About "The Americanization of Mental Illness" and then some...

What a week! 

It began on Sunday when I read a fascinating and provocative critique of the global influences of Western psychiatry by Ethan Watters titled The Americanization of Mental Illness in the Sunday New York Times Magazine,. Great title.  

I went through that piece initially on Saturday night online, when my friend Susan, a New Jersey-based bipolar blogger emailed me about it thinking it might be a good story to write about here.

Her email arrived while I was madly preparing for my first classes at Seneca College that began this week, so I decided I'd read this lengthy feature more carefully in print with my hard-copy of The Sunday Times the next morning, which I did.

Still, it started percolating at the back of mind. Though I expected the blogosphere to light up with comments, it didn't, as far as I could tell. Only Gianna Kali at Beyond Meds mentioned it and linked to it.

Reading it on Sunday morning in print, I penciled it up like a student preparing for a class. I found myself feeling comfortable and at ease, repeatedly nodding in agreement. After all, many of the points Watters makes, I've made here numerous times. 

Then at 5:11 a.m. Monday morning, as I was getting ready to leave for my class, my niece who teaches philosophy at a northeastern university sent me a link to it.

"hi sandy," she wrote. She never capitalizes in her missives to me. "did you see this? i haven't finished it yet  but it is very interesting and i think i'm going to include it in my emotions class..."

Interesting. Then, a red light went on in my mind. 

I started asking myself questions. I was beginning to wonder if there was something missing in Watters approach to a series of highly complex issues. He's a San Francisco-based published author and journalist with interests in cross-cultural psychiatry, anthropology, globalization and psychology, according to his blog. 

Does he have a psychiatric diagnosis, I wondered? I couldn't find any evidence of it, but to be honest, I didn't spend a great deal of time looking. I didn't have the time. I was racing against the clock trying to finish my course prepping.

Since Watters was so critical of American psychiatry, I decided to ask an American psychiatrist what he thought of this essay and I whipped off a series of questions to my friend and muse, my font of knowledge and wisdom, Dr. Ron Pies, Tufts University clinical psychiatrist and researcher and Editor-in-Chief of Psychiatric Times, the largest international online psychiatric magazine on the planet. 

Ron also contributes to The New York Times, The Boston Globe and PsychCentral's World of Psychology as well as endless psychiatric journals. 

I've devoted a number of posts to him here, too.  

Then, at 6:45 a.m., nervously, I drove off to school for my first class of the term – an 8 a.m. Monday class – a students' favourite. 

This is the first of my two Seneca classes. Twenty-two out of 35 students showed up and they were jittery. Not only because of today's Ontario Community College OPSEU province-wide faculty strike vote (I'm not in the union as a part-time teacher, so I'm not voting, by the way) but because of my course and what its demands will mean for them.

It was a good class. When I got home, I continued my correspondence with Ron. What a wild few days.

Yesterday at another Seneca campus at 1:30 p.m. I went through the same nerve-wracking experience with another 35 students.

Why nerve-wracking, you ask? 

Because I teach an elective course, required of all Seneca students who wish to graduate, no matter what program they are in, and I have a very diverse groups of students. Lots of business students of every stripe from administration and financial management to marketing and accounting, plus fire protection technology, early childhood education, library technology, fashion and any other of the dozens of programs Seneca offers. 

My classrooms look like a mini-United Nations. It's extraordinary. Teaching is learning, and I swear, teaching an elective at Seneca is a post-graduate degree in itself.

My course is called Leadership in Society and it is for college students who want to make a difference – more than money. It's what I do here. It defines my life today.

This course has become a life-changing experience for many of my students. It combines leadership training and Community Service-based learning, a growing movement in North American colleges and universities. In my course, 30% of their final mark is based on a major Community Service Project requiring each student to do a minimum of 20-hours of community service over a period of three to five consecutive weeks with a non-profit organization – in addition to their full academic load. 

They learn to write reflectively, keeping weekly journals. They must go out and find and interview a community leader. I teach them how to conduct an interview.

It's a major commitment. The subtextual prerequisite is that they care about making changes for the greater good of the community or society. Many students do. Others don't but learn to care, and often they continue their community service long after the course ends.

This is my course. I was asked to develop it in the Fall of 2007 while teaching Women Studies and I've been teaching two classes every Fall and Winter term since. It's a work in progress. In constant development. I've made a lot of mistakes but I've learned more than I could ever imagine.

