Crazy Like Us: How the West colonised our minds

In Bangladesh, conversations around mental health have shifted dramatically over the past decade. Depression, anxiety, ADHD, and eating disorders are being discussed more openly, especially among urban youth. Social media has amplified awareness, but it has also fuelled a surge in self-diagnosis, with young people increasingly identifying themselves through Western psychiatric labels.

At the same time, prescription rates for antidepressants and ADHD medications are on the rise, particularly in private healthcare settings, where Western-trained professionals often rely on DSM-based diagnostics. What was once barely understood is now medicalised, categorised, and, in many cases, medicated.

But as mental health awareness grows, so does an uncomfortable question: are we understanding these conditions in ways that make sense for our culture, or are we importing a foreign framework and forcing it to fit? 

The book is not saying that people are not suffering, but that the form and language of their suffering are not purely natural or biological — they are historically and culturally constructed. The danger, as Watters makes clear, is that the American model becomes the only acceptable story.

Journalist Ethan Watters' 2010 book "Crazy Like Us: The Globalisation of the American Psyche" is a topical and essential read in this context. His critique of Western psychiatry's global expansion offers a lens through which to question how mental illness is being redefined in the world, including Bangladesh — and whose version of the "mind" we are beginning to accept as the norm.

The book is more than just a journalistic investigation on the role that culture plays on mental illness — it is an indictment of how Western psychiatry, wrapped in the language of science and healing, has become a tool of soft imperialism. The book argues that American models of mental illness are being exported globally, reshaping not only how people suffer, but how they understand themselves.

As Watters shows through his reporting in Sri Lanka, Hong Kong, Zanzibar, and Japan, these imported frameworks from the West have started to overwrite local ways of coping, resulting in the creation of more pathologised identities. This process, which is often framed as medical progress, is something closer to cultural colonisation.

The effects of the rise of Western psychiatric authority, as revealed in the book, parallel what Michel Foucault described in his work on the "history of madness". Psychiatry is not a neutral or purely scientific field, but a power-laden system that defines, categorises, and disciplines individuals according to social norms. Watters' book, while journalistic in style, essentially demonstrates this premise across four countries.

Western psychology as cultural hegemony

The firm belief of Watters' argument is the idea that mental illness is not universal in nature. While suffering is undeniably real across all cultures, the ways it is expressed, understood, and treated are deeply embedded in local norms, beliefs, and social structures. 

Western psychology, particularly its American variant, tends to flatten these distinctions under the assumption that its categories, such as depression, PTSD, anorexia, schizophrenia, etc., are biologically based, universally applicable, and scientifically neutral.

But what Crazy Like Us reveals is how this assumption is erasing the cultural complexities of non-Western countries. For instance, in a chapter focusing on post-tsunami Sri Lanka, the book shows how Western aid workers rushed to the country with PTSD manuals in hand, convinced that survivors needed to "talk about their trauma" of living through the devastating tsunami to avoid future mental breakdowns. 

Yet Sri Lankan cultural responses to suffering favoured community rituals, collective mourning, and religious interpretations — none of which were recognised within the Western diagnostic model. Instead, psychological aid workers introduced a new identity: the trauma survivor in need of therapy.

This process mirrors what Foucault called the "psychiatric gaze" — the power to define who is sane and who is not, who is normal and who needs intervention. Under this gaze, local customs become suspect, and emotional expressions that do not fit the DSM criteria are either ignored or forced into diagnostic categories.

The manufacturing of illness

The chapter on anorexia in Hong Kong offers a clear case of how mental illnesses do not just travel to other countries on their own — they often mutate and manifest in new places after a Western framework has been introduced. The chapter deals with the very public death of Charlene Hsu, whose death would change how anorexia was viewed in Hong Kong forever.

For decades, anorexia was rare in Hong Kong, with around 10 or so cases appearing annually. Furthermore, the illness did not typically involve fear of fatness that has come to now be universally associated with it. Watters shows how this symptom was relevant to America due to local American cultural factors, such as the influence of Hollywood, the fetishisation of thinness, and pervasive female beauty standards.

In Hong Kong, however, fatness did not carry the same negative stigma as it did in America. So, when doctors came across cases of women refusing to eat, their reasons were unique to their own cultural experiences. It was often seen in women who experienced unbearable abuse by family members or unbearable sadness from loss. These women only ever explained their complete lack of ability to eat in physiological terms, such as stomach or throat problems.

