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.
Watters takes us to Zanzibar, where “spirit possession” is being replaced by schizophrenia, and to Sri Lanka, where PTSD was spread like a virus by Western trauma counselors who told tsunami survivors exactly how they would react to the aftermath of a disaster. In each of his stories, Watters vividly describes the way this kind of disease mongering promulgates a “universal metaphysic of emotional experience”—and, by extension, of human nature. This leads to a deep and troubling irony: By replacing valid local beliefs about identity and healing with the hyperindividualized self that the APA considers mentally healthy, “we are speeding along the disorienting changes…at the very heart of much of the world’s mental distress.”