Are American psychiatrists (and Chinese media) to blame for anorexia in China?

Coming up with a good dogma is hard work.

For example, what are we to make of a fascinating article in the New York Times magazine about the exportation of Western, mainly American, ideas of mental illness to the rest of the world? It’s adapted from an upcoming book by Ethan Watters, of urban tribes fame, called “Crazy Like Us: The Globalization of the American Psyche.”

Here is the argument Watters wants to advance:

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our 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 us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.

As his first piece of evidence, Watters tells us of Sing Lee, a Chinese doctor who was documenting “a rare and culturally specific form of anorexia nervosa in Hong Kong.” I’m not sure if that means Hong Kong had other, more common forms of anorexia nervosa. Anyway, everything changed after a teenage anorexic girl collapsed and died on the street in Hong Kong in 1994. Local news reports looked to American diagnostic manuals to explain the condition. Whereas the doctor’s former patients did not diet and had only complained of bloating, his new patients dieted and expressed fear of being fat. He also began to see many more of them.

What is being missed, Lee and others 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,” Lee says. “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.”

Super sexy, right? But is Watters overstating his case? Here’s Greg Downey writing on the blog Neuroanthropology:

Was it simply a matter of mental-health professionals inadvertently causing the more benign strain of anorexia in Hong Kong to mutate into the American version? The increase in fat phobia among anorexic sufferers did not occur in a vacuum, I would argue, affected only by mental health specialists. I suspect other Western influences likely also contributed to the shift, including ‘diet’ discourse, maybe even changes in actual diet, media imagery of idealized bodies, the fitness industry. And what about shifts within this population in anxiety levels, sexuality-related expectations, fashion, socializing, male-female relations, and other more indigenous, though certainly not isolated dynamics? And was their an incursion of the material culture of Western dieting, such as diet drinks, calorie counting techniques or food labelling, or even high-fat foods to both affect body type and to provide a medium in which to express control over oneself. Just as the changing prevalence of anorexia nervosa in the West can’t simply be chalked up to a single cause such as patients’ suggestibility, I doubt we could do the same in Hong Kong. Sure, the anorexia may be ignited by ‘psychic conflict,’ but why does it take this specific form, and why does the form change in prevalence?

In other words, maybe China had become more like America on many fronts, and that’s why anorexia changed.

The whole article is worth reading.