The Influence of the American Mental Health Paradigm Cross-Culturally
Since its first publication in 1952, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has influenced the teaching, research, and clinical practice of mental health. The first manual’s 108 diagnostic categories have more than tripled over the years as the validity of the book continues to be called into question (Rogler, 1997). The latest edition of the manual (DSM-5), published in May 2013 by the American Psychiatric Association (APA), has received extensive criticism. Primary concerns revolve around the scientific validity of the manual, but have not been enough to trump the almost century-old monopoly that the APA has over the mental health field. The DSM continues to enjoy a nearly hegemonic status as the primary reference for the assessment and categorization of mental disorders of all types—not only in the United States, but increasingly in Europe and Asia (Kawa & Giordano, 2012).
Working for Division 32 and managing the GSDA site have opened my eyes to the effects of the American mental health system cross-culturally. Mental health professionals from Britain to India have reached out to become writers on the site and often detail how their experiences are influenced by America’s perspective on mental health diagnosis. Psychological research in America is, not surprisingly, based primarily on the habits of United States citizens. When considering the world’s population of over 7 billion people, the United States’ population of over 300 million people seems quite small. Statistically, this number attributes to less than 5% of the world’s population. This means that 95% of the world, much of which is heavily influenced by American culture, is left out (Arnett, 2008). The topic of how America influences other countries is a phenomenon that I personally believe needs to be researched more.
Along with the discussion of the American mental health model and its influence overseas also comes the topic of the pharmaceutical industry. A recent study by the Mayo Clinic concluded that nearly 7 in 10 Americans take prescription drugs regularly with half that number taking more than one pill (DeLong, 2013). Spending on prescription drugs is the fastest growing component of the health care budget. In 1997, the Food and Drug Administration (FDA) established that pharmaceutical companies would be able to engage in direct-to-consumer advertising (Rosenthal, Berndt, Donohue, Frank, & Epstein, 1982). This means that drug companies are able to market their products directly to their targeted audience rather than having to go through healthcare professionals. This trend spread quickly around the nation and overseas.
What occurs in American culture does not only affect American citizens. New trends are closely studied, followed, and reciprocated in a variety of other cultures around the world. American culture is often envied and looked at as an example. Is the example a good one? In the decade following the pharmaceutical company’s success in gaining direct-to-consumer marketing, spending tripled on marketing Attention Deficit Hyperactivity Disorder (ADHD), bipolar, social phobia, depression, and sexual disorder drugs. In 2000, the Japanese company Glaxo Smith Kline began marketing depression-reducing drugs under the slogan, “Does your soul have a cold?” Advertisements explained that depression symptoms should only last for one month and if they persist a doctor should be seen immediately (Mills, 2007). Today, patients who request a drug they have seen advertised before their appointment are seventeen times more likely to walk out of the office with that prescription (Frances, 2013, p. 168).
But the emphasis on prescriptions has spread beyond American culture. Kayoko Yamagishi is one of the seven Japanese individuals documented Mike Mills’ 2007 film, Does Your Soul Have a Cold? Yamagishi says that, “everything in America is good,” indicating that the trends in America are closely examined and followed in Japanese culture. Before 2000 “utsu,” which is the Japanese word for depression, was seldom heard outside of psychiatric circles (Mills, 2007). But Japan is not the only country that has been affected by the pharmaceutical trend. Use of medication has increased by 20% each year across Europe since 1995 (Reilly, 2013). Sweden and Slovakia have seen large growth in the use of the drugs, with a 1000% increase in Sweden between 1980 and 2009, while Icelanders are the heaviest medication users with almost 9% of the population taking a daily dose of antidepressants (Reilly, 2013). We cannot continue to remain oblivious to how our treatment of mental health affects other countries. Perhaps it is time to start asking if other countries have alternative ways of looking at mental health we can utilize in our culture instead of the other way around.
Arnett, J. J. (2008). The Neglected 95%: Why American Psychology Needs To Become Less American. American Psychologist, 63(7), 602-614.
DeLong, K. (2013). Mayo Clinic study: 70% of Americans on prescription medication. Fox6Now, 1.
Frances, A. (2013). Saving normal: an insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, Big Pharma, and the medicalization of ordinary life. Harper Collins Publishers.
Kawa, S., & Giordano, J. (2012). A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice. Philosophy, Ethics, and Humanities in Medicine (PEHM), 7. http://www.peh-med.com/content/7/1/2
Mills, M. (Director). (2007). Does your soul have a cold? [Documentary]. Japan.
Reilly, R. (2013). Prozac Nation: Use of antidepressants in the UK has soared by 500% in the past 20 years. DailyMail UK.
Rogler, L. (1997). Making Sense of Historical Changes in the Diagnostic and Statistical Manual of Mental Disorders: Five Propositions. Journal of Health and Social Behavior, 38(March), 9-20.
Rosenthal, M., Berndt, E., Donohue, J., Frank, R., & Epstein, A. (1982). Alleged Direct Promotion Of Prescription Drugs To Consumers. New England Journal of Medicine, 306(3), 181-182.