However, this all changed with the death of a school student, Charlene Hsu Chi-Ying, who collapsed and died in a public street. She had been suffering from anorexia, though not in the form familiar to Western psychiatrists — she was not particularly afraid of becoming fat, nor did she exhibit classic "body dysmorphia." She too was complaining about stomach issues.

The young woman's death was covered by the media, which brought anorexia to the limelight. It was all over Hong Kong, and the country turned to Western psychiatrist experts for an explanation. Anorexia became interpreted through a Western lens, with widespread media coverage, and schools began teaching young girls about the dangers of anorexia, along with how to recognise the Western symptoms.

Within just five years of this, eating disorders in the region began to resemble the American version. Anorexia cases started exploding, with over a hundred cases showing up annually now. And what is even more disturbing is that every single girl complained of a fear of fatness or body dysmorphia. The Western-backed campaign had effectively introduced a new script for exhibiting symptoms of illness.

This is where Foucault's concept of subjectivation becomes crucial. Western psychiatry does not just diagnose mental illness — it offers templates too. Once a person internalises these templates, for example, "I am anorexic," "I have PTSD," "I suffer from clinical depression," etc., they begin to understand and narrate their lives within those terms. Mental illness becomes a personal identity, shaped by external discourses of medicine, media, and culture.

The book is not saying that people are not suffering, but that the form and language of their suffering are not purely natural or biological — they are historically and culturally constructed. The danger, as Watters makes clear, is that the American model becomes the only acceptable story. Other narratives — spiritual, social, political — are erased.

Globalisation of suffering

One of the most damning chapters in Crazy Like Us is about Japan, where pharmaceutical companies worked hand-in-hand with Western psychiatrists and advertising agencies to reframe mild sadness as clinical depression. Campaigns encouraged people to think of their emotional lows as symptoms of a chemical imbalance — easily fixable with antidepressants like Paxil.

This development shows how psychiatry, under the influence of corporate interests, has become a tool for commodifying human suffering. Western pharmaceutical companies do not just sell drugs — they sell diagnoses. And once a society adopts the framework of "brain chemistry," the solution is always the same: medication.

Foucault's idea of biopower is particularly relevant here. He argued that modern power operates not through overt repression, but by managing bodies and populations. Psychiatry, when aligned with capitalism, does not just pathologise individuals — it generates profitable disorders, normalises pharmaceutical dependence, and creates medical norms. 

In this way, psychology becomes an arm of neoliberal governance. People are not unhappy because of social or existential reasons, but because their brain is not working properly or they do not produce enough serotonin. The solution comes in the form of taking medicine to 'repair' oneself.

The limits of the DSM

At the core of American psychiatry is the Diagnostic and Statistical Manual of Mental Disorders (DSM), often treated as the gold standard of mental health classification. But as both Watters and many other critics have pointed out, the DSM is less a scientific document than a political one. It changes with time, reflects cultural biases, and has expanded dramatically to include a wide range of everyday behaviours.

The DSM's expansionism has had global consequences. When a DSM-defined disorder gains traction internationally, it becomes the new default way of understanding suffering — regardless of whether that framework fits the local context. And with the World Health Organization and international and local NGOs increasingly aligned with Western psychiatric standards, the DSM's reach continues to grow.

The problem is DSM delegitimises alternate systems of knowledge. Traditional healers, spiritual practices, community rituals — all of these are cast as backward or unscientific when measured against the DSM's authority. This, again, echoes Foucault's critique of psychiatry as a tool for social control. It shows that defining madness is less about science than about power.

Reclaiming cultural and psychological sovereignty

Watters does not suggest that Western psychology should disappear. There are cases where antidepressants help, where therapy changes lives, and where diagnosis brings relief. But his book is a call for recognition that American mental health models are not the final word, and often not the right one.

Watters asks us to think of the loss of local forms of mental illness as similar to the loss of biodiversity due to 'progress'. As the world's natural reserves are depleted, it erases and makes extinct flora and fauna that could bring us new knowledge and understanding. Similarly, the bulldozing of local ways to express suffering through mental illness may make knowledge extinct; knowledge that we cannot afford to lose. Our understanding of the true nature of mental health may be at risk.

Watters argues that healing must be culturally grounded. Efforts to address mental illness need to work within local understandings of the self, the soul, the body, and the community. That means accepting that there are many valid ways to suffer — and many valid ways to heal.

Foucault once wrote that "madness" is not a fixed thing but a shifting category that tells us more about a society's values than about the people it labels.