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Ashley Tolbert

PSYC 384

“Crazy Like Us” Paper

4-15-2015

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The Rise of Anorexia in Hong Kong

In this chapter, Watters interviews Dr. Sing Lee, who is the first person to document

anorexia in Hong Kong or China. Dr. Sing Lee noticed that the patients that had anorexia in

these areas where not properly diagnosed because their symptoms did not follow those listed in

the DSM (The Diagnostic and Statistical Manual of Mental Disorders). The DSM symptoms

were collected from patients in Western culture (U.S.), and the symptoms of the patients from

the Asian culture were very different. Therefore, since the patients in Asian culture did not have

the same symptoms, they “technically” did not have the disorder. Dr. Sing Lee started noticing

that many cultures had different symptoms for it as well, but knew that everyone in the medical

profession followed the DSM. He wanted to prove that different places had different symptoms

and that disorders did not have a universal symptoms.

Lee first learned about anorexia while he was studying in England, but they also had the

same symptoms as the U.S. When he got back to China, he tried finding medical papers on

anorexia, but found none. This is because people in China weren’t exposed to this disorder as

much as Western culture was. The belief in China is that being of bigger size means that you

have good fortune. When Lee finally found a few cases in China, he was not sure if it was the

same disease because the symptoms were so different. He called these patients “atypical

anorexics”.

One of his very first patients was a 31-year-old woman, renamed Jiao for the book. Lee

described her as a skeleton with skin. She only weighed 48 pounds when she was supposed to

weigh around 110 pounds. He gave her a physical exam and asked her some questions about

herself, like how this all started for her. Jiao told Lee that she stopped eating after her boyfriend

of four years left. This is what triggered her not wanting to eat. Although her physical

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characteristics were the same as a person with anorexia in the Western culture, her mental

outlook what a lot different. Jiao did not fear becoming fat nor did she have a distorted self-

image of herself. She told Lee that she did not restrict her food intake, she just never felt hunger.

Jiao mentioned to Lee that after a while she developed a pain in her abdomen. In fact, many of

Lee’s patients mentioned something of this nature. They said that they could not eat because

there was a blockage in their throat or there was a fullness in their stomach. Many of these

patients had different reasons for why they stopped eating and none of them were afraid of

becoming fat or saw their bodies differently than what they actually were.

Wanting to know more about anorexia, he searched for more findings. Lee came across

the work of Edward Shorter, who was a medical historian and had written several papers about

the history of anorexia. Surprised, Lee noticed that the symptoms that were recorded in the mid-

nineteenth century were the same as the ones in his patients in Hong Kong. Shorter compared

modern day anorexia to mid-nineteenth century hysteria. Anorexia did not get a formal

recognition until 1873. Continuing his research, Lee read many papers about anorexia, he even

looked over doctors notes on patients. Some of the notes suggested that the patient was denying

having the fear of becoming fat. Most of the doctors would not consider the patients’ condition

as anorexia because the symptoms did not follow the list implemented in the DSM.

Even though anorexia was very rare in Hong Kong, most likely due to the lack of public

awareness, Lee was afraid that something would happen and it became a trigger for anorexia.

The death of Charlene Hsu Chi-Ying was that trigger. She was a 14-year-old girl that died on the

way home from school. It had been a stressful time in Hong Kong in 1994, and until that summer

she was in perfect health. The reason that seemed to have caused Charlene to stop eating was that

she was not allowed to go on a class trip. After she stopped eating, her personality changed

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rapidly. Her elders encouraged her to eat more and told her that she should visit a doctor. When

she fainted the first time at school, her parents were not told. The school decided to use it as

leverage to get her to do better. The only reason Charlene’s death sparked the rise of anorexia in

Hong Kong is because she died in public. Many people were around her when it happened and

there was no surprise that it reached the news. People wanted to know why this young girl had

dropped dead in the middle of the street. They got their answer and it started to consume their

population. Hong Kong’s biggest business now is beauty products and weight loss supplements.

Lee stated that all of the unique symptoms that his patients had before Charlene’s death had

virtually disappeared because the population was exposed to the Western culture definition of

anorexia and its symptoms.

