In its latest issue, New Scientist magazine reports on a troubling trend being witnessed by medical anthropologists:

Drug companies, with the aid of the U.S. medical establishment, are exporting a western interpretation of mental illness — and not always for altruistic reasons.

“Our western conception of depression is being promoted by multinational drug companies who profit mightily when other cultures adopt the idea and then buy their antidepressants,” writes science writer Ethan Watters.

“[M]ental illnesses are not evenly distributed globally,” he reports, “and do not take the same form from place to place. Unfortunately, mental health professionals in the U.S. who dominate the global discussion about how mental illnesses are categorized and treated, have often ignored or dismissed these differences.”

As an example, Watters describes how GlaxoSmithKline (GSK) launched the antidepressant paroxetine in Japan in 2000.  A front-row observer to this marketing event was Laurence Kirmayer, MD, director of the division of social and transcultural psychiatry at McGill University in Montreal, Canada, and an expert on how cultural beliefs affect mental illness. Writes Watters:

Globalizing PTSD

Watters also discusses how, “[i]n our rush to treat the psychic wounds of traumatized people, we seldom ask if PTSD [post-traumatic stress disorder] can be usefully applied everywhere”:

Because of these very different cultural reactions to trauma, medical anthropologists "worry whether counsellors can be effective if they don't know the local idioms of distress," reports Watters. "Arthur Kleinman, a medical anthropologist at Harvard University, says that although most disasters do not occur in the west, 'we come in and pathologise their reactions. We say "you don’t know how to live with this situation." We take their cultural narratives and impose ours. It’s a terrible example of dehumanizing people.'”

Haitians and PTSD
Of course, I immediately thought of Haiti, and wondered if our mental-health efforts there in the wake of the devastating earthquake will be culturally sensitive. The media is already reporting on how Haitians are going to be needing treatment for PTSD.

Haitian-born psychologist Marie Guerda Nicolas of the University of Miami told Health.com that she expects to see PTSD among some of the earthquake survivors, but that Haitians will turn to their lakou, or extended social network, for support and solace.

“I think it’s important to realize that we don’t experience things the same way,” she added. “We express what we feel differently. There may be a lot of crying and wailing. They might faint; they might fall down. All of that is part of responding to the trauma — but it doesn’t mean they’re not able to cope and function. A person in a state of shock may look like they’re going to fall down or faint, and then an hour or so later they’re fine. This is one of the remedies for dealing with that sense of shock. It’s not part of the Haitian mentality that we’re not able to do for ourselves. There’s always the sense that bad things happen in Haiti and to Haitian folks, but that we have the ability to overcome and get through it."