I’ve recently read Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters (Free Press, 2010).
It’s a great book, the theme of which is that western countries, especially America, are exporting the medicalization of human problems to less developed regions of the world. The new “illnesses” are being avidly promoted as if they had the same kind of reality as pneumonia or cancer, and are being foisted on vulnerable populations, with little regard for their impact on the cultures, ideas, sensitivities, and health of the recipients.
The author discusses four examples of this kind of “illness” exportation: anorexia in Hong Kong in the 90’s; PTSD in Sri Lanka in 2005; schizophrenia as a brain illness in Zanzibar; and the marketing of depression as an illness in Japan in the early 2000’s.
All sections of the book are worth reading, but for the purpose of this post, I will be focusing on the exporting of western-style PTSD to Sri Lanka in the wake of the December 2004 tsunami that took about 250,000 lives.
What brought PTSD to Sri Lanka was the large number of trauma counselors who rushed to the tsunami disaster zone armed with PTSD checklists and western “knowledge” of this “illness.” They carried within them a certainty that if the survivors of the tsunami weren’t “properly” debriefed, they would suffer devastating psychological consequences for years, or even for the rest of their lives. The western crusaders routinely ignored the fact that the people in Sri Lanka had a long history of coping with disaster (natural and man-made). The methods traditionally used by Sri Lankans to cope with tragedy were dismissed by most of the PTSD proselytizers as irrelevant, and even as evidence of denial!
Here are some quotes from the chapter in question:
“Mental health professionals around the world were telling reporters that millions of people would soon be suffering the debilitating effects of PTSD.” (p 69)
“Seldom considered in our rush to help treat the psychic wounds of traumatized people was the question of whether PTSD was a diagnosis that could be usefully applied in all human cultures.” (p 71)
“Traumatologists have also advanced the idea that psychological rehabilitation is best managed by mental health experts, certified in and sensitized to Western understanding of how humans suffer and heal. The post-tsunami intervention would prove to be a crucible for these Western certainties.” (p 73)
“The drug company Pfizer was quick to get in the mix as well. In early February 2005, just over a month after the disaster, the company sponsored a symposium in Bangkok titled ‘After the Tsunami: Mental Health Challenges to the Community for Today and Tomorrow.’ Professor [Jonathan] Davidson…predicting pathology rates of 50 to 90 percent, helped organize the conference with an ‘unrestricted grant’ from the company.” (p 80)
“He [Professor Davidson] described PTSD as ‘a severe, chronic, and disabling condition with major consequences for the individual and society,’ but assured his audience that antidepressants such as Pfizer’s Zoloft could become ‘an effective tool in promoting the long-term psychological and psychosocial health and economic recovery of those in the region affected by the tsunami.’ Zoloft, he reported, had been shown to reduce anger after the first week of treatment and lessen ’emotional upset’ by week six.” (p 80)
“A radio, TV, and newspaper ad campaign was launched to make the population aware of what psychological consequences to expect, and posters of the PTSD symptom list were placed in schools, community buildings, police stations, churches, and grocery stores.” (p 106)
“Despite the public and professional certainty that counselors and debriefers should rush in after disasters to treat traumatized populations, there was one problem: there was little evidence that such efforts helped.” (p 118)
“Early interventions sometimes appeared to be priming victims to experience certain symptoms. ‘When dealing with people after an accident we need to remember that emotionally aroused people are suggestible,’ David Brown, a psychologist from Australia wrote later in the British Medical Journal. ‘If we suggest they might feel angry, it is likely to come true.'” (p 118)
As I was reading this chapter, I was struck obviously by the crass arrogance of the pharma-supported trauma “experts” who, because they had memorized the APA’s facile symptom list, somehow imagined that they could teach these resilient people how to cope with tragedy.
But I was also struck by the fact that this is exactly what happened here in America after the Vietnam War. From time immemorial, soldiers have come home from war with truly horrible memories, and have dealt with these memories using the concepts, skills, and support groups that were available to them in their families and in their communities.
But PTSD changed all that. The horrific memories became an illness which needs to be “treated” by experts – and the first-line “treatment,” of course, is drugs. People who have experienced psychological trauma are given the message that they cannot deal with this from their own resources, and protestations of resilience and ability to cope, are characterized as denial.