Many cultures do not have the same symptoms for anorexia, they each have their own

unique set of symptoms. It’s possible the some cultures do have some of the same symptoms, but

most of them have different ones because of their belief systems. For instance, in India, the

symptoms do not fit the Western description. The female patients that were diagnosed with

anorexia in India had decreased appetite, excessive weight loss, and amenhorrea. They did not

show any fear towards becoming fat and they did not think their body was deformed (Simpson

2002).

A lot of the time, the disease isn’t thought to be dealing with a disorder at all. Some

people who have anorexia, have said that it has to do with their religion. Most religions that deal

with not eating call it fasting. A woman from Minnesota, who was very religious, often used

religious symbols and language to give meaning to what was happening to her. This woman

wanted God to control her body. She felt that bigger people had heavier souls, which means they

wouldn’t get into Heaven with all the burden that they carried. She also felt that her being thin

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was a good thing because it kept men from coming on to her, which kept her a virgin. (Simpson

2002).

Anorexia is a very rare disorder in Africa. In the recorded cases that have been found,

none of the people have been ethnic Africans. Being plump is desired in the African culture

before the 21st century. One case that was found was of a Caucasian girl who was born in Kenya.

She developed anorexia after going to the UK when she was fourteen. The identified triggers

were the new culture, new living arrangements, and weather. Even after returning to Kenya, she

suffered from anorexia for six years after. After months of psychotherapy and having to write

about the trauma of living in a different place, the girl, who is now twenty-five, started to gain

weight and her periods returned. Even though she was fearful of putting on weight, she wanted to

have children. After having children, the woman still wanted to remain as small as possible.

Now in the 21st century, the pressure for girls to be small is widely known. They are very

health conscious and go to the gym to watch their figure. There is still no increase in the cases of

anorexia in Africa even with the pressure. Studies were done to examine the psychiatrists in

Africa to see if they had been misdiagnosing the disorder or if they couldn’t even see a disorder.

The results were that the psychiatrists that did respond to the survey and were questioned about

the symptoms of anorexia were able to identify at least two symptoms from the DSM V. There

has only been one reported case of anorexia in sixteen years. Depression and major life events

are common in Africa, but still do not impact the very low rate of anorexia in the culture. Kenya

is influenced by the British, where anorexia is very well known, yet the rates have never risen

past what they are. Some seem to think that genes have something to do with it, but have not

proven anything to suggest that. The rarity of anorexia in Africa cannot be explained (Njenga

2004).

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The Wave That Brought PTSD to Sri Lanka

In 2004, there was a tsunami that destroyed thousands of peoples’ lives and homes in Sri

Lanka. This disaster caught attention of many people that studied trauma and had dealt with big

disasters before. Most of these people wanted to help because that was the right thing to do,

others wanted to help because they did not want to miss this “once-in-a-lifetime” disaster. People

thought that this disaster would result in many people suffering from PTSD. The tsunami

aftermath would cause the largest international psychological intervention in history.

Debra Wentz was in Sri Lanka for a friend’s wedding when the wave hit. She describes

some things that she saw and how she didn’t register what had just happened until it was over.

Wentz was the executive director of the New Jersey Association of Mental Health Agencies. She

thought that the Sri Lankan were unprepared for the psychological trauma that was to come.

Wentz assumed that the psychological reaction to horrible events was universal. The symptoms

of PTSD are organized into three categories: avoidance, numbness, and hyperarousal. This is

what Wentz assumed she would see from the natives of Sri Lanka.

When the word got out around the world about what had happened in Sri Lanka, many

traumatologists, and others, were asked to go and help out as much as possible. One of those

traumatologists was Kate Amatruda, who is also a play therapist and a BCETS (Board Certified

Expert in Traumatic Stress). Her job was to help children in the community that were suffering

from mental trauma. Amatruda is well known in the field of PTSD. Unfortunately, Amatruda did

not understand the Sri Lankan culture. It seemed that it didn’t matter that most of the trauma

counselors did not understand the culture that they were going to be helping. Watters asked

Amatruda about a moment during her trip to Sri Lanka that her presence was effective in healing

the psychological wounds from the tsunami. She said that it was when she was helping a child

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paint because during this she made the child feel important. Watters asked how she made the

child feel that way and she said because a blonde person had come all this way to see them.

