Brave new world: according to DSM-ETC

For someone, like me, who has devoted
lots of energy to the study of several versions of the 'Bible of
Psychiatry '—DSM – ETC as, I affectionately, call it —
I remain worried as I anticipate with concern the May, 2013 date
when we"ll witness the birth of a monster Caliban-like, polymorph
and perverse: called DSM-V.

Abstract

Thanks to DSM-ETC, the American Psychiatric
Association (APA) has for many years been busily engaged in a
grand project of Americanizing the world"s understanding of
mental health and illness. They may indeed be far along in
homogenizing the way the world goes crazy.

Blue Moby Dick by Jackson
Pollock

Americans, particularly if they are the
college-educated type, worry about their country"s awesome
blunders into other cultures.

For all the self-recrimination, however,
the world may have yet to face one of the most remarkable effects
of American-led globalization. They have for many years been
busily engaged in a grand project of Americanizing the world"s
understanding of mental health and illness. By now, they may
indeed be far along in homogenizing the way the world goes
mad.

This unnerving possibility springs from
recent research by a loose group of anthropologists and
cross-cultural psychiatrists. Swimming against the biomedical
currents of the time, they have argued that mental illnesses are
not discrete entities like the polio virus with their own natural
histories. These researchers have amassed an impressive body of
evidence suggesting that mental illnesses have never been the
same the world over (either in prevalence or in form) but are
inevitably sparked and shaped by the ethos of particular times
and places, as I have expressed in countless
occasions.

The fools" Bible

In some Asian cultures, people have been
known to experience what is called amok, an episode of murderous
rage followed by amnesia; men in the region also suffer from
koro, which is characterized by the debilitating certainty that
their genitals are retracting into their bodies.

The diversity that can be found across
cultures can be seen across time as well.

The hysterical-leg paralysis that afflicted
thousands of middle-class women in the late 19th century not only
gives all a visceral understanding of the restrictions set on
women"s social roles at the time but can also be seen from this
distance as a social role itself — the troubled unconscious
minds of a certain class of women speaking the idiom of distress
of their time.

They did it in similar vein as Susan Sontag
expressed in her book Illness as a metaphor.

In any given era, those who minister to the
mentally ill — doctors, shamans or priests — unwittingly help
to select which symptoms will be recognized as legitimate.
Because the troubled mind has been influenced by healers of
diverse religious and scientific persuasions, the forms of
madness from one place and time often look remarkably different
from the forms of madness in another.

Enters
DSM-ETC

For more than a generation now, the
American Psychiatric Association has aggressively spread its own
conception of mental illness around the world.

It has done this in the name of science,
believing that their narrow approaches reveal the biological
basis of psychic suffering and dispel prescientific myths and
harmful stigma. There is now good evidence to suggest that in the
process of teaching the rest of the world to think like they tell
us, they have been exporting their self styled "symptom
repertoire" as well.

Galatea de las esferas by
Salvador Dalí

That is, they have been changing not only
the treatments but also the expression of mental illness in other
cultures. Indeed, a handful of so-called mental-health disorders
— depression, post-traumatic stress confusion and anorexia
nervosa among them — now appear to be spreading across cultures
with the speed of contagious diseases.

Notably in this regard, is how DSM-ETC has
kept all hands off obesity and its related behavioral
complications.

These symptom clusters are becoming the
lingua franca of human suffering, replacing indigenous and
traditional forms of mental illness.

In a story that appeared in an important US
periodical, a psychiatrist and researcher at the Chinese
University of Hong Kong, watched the Westernization of a mental
illness firsthand. In the late 1980s and early 1990s, he was busy
documenting a rare and culturally specific form of anorexia
nervosa in Hong Kong. Unlike American anorexics, most of his
patients did not intentionally diet nor did they express a fear
of becoming fat. The complaints of the doctor"s patients were
typically somatic — they complained most frequently of having
bloated stomachs. He was trying to understand this autochthonous
form of anorexia and, at the same time, figure out why the
disease remained so rare.

As he was in the midst of publishing his
finding that food refusal had a particular expression and meaning
in Hong Kong, the public"s understanding of anorexia suddenly
shifted. On Nov. 24, 1994, a teenage anorexic girl named Charlene
Hsu Chi-Ying collapsed and died on a busy downtown street in Hong
Kong. The death caught the attention of the media and was
featured prominently in local papers. "Anorexia Made Her All
Skin and Bones: Schoolgirl Falls on Ground Dead," read one
headline in a Chinese-language newspaper. "Thinner Than a
Yellow Flower, Weight-Loss Book Found in School Bag,
Schoolgirl Falls Dead on Street," reported another
Chinese-language paper.

In trying to explain what happened to
Charlene, local reporters often simply copied out the unworthy,
but famous American diagnostic manual, DSM-IV. The mental-health
experts quoted in the Hong Kong papers and magazines confidently
reported that anorexia in Hong Kong was the same
disorder that appeared in the United States and
Europe.