In Crazy Like Us, Ethan Watters touches on this aspect of the matter:
“Indeed, many have pointed out that we are now a culture that has a suspicion of resilience and emotional reserve.” (p 123)
The fact is that traumatic memories – no matter how severe – are not illnesses in any meaningful sense of the term. The notion that they are illnesses is psychiatry/pharma propaganda, and the fact that the fiction is so widely accepted (and even being exported) is a tribute to the resources that psychiatry/pharma can bring to bear in promoting their self-serving agenda.
But the proof of the pudding is in the eating. Americans have been returning home from wars since before the country was born, and were re-adjusting successfully to civilian life using their own resources and community support.
Nor is the experience of disaster confined to the military. Civilians in all ages have experienced devastating floods, fires, hurricanes, tornadoes, murders, rapes, accidents, etc…
Tragedy, sooner or later, touches us all, and sometimes the nature and circumstances of these encounters can be truly horrific.
But through all of this, people have coped. They’ve coped by drawing on their own resources and the support of family, friends, mentors (religious and secular), and even random strangers. They’ve drawn strength from embraces, whispered condolences, and graveside rituals. We all know that any of us can be touched by terrible tragedy, and we reach out individually and collectively to offer comfort to those in grief.
But psychiatry undermines all of this. The horror-struck soldier returning from war – he has an illness – a broken brain – he needs drugs.
The children who witnessed their parents being killed in a car accident – they also have a brain illness – they need drugs.
The mother who saw her three children carried off to their deaths by floodwaters – she has a brain illness – she needs drugs.
This tawdry, spurious medicalization of tragedy trivializes human suffering, undermines the dignity of the sufferer, and relegates him or her to the status of drug customer.
The psychiatrists contend that they only offer their “treatments” to those who really need them, but they ignore the fact that it was their propaganda coupled with pharmaceutical advertizing that created the need in the first place. It was their propaganda that convinced people that they were “broken” and needed “medication.”
It might be argued that the psychiatric-pharma “solution” works, and that this is really all that matters. But reading the various reports from the VA, it’s easy to get the impression that the “treatment” is not enjoying unqualified success.
On April 23, a panel of PTSD experts presented a seminar on PTSD to the general public at Cumberland County Public Library in Fayetteville, North Carolina. One of the presenters, Kevin Smythe, PsyD, a supervisory psychologist with the Mental Health Service Line at the Fayetteville VA, is reported (on fayobserver.com) as saying that there is no way to cure post-traumatic stress disorder, but that those suffering from it can learn to manage it.
For me – that sounds awfully like: “you must take the pills for life.” Where have we heard that before?
Incidentally military.com picked up the piece and ran it, and it generated some interesting comments, most of which appear to come from military or ex-military people. A good proportion of the comments express the belief that drugs are not the answer. Some of the commenters maintain that there is a good measure of fraud in the system: i.e. people pursuing a “diagnosis” of PTSD in order to qualify for disability benefits.
On that topic, incidentally, I’ve come across two interesting Australian reports, courtesy of Nanu. The first, dated March 27, 2013, predicts a “tidal wave” of PTSD cases as Australian troops are brought home from Afghanistan. The other report, however, which was published two years earlier (Jan 6, 2011), quotes a senior military doctor as saying that up to 90% of PTSD claims are fraudulent.
Obviously people will dispute these perspectives. But the fact remains that virtually every “diagnosis” in the DSM can be faked by anyone with a modicum of imagination and resourcefulness.
That, however, is not the main issue. Even the individuals who aren’t actually consciously trying to game the system are not sick. They do not have an illness. What they have are painful memories and unresolved grief.
Once psychiatric muscle and pharmaceutical money had achieved acceptance of these so-called illnesses, the government had little choice but to qualify the affected individuals for benefits. If you’re sick, you’re sick! The AMA, incidentally, according to Wikipedia, “has one of the largest political lobbying budgets of any organization in the United States.”
When the APA invented this “illness”, they opened two equally tragic doorways. Firstly, they encouraged distressed people to think of themselves as broken; secondly, they created a situation in which people are encouraged to fake the symptoms for the sake of a disability pension.
The tragedy of the first group is that they are disempowered, and end up taking toxic drugs, often for years. The tragedy for the second group is that they settle for an unproductive, aimless life in return for a small pension.
The beneficiaries, as usual, are the psychiatrists and the pharmaceutical industry.