I love teaching this course. It's my passion because, like creating and writing Coming Out Crazy here at HealthZone and exchanging ideas and community-building with you, teaching and learning are what I love to do most. I'm happier with these two part-time jobs, than I ever was in my full-time journalistic career. I make less money. I have no benefits. My life is rich, rewarding, meaningful and endlessly challenging and exciting. 

Proof that making a difference and having true meaning in your life is more rewarding than a huge bank balance. All you need is enough. Thank you, Daniel H. Pink! He happens to be one of my resources for my course.

Yet this course is often a very tough sell to the students. Yesterday, in one of my classes, I had 35 students registered. They arrived late. They didn't want to do Community Service and were very vocal about it. They were also so disruptive during that class, I came home with a backache, a headache and a stomachache. Thoroughly spent. No energy to write this post. 

I've learned that disruption in a classroom is contagious. A few can destroy the class culture for everyone. I was so stressed out, I had a snack and went to sleep at 5:30 p.m. worrying about how I would be able to manage this group for the next three months.

I felt awful, even though Ron Pies had blogged about the Watters piece himself and cited me and another doctor as having inspired it.

"Thanks for providing the 'spark'! --- Best, Ron," he wrote in an email at 4:45 p.m. yesterday.

I was a mess.

Sometimes I think the ongoing stresses of everyday life are insidious and potentially dangerous. Their relentless pressures hammer away at you, again and again, week-in and week-out. They're cumulative and more difficult to live with and manage that annual stresses like Christmas or peak stresses like having to move to a new home or the shock of losing your job or even experiencing the death of someone dear to you.

Their repetitive onslaught on our minds, spirits and bodies is doggedly destructive and distressing. 

Yesterday night, I was devastated. Then, just before I went to sleep, I checked my class lists. All those disruptive students had dropped my course. My class list was down to 29. 

So, on Friday, I will share with you my concerns and what I've learned about "The Americanization of Mental Illness..." I promise. I'll share some of the correspondence I had with Ron Pies, with whom I do not always agree, by the way. How could we? I have a 49-year psychiatric history. I'm Canadian. He was a toddler when I went to see my first psychiatrist in 1960. He's also a polymath with interests in philosophy, Talmudic studies, poetry and ethics. He's published widely and not just psychiatric texts but a wonderful book I give as a gift called Everything Has Two Handles – The Stoic Guide to the Art of Living (Hamilton Books, 2008). He's one of the wisest people I know, but we come from very different places. Yet we respect each other. I adore him.

So, today, I'm decompressing and planning my classes for tomorrow. I teach at two campuses every Thursday. I have 100 minutes to get from one campus to another. It's tough, when your students need you and want talk to you!

I pray that it does not snow on Thursdays this winter.

Be well. Stay warm. Speak soon.

Comments

[susan]

Thank you for the shout out!

I think Americans are very insular in their politics and their world views- whereas, the rest of the world isn't. Maybe that is why there has been no discussion on the blogosphere on this brilliant article. Liz brought it up on Monday. There has been some Tweets and what not....

I am glad you liked the article Sandy. Take care, stay warm....... picture yourself with Marty an the dogs on a beach drinking ice teas.....

[Sandra]

Mind hacks has a good post on Watters' article:

http://www.mindhacks.com/blog/2010/01/american_madness.html

And from a Dutch perspective:

http://astridvanwoerkom.wordpress.com/2010/01/12/americans-define-mental-illness-all-over-the-world/

[Sandy Naiman]

Hi Susan and Sandra,

Thank you for your feedback and your leads to other sites that discuss this story.

I'm coming at this article from the inside. As a psychiatric patient in her 50th year of therapy. I'll be posting about my take on this next week.

Susan, you make a very good point about "U.S. insularity and world view" and I'm reminded of the famous Saul Steinberg's March 29, 1976 New Yorker Magazine cover of "The World As Seen from New York's 9th Avenue."

Have a look:

http://strangemaps.wordpress.com/2007/02/07/72-the-world-as-seen-from-new-yorks-9th-avenue/

As a Canadian, it doesn't take much research to see that. We're covered in snow up here year round and overrun with Mounties according to many living south of the border. Though that stereotype is changing, I sense.

