Month: January 2010
We live in the age of blame. Blame is king.
All the evidence is in the day-to-day headlines. Selling fear has always been emotionally appealing. All you have to do is polarize people into camps of right and wrong. This is what happens in democracies. Politicians need to energize large groups of people.
Nothing works better than fear and adrenalin to get people moving. Can you imagine if someone tried to ride into office on a platform suggesting, “People just stay calm. We need to think more about these problems.”
Last week, Scott Brown showed us how to win in Massachusetts. His top pick for our national focus is how the US handles terrorists. He posed this question: Should terrorists be declared enemy combatants and turned over to the federal government?
Two advisers to Brown, strategist Eric Fehrnstrom and pollster Neil Newhouse, said yesterday that they believed the terrorism issue actually broke more in Brown’s favor than did his opposition to Obama’s health care reform plan. “National security was a more potent issue than health care, based on the polling we saw, on dealing with terrorists as ordinary criminals versus enemy combatants.”
“On the issue of dealing with accused terrorists, for whom would you vote for U.S. Senate if you knew that Scott Brown believes that accused terrorists should be treated as enemy combatants and face military justice [and] Martha Coakley believes that accused terrorists should be provided constitutional rights and tried in civilian courts?” the Brown camp’s poll asked. Respondents split 61% to 29% in Brown’s favor, Newhouse said. 
What would have happened if Scott Brown said we do not understand enough about terrorists and what kind of families and circumstances produce terrorists. Gaining an understanding of this should be a national priority.
You know the answer. Since when are we, the voters, asked as to think carefully or ask good questions?
Under conditions of heightened anxiety people want simple answers. If we dare to question authority, we risk being seen as the enemy or stupid and become marginalized. This happens in many small and large groups. It is simply the way emotional systems are wired. Uncertainty and increasing anxiety go hand in hand promoting polarization [see Brooks’ NY TIMES article for another look at polarization anger and/or defensiveness. ,
During times of increasing strident polarization it becomes harder and harder for one to have a “different” idea or opinion.
OK, so the calm voice of reason may not make the front page. The front page and the popular media reflect the strongest emotions, which are useful to attract attention. But is it possible that if we as a nation saw the benefits of deep understanding, the age of anxiety could become the age of mindfulness?
Questions to consider if we lived in a Mindful Age:
1) What would deep thinking require from the average person?
2) Does the first step in deep thinking just require checking out the basic facts in controversial statements?
3) Is it possible to get facts on who has been able to obtain useful information from terrorists?
4) If as in the case of information gained from terrorists, from either the federal or the local law enforcement agencies, is not available, then how can we make rational decisions?
5) If facts are not available can we make an argument based on logic, principles or person beliefs? Hopefully people can recognize that these kinds of arguments are not as viable in convincing others about the rightness of arguments if we have no facts to base our decision on.
6) How can we know if physically threatening ways of gathering information is useful? For example has water boarding produced useable information?
7) How do we decide how important human rights are when one is at war?
7) If there are no real facts available can we just monitor our feeling responses to see if we are vulnerable to make decision based on emotion rather than factual information?
8) Can any of us notice if we have feelings of vengeance (and/or relief) when we pick a solution?
9) Does making quick, fact-free decisions, make us feel relief as now we have ended the suspense or the not knowing experience?
10) Perhaps the biggest question is how strong is our tolerance for ambiguity?
Overall, mindful people are able to evaluate whether any important decision, personal or national, is “right” both by evaluating the facts and the feelings that rise up in us as we “listen” to the arguments. It takes being emotionally strong to increase our ability to consider options. If we can consider all the options carefully then mindfulness has worked its magic.
In this hoped for age of Mindfulness more people will easily acknowledge that emotional reactions are informing policy and are used by people seeking election to public office.
I am not sure when newscasters will jump up and demand, “where is the evidence” before they simply amplify fear and reactivity. How probable will we see decreased emotionality in the media and more thinking?
If it seems less than possible that each of us is on our own to figure out what does make rational sense when it comes to terrorism, and most everything else.
We could think about the news media and the talking heads as our nightly entertainment instead of our nightly entrainment. Perhaps then our world will be a better place and each of us more responsible people.
