Archive for July, 2010

Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters   no comments

Posted at 8:21 pm in Book review

A woman tries to walk across a room, but collapses. Another suddenly goes blind, for no obvious physical reason. Victorian hysteria, clearly a product of a time when women lived highly constricted, repressed lives. A veteran suffering from PTSD, on the other hand: doubtless a real disease, immutable, applicable in all situations and cultures. Not so, says Ethan Watters, who convincingly argues that all mental illnesses are circumscribed and molded by the cultures in which they occur. A person who is distressed will express it by drawing from whatever pool of symptoms is available in his culture–which may well be entirely different from what is available in my culture.

In Crazy Like Us: The Globalization of the American Psyche, Ethan Watters, a veteran journalist who presented a scathing indictment of the recovered memory movement in Making Monsters, examines four illnesses in four parts of the world: anorexia in Hong Kong, PTSD in Sri Lanka, schizophrenia in Zanzibar, and depression in Japan.

These four illnesses (and cultures) are quite different from each other, but share something important: none of them looked like the accepted Western clinical definition of the disease. Anorexics in Hong Kong did not believe that they were fat, trauma sufferers in Sri Lanka tended to describe physical symptoms and damage to family relationships rather than psychological problems, schizophrenics in Zanzibar were believed to be possessed by spirits, and in Japan, milder forms of depression were not viewed as an illness that required treatment.

Watters describes a world far from the definitive-sounding edicts of  the DSM (the diagnostical and statistical manual of psychological disorders, the handbook of Western psychology); one in which distress is signaled in an enormous variety of ways. “The simple but mind-bending truth,” the anthropologist Allan Young explains, “is that mental illnesses such as PTSD can be both culturally shaped and utterly real to the sufferer.” This world collides unhappily with the immutable-disease view of much of the Western mental health establishment.  (Anne Fadiman’s The Spirit Catches You and You Fall Down makes a good companion read.)

Western health professionals increasingly treat patients throughout the world, and Watters suggests that they are often far less helpful than they believe. A DSM-trained therapist, unwilling to consider that a Hong Kong anorexic does not believe herself fat, is unable to hear what the patient is actually saying. This is one problem with the globalization of the DSM. An even larger concern is that in the course of describing an illness, particularly if the description is dispersed widely throughout a culture, therapists may actually create an illness where it did not exist before. The local expressions of mental illness begin to disappear, and the clues that could have been gleaned from them are lost.

Crazy Like Us is not a polemic against Western mental health care: it is clear that competent Western therapists can be very helpful, under the right circumstances. It is equally clear, though, that they can be distinctly unhelpful under the wrong circumstances, when they fail to understand that their definitions are not universal.

This is especially clear in Sri Lanka, as American therapists rush to the scene of the tsunami, insisting that the local population has no understanding of trauma, and no idea how to treat victims. The psychology professor Ken Miller suggests that we consider the opposite scenario, with Mozambicans telling 9/11 survivors which rituals they need to engage in to sever their relationships with deceased family members. That the therapists earnestly believe themselves to be doing good makes these scenes no less disturbing. They explain that large segments of the population will fall victim to PTSD, and that it is not necessary to understand Sri Lankan culture to make this prediction. (There is an obvious connection to Watters’ previous work, with echoes of the victim mentality that characterized the recovered memory movement in these PTSD predictions, as well as in the medicalization of very minor depression in Japan. Human beings occupy a large spectrum, from fragility to resilience, and it’s not clear why fragility should be the default option.) These therapists are, of course, wrong: Sri Lankan history is sadly full of tragedy, and Sri Lankans have developed specific and effective methods of coping with it.

In all of these cultures, a shift is underway to a more Western view of the mind. Watters believes that a society is most susceptible to this influence when it is under a great deal of strain: the Chinese takeover in Hong Kong, for instance, or the tsunami in Sri Lanka. These changes do not happen on their own, but tend to be encouraged by outside agencies. The most striking instance that Watters describes of Western intervention is a successful attempt by a consortium of pharmaceutical companies to change the definition of depression in Japan, through an enormous and society-wide campaign. The high regard in which U.S. knowledge is held in much of the world makes such attempts to influence local mental health practices particularly effective–and dangerous.

From the U.S. point of view, the culture-blind promotion of Western ideas on the mind could appear to be a good thing. Shift your vantage point a bit, though, and these efforts look misguided and even harmful. This is a brilliant and genuinely paradigm-shattering book.

