Astral Codex Ten

Crazy Like Us

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Crazy Like Us

Article

Crazy Like Us is a recurring book in the Astral Codex Ten archive, appearing 4 times across 4 issues between July 15, 2021 and May 21, 2024. The archive places it in contexts such as “In Crazy Like Us, Ethan Watters sounds the alarm about falling psychiatric biodiversity”; “do justice to Crazy Like Us ’ excellent portrayal of these people”; “These mechanisms (which also exist in other cultures) are so strong that I think they mostly invalidate whatever Crazy like Us is trying to say”. It most often appears alongside China, US, America.

Metadata

  • Category: Books
  • Mention count: 4
  • Issue count: 4
  • First seen: July 15, 2021
  • Last seen: May 21, 2024

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Book Review: Crazy Like Us
July 15, 2021 · Original source
We talk a lot about falling biodiversity. Sometimes we apply the same metaphor to the human world, eg “falling linguistic biodiversity" when minority languages get replaced by English or whatever. In Crazy Like Us, Ethan Watters sounds the alarm about falling psychiatric biodiversity. Along with all the usual effects of globalization, everyone is starting to have the same mental illnesses, and to understand them in the same way. This is bad insofar as greater diversity of mental illness could teach us something about the process that generates them, and greater diversity of frameworks and responses could teach us something about how to treat them.
Inline links: Crazy Like Us
Here I’m less sure about where Watters is going. It seems like a stretch to argue that 1990s pharma companies introduced depression to Japan - a country where committing suicide is basically the national pastime. But Crazy Like Us tries its best. It says that although Japanese people commit lots of suicide, in their culture this is considered a reasonable response to feeling like they’ve shamed their family or lost their honor or something, very different from the Western idea of “some person isn’t able to cope with their depression and shoots themselves in a fit of despair they would have regretted in a few days if they had lived”. And although pre-1990s Japanese people sometimes got, let’s say, “spells of low mood”, they thought of this as a normal part of life which it’s important to go through and probably learn lessons from.
I cannot do justice to Crazy Like Us’ excellent portrayal of these people. They combined a genuine and admirable desire to go halfway around the world to help people in need, with a burning desire to be “culturally sensitive” and reject “white savior narratives”, with a total lack of even the tiniest amount of actual knowledge about Sri Lanka. The island nation was [insert some term other than “inundated” or “flooded”] with a [insert some term other than “tide”] of counselors, therapists, and psychiatrists, holding public awareness campaigns, appearing on TV/radio/etc, browbeating Sri Lankan officials for not caring enough about the mental health aspect of recovery. Through this whole process they were all tripping over each other to look culturally aware despite having no clue what they were doing. My favorite anecdote was the training lectures, where earnest sensitivity counselors would tell play therapists not to play “Go Fish” with young survivors - given that many of their parents had just been swallowed by the sea.
Highlights From The Comments On "Crazy Like Us"
July 21, 2021 · Original source
What conclusion can we draw from this? I think the most reasonable one is that psychiatrists (and doctors in general) are EXTREMELY bad at their jobs. They see what they want to see, they are controlled by the prevailing narratives they’ve been taught, and they don’t really listen to their patients. It’s clearly true that if you’re told during medical school to ignore really significant problems that essentially all doctors will happily ignore these problems for their whole career. And society has awesome mechanisms in place that can brutally suppress any stories of abuse or problems from getting out into wider awareness. These mechanisms (which also exist in other cultures) are so strong that I think they mostly invalidate whatever Crazy like Us is trying to say. The author of Crazy like Us would have to have done MUCH more rigorous work to overcome the fact that there are powerful conspiracies in every society that work to obscure and hide all kinds of mental problems / abuse / internal feelings. It doesn’t look to me like he’s done that work.
Perhaps some are outright malingerers, but clearly for a large number (including a friend of mine) this is real. They really are suffering from a set of symptoms consistent with PTSD. And yet, the vast majority of WWI veterans, Holocaust survivors, everyone who lived through WWII in Western Russia etc., a large fraction of people in the Middle Ages etc. experienced as bad or worse stuff and the vast majority could function as adults. It's hard to escape the conclusion that we've created an expectation of disabling trauma and people fulfill it. Crazy Like Us quotes an American soldier who said that he felt like an actor given a script. Here's PTSD, this is what you do next.
Book Review: The Geography Of Madness
February 22, 2023 · Original source