I am clear that we could learn more about terrorism from an effort to understand the families of terrorists. I am fascinated by news stories about the families who are able to convince recruits to come back from the edge of martyrdom to lead more rational lives. Below is an interesting article that looks at terrorists and their families or origin.
Terrorist Dropouts: Family Ties May Deter Violence by Pamela Hess 1/21/10 http://www.huffingtonpost.com/2010/01/21/terrorist-dropouts-family_n_430999.html -
WASHINGTON — Since 2001, al-Qaida is believed to have dispatched three men to blow up American airliners. Two of them tried but failed to set off explosions, and the third backed out of his assignment.
What made him different? A new study suggests family ties may have played an important role.
The report to be released this week by the Washington Institute for Near East Policy looked at dozens of terrorists in trying to figure out what motivates terror dropouts and how others might be influenced to turn their backs on violent operations.
Michael Jacobson, who wrote the study, said one of the key differences in the case of British student Sajid Badat was his continued connection to his family, which had emigrated from Malawi to Britain before he was born.
Badat, then 21, didn’t go through with a December 2001 shoe-bombing operation. He stashed the bomb under a bed in his family home in Gloucester, England.
British intelligence tracked down Badat two years later using evidence found on shoe bomber Richard Reid, who attempted to bring down a plane in December 2001 and is serving a life sentence in a high-security U.S. prison. More recently, a Nigerian man, Umar Farouk Abdulmutallab, was charged with trying to blow up a Detroit-bound airliner last Christmas with explosives sewn into his underwear.
Jacobson, who interviewed 10 of the dropouts, said that unlike Reid and Abdulmutallab, Badat returned from militant camps in Afghanistan and Pakistan and eventually moved back in with his family.
Badat told prosecutors he bailed out because he was hoping “to introduce calm into his life.” He is serving a 13-year sentence.
Families can play either a positive or negative role in a terrorist’s plans, something al-Qaida recognizes. Lead Sept. 11 hijacker Mohammed Atta instructed his compatriots to cut off ties to their families. However, the two Sept. 11 conspirators who dropped out were both in touch with their families, against al-Qaida instructions.
At the same time, al-Qaida is known to realize the power that families can exert in keeping a terrorist in the fold. It has paid extra to men with wives, given them additional time off to be with their families and encouraged them to recruit their spouses to the cause, according to the report, which cites captured al-Qaida documents.
In one case, it was al-Qaida’s seeming indifference to the plight of the wife of one of its operatives that ultimately turned him into an American informer.
L’Houssaine Kherchtou, a former member of al-Qaida who was a key witness in the trial of four men accused in the 1998 bombing of two U.S. embassies in Africa, turned against the organization in part because it rejected his request for $500 to cover the cost of his wife’s Cesarean section. Khertchou saw the slight as part of a larger pattern of stinginess, and he split from the group when it moved from Sudan to Afghanistan.
Another would-be extremist from the United States was intercepted by his sister at a foreign airport en route to Pakistan and persuaded to go home. The intercept was orchestrated by an imam in Texas who was contacted by the family and who has close ties to the FBI, according to the report.
Others have been turned off by the gritty reality of the terrorist life versus the romantic vision that brought them into it in the first place.
Five of six young Yemeni-Americans from Lackawanna, N.Y., who pleaded guilty to supporting terrorism in 2003 dropped out of their Afghan training camp in 2001 despite pressure from their al-Qaida recruiter. Bad food was one irritant; when one discovered the meals were better in the infirmary, another faked a leg injury and spent the rest of the time in the facility.
An unidentified British official quoted in the report said many young Britons who have traveled to the tribal areas of Pakistan have quickly returned home after being disappointed by their experience.
The disappointment is due in part to the severe changes al-Qaida made in its training camps because of the war in Afghanistan. Before Sept. 11, the camps had not just religious studies but also weapons and physical training.
Camps now are smaller and more ad hoc, and recruits have sometimes been asked to pay for their own equipment and housing, Jacobson writes.
The reasons terrorists and extremists reverse course vary but could point to a way to encourage more dropouts, Jacobson says.
