More on exporting American madness

Ethan Watters, whose recent article in the New York Times Magazine was discussed at length here and at Neuroanthropology, has a new piece on the globalization of US mental illness diagnoses.  This one appears in New Scientist and focuses on a couple of themes not addressed by the Times Magazine article: namely, the transformation of psychiatric ideas about depression in Japan and the worldwide dissemination of the PTSD diagnosis.

Watters recounts how GlaxoSmithKline mounted a campaign to transform Japanese professional psychiatric and lay understandings of depression during the 2000 launch of its antidepressant paroxetine (marketed as Paxil/Seroxat) in Japan.

“The challenge GSK faced in the Japanese market was formidable. The nation did have a clinical diagnosis of depression – utsubyo – but it was nothing like the US version: it described an illness as devastating and as stigmatising as schizophrenia. Worse, at least for the sales prospects of antidepressants in Japan, it was rare. Most other states of melancholy were not considered illnesses in Japan. Indeed, the experience of prolonged, deep sadness was often considered to be a jibyo, a personal hardship that builds character. To make paroxetine a hit, it would not be enough to corner the small market for people diagnosed with utsubyo…. GSK intended to influence the Japanese understanding of sadness and depression at the deepest level,” (Watters 2010).

Watters’ account comes from McGill’s Laurence Kirmayer, who had been invited to a GSK-sponsored academic conference in Japan–realizing only upon his arrival that the corporation had organized the event in order to draw upon the knowledge of cultural psychiatrists–and thus, better market their drug.

“What I was witnessing was a multinational pharmaceutical corporation working hard to redefine narratives about mental health,” Kirmayer said. “These changes have far-reaching effects, informing the cultural conceptions of personhood and how people conduct their everyday lives. And this is happening on a global scale. These companies are upending long-held cultural beliefs about the meaning of illness and healing.”
Which is exactly what GSK appears to have accomplished. Promoting depression as a kokoro no kaze – “a cold of the soul” – GSK managed to popularise the diagnosis. In the first year on the market, sales of paroxetine in Japan brought in $100 million. By 2005, they were approaching $350 million and rising quickly,” (Watters 2010).
Kalman Applbaum’s series of posts on this blog–“Pharmaceutical Marketing, Capitalism and Medicine: A Primer,” explores many of these issues in greater detail.
The second part of the short article, which focuses on culturally-distinct reactions to traumatic events, such as the tsunami which struck Sri Lanka in 2004, is particularly timely in light of the aid efforts currently taking place in Haiti. (On this topic, see the review of Fassin and Rechtman’s Empire of trauma, posted on this blog last year).

Below are a few publications referenced by Watters’ article, as well as texts which give additional background on these issues.

Further Reading:

Laurence J. Kirmayer, “Psychopharmacology in a globalizing world: the use of antidepressants in Japan,” Transcultural Psychiatry 39, no. 3 (2002): 295.

Kalman Applbaum, “Educating for Global Mental Health: American Pharmaceutical Companies and the Adoption of SSRIs in Japan,” In A. Petryna, A. Lakoff, & A. Kleinman, (Eds.), Global pharmaceuticals: Ethics, markets, practices. (Duke University Press, 2006).

Kenneth E. Miller et al., “The validity and clinical utility of post-traumatic stress disorder in Afghanistan,” Transcultural Psychiatry 46, no. 2 (2009): 219.

Allan Young, “Our Traumatic Neurosis and Its Brain,” Science in Context 14, no. 04 (2001): 661-683.

Allan Young, The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. (Princeton, N.J.: Princeton University Press, 1995).

Hanna Kienzler, “Debating war-trauma and post-traumatic stress disorder (PTSD) in an interdisciplinary arena,” Social Science & Medicine 67, no. 2 (July 2008): 218-227.