Before the 1990s, anthropologists were studying the effect of westernization on psychiatry and how we view mental health in other cultures. Over the decades, anthropologists have continued their research in this field, but with an added focus on how Western notions of psychiatry and mental health can be adapted and adjusted for different cultures, with examples of how it is already being done in certain parts of the world. 

In 1987, Kleinman wrote an article on “The Role of Culture in Cross-Cultural Psychiatry” which argues that under the standard approach to cross-cultural psychiatry, we take a category from one cultural context and impose it onto a different cultural context without adjusting for the culture. It assumes that tools designed in one culture work in all contexts. In contrast to this, the anthropological model assumes that disease is distinct from illness, and that illness can be defined as an interpretation of the underlying biology that can shape the outcome of a given disease. Kleinman discusses forms of validity in translation between cultures: content, semantic, technical, criterion, and conceptual validity. He explained that translation must account for intracultural diversity as well as cultural norms. He uses the example of the Chinese term of huo qui da, which means heat rising from abdomen to chest, but also conveys the idea of an irascible personality. Its metaphoric meaning can’t be understood by standard research, but is nonetheless important for psychiatric assessment. Kleinman also introduced the idea of a category fallacy: the reification of a category developed for one group that is then applied to another even if they can’t be transplanted well. He gives the example of dysthymic disorder, which makes sense in the affluent West, but in the rest of the world “severe economic, political, and health constraints create endemic feelings of hopelessness and helplessness, where demoralisation and despair are responses to real conditions of chronic deprivation and persistent loss, where powerlessness is not a cognitive distortion but an accurate mapping of one’s place in an oppressive social system, and where moral, religious and political configurations of such problems have coherence for the local population, but psychiatric categories do not” (Kleinman 451). 

This concept relates strongly to another article from Obeyeskere in 1985 about Depression and Buddhism in Sri Lanka. This article was written before Kleinman’s and explores the separation between different cultures and their attitudes towards mental illness from a more focused lens, looking specifically at depression in Sri Lanka. The problem identified is that symptoms were treated in isolation from the cultural context that surrounded them, which was ineffective: “If a cluster of symptoms operationalized by a foreign psychiatrist does not exist as a conception of a disease, it is neither disease nor illness but it may be something else, for example, religion” (Obeyeskere 139). This is essentially explaining category fallacy. Buddhism is embedded in Sri Lankan culture, and it considers the body to be temporary but the soul to be immortal, and that “hopelessness lies in the nature of the world, and salvation lies in understanding and overcoming that hopelessness” (Obeyeskere 134). Western psychiatrists would call this depression because the DSM tells us that constant thoughts of suffering are bad, but Buddhists cultivate suffering as a way to understand nirvana. The most important insight from Obeyeksere was that “The work of culture is the process whereby painful motives and affects such as those occurring in depression are transformed into publicly accepted sets of meanings and symbols” (Obeyeskere 147). He specifically states that the existence of depressed people is not the same thing as a large category of disease called Major Depression, and that this is simply a way to combine a large constellation of symptoms into something recognizable. 

Research into the effect of westernization on non-Western cultures and how they interpret mental illness has continued into the 21st century and expanded into how Western treatments can be adjusted to a culture to find a balance. Whereas in the past it was all or nothing, new anthropological research finds us coming to compromises. The article “Global Knowledge Flows and the Psychiatric Encounter in Indonesia” finds that notions of mental health are transported into local communities to work with biomedically trained spiritual healers, and that these notions can be homogenizing. The author Cristea explains that the clinical encounter is considered moral and prescribes certain behaviors and ideas onto the people involved. As such, the healers need to explain concepts in local terms instead of psychological terms at times to get around the moralization and stigma of mental disorder. Cristea also explains something that the older articles didn’t: not just that the cultures are different, but that people are socialized into a specific idea of morality in a cultural context, and that there are ways to meet people where they are at instead of forcing Western ideals onto them. Pak Cokot, who ended up in a psychiatric hospital after an outburst, explained that “Many people in Bali believe that a mental illness is an illness of the spirit [roh]. In Hinduism, we call it Atman. A pure element of God. But when I use mental illness, schizophrenia, the spirit remains right.” (Cristea 6). Integration with the local community is considered important for healing. When asking patients, they cited local moral economies, kinship structure, faith, and overcoming suffering as more likely resources for recovery. This article ultimately explained that biomedical insight can produce better outcomes and reduce stigma, which is very different from what another article, Hale 2017, found. 

Hale wrote about “Discourses and Discontents Surrounding Puebla’s Psychiatric Care,” and while it also demonstrated how treatments can be adjusted to a culture, it doesn’t argue that biomedical insight is superior to local insight as the first article does, and discusses merging the two. Hale is clear at the beginning that there is a lot of literature critiquing the hyperindividualism that comes from Western explanations for mental illness and that you can’t look for explanations of globalization trending towards Western medicine as a way of confirming your biases—something Kleinman discusses. Hale explains that in Puebla, “clinicians, patients, and caregivers mobilize family values and notions of agency in order to cobble together therapeutic efficacy—focused much more on relapse prevention and mental health than on diagnostic labels or psychopharmaceuticals” (Hale 501). There is specific evidence arguing against a standard global treatment of mental illness; she mentions interviews talking about how the psychiatrists assume familial support in the treatment process, and that interviews are done with the whole family as a group discussion. The customer was not the patient, but the family unit. Further, Puebla has medicine shortages and a general lack of resources compared to more affluent countries; having access to global knowledge does not mean it can be used in the same way. Hale also defines psychiatric globalization as the transnational spread of mental pathology as outlined in the DSM and argues that it is less pervasive than psychological globalization, which encompasses the cultivation of self and emotions as components of mental health. It is similar to people online defining themselves by their anxiety or depression and making it a part of their personality. Globalization “privileges capitalist institutions over other forms of labor… and influences the local enactment of familism, social mobility, and household arrangements” (Hale 505). Hale gives the example of Providencia, a 26 year old patient suffering panic attacks whose family all helped ensure she took her medications, and who were very involved in her treatment. There are downsides to this community centric treatment, however; Hale mentions that there was no voluntary hospitalization witnessed at El Batan, the hospital, and that doctors would ask whoever was with the patient to sign off as “morally responsible for the decision to initiate inpatient care” (Hale 519). 

Both Hale and Cristea’s articles discuss how the Westernization and globalization of mental health and psychiatry have affected these countries, but also different approaches to globalization: adaptation versus the merging of two treatments, whereas the older articles from before the 90s had an all-or-nothing attitude towards psychiatry. Engaging with the sources via discussion and writing has helped me analyze them both in detail, and also changed my perspective on mental health in other countries. I hadn’t realized how baked into culture the attitudes were, and how hard they can be to change when it is a part of everyday life.