One effective method: puncturing the mystique of terrorist leaders. Jacobson said the 2006 dissemination of a videotape showing slain al-Qaida in Iraq leader Abu Musab al-Zarqawi not knowing how to fix and fire a jammed machine gun was a good example.
Highlighting the hypocrisy of killing civilians and other Muslims in terrorist attacks can also be effective, Jacobson found.
The U.S. government should also publicize the fact that leaving terrorist organizations is possible, Jacobson said. The Lackawanna Five actually received permission from Osama bin Laden himself to leave the camps early.
But Jacobson points out that the government is often the least effective messenger for a counter narrative to terrorists; former terrorists and extremists are in a better position.
Research on Families of Terrorists:
Professor Clive Walker, who has both an LLB and PhD, is a terrorism specialist and Professor of Criminal Justice at Leeds University. He notes that terrorists feel rejection by both their culture and their fathers. They then reject the culture and form a close bond with a small close circle of friends who reinforce their beliefs.
A slightly different finding was presented by Marc Sageman-
A study of 172 al-Qaeda terrorists conducted four years ago by Marc Sageman, a forensic psychiatrist and former CIA case officer in Pakistan, found that 90 per cent came from a relatively stable, secure background.
Three quarters were from middle-class or upper-class families, two thirds went to college and two thirds were professionals or semi-professionals, often engineers, physicians, architects or scientists. The average age for making an active commitment to violent jihad was 26, and three quarters of the terrorists were married, most of them with children. Only one in a hundred had shown any form of psychotic disorder. Two thirds became drawn towards a terror group while living in a country that was not their homeland.
Dr Sageman’s findings, published in 2004 in Understanding Terrorist Networks, led him to conclude that “most of these men were upwardly and geographically mobile”. He wrote: “Because they were the best and brightest, they were sent abroad to study. They came from moderately religious, caring, middle-class families. They spoke three, four, five, six languages.”
Unlike the lone serial killer, these men functioned well in groups. Indeed they depended, isolated as they were in a foreign country, on a close circle of friends who reinforced and legitimised their beliefs. “You could almost say that those least likely to cause harm individually are most likely to do so collectively,” Dr Sageman wrote. Yesterday he told The Times that the existence of a terror plot involving foreign doctors should surprise no one.
“When you look at the global Salafi jihad, you have three waves. The first were the companions of bin Laden, the characters in Afghanistan in the 1980s,” he said. “The second, on whom my 2003 research was based, were the best and the brightest from the Middle East. Those are the guys who became radicalised in the West. Many of them are engineers and physicians.
“And the third are what people call the home-grown, these are the guys who are second or third generation in the West, and they are less well-educated. Their average age is about 19 or 20, and there are more criminal elements there.”
Both groups, however, typically experience a sense of dislocation from the society in which they live and work. Clive Walker, a terrorism specialist and Professor of Criminal Justice at Leeds University, says that Mohammad Sidique Khan and his three companions shared a form of “social anomie”.
“It’s a kind of in-between state, a symptom of rejection in many ways. They feel rejected, but equally they reject the available cultures, both of their fathers and of the society they find themselves in,” he said.
Dr. Walker’s is Professor Clive Walker | Staff | School of Law | University of Leeds he obtained his LLB from the University of Leeds in 1975, Leeds and his PhD from the University of Manchester. His research also seems to fit with the research on the families who suffer from intense cut offs over the generations. These kinds of descriptions also fit with how families that produce “terrorists” are portrayed in fiction.
Is Life Stranger than Fiction ?
In Dan Brown’s newest novel The Lost Symbol, he creates a believable look at how a family unit innocently drives a young son into becoming a “terrorist” of sorts by over helping and not holding the son responsible for his actions. This son, like those in the research mentioned above, also rejects his father and his culture. He strikes back at both and attempts to destroy them.
Dan Brown also realizes that the polarization in society and especially polarization around religious groups, leads to extreme dysfunction. His books make us mindful of the role of both families and organizations in setting up one person or one group against another.
I am not going to give away too much of Brown’s novel, just recall a fact, the Catholic Church took it up against Galileo resulting in the bashing of science for three hundred years.
