Ethan Watters wrote a book that makes people deeply uncomfortable. It’s called Crazy Like Us: The Globalization of the American Psyche, and honestly, if you care about how we treat the human mind, it's required reading. We often assume that because the United States spends billions on psychological research, we have the "correct" map of the human brain. We think we’re exporting a cure. Watters argues we’re actually exporting the disease.
It's a heavy thought.
The core premise of the crazy like us book isn't just that we’re misunderstood; it’s that mental illnesses aren't fixed biological "things" like a broken leg or a kidney stone. They are shaped by culture. When we bring our diagnostic manuals (like the DSM) to places like Hong Kong, Sri Lanka, or Zanzibar, we aren't just teaching people how to name their pain. We are literally rewriting how they experience it.
The Anorexia Epidemic in Hong Kong: A Warning Label
Take the chapter on anorexia in Hong Kong. It’s perhaps the most haunting part of the book. Before the 1990s, doctors in Hong Kong saw a version of self-starvation that didn't look like the American version. Patients didn't claim they felt "fat." They talked about bloated stomachs or physical discomfort. They weren't obsessed with calories in the way a girl in suburban Ohio might be.
Then a high-profile death of a schoolgirl happened.
The media rushed in. Well-meaning Western-trained experts explained anorexia using American templates. They talked about body image, fat-phobia, and the "fear of gaining weight." Suddenly, the way young women in Hong Kong experienced starvation shifted. They started reporting the exact symptoms they saw on the news. The "American" version of the illness replaced the local one.
This is what Watters calls the "symptom pool." Every culture has a pool of behaviors that signal "I am in psychological distress." When we broadcast our specific symptoms to the world, people subconsciously dive into that pool to express their own pain. It’s not that they are faking it. It’s that the mind is incredibly suggestive.
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PTSD in Sri Lanka and the Problem with "Universal" Trauma
We see this again with the 2004 tsunami. After the waves receded, a literal army of Western counselors descended on Sri Lanka. They were armed with checklists for PTSD. They expected people to have flashbacks, to be hyper-vigilant, and to center the trauma on their individual selves.
But Sri Lankans didn't see it that way.
For many in that culture, the damage wasn't located inside the individual's head. It was located in the social fabric. The "illness" was the fact that their village was gone, their roles were destroyed, and their ancestors' graves were washed away. Western therapists tried to get them to talk about their "feelings." The locals wanted to talk about their community duties. By forcing the American model of individual trauma onto a collective culture, we might have actually slowed down their healing process.
It sounds arrogant because it is. We assume our science is "culture-blind." Watters proves it isn't.
The Pharmaceutical Push and the Marketing of Depression
The crazy like us book also digs into the business side of things. You can't talk about the globalization of mental illness without talking about the "Big Pharma" push in Japan.
For a long time, Japan didn't really have a concept of "mild depression" (utsubyō). To them, sadness was often seen as something profound, even beautiful—a sign of sensitivity or maturity. You didn't take a pill for it any more than you'd take a pill for being "thoughtful."
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GlaxoSmithKline changed that.
They launched a massive marketing campaign to redefine depression as a "cold of the soul." They told the Japanese public that sadness was a chemical imbalance that needed correction. They literally created a market for SSRIs where one didn't exist. They didn't just sell the drug; they sold the disease.
Schizophrenia: The Surprising Twist
One of the most mind-blowing facts in the book is that people with schizophrenia actually fare better in developing nations than in the US or Europe. This has been documented by the World Health Organization (WHO) in multiple studies.
Why?
In many non-Western cultures, the voices in a person's head are seen as external—maybe it's a spirit, an ancestor, or just a temporary affliction. In the US, we tell the patient they have a "broken brain" that will never be fixed. We isolate them. We tell them their identity is their illness.
In a village in Zanzibar, a person might be seen as "having a spirit" but is still expected to help with the harvest or participate in the family. They remain part of the group. In the US, we put them in a group home and give them a disability check. Our "advanced" medical model might actually be creating a worse long-term outcome for the most vulnerable people.
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What This Means for Us Right Now
If you're reading the crazy like us book, you start to realize that our "certainty" about mental health is a bit of a house of cards. We are so quick to diagnose and medicate, yet our rates of anxiety and depression keep climbing. Maybe the way we think about the mind is just one way—not the only way.
Watters isn't saying that mental illness isn't real. He’s saying that the shape it takes is a dialogue between the brain and the culture it lives in. When we destroy local ways of understanding suffering, we leave people without the traditional tools they used to stay sane.
Actionable Takeaways for the Curious Reader
If you're looking to apply the insights from Watters' work to your own life or your community, consider these steps:
- Question the "Chemical Imbalance" Narrative: While medication is a lifesaver for many, realize that it is a simplified metaphor. Your environment, your history, and your community matter just as much as your serotonin levels.
- Respect Cultural Diversity in Healing: If you work in healthcare or HR, don't assume every person experiences stress or grief the same way. What looks like "avoidance" in one culture might be "resilience" in another.
- Read the Source Material: Don't just take my word for it. Pick up the book. It’s filled with deeply reported stories from researchers like Anne Becker (on Fiji's sudden rise in eating disorders after TV arrived) and others who saw these changes firsthand.
- Look for Local Strengths: Instead of only looking for "symptoms," look for the "indigenous" ways people in your life find meaning. Sometimes a community dinner or a shared responsibility does more for the mind than an extra hour of individual talk therapy.
- Advocate for Nuance: When you see a new "mental health trend" on social media, ask yourself: Is this a universal truth, or is this just the latest addition to our culture's symptom pool?
The American psyche is a powerful export, but it isn't the only map of the human heart. Learning to appreciate how other cultures handle the "crazy" parts of life might just be the best way to find our own balance.
If you want to understand the modern world, you have to understand how we've colonized the mind. Watters gives you the tools to see it. It’s an uncomfortable journey, but a necessary one. Stop looking at mental health as a static list of symptoms in a book and start seeing it as a living, breathing part of our culture. That shift in perspective changes everything about how we see ourselves and how we see the world.
Next Steps for Deepening Your Understanding:
Identify one "mental health" label you use frequently. Research how that specific condition is described or treated in a non-Western country—such as the "spirit possession" frameworks in parts of Africa or the "social withdrawal" (Hikikomori) phenomenon in Japan. Compare how these frameworks offer different paths to recovery than the standard US clinical model. This exercise reveals the boundaries of our own cultural assumptions about sanity.