CARE, the Red Cross International, the World Health Organization (WHO), etc. assumed

that the people all over the world are the same in their emotional experience and expressions.

Instead of trauma reactions being automatic physiological reactions in the brain, they are cultural

communications. A counselor that was being interviewed expressed his worry because the

children were more interested in going back to school than talking about what had happened.

This counselor claimed that these children were “in denial”. Many reporters and counselors were

convinced that the Sri Lankans would soon experience the full blown effect of PTSD. They said

these things because the natives wanted to leave the refugee camps and go back to their villages.

Many people that volunteered did not understand the Sri Lankan culture, but there were

some that did understand it and felt it was wrong to send in people that did not. Shekhar Saxena,

who works for WHO, was one of those people that felt this way. He pointed out that sending in

people that did not speak the language or understand the culture were useless and would get in

the way. Some of the trauma counselors ignored the customs in Sri Lanka and thought that they

knew better about psychological aftermath of the tsunami than the locals did. Most of the

traumatologists that were recruited thought that the native people did not understand their own

psychological needs and thought getting their opinion would be a waste of time.

There were many people trying to help with what happened, but there were also people

that just wanted to go so they could further their research and a drug company wanted to

distribute their product. One drug company in particular is Pfizer, which produces Zoloft,

sponsored a conference that would show how well Zoloft would help with the PTSD. Professor

Davidson was one that presented at the conference, and he said that PTSD was a disabling

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disease and that Zoloft would help with long-term psychological and psychosocial health. The

researchers that did go to further their findings, did not do an effective job at debriefing the Sri

Lankans that did participant in their studies. The Sri Lankans did not fully understand that they

did not have to participant if they did not want too. Some thought that if they did participant that

they would receive some kind of financial assistance or other help.

Dr. Gaithri Fernando, an assistant professor, is a native of Sri Lanka. She was in Sri

Lanka doing a study on the psychological impact of the earthquake that had happened in 2001

when the tsunami hit. She also returned to her native land to conduct research on the

psychological impact of the long civil war that was still going on at the time. Before the tsunami

happened, Fernando’s research showed that the Sri Lankan people had remarkable psychological

resilience, which means that the people “bounce” back rather quickly after some disastrous has

happened. Fernando knows that when there are times of hardship in Sri Lanka, the people turn to

their rich cultural traditions. In this section of the chapter, there was an alternative possibility that

was mentioned. It was that Sri Lankans had evolved a culture better able to integrate and give

meaning to terrible events because of their familiarity with poverty, hardship, and war. Fernando

did not think any progress would be made unless the volunteers understand the local idioms of

distress only then could appropriate treatment could be formed. Fernando did a study where she

asked participants to tell two stories in their own language, and out of all of them the majority

were about the tsunami. After this study, she came up with the Sri Lankan Index of

Psychological Status, which is a twenty-six measure of the local indicators of distress. Unlike the

U.S., Sri Lankans were more likely to experience physical symptoms are a horrible event.

Western beliefs about trauma may throw countries like Sri Lanka back into a violent motion with

their rivals.

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In the Chinese culture, psychological mental disorders are also considered physical

illnesses. The Chinese belief system for their health deals greatly with Ying and Yang. One

should have perfect balance if they wish be healthy. If someone is imbalanced between the two,

they have to get treatment quickly or it could do damage to the organs. For many people in China

are unwilling to express emotions and they deny they have a mental illness. According to the

Chinese culture, life events are determined by external forces. The term “PTSD” only became

widely known by professionals and the public after the earthquakes in North China. China had

two sublevels of PTSD, which were acute stress reaction and delayed stress reaction. The

symptoms for PTSD in China were different from the DSM. The CCMD-3 (Chinese

Classification of Mental Disorders) required at least one re-experiencing symptom, one

hyperarousal symptom, and at least two avoidant symptoms (Wilson 2007).

