The High Cost of Expertise
A response to the case studies in cross-cultural psychology of Crazy Like Us: The Globalization of the American Psyche by Ethan Watters
“I do believe each person knows for themselves what’s best and when approaching their deep psychological experiences, we, as mental health professionals, must put aside our egos and professional pride to engage in honest dialogue. Each person is, in many ways, their own country, embedded with impacts from many different cultures and subcultures. Approaching their experience with a sense of not-knowing seems to be the key to avoiding the homogenization of their experiences to fit my own assumptions.”
Vijay Ramanathan
In Crazy Like Us: The Globalization of the American Psyche, Ethan Watters describes the ways in which Americans find it comfortable to come from a place of knowing, brandishing expertise as if it were a shining sword in the realm of the unknown, especially when approaching problem-solving in unfamiliar terrain. I felt frustration at the accounts of the eagerness of the American professionals to wield their knowledge as a weapon, strongly influencing foreign perceptions, rather than a compass, to use to direct dialogue with those cultures; this approach actualized a very real psychic post-colonialism by pushing American understanding onto others who perceive or are encouraged to perceive themselves as lesser than us. This was most evident in accounts of the handling of post-tsunami Sri Lanka where droves of psychologists failed to listen to or acknowledge the wisdom of local traditions, instead assuming and perpetuating the myth that they held more expertise on the human mind, even stating that they knew more than Sri Lankan community on the Sri Lankan experience.
The lauding of Western experts to the outright demeaning of locals was a bit triggering for me as it betrays a post-colonial indoctrination that what’s West is best. If we give up the idea that we hold the cornerstone of expertise we can allow for the experiences of others to influence our experience of mental illness. Watters recounts one psychologist using terms like “psychologically unsophisticated” to refer to local “trainees” who they claimed were “not particularly self-aware” (Watters, p. 82). Although the book illustrates that there are no easy right answers, it’s also clear that certain responses are damaging.
As a person who has been moving firmly away from the ever-growing reach of biological reductionism, relegating the human mind to neuroscience that eliminates the subjective experience of the individual in favor of pseudo-scientific objectivism, towards a more robust and expansive understanding of subjectivity in consciousness, this book confirmed my fears that we’re headed in the wrong direction. Yet, I do not share the implicit cynical and fatalism of the text. I hold optimism that future integration of views is possible.
I like that the book seems to act as an affirmation of our cultural and mental plasticity. Views of people change over time, as do cultural perceptions. However, I did not agree with the cynical undertone present in the text. Watters interviews a psychiatrist in Hong Kong, recounting how Dr. Lee “had spent the better part of two decades trying to convince the profession of psychiatry that Western assumptions about eating disorders were not only steamrolling local variations but also potentially acting as a vector, both spreading these illnesses and shaping their expression.” I felt a strong negative reaction to the idea that the battle has already been lost, that we have passed the point of no return, pushed by a historical current that is simply too strong (Watters, p. 63). And yet, in a later chapter, in acknowledging that “cultural beliefs about depression and the self are malleable and responsive to messages that can be exported from one culture to another” (Watters, p. 197), there appears some foundational hope that trends can continue to evolve and reimagine expressions of the self and one’s experience of illness in the future towards a more subtle understanding than is presented in the Western, particularly American, neurobiological explanation.
While we see that there is an experiential homogenization happening, there’s also a sense of hope in the mere act of awareness of these phenomena may allow room for its reversal, or at the very least, an integration. If we applied the brand of curiosity that this book employs in understanding cultural beliefs in Zanzibar that frame the prognosis for schizophrenia in our practices, we might be able to reframe the illness in the West. It’s our judgment about African culture that ultimately blinds us to accepting their wisdom and binds us to stay within the lines of our own increasingly rigid understanding of the human experience to our own detriment.
I believe my future clinical practice will create space for a two-way flow of influence and am empowered by Watters's accounts to learn from these mistakes as documented. I do believe each person knows for themselves what’s best and when approaching their deep psychological experiences, we, as mental health professionals, must put aside our egos and professional pride to engage in honest dialogue. Each person is, in many ways, their own country, embedded with impacts from many different cultures and subcultures. Approaching their experience with a sense of not-knowing seems to be the key to avoiding the homogenization of their experiences to fit my own assumptions. Although it’s not Watters's aim to give easy solutions, his observations serve as a foundation for this new understanding of the power we have as mental health professionals to create the experience as much as we respond to what’s already present.
When observing the marketing of depression and its treatment in Japan, Watters observed that the pharmaceutical companies needed to know that cultural assumptions could be changed and how to exploit this for their own financial success. Although I understand pharmaceutical drugs address presenting ‘symptoms’, the overreaching hubris of the psychiatric community coupled with the primacy of Western understandings has done its share of damage, creating as much as they are raising awareness for needs around specific experiences. Now when we move forward we must keep this open mind of not-knowing with us; this awareness is more than half the battle. I understand the truth of this phenomenon. I also understand that, because of this, we can, as mental health professionals, continue to change public perception of illness and its treatment. If we listened to others’ traditions more and pushed our viewpoints on others less, we would be more ready to address the truth of the human experience to which our expertise is blinding us.
Watters, E. (2011). Crazy like us: The globalization of the American psyche. Free Press.
https://vijayrnathan.com/