Initially, I was sucked in by Ethan Watters critique of psychiatry. Then, my skepticism kicked in and I started asking a few questions. He skitters along the surface of very complex subjects and to be fair to him, his article in the New York Times Sunday Magazine is an adaptation from a book.

In order to really understand where he's coming from, you'd have to read his book just published this week. As yet, I have not.

So, see you next week and again, enormous thanks to you both for your help with this. It's a tough one for me. I am no anthropologist and overwhelmed by a challenging first week of school plus an unfortunate "yes" strike vote but with only 57% of Ontario faculty backing a strike. That's the worst case scenario. Negotiations will be very challenging. Students are very upset. I'm not a member of the Union, so I'll have to cross a picket line or break my contract and risk losing my job.

It's all very upsetting.

And far more than anything else, there's the heart wrenching devastation in Haiti.

Speak soon.

sln

[Carolyn]

As a teacher Sandy, I'm going to give you some unsolicited advice. Have one rule for class discussions, respect the whole class or leave. So, state your point, no matter how controversial, but wait your turn, and don't interrupt. If someone breaks the rules ask them to leave. Otherwise, quiet but just as valued voices get lost in the mix. I guarantee, after the first time you ask someone to leave, it will never happen again. Everyone can have a point of view but they get hijack the conversation.
As a teacher you can and will get worn down by the emotions, lives and expressions of your students. They effect each other too. It is important thus, to control the environment.

Don't want to sound preachy, but I've been there...

[elizabeth clarke]

Hi Sandy,
Here is another comment on the same article.http://holisticschizophrenia.blogspot.com/2010/01/death-to-diseased-brain-model-is-comin.html

[Rossa Forbes]

I commented on the Watters article in my blog Holistic Recovery from Schizophrenia: A Mother and Son Journey. Rather than see the article as just another put-down of how USA-centric psychiatric labelling has become, the bigger point to me is that since Western countries have such a poor track record with mental health outcomes we should pay serious attention to why under-resourced countries do it better.

[Peter Harris]

Like everything else that involves the elephant in the room - America - we all have our reservations about psychiatric care being without a necessary world view. After all, America is the country that introduced the Super Big Gulp and 4 patty Big Macs to the world.

Needless to say, I find the size and depth of that country when it comes to on-line resources is incredibly powerful. I can remember times when the only other shoulder to cry on - barring CAMH hospitalization - were the About.com bipolar disorder discussion forums with live support. That said, where would we be without the 1-2% of citizens of the United States to commiserate with about our shared psychiatric problems?

I'm definitely for more USA USA USA.

Also, I just wanted to send a shout out via your blog about a new Wordpress blog I am authoring to coincide with working with others in a peer support role to improve Internet communication skills to alleviate the pain of bipolar disorder - http://thestar.blogs.com/mentalhealth/rss.xml

I hope and pray that even though rapid cycling BP is a total life headache, Some of your readers can befriend me and work together...Thanks for the time on-line...I'm Peter Harris on Facebook - previously known as other aliases on the Coming Out Crazy blog. Friend me!

[Sandy Naiman]

Peter, here I disagree strongly.

I am not for more USA! Not by a long shot!!!

Here, we are conservative and careful. We are also compassionate and humane. We have universal health care. Sadly, it's sometimes hard to find a psychiatrist, but there are many options open to us, like some of the new agencies popping up offering all kinds of psychiatric and psychological support.

Like Metamorphosis ~ The Toronto Psychosomatic Clinic in North York. It promotes "Emotional Fitness." I love that phrase.

http://74.53.90.154/~cmoseley/

Trained psychiatrists, psychologists and social workers help and heal people with a range of mental, emotional and addiction issues from drug addictions to phobias, anxiety attacks and panic problems to migraines, weight loss and anger management. There are more and more of these clinics opening in Toronto and I'm sure, in other regions for specific mental health problems. Especially because there is a shortage of psychiatrists and increasingly, family doctors are overwhelmed with having to treat issues they may not be qualified to handle.

Do you know that the only two countries in the world allowed to advertise pharmaceuticals on television are the U.S. and New Zealand. Think about that. It's a real problem.

So, without going into a diatribe about Big Pharma and the ethics of some leading U.S. academics in psychiatry and their dubious and unethical research practices, you can see why I will have to disagree with you.