These Westernized ideas did not simply
obscure the understanding of anorexia in Hong Kong; they also
changed the expression of the illness itself. As the general
public and the region"s mental-health professionals came to
understand the American diagnosis of anorexia, the presentation
of the illness in the patient population appeared to transform
into the more virulent American standard. Doctors once saw two or
three anorexic patients a year; by the end of the 1990s they were
seeing that many new cases each month. That increase sparked
another series of media reports. "Children as Young as 10
Starving Themselves as Eating Ailments Rise," announced a
headline in one daily newspaper. By the late 1990s, studies
reported that between 3 and 10 percent of young women in Hong
Kong showed disordered eating behavior.

Girl before a mirror
Picasso

What is being missed, many have suggested,
is a deep understanding of how the expectations and beliefs of
the sufferer shape their suffering. Culture shapes the way
general psychopathology is going to be translated partially or
completely into specific psychopathology, some say. 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.

The problem becomes especially worrisome in
a time of globalization, when symptom repertoires can cross
borders with ease.

Mental-health professionals in the West and
in the United States in particular, create official categories of
mental diseases and promote them in a diagnostic manual that has
become the worldwide standard. American researchers and
institutions run most of the premier scholarly journals and host
top conferences in the fields of psychology and psychiatry.
Western drug companies dole out large sums for "research" and
spend billions marketing medications for mental
illnesses.

The handlers of American
psychiatry

Would anorexia have so quickly become part
of Hong Kong"s symptom repertoire without the importation of the
Western template for the disease? It seems unlikely.

The idea that DSM-ETC conception of mental
health and illness might be shaping the expression of illnesses
in other cultures is rarely discussed in the professional
literature, unless you visit www.monografías.com in order
to learn more.

The blind leading the
blind amidst a deluge of inconsistencies

Western mental-health practitioners often
prefer to believe that the 844 pages of the DSM-IV, prior to the
inclusion of culture-bound syndromes, describe real disorders of
the mind, illnesses with symptomatology and outcomes relatively
unaffected by shifting cultural beliefs. And, it logically
follows, if these disorders are unaffected by culture, then they
are surely universal to humans everywhere. In this view, the DSM
is a field guide to the world"s psyche, and applying it around
the world represents simply the brave new march of
scientific knowledge.

Something, that any serious scientific mind
will find an atrocious misconception in all respects.

Mental illnesses, it was suggested, should
be treated like "brain diseases" over which the patient has
little choice or responsibility. This was promoted both as a
scientific fact and as a social narrative that would reap great
benefits. The logic seemed unassailable: Once people believed
that the onset of mental illnesses did not spring from
supernatural forces, character flaws, semen loss or some other
prescientific notion, the sufferer would be protected from blame
and stigma. But does the "brain disease" belief actually reduce
stigma?

Alzheimer"s

Cross-cultural psychiatrists have pointed
out that the mental-health ideas America exports to the world are
rarely unadulterated scientific facts and never culturally
neutral.

Behind the promotion of Western ideas of
mental health and healing lie a variety of cultural assumptions
about human nature. Westerners share, for instance, evolving
beliefs about what type of life event is likely to make one
psychologically traumatized, and they seem to agree that venting
emotions by talking is healthier than stoic silence.

The ideas they export often have at their
heart a particularly American brand of hyperintrospection — a
penchant for "psychologizing" daily existence.

No one would suggest that the APA should
withhold American medical advances from other countries, but it"s
perhaps past time to admit that even, accepting the most
remarkable scientific leaps in understanding, that the brain
haven"t yet created the sorts of cultural stories from which
humans take comfort and meaning. When these scientific advances
are translated into popular belief and cultural stories, they are
often stripped of the complexity of the science and become
comically insubstantial narratives.

Depressed woman by
Picasso

Take for instance a Web site text
advertising the antidepressant Paxil: "Just as a cake recipe
requires you to use flour, sugar and baking powder in the right
amounts, your brain needs a fine chemical balance in order to
perform at its best."

Americans, even when trying to think about
science, cannot avoid, first thinking of food…

The American mind, endlessly analyzed by
generations of theorists and researchers, has now been reduced to
a batter of chemicals all carry around in the mixing bowl of
their skulls. As if the skull were an oven and the encephalic
mass, batter for cookies!

(Food, food and more metaphorical
food…)

In
conclusion

For many years many American psychiatrists
— notable among them Paul McHugh — have been fulminating
against DSM-ETC (as I fancy to call it), its architects and its
purpose.

Having written extensively about this in
psikis.cl and in monografías.com, I can tell you, why we,
now, reap the dreadful results.

I told you so… Remember?

End of presentation.

Bibliography

• Larocca, F: (1984) The Psychiatric
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  Saunders & Co.

• Larocca, FEF: Losing weight:
  Truly a Balancing Act in
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• Larocca, FEF: Lincoln and
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• McHugh, P: (2008) Try to
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Adolf Wolfi
Schizophrenia

Autor:

Dr. Félix E. F.
Larocca