She reminded me that yesterday she was unusually grumpy, so much so that she had apologized to me for it and tried to come up with explanations - and then later yesterday she had her period. Meanwhile, Bures’ counterargument is - what? That it sounds kind of sexist to accuse female hormones of making women overly emotional? Hasn’t he ever heard of stereotype accuracy? That people asked their doctors to be treated for it more often after they knew it was considered a medical condition, and was treatable? That seems to have a much simpler explanation! That there are no biomarkers? There are inconsistent biomarkers that work sometimes but not other times, just like for schizophrenia, epilepsy, cancer, and half the other conditions in medicine. That these conditions don’t occur in most cultures? From here: A World Health Organization (WHO) study on menstruation (1981) surveyed 5,322 women from Egypt, India, Indonesia, Jamaica, Korea, Mexico, Pakistan, Philippines, United Kingdom and Yugoslavia. . . The majority of women in all cultures report some premenstrual physical discomfort in addition to negative mood changes, however fewer women report mood change than physical change. The main cross-cultural difference was in the prevalence of specific symptoms. Immigrants to the United States report more PMDD the longer they’re here? True (source), but it’s a matter of degree, and seems more true of the PMDD diagnosis than specific symptoms. The diagnosis requires impairment, which is subjective. I imagine an immigrant from a culture where mental disorders are unthinkable - something that only happens to a few psychos in asylums - and where you work 12-hour days in sweatshops. Someone asks her “hey, has this mental disorder ever prevented you from working?”, and she says no, because obviously you grit your teeth and work through the symptoms. And I imagine an American seeing the same question and saying “Yeah, I did decide I had to take a couple of sick days because of that.” I’m not saying this definitely happened, just that it’s a possibility. Meanwhile, this entire area of study is a mess. The “PMDD is culture-bound” hypothesis was originally invented by feminist scholars trying to argue that the diagnosis was a sexist attempt to pathologize women as overemotional and untrustworthy (this is also where Bures got his “it’s just hysteria by a different name” idea). See for example here and here, the second of which says that “the feminist argument is that if women are angry/distressed, it is for good reason, not due to pathology”. Bures somehow swallowed and repeated this, and then some feminists on Vox wrote an article attacking him as a “male writer” who was denying women’s lived experiences of PMS and stereotyping them as stupid and gullible. Neither side has an argument beyond “I can think of a reason it would be sexist for people to disagree with me” and neither side will acknowledge that the other side is also feminists basing their argument entirely on how it would be sexist to disagree with them. Everything in every area of social science has been like this for at least the past twenty years. But also, this highlights the difficulties with declaring something culture-bound. How do you know if something’s culture-bound, vs. people don’t notice it or mention it if they don’t have a name for it? How do you know if something’s culture-bound vs. some cultures consider it too embarrassing or taboo to think about? How do you know if something’s culture-bound, vs. people will go to doctors about it if they think doctors can treat it, and otherwise they won’t? I’ll discuss these questions more later, but I want to finish Bures’ argument. He gestures at a few other possible candidates for culture-bound mental disorders, including repetitive strain injury and chronic pain. But he quickly moves on to a long section that tries to establish the reality of “voodoo death”, ie the thing where if you believe you are going to die hard enough, you actually die. I think most arguments for voodoo death are pretty bad, and I didn’t find Bures’ convincing. But bonus points for referencing a study claiming that chronically stressed people only die at higher rates if they believe chronic stress is bad for them, and if not then they don’t (this is not really how I interpret the abstract, but I haven’t looked closely) Is it weird to stay on the crazy train long enough to agree that cultural effects are strong enough to make you think witches are stealing your penis, and then get off it once people start talking about voodoo death? I think no - these are very different situations. Believing in koro can make you hallucinate that your penis is shrunken or gone, but no belief, however strong, can (directly) remove your penis itself. Culture → beliefs is fine; culture → reality is a step I’m not willing to take. V. Since I rejected Bures’ PMDD example, I want to digress to what I think is a stronger argument: anorexia, which Ethan Watters discusses in his book Crazy Like Us. Anorexia was mostly unknown in the West, until becoming “trendy” in the mid-1800s. During that period, doctors reported high prevalence of anorexia among “hysterics”, but the fad ended after about ten or twenty years, and it went back to being basically unknown. In 1983, famous singer Karen Carpenter died of anorexia, thrusting it back into the national news, and suddenly lots of people (in the West) were anorexic again. Meanwhile, foreign doctors who trained in the West went back to their home countries, searched far and wide for it, and found almost nothing. The few cases they did see didn’t resemble the typical Western version at all - for example, one Hong Kong psychiatrist was able to find a woman who refused to eat out of grief when a boyfriend left her, but she didn’t think she was fat, or feel any cultural pressure to be thinner. The absence of anorexia abroad was especially surprising since anorexics tend to end up in the hospital with extremely noticeable malnutrition that doesn’t really mimic anything