Why are Americans Number One in Mental Illness?
It’s important to remember that not all cultures describe
mental illness, especially depression, in the same way. In the 1970s and 80s, an
anthropologist from Harvard, Arthur Kleinman, conducted landmark research about
the attitudes of the Chinese towards mental illness. He learned that people in
China didn’t perceive the so-called mood disorders—such as depression and
bipolar disease—in the same way that people in the West do.
Westerners are likely to describe depression in terms of
mental symptoms, such as depressed mood, loneliness, sadness, lack of interest
in activities that used to be enjoyable, and so on. The Chinese, on the other
hand, were more likely to use physical symptoms to describe depression. They
spoke in terms of fatigue, weakness, inability to sleep well and weight loss.
Kleinman described a Chinese man who entered a medical
clinic at Massachusetts General Hospital. He complained of “tiredness,
dizziness, general weakness, pains in the upper back, a sensation of heaviness
in the feet, weight loss and insomnia that had lasted for months.” His doctors
performed a medical workup and found no medical problems other than anxiety and
depression, but the patient said he had no emotional complaints. He resisted
talk therapy at first, but then said he would agree to it if he could also
receive medication. According to the study research, the patient never accepted
the idea that he was suffering from a mental illness. Both he and his family
suggested that his problem was due to “wind” and “not enough blood.”
It appears that a similar attitude toward mental illness
continues today. In 2004, the World Health Organization (WHO) published a survey
showing that 2.5 percent of Chinese reported a mood disorder in the last year,
compared with 9.6 percent in the U.S.
Japan also reported low levels of depression. The same WHO
survey showed only 3 percent of Japanese had reported a mood disorder in the
last year. According to researchers, Japan is a more stoic culture. People are
more likely to keep their complaints to themselves so that they don’t appear to
Archives of General Psychiatry, 6 June 2005; National Institute of Mental Health, National Comorbidity Survey Replication; A Kleinman and B Good, Culture and Depression: Studies in the Anthropology and Cross-Cultural Psychiatry of Affect and Disorder, University of California Press, 1985; The New York Times, “Who’s Mentally Ill? Deciding is Often All in the Mind,” 12 June 2005; The Washington Post, “U.S. Leads in Mental Illness, Lags in Treatment,” 7 June 2005.