Other kinds of extreme behaviors in families end up with one child being seen as “the problem.”
The child is spoiled and or infantilized and becomes a person who never expects he will or can be held responsible and so indulges in all kinds of activity to pay the family back for seeing them as week, being ambivalent and on and on.
There may be inconvenient facts about how the family influences the behavior of the young. It may be that we set ourselves up as “experts” and get an emotional high by blaming, shaming and posturing rather than thinking through hard questions?
Because of the polarization that occurred in my family when my father joined the Air Force during WWII, I have remained interested in how families inadvertently make life more difficult for returning veterans.
Over the years I wondered how much his inability to integrate himself back into society after the war had to do with 1) his reasons for joining the service, and 2) with how little he was able to talk about his experience and 3) to what degree people’s expectations of him made it more difficult to adapt to a new world.
There are usually many factors that lead to one person’s dysfunction and we need to know what they are in order to aid other returning veterans.
Warriors and Terrorists Different Families or the Same?
We know that in every family children turn out differently. There are many factors, but one of the important ones is a few are: the quality of relationship the parents have with one another and with the extended family during their developmental years.
1. The child’s niche in the system,
2. What are the other siblings like, and what is their position with one or both parents?
3. Is the child’s position similar to or different from the position of the parents in their families or origin?
4. Are the parents other focused projecting blame or hope?
5. Are the parents looking at the reality of the child’s talents?
6. What kind of fiends does the child make?
7. How much and what kind of contact is there with the extended family?
8. Have their been unusual stressors in the child’s life?
Osama Bin Laden has many sons. What determines which ones are close to him do you think? Was the “dye cast?” Did it happen before the child was a teenager?
How mindful are the military or any of us about the reasons people become warriors or terrorists? How much do we know about the kinds of families that produce warriors versus those who produce terrorists?
Of course, who’s a warrior and who’s a terrorist may depend on your point of view. One person’s “terrorist” is another’s “warrior”. What difference do the words mean to the health of an individual and a nation? If your family is invested in the military you have a better chance to be a warrior as long as you get along with the family and feel valued.
If the family is full of pacifists you may have a harder time being a well-respected warrior. Words are the vehicle on which emotional energy is loaded up and aimed at a person.
How mindful are any of us about how our family relationships have influenced us to be the people we are? How many of us have had to define ourselves to our family that we were going to be “different,” from their hopes and dreams.
The scale of differentiation may help us understand the influences that create terrorists or warriors, though even the distinctions between the two may only be clear within a particular cultural context.
The scale of differentiation is based on the observation that people who are highly fused with others do not have the backbone to develop a well-developed self. Less differentiated folks are more likely to make decisions to minimize their current discomforts and to sell out their future to get along with others.
It’s a short-term solution to find some kind of love or a bit of approval from others who might use you down the road. Once people have undue influence over you its easy to become a scapegoat or a martyr for them
In reading Bowen’s book, Family Therapy in Clinical Practice, you get a different idea of what it takes to be self, especially in your own family. Perhaps this knowledge will one day become useful as we move from the age of anxiety to the age of mindfulness.
”We forget that Family System Theory is a way of life to be lived out in everything we do, and that it is not just another dogma to be preached to gullible disciples. We know with our heads that good things can happen in families when we can maintain a modicum of self control and stay in contact, but we forget the same things applies to us as professionally.”
Murray Bowen in a letter to the faculty and staff in 1982
Many thanks to Judy Ball for her very thoughtful editing help!!!!
Reading the New York Times this morning I found a very thoughtful piece on how our BELIEFS shape our interactions with others, The Americanization of Mental Illness.
I was fascinated by research showing the destructive ability of the mental health world to spin a story around diagnosing people. The research shows that diagnosing ends up doing more harm than good. You can read the abstracts below or read the whole piece and form your own take away.
This push to see, believe and act the right way is not just in the world of mental heath. The forces for fusion and/or togetherness work in such subtle ways that we hardly notice them. One manifestation of this is the blame game. Here we can see how the forces for agreement can destroy individual differences by putting others down. This article describes how categorizing others, destroying or belittling differences becomes a part of our destructive urge to “help.”