In Rwanda, after the civil war ended in 2004, psychiatric disorders were becoming more

relevant. One girl, whose family was murdered before the war ended, went to a clinic

complaining of nausea and bugs crawling on her skin. These symptoms are different from the

Western criteria for PTSD. When she was being examined she revealed what had happened to

her parents and siblings. The people who did this thought she was dead too and threw her into a

whole filled with feces and maggots. She stayed there for a week before getting out. Although

there has only been one study on psychiatric disorders, it is believed that almost 20% of the adult

population, which is much more than other war-torn countries (Wulsin 1998). A study on

children and adolescents after the genocide showed that they had extreme degree to traumatic

exposure. 79% of those surveyed scored over a seventeen on the Impact of Event Scale. These

results suggest PTSD in the children (Hagengimana 2003).

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The Shifting Mask of Schizophrenia in Zanzibar

Watters traveled to Zanzibar to learn about how schizophrenia has impacted the people

and the culture. He was staying with Juli McGruder and Ahmed Kassim. The first night that

Watters is there, there is a phone call early in the morning hours. Kassim, who is McGruder’s

partner, leaves right after the call. Later that morning, Watters asked McGruder what the phone

call was about and he learns that Kassim’s daughter had died in the middle of the night. Kassim

had to go help with the burial to follow his Muslim religion. Watters did not understand why

Kassim didn’t show any emotion after finding out such horrible news. He has to assume that the

local machismo, which is pride, made him push his true feelings inside. The only thing that

Watters could understand the meaning of Kassim’s use of the Kiswahili language. He was

expressing himself through this emotional language even though Watters did not understand

what the words meant.

McGruder is a retired professor from University of Puget Sound in Washington. She has

a PhD in anthropology and her field research focused on three families struggling with

schizophrenia. She wondered why people that were diagnosed with schizophrenia in developing

nations had better prognosis, which is the course of the disorder or disease, than those who were

diagnosed in industrialized countries around the world. The emotional thought of families

dealing with mental illness in Zanzibar is different than those of families in the U.S. Patients in

Zanzibar that are diagnosed with a mental illness will do better with the course of the disorder

than the people that are diagnosed with the same disorder in the U.S.

The idea that diseases come from chemical imbalances or brain abnormalities had not

been accepted by Zanzibar’s population. The more common explanation for these diseases are

spiritual possession and permeability of the human consciousness by magical forces. The local

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belief in spirits shaped the experience of mental illness for both families and patients. McGruder

found that there were many different variations of schizophrenia. There are so many that it

suggests that the disease was shaped by other things besides genetics. One obvious difference

between cultures are the symptoms of delusions and hallucinations. Delusions and hallucinations

are often distorted reflections of the phobias of specific cultures.

Janis Hunter Jenkins and Robert John Barrett are two researchers that study

schizophrenia. They believe that culture is a critical aspect of schizophrenia and the experience.

They found that people that are diagnosed in developing countries appeared to do better over

time than those in industrialized nations. McGruder dug deeper into others findings, like Jenkins

and Barrett, and found studies that were conducted by the World Health Organization. These

studies started in the late 1960s. These studies took place around the world in ten countries with

more than a thousand patients both rural and urban settings, and they also had follow-up periods

of two and five years. WHO found that patients that were diagnosed in developing countries had

a less severe form of the disease, longer periods of remission, and higher social functioning than

those who lived in industrialized nations. Over 30% of people with schizophrenia in

industrialized places were judged to be severely impaired. It is thought that the traditional beliefs

in supernatural and spirit possession removed the weight of guilt from the person and their

family in the developing countries. “Expressed emotion” suggests that people with schizophrenia

will become worse if they are around family who were constantly criticizing them or if they

showed too much interest in their condition.

Hemed and his daughter Kimwana, who both have been diagnosed with schizophrenia,

lived with their family in a little house that McGruder showed Watters. Amina, who is Hemed’s

ex-wife, ran the house on a daily basis taking care of the whole family. McGruder visited this

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family for over a year silently studying both Hemed and Kimwana. She didn’t want them to feel

uncomfortable about her being there watching them so she did not write anything down in front

of them. Hemed and Amina were an arranged marriage and Hemed had his first psychotic

episode. When he started experiencing symptoms, it was a time of political upheaval on the

island. McGruder believes that this social happening is what triggered Hemed’s first experience

with the disease. Hemed loved to talk about politics but as the disease worsened, his talking

turned into discussions with unseen persons. The way this disease sparked could be explained by

the stress-diathesis model, which is a theory schizophrenia is biological factors make one more

vulnerable, but stress in the environment is what triggers the illness. Hemed was admitted into

the local mental hospital multiple times. The doctors there certified Hemed as a person with

unsound mind. His charts said that he was aggressive, had hallucinations, and lost his temper

easily. During a couple of his stays, Hemed was give electroconvulsive shock therapy. McGruder

found from looking at his charts that some of his worst episodes were during or right after family

stress or something to do with political strife.

