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Anth 207.13 Globalising psychiatry: exporting anorexia & other problems

Lecture for Psychological Anthropology: Body, Brain, Culture at Macquarie University by Greg Downey. Final lecture from 2012. Newer version available.
by

Greg Downey

on 8 November 2013

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Transcript of Anth 207.13 Globalising psychiatry: exporting anorexia & other problems

Princess Masako
Globalising psychiatry:
exporting anorexia & other problems
Greg Downey
Anth 207, Macquarie University
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Under pressure to produce a male heir for Chrysanthemum Throne.
Highly educated (Harvard, Oxford & Tokyo) with career as a diplomat.
Turned down repeated proposals by His Imperial Highness Naruhito before marrying in 1993.
Imagined she would live like Princess Dianna, some observers say, but Japanese imperial family much more restricted.
Gave birth to Princess Aiko in 2001 (Masako was 37).
Virtually absent from public life since 2003.
In 2004, Crown Prince Naruhito revealed that Masako was suffering from stress-related depression.
depression in Japan
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Ethan Watters
GlaxoSmithKline
“its association with such prized Japanese traits as orderliness and high achievement meant that having such a sadness-prone personality was something not to be feared but aspired to” (Watters: 208).
a melancholy personality
'Feeling sad and reacting sensitively to losses, particularly of loved ones, is an idea that has singular appeal in Japanese. The theater, a range of literature and indigenous popular songs, traditional and modern, positively wallow in nostalgia, sensation of grief and loss, and a sense of the impermanence of things. People cry freely (by North American and northern European standards) about separation and lost loved ones, but at the same time they seem to draw strength from these experiences, to tighten their bonds with those who remain living, and to reaffirm group solidarity.' (212)
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suicide in Japan
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Aokigahara, the Sea of Trees, near Mt. Fuji
Novel by Seicho Matsumoto about a young prosecuter who has affair with a woman and the lovers are blackmailed by her husband. Only escape is through couple's double suicide at Aokigahara.
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According to a police white paper, when people left notes, the most common reason for suicide was financial or living problems, followed by health and family problems.
The unemployed were the most likely to commit suicide (57% of cases).
Depression cited as the leading risk factor for suicide.
leading cause of death for men 20-24.
a perception that, although suicide 'traditional' in Japan, the rate has been increasing since 1990s.
government response
In 2007, the Japanese government implemented policy to try to cut suicide 20% by 2017.
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Focused on investigating causes, changing cultural attitudes toward suicide, and treating failed suicide cases more carefully.
10 September, 2012, Tadahiro Matsushita, the Minister of Financial Services, committed suicide on World Suicide Pervention Day.
However, resources stretched: it can take 30 calls to get through on suicide prevention lines.
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"Most people don't kill themselves because they want to die. They kill themselves because they don't know how to go on living. We need to make Japanese a place easier for people to live."
Taiki Nakashita, Buddhist priest & counselor
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Image by Robyn Jay, 2008
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Tokyo, image by Kondo Atsushi, 2008
Selective serotonin reuptake inhibitors
(ssri)
only introduced into Japan in 1999, 10 years after US.
'kokoro no kaze' (a 'cold of the soul')
a book on the new condition
the link to SSRIs
How effective are SSRIs?
what are the implications of this add?
medicalising our distress
goal is often to de-stigmatise mental conditions.
in some cases, mental illness disease model does lead to decreased stigma (behaviour not simply recalcitrance, moral failing, etc.)
but in some cases, mental illness disease model makes for a more severe stigma (broken brain, diseased, permanent, defective, uncurable, requiring treatment).
commercialising our medicine
the globalisation of the DSM and psychiatry exists alongside the move to medicalise mental disorders.
combination of altruism and profit motive with the confidence that science has determined universal truth.
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The Japanese word best translated as 'depression' (utsubyo) traditionally referred only to major or manic depressive disorders & was seldom heard outside psychiatric profession.
no depression in Japan?
Usually, to discuss feeling low, people described conditions of ki or 'vital energy.'
'Depression' was reserved for those with severe conditions.
Princess Masako & awareness of depression
The case (along with other celebrity cases) helped to markedly increase people seeking medical care for mild depression.
''There's no question in my mind that severe clinical depression is a real disease... I could take you all over the world, and you would have no difficulty recognizing severely depressed people in completely different settings. But mild depression is a totally different kettle of fish. It allows us to relabel as depression an enormous number of things.''
Arthur Kleinman, Harvard, to NYTimes, 2004
but how do you get around the stigma of talking about 'depression'?
'suffering exists.'
first of the Four Noble Truths of Buddhism
What's at stake?
estimated: $20 billion market worldwide for anti-depressants.
pharmaceutical companies argue 20% of people have depression at some time in their lives (121 million people worldwide).
Some recent research suggests up to 2/3 of depressed individuals do not respond to SSRIs.
Watters: people are 'vulnerable to new beliefs about the mind and madness during times of social anxiety or discord' (p. 249)
'Psychological' or 'psychiatric' approaches, even in anthropology, can seem to assign cause of issues to the functioning of the individual, not to society or cultural context.
PhRMA: 'No kidding, me too!' movie and website with Sopranos actor.
Persuading individual that they have an incurable, chronic condition that requires treatment is best of all possible worlds for pharmaceutical companies.
Destigmatising of mental illness is laudable goal.
10 million prescriptions for anti-depressants in Australia each year.
In July 2012, GlaxoSmithKline reached $3 billion settlement with the US Department of Justice for pushing the drug for children without approval.
Cases of depression in Japan: 240,000 in 1999 to 700,000 in 2008.
In one study, 69% of suicide victims likely to have been on phsychiatric drugs.
major educational campaigns (drug ads prohibited) to teach people about depression, likened to a 'cold of the soul'.
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One method was to recruit people for participation in clinical trials of the new drugs (recruitment announcements doubled as advertising).
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Tourette Syndrome
Rob Lemelson & Gusti
How does a diagnosis effect Gusti's life?
What works to make her life better?
Does 'medicine' make her life better?
May have profound effects on sex & sexuality.
US FDA required 'black box' warning on dangers of suicide in children using some SSRIs.
Not clear how SSRIs work to affect individuals.
Thank you!
Example: 'PTSD' and the Boxing Day tsunami, 2004
Western teams of 'trauma' recovery specialists descended on Sri Lanka.
Demanded that Sri Lankans cope in US ways, suggesting that anything else was denial or symptom of trauma.
Conclusions:
what we think about ourselves, including reasons for health & illness, affect how we function.
'normalising' requires us to pick out a range of our functioning & designate it 'normal.'
'normalising' is politically loaded & context specific.
if Western psychiatry is going to seek to undermine the legitimacy & efficacy of local alternatives, we can be part of making it harder for others to cope.
suggested that a) not severe or stigma, b) of course you'd want relief, and c) pervasive and likely to afflict anyone.
Bottom line:
a concerted effort, not to sell particular product, but to change a society's understanding of mind & what was normal.
drug companies frustrated by slow approval process required in Japan.
to cure illness, first you must convince people that they are ill.
by 2009 sales of Paxil reached US$1 billion.
decided to target Japan strongly.
distress & frustration medicalised in part to attract public sympathy.
used approval process as de facto advertising (full page ads seeking subjects).
Theory of 'natural balance' of serotonin appears to be appealing fiction.
We don't necessarily understand the 'knowledge practices' in our own society (medical trials).
Full transcript