Our topic for this week is Culture and Mental Illness. Our aim is to consider the ways in which culture influences and shapes the very idea of mental illness and the also the way culture conditions the way particular mental illnesses express themselves.

Start with the way culture shapes the very idea of what counts as a mental illness. Take the case of koro. Koro is mental disorder, characterized by a debilitating fear that that one’s genitals are retracting into ones body and that once they are fully retracted you will die. You don’t find many instances of in Western societies. But Southwest Asia koro epidemics have been known to break out. There was such an epidemic in 1984-85 in Guangdong, China. And between 997 and 2003 in several different West African nations, there were local outbreaks of koro-like panics. Koro seems to be at least partly based on a set of culturally specific beliefs about sexuality. Most koro sufferers appear to be immature, younger men, who lack self-confidence, who engage in a lot of auto-erotic activity, and who suffer extreme guilt and anxiety as a consequence. Culturally conditioned views about sexuality seem to play an important role in causing their guilt and anxiety to express themselves in a certain way.

One could think that it makes little sense to call koro a mental disease at all. Koro seems very much like a form of culturally conditioned fear or panic or something. But is that enough to make it a mental disease? A mental illness, one might think, is is something that happens to you because your brain goes haywire in a certain way -- like in schizophrenia, for example. A mental disease isn’t something that happens to you because you have weird beliefs. Indeed, if you look up koro in the Diagnostic and Statistical Manual – the book that covers all mental health disorders for both children and adults -- you will find koro listed there. But you’ll find it listed toward the back of the book -- with what are called “culture-bound syndromes.” That’s a way of recognizing koro and its cousins, like amok, which was once prevalent in Maylasia, or zar, which occurs mostly in the Middle East, are real things – sort of. But it’s also a way of saying that they are not quite your garden variety mental disorders, more or less directly rooted in the physiology of the brain

But this isn’t to suggest that only certainly weird and exotic conditions are shaped and influenced by culture. Take schizophrenia. Though there is some disagreement about what exactly Schizophrenia consists in, nobody would deny that schizophrenia is something real and something really devastating. And it occurs everywhere, not just in this or that culture. But even a disease as “transcultural” as schizophrenia seems to be culturally and socially conditioned in certain ways. Schizophrenics often suffer from various kinds of delusions. And it wouldn’t be at all surprising if the content of those delusions were keenly sensitive to locally culturally shaped beliefs and practices.

另一方面，我们也需要注意不要夸大精神疾病表达方式的实际文化差异。就像我们快速全球化的经济中的其他一切一样，有一些力量威胁着消除文化差异的同质化——包括我们体验、治疗和理解精神疾病的方式的文化差异。事实上，本周的嘉宾是《像我们一样疯狂:美国心理的全球化》的作者伊森·沃特斯。他认为，美国精神病学的权威机构实际上正在改变全球范围内人们体验、治疗和理解精神疾病的方式。沃特斯注意到的美国精神疾病模式的霸权崛起是好事还是坏事?它代表的是科学进步还是一种文化帝国主义?在精神疾病的治疗、理解和体验上，让文化百花齐放会更好吗?这些只是我们希望解决的一些问题。