When Kimwana had her first psychotic break, the family thought that she was possessed

by spirits because they could not calm her. The family thought it was either an ancestor that

thought they were being ungrateful or someone Kimwana worked with sent the spirit using

witchcraft. They took her to the hospital where she was examined, given some antimalarial pills,

and was kept for four days. After another hospital visit, Kimwana heard voices on a daily basis.

The voices that she heard were male and she felt that she had to respect the codes of conduct and

would not bathe, undress, or go to the bathroom when she heard them. Kimwana said that when

she was alone she felt better. The family provided steady care for Hemed and Kimwana came

from the family’s religious desire to prove that they could handle what God had given them.

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Shazrin al-Mitende was forty-three when McGruder started vising her family. She was

taken care of by her half-brother, Abdulridha. Shazrin started having trouble when she was

thirteen. She started screaming when her mother tried to help her out of her dress, and wasn’t

calmed for seven days. She started acting strangely before that after she saw a black cat, so her

family assumed that it was a spirit possession. Charles Swift was the doctor that took care of

Shazrin when she was admitted a couple weeks after her first episode. He was the only trained

psychiatrist in the country. He was the one who diagnosed Shazrin with schizophrenia. Swift

hoped that by providing Western knowledge he could help get rid of the myths that he believed

brought stigma to the mentally ill.

Abdulridha thought that his sister’s mind was broken but could be fixed with medication

because of the biomedical approach. He started to believe the Western ideals more than the local

beliefs that God had sent this illness as a burden or a blessing. He used this to dehumanize his

sister and justify his control. Those who adopted the biomedical and genetic belief about mental

illness were those who wanted less contact with the people who had the mental illness.

In the Chinese culture, schizophrenia is known as the disease of disorganized mind. Since

this term challenges personal morals, it causes stigma. This stigma makes Chinese/ Japanese

psychiatrists are reluctant to properly diagnose their patients because they don’t want to tell them

what they really have. Taking medication requires informed consent, so that means that patient

won’t take it because they won’t know what it is for. This causes many negative effects for the

patients. Chinese children were asked about their attitudes toward the word ‘schizophrenia’ in

Chinese, and some of them said that it’s okay because it gives the balance of sanity and insanity.

The other children still felt stigma towards the word because they were afraid of falling back into

a “disorganized mind” when they are in remission (Kim 2001).

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Most developing countries have a better outcome with most mental illnesses because they

believe that it is coming from a higher source so they accept it more than they push it away.

Some Americans, when diagnosed, do not take the news very well and give up because they

don’t think they can get better. India is not one of those countries that accepts it. Many people

that are diagnosed with schizophrenia in India are looked at like a bad omen and start treating

them differently than they did before they got the actual diagnosis. They have a program called

Project COPSI (Community Care of People with Schizophrenia in India). This program tests the

results of additional community care along with medical treatment. It’s basically a counseling

center for people with schizophrenia where they can come talk about their feelings if someone is

mean to them. The counselors talk to the patients as friends and not as strangers. Many patients

are grateful for the program because they have interactions with people that don’t treat them

differently (COPSI).

The voices that a person that has been diagnosed with schizophrenia hears are shaped by

their culture. The Western cultures tend to experience more disturbing psychotic episodes than

others. People from the Western culture claim that the voices tell them that other people can read

their minds and are trying to kill them. In African culture, these voices are almost playful

according to some studies. The study suggests that therapies encouraging forming relationships

with the voices could be very useful for the patient. All of the participants that were not from

America said they had a positive experiences with the voices in their heads. In African culture, it

is accepted to accept that disembodied spirits can talk. The difference between the two cultures

could be that Western and European cultures see themselves as more of an individual while

people outside the Western culture think that the mind and self are intertwined. The participants

from Africa felt that the voices were not a threat but more of a friend unlike Americans. (Parker).

