of mental health issues based on people’s tendency to correspond to dominant ideals and values. On the other hand, cultural globalization empowers capitalistic forces, such as multinational, transnational corporations and leading pharmaceutical companies: it gives them tools to boost their profits efficiently at the same time causing growth in mental illness incidence. Western medicine and global brands are world-changing forces influencing the practice of psychiatry around the globe. The impact of these forces can be beneficial in some cases. However, the diagnosis and treatment of mental illness within the context of the local culture in which it is found is essential and should not be overlooked. Furthermore, primary caregivers should be cautious considering the possibility that economic forces may insidiously lead to the discovery of cures seeking potential diseases.

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