In the late 1990s, GlaxoSmithKline wanted to bring its blockbuster antidepressant Paxil to Japan, where a dour national temperament, a high suicide rate, and ongoing economic troubles seemed to make for a perfect market. But the idea that had made antidepressants so lucrative here—that depression is a chronic, widespread illness—was largely unheard of in Japan. The pharmaceutical giant put its best marketing minds to work, and the result was kokoro no kaze, "a cold of the soul," a common illness of the brain that, according to the ads, could kill you if left untreated. By 2008, the Japanese were spending $1 billion a year on Paxil.
The selling of depression in Japan is one of four stories about the export of mental illness that Ethan Watters tells in his compelling new book. In crisp journalistic style, he argues convincingly that what the American psychiatric industry exports is not so much drugs as diseases. It's a strategy made possible by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, which lists the symptoms that constitute the various mental disorders that the NIH claims will afflict 30 percent of Americans in their lifetimes. As the DSM's one-size-fits-all checklist approach makes its way around the world, Watters says, it changes not only the way psychiatrists render diagnoses, but also the way people experience and express their psychological suffering.