It is not easy to think for self when we are constantly bombarded with the many ways we should think like others. We can see everywhere, at home, in school, with our friends, at our jobs, -the pressure to believe and act the “right way”.
One of the main problems is perceptual blindness. People cannot see the pressure that is being applied to be the “right way” for others. Some people call this fusion when two people agree and become a one in how they see the world. The DSM is one way to help people think and see the same way.
It requires a disciplined effort to become a better observer. What is it worth to see how often we are agreeing with others rather than thinking for self? It does require an emotional backbone to stick to a different way of seeing the world.
Perhaps eventually mental illness categorizations will begin by first looking at how much any way of diagnosing or even thinking allows us to focus and act negatively towards others. The problem is when we are blaming others we are leaving ourselves blameless.
The difficulty is that the way people function is seamlessly influenced by the ways others function. This is impossible to see without real effort. Few people can see the reciprocal forces of over and under functioning that are clearly present in symptoms like alcoholism.
Nothing will stop the efforts to try to change “them” to act, think and believe “the right way” in order to be in harmony with whoever is in authority or with the social group. The challenge is to constantly consider how we can change ourselves in relationship to others who are suffering.
Just as in kindergarten, we are all participating in diagnosing and being critical of others, putting others down, engaging in the blame game, in the put downs, in being close to some and far removed from others. In its simplest form we are expressing the natural forces deep in human nature to see others as not doing it “right” which gives us a better position in the social groups of which we’re a part.
My take away is this: Be careful what stories you buy into, be careful how you categorize others as “different.” Be careful to think twice (and deeply) when your feelings say the problem is in “the other.” This observing of self will not end the blame game but it might make for a deeper understanding of how we are wired and how we react to being part of a group
New York Times January 10, 2010
The Americanization of Mental Illness
By ETHAN WATTERS
We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness. We may indeed be far along in homogenizing the way the world goes mad.
This unnerving possibility springs from recent research by a loose group of anthropologists and cross-cultural psychiatrists. Swimming against the biomedical currents of the time, they have argued that mental illnesses are not discrete entities like the polio virus with their own natural histories. These researchers have amassed an impressive body of evidence suggesting that mental illnesses have never been the same the world over (either in prevalence or in form) but are inevitably sparked and shaped by the ethos of particular times and places.
In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.
That is until recently.
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.
“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.”
Mental-health professionals in the West, and in the United States in particular, create official categories of mental diseases and promote them in a diagnostic manual that has become the worldwide standard. American researchers and institutions run most of the premier scholarly journals and host top conferences in the fields of psychology and psychiatry. Western drug companies dole out large sums for research and spend billions marketing medications for mental illnesses. In addition, Western-trained traumatologists often rush in where war or natural disasters strike to deliver “psychological first aid,” bringing with them their assumptions about how the mind becomes broken by horrible events and how it is best healed.
“As Western categories for diseases have gained dominance, micro-cultures that shape the illness experiences of individual patients are being discarded,” Lee says. “The current has become too strong.”
THE IDEA THAT our Western conception of mental health and illness might be shaping the expression of illnesses in other cultures is rarely discussed in the professional literature.
Many modern mental-health practitioners and researchers believe that the scientific standing of our drugs, our illness categories and our theories of the mind have put the field beyond the influence of endlessly shifting cultural trends and beliefs. After all, we now have machines that can literally watch the mind at work. We can change the chemistry of the brain in a variety of interesting ways and we can examine DNA sequences for abnormalities. The assumption is that these remarkable scientific advances have allowed modern-day practitioners to avoid the blind spots and cultural biases of their predecessors.
Western mental-health practitioners often prefer to believe that the 844 pages of the DSM-IV prior to the inclusion of culture-bound syndromes describe real disorders of the mind, illnesses with symptomatology and outcomes relatively unaffected by shifting cultural beliefs. And, it logically follows, if these disorders are unaffected by culture, then they are surely universal to humans everywhere. In this view, the DSM is a field guide to the world’s psyche, and applying it around the world represents simply the brave march of scientific knowledge.