Written by Lorin on July 18th, 2010

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The Perfect Scoop: Ice Creams, Sorbets, Granitas, and Sweet Accompaniments, by David Lebovitz   2 comments

Posted at 4:11 pm in Book review

There are millions of cookbooks. General cookbooks that explain how to boil an egg, specialty cookbooks that teach macaron-making, good cookbooks, bad cookbooks, cookbooks for every conceivable culinary interest.  And every so often, a great cookbook.

I’m a big fan of David Lebovitz’s blog, but his book The Perfect Scoop had sat unused until last week. I’m not sure why: what better way to spend the summer than making ice cream? But then, finally, I made chocolate ice cream and caramel sauce and French almonds and butter pecan ice cream and mocha sauce and strawberry sorbet and lemon sorbet.  They were all spectacular. (Lebovitz claims that it’s called butterscotch because it needs scotch, and with the Jack Daniels I put in, it was the best butter pecan ice cream I’d ever eaten.)

The Perfect Scoop is cheerfully and clearly written–and extremely well tested. The recipes–which cover ice cream, sorbet, granitas, toppings and containers–vary from the uncontroversial to the adventurous.  I haven’t made parsley ice cream yet, but I’m sure it will be delicious.

So if you’ve ever wanted to make ice cream, buy this book.  (And an ice cream maker, if necessary.)

Written by Lorin on July 15th, 2010

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Denialism: How Irrational Thinking Harms the Planet and Threatens Our Lives, by Michael Specter   2 comments

Posted at 11:17 pm in Book review

At a party the other day, a volunteer for the National Museum of Natural History described a visitor to the Hall of Human Origins. The young woman looked at a male skeleton and noted that the rib cage narrows as it moves downward.  She pointed to a particular spot and asked if that was where the rib was removed to form woman. She was not joking.

Would that this kind of ignorance, of even the most basic facts of science, were an anomaly. As Skeptics Society founder Michael Shermer has observed, the world is decidedly more rational than it used to be: many fewer people believe in witches, for instance.  But pseudoscience persists.

In Denialism: How Irrational Thinking Harms the Planet and Threatens Our Lives, Michael Specter examines five examples of this way of thinking. Leaving aside  the more common bugbears of skeptics–creationism, global warming denial, alien abduction claims and their ilk, which have been amply documented elsewhere–Specter discusses the fear of science and its disastrous intersection with vaccines, genetic engineering, alternative remedies, race and human origins, and synthetic biology.

The most infuriating, and strongest, section of the book concerns vaccines, and the very determined and deeply misguided people who oppose them.  Their beliefs originated with a journal article which linked vaccines to autism, and which has since been thoroughly discredited. Last year, I found myself in conversation with a woman–an EPA employee, no less–who said that clearly it could be no coincidence that she knew of several children who had been diagnosed with autism soon after being innoculated. I barely responded, being horror-struck but insufficiently informed.  Had I read Specter’s book, I would have pointed out that vaccinations and autism diagnoses tend to take place at the same age (between one and two), as well, of course, as that even a non-scientist EPA employee should know the difference between correlation and causation.  (Of course, that assumes that these parents remember the timing correctly. Specter is sympathetic to the leagues of desperate and confused parents of autistic children, who want an explanation, any explanation, for the plight of their children.)

Denialism is one of a number of interesting current books that allude to the great difficulties we have in gauging risk. Vaccine deniers, while giving entirely fictitious warnings about vaccines, do not tend to consider what happens in their absence. As Specter demonstrates, the pre-vaccine world was far from a naturalistic paradise. (In the developing and often still pre-vaccine world, around 200,000 children died of the measles in 2007. This represented a significant decline in measles deaths–from c. 750,000 in 2000–which of course will not continue if the anti-vaccine lobby has its way.) Specter does not deny that caution is necessary and important, and that scientists can be wrong and even occasionally criminal.  But he depicts a world in which the pendulum has swung so far onto the side of caution that the joys of scientific discovery have practically been forgotten, and the truth is almost incidental.

The world of natural remedies is no less filled with fraudulent claims, and many of these (largely unregulated) substances are not only ineffective, but can actually be harmful. I know this from my own experience: working at a health food store, I regularly saw people looking for “natural” remedies to treat what were clearly real health problems requiring real medicine.  In South Africa, the Mbeki government denied a connection between HIV and AIDS, refusing to provide antiviral drugs and causing hundreds of thousands of deaths in the process.

Pseudoscience can be merely irritating, the realm of UFO nuts and astrologers. But as the families of South Africans killed by AIDS, as the parents of any unvaccinated child who has succumbed to a preventable disease know, it can be deadly. In Denialism, Specter issues a clarion call for a rational world view.

Written by Lorin on July 2nd, 2010

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