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The Mega-Marketing of Depression in Japan

Watters visited Dr. Laurence Kirmayer because he had an interesting story to tell about

his interaction with the pharmaceutical giant GlaxoSmithKline and how the company tried to

create a market for their antidepressant pill Paxil in Japan. In 2000, Kirmayer accepted an

invitation from the International Consensus Group on Depression and Anxiety. He knew that

GlaxoSmithKline paid for this event. He said that all of the invites went to highly influential

clinicians and researchers from all over. Along with the many incentives, the people attending

would be given a change to publish their presentations in a prestigious Journal of Clinical

Psychiatry.

Kirmayer was caught off guard when his airline ticket arrived. It was worth $10,000.

Another hint that this wasn’t a normal conference was when he got there they told him that it was

a closed door conference and that his graduate student would not be able to sit in a listen. The

hotel was extravagant, as was his room. Kirmayer said that everything was so expensive that it

was scary to him because he would never be able to afford that on a daily basis.

GlaxoSmithKline was not interested in selling their drug to the attendees, instead, they wanted to

learn about how culture shapes the illness experiences. Their drug, Paxil, was about to be

released in Japan, so it made sense to Kirmayer why they wanted to know.

Paxil was supposed to be released in Japan years earlier, but it was pursued because Eli

Lilly, a world leader in the SSRI race with Prozac, didn’t think that the people in Japan wouldn’t

take it. Only because the people would not want to accept the disease. The Japanese culture

viewed depression than in the West, one view that made it unlikely that a significant number of

the population in Japan would want to take a drug that dealt with this disease. In Japan,

depression was described as a chronic and devastating as schizophrenia. Depression made it hard

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to hold down a job or have a normal life. The sales prospects of Paxil in Japan would not have

been good before because depression was considered a rare disease. The conference that

Kirmayer went to was for the drug company to learn how to market depression.

Osamu Tajima, a professor in the Department of Mental Health at Kyorin University, was

a leading psychiatrist in Tokyo, and was a speaker at the conference. He expressed to the

gathered group his concern for the rising suicide rates in Japan. He told them about the suicide

forests, where dozens of men travel there to hang themselves. He also told them about how many

of the Railway workers would jump in front of the trains. Tajima also said that the Western

definition and the checklist for symptoms for depression were steadily gaining ground among

psychiatrists and doctors because of the DSM.

Kirmayer spoke at the conference on the second day. He found that every culture has a

type of experience that is different from the Western conception of depression. He also found

that cultures have unique expressions, descriptions, and understanding for the mental state and

set of behaviors that relate to loss of connection to others and rise in social isolation. He

explained to the group that a person from Nigeria and a man from India would have different

symptoms for the same disease. One might feel like he’s hot all the time and the other might feel

like something is wrong with his head. Culturally distinct symptoms are very important and hold

clues about the causes of the distress so it is very important the one understand these symptoms

for whichever culture they are in. Something that might be categorized by an American doctor as

depression could easily be viewed by another culture as a moral compass which makes both

individual and group to search for the source of the discord whether it be social, moral, or

spiritual. Cultures are more vulnerable to outside ideas about the human mind at time of social

change.

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Oshima Ichiro started working for the largest advertising company when he was twenty-

four years old. He was healthy and happy, and many people would describe him as committed to

his work. Ichiro handled public relations at his job and he started working there around the time

that the panic in the economy was about to start in all financial markets. He showed that he was a

hard worker and would devote many hours to get the job done. He stayed at work very late and

only returning home for a couple of hours before heading back. After ten months of working for

this company, Ichiro’s parents started to worry about him. They suggested that he take a few

days off, but he refused. He never took a day off. Soon Ichiro began to make small comments

about himself when he messed up at work. Ichiro was even beaten by his boss one night when he

was drunk.

The next summer, after being at the company for a year, Ichiro’s work load basically

doubled. He had to do his normal work and be in charge of a four day conference. He had to

drive his boss to the conference and was swerving and mumbling. His boss said that he mumbled

something about being possessed. When Ichiro finally returned home from the conference, his

brother was worried about him and Ichiro said he would go to the hospital the next day. He

called into work to tell them he was sick. Not even an hour later, he hung himself.