else. It’s not really possible to hide severe anorexia the way you can hide severe depression. In 1994, Hong Kong got its own Karen Carpenter - a young girl died of anorexia, setting off a national panic and many public awareness campaigns. Near-instantly, anorexia rates shot up to the same level as the West, with the appropriate number of people presenting to hospital ERs with severe malnutrition. This story raises a lot of questions. For example: where did the first anorexics (Karen Carpenter, the girl in Hong Kong) come from? Why anorexia and not something else? And how come knowing about anorexia makes it spread so quickly? VI. Past this point I’m using this review to discuss my own thoughts, not Bures’ or Watters’. “Culture-bound” is less all-or-nothing than you’d think. Look hard enough, and you’ll find people having “culture-bound syndromes” from cultures they’ve never heard of. Ntouros et al in Thessaloniki describe “koro-like symptoms in two Greek men”. One, a paranoid schizophrenic: . . . reported for the first time a sensation that his penis retracts into the abdomen and a fear that it will subsequently be lost. This would be accompanied by anxiety and sadness pertaining only to the loss itself. He would then proceed to search manually for his penis and masturbate. No pleasure was gained by masturbation, but the anxiety would be lifted. Romero et al describe a case of koro in "an intellectually disabled Caucasian patient" in Spain. They write that "although it is widely regarded as an epidemic in South-east Asia, there are some isolated cases in other cultures as well." Wilson and Agin describe a 29 year old white male from New York, "not exposed to the Chinese culture”, who went to the doctor with a five month history of worrying that his genitals were retracting into his body: Sometimes, he would manually reaffirm the presence of his genitals. Occasionally he would, in private, remove his garments and visually confirm the presence of his genitals. On one occasion, while taking the train home from work, he experienced an acute exacerbation of these symptoms. His pain increased from 3/10 to 10/10, and he felt as if his genitals had fully retracted within his belly. Upon reaching his hometown, he immediately went to the local hospital emergency room where examinations for inguinal hernia, urinary tract infection, proctitis, prostatitis, and testicular disorders proved negative. He improved significantly on the anti-anxiety medication desipramine. Chowdhury surveys the evidence on koro and divides the condition into two types: culture-bound and non-culture-bound. The culture-bound type usually goes in large epidemics, hundreds to thousands of people, in koro-believing parts of Africa and Asia; the victims were usually previously psychologically normal. The non-culture-bound type hits a few scattered individuals, is not contagious, and can happen anywhere - Greece, Spain, America. Some patients are psychologically normal, but there are a disproportionate number of schizophrenics, drug users, brain damage victims, and other previously-mentally-ill people. Other culture-bound illnesses seem to be like this too. Running amok has been big in Malaysia for 300 years. The Columbine shooters seem to have been autocthonous American cases, equivalent to that one New Yorker who got koro - before their fame inscribed amok onto the US collective consciousness the same way Karen Carpenter’s inscribed anorexia. Japan’s jikoshu-kyofu affects occasional victims in the US under the name olfactory reference syndrome. Watters admits there were a tiny handful of unusual anorexia cases in Hong Kong before Westernization. And even that Indian there’s-a-lizard-in-my-skin condition differs only in species from delusional parasitosis. Delusional parasitosis - the false belief that you are infested with parasites and can feel them crawling in your skin - is actually an especially interesting case. Two groups are disproportionately represented among patients: menopausal women and cocaine addicts. Relatedly, two biological conditions that can sometimes cause weird skin sensations that feel like crawling insects are . . . menopause and cocaine use. So there’s no mystery here. But, also represented among delusional parasitosis patients are the roommates and family members of these people. The index case hallucinates insects for a well-understood biological reason; their close contacts hallucinate insects through social contagion. So a unified theory of these conditions might be: Some people have the condition for a normal biological or psychiatric reason. For example, someone might believe a lizard is crawling under their skin because they use cocaine, which causes hallucinatory crawling sensations. Or someone might believe their penis is missing because they’re schizophrenic, which makes them naturally hallucination-prone.
Inline links: stereotype accuracy, inconsistent biomarkers that work sometimes but not other times, here, source, here, here, and then some feminists on Vox wrote an article, chronic pain, are pretty bad, a study, Ethan Watters discusses in his book, Ntouros et al, Romero et al, Wilson and Agin, surveys the evidence, olfactory reference syndrome, delusional parasitosis
Book Review: The Others Within Us
May 21, 2024 · Original source
So I want to take on the task Falconer avoids, and try to provide a boring materialistic explanation of all of this. This won’t be surprising to people who have read other essays of mine, especially my reviews of Breakdown Of The Bicameral Mind, Crazy Like Us, and The Geography Of Madness.
Inline links: Breakdown Of The Bicameral Mind, Crazy Like Us, The Geography Of Madness