Of course, we can become psychologically unhinged for many reasons that are common to all, like personal traumas, social upheavals or biochemical imbalances in our brains. Modern science has begun to reveal these causes. Whatever the trigger, however, the ill individual and those around him invariably rely on cultural beliefs and stories to understand what is happening. Those stories, whether they tell of spirit possession, semen loss or serotonin depletion, predict and shape the course of the illness in dramatic and often counterintuitive ways. In the end, what cross-cultural psychiatrists and anthropologists have to tell us is that all mental illnesses, including depression, P.T.S.D. and even schizophrenia, can be every bit as influenced by cultural beliefs and expectations today as hysterical-leg paralysis or the vapors or zar or any other mental illness ever experienced in the history of human madness. This does not mean that these illnesses and the pain associated with them are not real, or that sufferers deliberately shape their symptoms to fit a certain cultural niche. It means that a mental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions — the idiosyncratic cultural trappings — of the mind that is its host.
Mental illnesses, it was suggested, should be treated like “brain diseases” over which the patient has little choice or responsibility. This was promoted both as a scientific fact and as a social narrative that would reap great benefits. The logic seemed unassailable: Once people believed that the onset of mental illnesses did not spring from supernatural forces, character flaws, semen loss or some other prescientific notion, the sufferer would be protected from blame and stigma.
This idea has been promoted by mental-health providers, drug companies and patient-advocacy groups like the National Alliance for the Mentally Ill in the United States and SANE in Britain. In a sometimes fractious field, everyone seemed to agree that this modern way of thinking about mental illness would reduce the social isolation and stigma often experienced by those with mental illness. Trampling on indigenous prescientific superstitions about the cause of mental illness seemed a small price to pay to relieve some of the social suffering of the mentally ill.
But does the “brain disease” belief actually reduce stigma?
In 1997, Prof. Sheila Mehta from Auburn University Montgomery in Alabama decided to find out if the “brain disease” narrative had the intended effect. She suspected that the biomedical explanation for mental illness might be influencing our attitudes toward the mentally ill in ways we weren’t conscious of, so she thought up a clever experiment.
Analyzing the data, Mehta found a difference between the group of subjects given the psychosocial explanation for their partner’s mental-illness history and those given the brain-disease explanation. Those who believed that their partner suffered a biochemical “disease like any other” increased the severity of the shocks at a faster rate than those who believed they were paired with someone who had a mental disorder caused by an event in the past.
“The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms,” Mehta wrote. “We say we are being kind, but our actions suggest otherwise.” The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events. “Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.”
When asked to name the sources of mental illness, people from a variety of cultures are increasingly likely to mention “chemical imbalance” or “brain disease” or “genetic/inherited” factors.
Unfortunately, at the same time that Western mental-health professionals have been convincing the world to think and talk about mental illnesses in biomedical terms, we have been simultaneously losing the war against stigma at home and abroad.
Trying to unravel this mystery, the anthropologist Juli McGruder from the University of Puget Sound spent years in Zanzibar studying families of schizophrenics. Though the population is predominantly Muslim, Swahili spirit-possession beliefs are still prevalent in the archipelago and commonly evoked to explain the actions of anyone violating social norms — from a sister lashing out at her brother to someone beset by psychotic delusions.
McGruder found that far from being stigmatizing, these beliefs served certain useful functions. The beliefs prescribed a variety of socially accepted interventions and ministrations that kept the ill person bound to the family and kinship group. “Muslim and Swahili spirits are not exorcised in the Christian sense of casting out demons,” McGruder determined. “Rather they are coaxed with food and goods, feted with song and dance. They are placated, settled, reduced in malfeasance.” McGruder saw this approach in many small acts of kindness. She watched family members use saffron paste to write phrases from the Koran on the rims of drinking bowls so the ill person could literally imbibe the holy words. The spirit-possession beliefs had other unexpected benefits.
Critically, the story allowed the person with schizophrenia a cleaner bill of health when the illness went into remission. An ill individual enjoying a time of relative mental health could, at least temporarily, retake his or her responsibilities in the kinship group. Since the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity.
For McGruder, the point was not that these practices or beliefs were effective in curing schizophrenia. Rather, she said she believed that they indirectly helped control the course of the illness. Besides keeping the sick individual in the social group, the religious beliefs in Zanzibar also allowed for a type of calmness and acquiescence in the face of the illness that she had rarely witnessed in the West.
