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Why are Americans Number One in Mental Illness?

separator 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 be weak.

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.
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