Ichiro’s parents sued the advertising company. The lawsuit came to court a few years

after his death and it was featured in newspapers and television news. The press was calling it

karoshi, which means death from overwork, because men had died from this before. The

family’s lawyer said that the stress from his job and the long hours brought on his depression,

which went untreated. In Japanese literature, depression was categorized as a disease of the brain

and not something triggered by something in one’s life. Even though Ichiro’s parents won the

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case, the company appealed the verdict because they felt that they should not be held responsible

for Ichiro’s death because he was already mentally weak before starting to work for them.

Kalman Applbaum is an anthropologist and he studies the rituals and practices of

international corporations. He thought that it was interesting that some of the pharmaceutical

companies were attempting to put SSRIs into Japan. He noticed that the different drug

companies weren’t trying to go up against one another to introduce these drugs first, but they

were joining forces. With retest the drugs that they wanted to distribute, the drug companies

wanted to shape the way the Japanese consumer thought of the disease. Applbaum called this the

mega-marketing campaign. The drug companies were trying to make it seem like it wasn’t so

bad having depression. They called it a “cold of the soul”. The drug companies only wanted to

know how culture effected depression because they wanted to sell and make a lot of money.

They would be able to do that if they convinced the Japanese people that depression was as

common as a cold, which would mean that more people would think they have depression and go

get professional help. That in return would make the companies money because the patients

would have to buy the drugs.

Like all other disorders and diseases, depression does not have universal symptoms.

Instead of experiencing depression as psychological, many Chinese people experience it as a

physical thing. Chinese people that have been diagnosed with depression haven’t reported

feelings sad, but instead feel bored or discomfort. They also have symptoms of dizziness and

fatigue. This is challenging for Chinese people that come to America because they will be

wrongly diagnosed because their symptoms do not fit those of the DSM (Kleinman 2004).

Vietnamese Americans are the fourth largest Asian group to be impacted by depression,

as well as other mental illnesses. Many Vietnamese Americans will only get help from their local

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doctors but most of the time it is ineffective. This is because of culture. Culture shapes how

people describe symptoms and how they look upon the disease. If the symptoms are different and

they go to a professional for help, they will not be diagnosed with the correct disease because

they do not match the specified criteria. When therapy is more culturally responsive, the outcome

is a lot better for the patient (Fancher 2010).

Depression, if left untreated, can lead to suicide. Greenland has one of the highest suicide

rates in the world. It is most common among teens and young adults. Males are more likely to

commit suicide more than women. For some time, people in Greenland were not offered therapy

or psychological help because they did not have therapists or psychologists. In the modern day,

they now have some psychiatrists, but they focus on the children to try and keep them from

becoming depressed and suicidal (Ghosh 2013).

In Australia, the symptoms for depression are both physical and psychological. In one

year, one million people will be diagnosed with depression in Australia. One of the personal

factors that can cause depression is one’s personality, especially if they worry a lot or are a

perfectionist. Another factor is genetic vulnerability. This implies that depression is already

embedded into one’s genes from their parents. There haven’t been many studies on this claim,

but it has not been scientifically proven. Some of the symptoms for depression can be thoughts

(like, “I’m not good enough” or “It’s my fault”), physical (tired all the time, headaches, and

churning gut), and behavior (isolation, alcohol abuse, and no concentration) (BeyondBlue).

Countries all over the world suffer from mental illnesses every day. The symptoms are

not always the same because there is not a universal set. They will differ from the DSM V

because our culture is not the same as someone from Kenya or India. Mental illnesses should not

go untreated just because the symptoms don’t fit. Every culture is its own puzzle.

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Fancher, T. L., Ton, H., Meyer, O. L., Ho, T., Paterniti, D. A. (2010). Discussing depression with

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culture- luhrmann-071614.html

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Hagengimana, A., Hinton, D., Bird, B., Pollack, M., & Pitman, R. (n.d.). Somatic panic-attack

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Alcoholism, Lengthy Seasons, Culture Clash Conspire To Trigger High Rates Of

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