Crazy Like Us

Before Western anorexia arrived. Researcher Sing Lee found early Hong Kong anorexics were nothing like Western patients. They didn't fear fatness or distort their body image. Instead they cited stomach bloating, throat blockages, or loss of appetite — somatic explanations rooted in Chinese traditions. They were often poor, not the "golden girls" of Western literature. Lee called them atypical anorexics.

Then Charlene collapsed. On November 24, 1994, 14-year-old Charlene Hsu Chi-Ying died on a busy Hong Kong sidewalk, weighing 75 pounds. Media coverage immediately imported Western explanations — fat phobia, dieting culture, body image distortion. Within three years, 80% of new anorexics cited fear of fatness. By 2007, nearly all did. What took the West fifty years to codify happened in Hong Kong almost overnight.

PTSD assumes a universal reaction. After the 2004 tsunami, Western experts predicted 50 – 90% of Sri Lankans would develop PTSD. Hundreds of counselors flooded the country. But psychologist Gaithri Fernando found Sri Lankan distress looked fundamentally different from the PTSD checklist. Trauma manifested as damage to social relationships — failure to fulfill kinship roles — alongside physical symptoms like joint pain and chest pain. Social disruption was the primary wound, not a byproduct of internal psychological damage.

Symptoms shift across centuries too. Civil War soldiers experienced chest pain ("Da Costa's syndrome"), WWI soldiers displayed paralysis ("shell shock"), Vietnam veterans reported rage. The unconscious mind reaches for culturally current expressions of distress. PTSD's focus on intrusive memories and hyperarousal reflects modern Western individualism, not timeless human nature.

"Cautious words" as cultural brakes. Anthropologist Alex Argenti-Pillen studied a Sri Lankan village brutalized by civil war. Villagers used elaborate euphemisms to discuss violence: torture was evoked with a word meaning a child's mischief; "funny nonsense" described the disorientation of the terrified. This wasn't avoidance — it was "acoustic cleansing" to prevent the gaze of the wild, the belief that direct speech about violence could trigger more of it.

Western counseling upended these protections. NGO-trained counselors insisted survivors speak directly about trauma. Women locally considered dangerously "fearless" — who violated speech norms and raised violent sons — were embraced as "empowered" and trained as counselors themselves. By pathologizing indirect speech, Western interventions risked dismantling fragile social mechanisms keeping revenge violence in check.

The WHO's surprising finding. Two massive studies spanning 25 years and 10 countries found schizophrenia patients in India, Nigeria, and Colombia had less severe outcomes than those in the US, Denmark, or Taiwan. Over 40% of patients in industrialized nations were "severely impaired" versus 24% in poorer countries.

Expressed emotion explains much of this. Families high in criticism and emotional overinvolvement — termed "high expressed emotion" — see 3 – 7x higher relapse rates. Anglo-American families scored highest (67% high-EE) versus Indian families (23%). Psychologist Jill Hooley found that critical relatives had a strong internal locus of control — they believed people master their own fate and applied that expectation to the ill relative, inadvertently worsening the disease with their hopeful intensity.

The campaign backfired. For decades, Western advocates promoted the "brain disease" narrative to reduce blame. The world adopted this model — people increasingly cite "chemical imbalance" and "genetics." But stigma rose in lockstep.

The evidence is cross-cultural. In Turkey, those who labeled schizophrenia a brain illness more often called patients aggressive. Across Germany, Russia, and Mongolia, endorsing biological causes predicted greater desire for social distance. In one experiment, subjects told a partner had a "disease like any other" gave harsher electric shocks than those told the illness stemmed from childhood events. In Zanzibar, by contrast, spirit possession — believed to affect everyone — made bizarre behavior forgivable, keeping the ill person within the group. Genetic framing makes the mentally ill seem permanently broken.

The cultural puzzle worth billions. In 2000, GlaxoSmithKline flew scholars to Kyoto on $10,000 first-class tickets, lodging them in suites with rose-petal baths. The company wasn't selling drugs to assembled experts — it was learning how cultures shape illness experience, knowledge needed to crack a country that didn't believe in common depression. Japan's word utsubyô described a rare, devastating psychosis. Deep sadness was culturally valued and tied to Buddhist beliefs.

The marketing was surgical. GSK coined kokoro no kaze — "a cold of the soul" — reframing depression as common, mild, and treatable. They funded fake patient advocacy websites, bypassed advertising bans via the Internet, and leveraged Japan's suicide crisis. First-year Paxil sales topped $100 million. By 2008: $1 billion annually in Japan alone.

The foundational myth. Drug companies market SSRIs as correcting a serotonin "imbalance." Researcher George Ashcroft proposed this idea in the 1950s and publicly abandoned it by 1970 after finding no evidence. No such imbalance has been demonstrated in depressed patients. The story persists because it works as marketing.

The data pipeline is rigged. Of 74 antidepressant studies, 37 of 38 positive ones were published versus only 3 of 36 negative ones. SSRIs outperform placebo in roughly 1 of 10 patients. GSK's internal documents revealed a Paxil adolescent study failed all 8 outcome measures with 5x more serious side effects than placebo — yet the published paper proclaimed "remarkable Efficacy and Safety." By the mid-1990s, over half of top-journal psychiatric studies were ghostwritten by firms paid by drug companies.

Crisis opens the door. Hong Kong's anorexia surge arrived during the anxious years between the Tiananmen Square massacre and China's takeover. Japan's depression epidemic took hold during the devastating "lost decade" recession. PTSD was deployed en masse in Sri Lanka after the tsunami. In each case, populations searching for explanations proved receptive to imported disease categories.

The pattern is now global. The 2008 economic crisis created worldwide conditions identical to those that made Japan vulnerable. Mental health experts immediately warned of psychological consequences; pharmaceutical lobbies announced 301 new medications in development. The proposed DSM-V disorder "post-traumatic embitterment disorder" — first discovered among dislocated East Germans — seemed engineered to medicalize the anxieties of globalization itself.

Vanishing understanding. Cross-cultural researchers documenting how different peoples experience and heal from mental illness are racing against time. Local idioms of distress — Sri Lanka's "terrified heart," the Quechua people's nakary and llaki, Zanzibari spirit possession rituals — contain hard-won knowledge about the human psyche that no Western laboratory has replicated.

The loss is irreversible. Mexican Americans who called schizophrenia nervios — a folk term for general distress — kept ill relatives closer through shared identity. Zanzibari families who saw God's hand in madness expressed less destructive emotion toward the sick. Once local understandings are bulldozed by the DSM and replaced with Western categories, the knowledge embedded in them vanishes with the finality of extinction.