The U.S. is not a panacea, I'm afraid.

I'm very happy to live right here in Canada and particularly in an urban centre. Living in rural areas with a mental health issue can be very isolating and help can be almost impossible to access.

Thanks for commenting.

Take care and speak soon!

sln

[Rossa Forbes]

Well, I may be hopelessly out of date, but CAMH only six years ago was telling us that our son had a hopeless brain disease. He was given Effexor and Respirdal and told he had a lifelong illness. CAMH's recommended reading was Dr. E. Fuller Torrey, not my idea of someone who's leading the charge in new ways of understanding mental health. It's no different than the system in the country where I currently reside. All countries have consumer groups, there's nothing unusual about Canada in this respect. When the big institutions begin to change, that's when we'll know something unusual is happening.

[Sandy Naiman]

Rossa,

This doesn't surprise me.

But six years is a long time in the world of mental health. Albeit, I am very wary of major mental health institutions that talk "recovery" but don't practice it. I'm very sorry this was your experience.

I would steer far from E. Fuller Torrey if I were you. Why not look into the work of Patricia Deegan or Mary Ellen Copeland.

Here are some links. They may hold more hope for you as does the whole Community Mental Health and Recovery world which, sadly, gets very little support or help in mainstream psychiatric medicine.

http://www.patdeegan.com/

You might find this interesting, too.

http://www.youtube.com/watch?v=jhK-7DkWaKE

And this:

http://www.mentalhealthrecovery.com/aboutus.php

And this, too:

http://www.yale.edu/PRCH/about/aboutrecovery.html

There are a number of recovery resources in Toronto that can offer you and your son more hope than CAMH.

I hope you'll consider looking outside the biomedical model. That's just one approach. There are many others. And many tools to help you.

Consider the Family Outreach & Response Program which has two locations. One in downtown Toronto and the other in Scarborough:

http://www.familymentalhealthrecovery.org/

One thing is certain. Your son does not have "brain disease." That term is damaging. I detest it. Try to distance yourself from the labels. Your son is your son. He is unique as is his experience. We are all unique. I wish you well.

Take good care.
sln

[Rossa Forbes]

Thank you, Sandy, for your thoughtful and helpful reply. I will check out your links. Keep doing what you are doing
. .. Rossa

[Sonia]

Hello Sandy,

I haven't read the Watters' article - time constraints and marking yet to do - but I get the feeling that panacea seems to be on the table, yet again. As a concept, "one size fits all" or the musketeer "one-for-all and all-for one", just doesn't seem to fit all.

As an example, I will go way off topic, seemingly. In Canada, I am neither tall, nor short, neither thin, nor plump. Other than my hair (8 colours, and growing longer), I could walk in a crowd, unnoticed. I think this is ok. However, where I am now, I must look at clothes marked "xxxl" in order to find something that fits - depending on the brand, pattern, etc. It really bothered me when I first was here (2002-2004), and it continues to irk as most of the sales clerks for women's clothes are men who don't mind commenting in their language (partly unintelligible to me, still) on how tall, big and fat I am, compared to the women native to this area.

The impact on my self-image and self-esteem is as corrosive, and might I say "erosive", as it is cumulative.

Then, let's visit one of my classes of undergraduate students. Many of my students have enjoyed lessons with a foreign teacher in their middle school, yet for some, I am their first foreign teacher. The comments that persist, year after year (this is the 5th school year I begin in this part of the world), focus on the shape of my body as it is different to their own - broader shoulders, longer limbs, bigger feet, longer fingers, colourful hair, etc. Intent aside, this wears one down as the questions become predictable.

As I prepare for next term (which begins March 1), I feel as though I were stranded in a shallow pebbled river of fast moving water - slippery, unstable, and just as far whether I step forward, or back.

All this to say: the words of others, including diagnostics, often don't fit because we are not comfortable discussing those details that would give a complete picture, thus helping to describe our feelings, perceptions, our hopes and aspirations, as well as our fears and confusions.

If I were to describe the history that has lead to 2010, as I am now ... there would be so much confusion, so many more prying questions. Few people take the time to delve deeply into their own complexities, let alone the statements of others (Watters, for instance), to try to understand where they stand, their centre (spiritual, intellectual, emotional, physical).

ps: Sandy, I received "The Massage" ... thanks