The course of a metastasizing cancer is unlikely to be changed by how we talk about it. With schizophrenia, however, symptoms are inevitably entangled in a person’s complex interactions with those around him or her.
In fact, researchers have long documented how certain emotional reactions from family members correlate with higher relapse rates for people who have a diagnosis of schizophrenia. Collectively referred to as “high expressed emotion,” these reactions include criticism, hostility and emotional overinvolvement (like overprotectiveness or constant intrusiveness in the patient’s life). In one study, 67 percent of white American families with a schizophrenic family member were rated as “high EE.” (Among British families, 48 percent were high EE; among Mexican families the figure was 41 percent and for Indian families 23 percent.)
Does this high level of “expressed emotion” in the United States mean that we lack sympathy or the desire to care for our mentally ill? Quite the opposite. Relatives who were “high EE” were simply expressing a particularly American view of the self. They tended to believe that individuals are the captains of their own destiny and should be able to overcome their problems by force of personal will.
Prof. Jill M. Hooley of Harvard University concluded. “Far from high criticism reflecting something negative about the family members of patients with schizophrenia, high criticism (and hence high EE) was associated with a characteristic that is widely regarded as positive.”
What McGruder found in Zanzibar was that families often drew strength from this more connected and less isolating idea of human nature. Their ability to maintain a low level of expressed emotion relied on these beliefs. And that level of expressed emotion in turn may be key to improving the fortunes of the schizophrenia sufferer.
Of course, to the extent that our modern psychopharmacological drugs can relieve suffering, they should not be denied to the rest of the world. The problem is that our biomedical advances are hard to separate from our particular cultural beliefs. It is difficult to distinguish, for example, the biomedical conception of schizophrenia — the idea that the disease exists within the biochemistry of the brain — from the more inchoate Western assumption that the self resides there as well. “Mental illness is feared and has such a stigma because it represents a reversal of what Western humans . . . have come to value as the essence of human nature,” McGruder concludes. “Because our culture so highly values . . . an illusion of self-control and control of circumstance, we become abject when contemplating mentation that seems more changeable, less restrained and less controllable, more open to outside influence, than we imagine our own to be.”
Behind the promotion of Western ideas of mental health and healing lie a variety of cultural assumptions about human nature. Westerners share, for instance, evolving beliefs about what type of life event is likely to make one psychologically traumatized, and we agree that venting emotions by talking is more healthy than stoic silence. We’ve come to agree that the human mind is rather fragile and that it is best to consider many emotional experiences and mental states as illnesses that require professional intervention. (The National Institute of Mental Health reports that a quarter of Americans have diagnosable mental illnesses each year.) The ideas we export often have at their heart a particularly American brand of hyperintrospection — a penchant for “psychologizing” daily existence. These ideas remain deeply influenced by the Cartesian split between the mind and the body, the Freudian duality between the conscious and unconscious, as well as the many self-help philosophies and schools of therapy that have encouraged Americans to separate the health of the individual from the health of the group.
All cultures struggle with intractable mental illnesses with varying degrees of compassion and cruelty, equanimity and fear. Looking at ourselves through the eyes of those living in places where madness and psychological trauma are still embedded in complex religious and cultural narratives, however, we get a glimpse of ourselves as an increasingly insecure and fearful people. Some philosophers and psychiatrists have suggested that we are investing our great wealth in researching and treating mental illness — medicalizing ever larger swaths of human experience — because we have rather suddenly lost older belief systems that once gave meaning and context to mental suffering.
Offering the latest Western mental-health theories, treatments and categories in an attempt to ameliorate the psychological stress sparked by modernization and globalization is not a solution; it may be part of the problem. When we undermine local conceptions of the self and modes of healing, we may be speeding along the disorienting changes that are at the very heart of much of the world’s mental distress.
Ethan Watters lives in San Francisco. This essay is adapted from his book “Crazy Like Us: The Globalization of the American Psyche,” which will be published later this month by Free Press.
An earlier version of this article misstated the publisher of Ethan Watters’s book.