Is mental illness a product of biology or culture? Ethan Watters, over at Pacific Standard, argues that whatever the biology involved in mental illness, its expression and our responses to it are shaped by culture far more than we realize.
The resounding lesson of the history of mental illness is that psychiatric theories and diagnostic categories shape the symptoms of patients. “As doctors’ own ideas about what constitutes ‘real’ dis-ease change from time to time,” writes the medical historian Edward Shorter, “the symptoms that patients present will change as well.”
Watters, author of the superb Crazy Like Us: The Globalization of the American Psyche, is among the sharpest observers of culture’s powerful but unacknowledged effect on how we view and experience mental illness. This latest contribution looks particularly at hysteria — a presentation and diagnosis unique to its time a century ago, and vanished ever since:
Women by the tens of thousands, after all, displayed the distinctive signs: convulsive fits, facial tics, spinal irritation, sensitivity to touch, and leg paralysis. Not a doctor in the Western world at the time would have failed to recognize the presentation. “The illness of our age is hysteria,” a French journalist wrote. “Everywhere one rubs elbows with it.”
Hysteria would have had to be included in our hypothetical 1880 DSM for the exact same reasons that attention deficit hyperactivity disorder is included in the just-released DSM-5. The disorder clearly existed in a population and could be reliably distinguished, by experts and clinicians, from other constellations of symptoms.
So did psychiatry make these people sick? Watters (and I’m with him here) argues that No, these diagnostic categories don’t create mental distress out of nowhere; but the expectations and responses of both psychiatry and wider culture can shape, and sometimes seem to outright dictate, the expression of this distress.
Some critics of the DSM-5, he notes, worry that its new, sometimes looser criteria will increase the number of Americans diagnosed with mental illness.
But recent history doesn’t support these fears…. In fact, as psychologist Gary Greenberg, author of The Book of Woe, recently pointed out to me, the prevalence of mental health diagnoses actually went down slightly [since the DSM-5’s publication]. This suggests that the declarations of the APA don’t have the power to create legions of mentally ill people by fiat, but rather that the number of people who struggle with their own minds stays somewhat constant.
What changes, it seems, is that they get categorized differently depending on the cultural landscape of the moment. Those walking worried who would have accepted the ubiquitous label of “anxiety” in the 1970s would accept the label of depression that rose to prominence in the late 1980s and the 1990s, and many in the same group might today think of themselves as having social anxiety disorder or ADHD.
Viewed over history, mental health symptoms begin to look less like immutable biological facts and more like a kind of language.
I think it’s hard to overstate this issue — in fact, that one can’t understand what we call psychiatry and mental health and illness without recognizing how powerfully culture shapes the expression of psychic distress. I looked at similar issues in a post responding to the “Batman movie killings” in Aurora last year: Batman Returns: How Culture Shapes Muddle Into Madness. The crucial story there concerned a young woman who began to feel violent urges when, and only when, she was ostracized from her profession after she received a diagnosiss of schizophrenia:
Her confusion and disorientation and anxiety — her schizophrenia — rose from complex sources. But her anger rose in large part from an alienation that came hand-in-glove with our society’s definition of what she experienced — to the mere application of the word schizophrenia. And her ideas about expressing that anger rose direclty from models of action brought to her from the media, and which expressed, in their violence and their repetitive, replicative nature — each bloody rampage imitating others — deep and multiple strains of our culture.
Watters post is: The Problem With Psychiatry, the ‘DSM,’ and the Way We Study Mental Illness, Pacific Standard.
Mine exploring the issue from other angles is Batman Returns: How Culture Shapes Muddle Into Madness, here at Neuron Culture.
Others related at Neuron Culture: