Save for our popular culture and our fast food, there is little that the United States exports anymore. But move over Miley, Madonna and McDonald’s: America’s newest export is madness. At least, that’s the thesis of Ethan Watters’ Crazy Like Us.

Watters argues that Americans are as overbearing and influential in their treatment of mental health as they are with their other major exports. “In teaching the rest of the world to think like us,” he writes, “we have been, for better and worse, homogenizing the way the world goes mad.” More specifically, American-born psychoses like depression, post-traumatic stress disorder and anorexia are being taught to people in foreign countries. And because American drug companies stand to make billions from treating these worldwide maladies, they are encouraging this behavior.

Watters argues that because of cultural, religious and other historical differences, a one-size-fits-all approach to mental health treatment doesn’t work: “Cross-cultural researchers and anthropologists . . . have shown that the experience of mental illness cannot be separated from culture.” He supports his position with detailed case studies in which Western doctors failed in their treatment of mental health disorders in foreign countries. And from his research, he makes some eyebrow-raising allegations, such as that in Hong Kong, teenagers began suffering from anorexia after Western experts started raising awareness of the disorder. He also posits that when Western crisis counselors swooped in to treat the PTSD they expected after a tsunami devastated a portion of Sri Lanka, in some cases they actually caused local communities more distress.

The major defect of Crazy Like Us is that it doesn’t spend enough time acknowledging that perhaps in some cases, the lessons Americans are teaching foreign nations about mental health treatment might actually be worthwhile. For instance, do Third World countries with no concept of mental disorders benefit in any way when Western doctors provide treatment? Still, the provocative thesis and the exhaustive research behind Watters’ examples makes Crazy Like Usworthy of consideration as we grapple to understand the impact of globalization—even if it is just a state of mind.

John T. Slania is a journalism professor at Loyola University in Chicago.

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