In Review: Crazy Like Us by Ethan Watters

Dear Audy,

When I first read the blurb for this book, my interest perked up like it had the force of a thousand cups of coffee. I ordered a copy, waited patiently for it to arrive and devoured it in a matter of days. Crazy Like Us is an incredibly fascinating read.

The most devastating consequence of the spread of American culture across the globe has not been our golden arches or our bomb craters, but our bulldozing of the human psyche itself. American-style depression, post-traumatic stress disorder, and anorexia have begun to spread around the world like contagions, and the virus is us. Traveling from Hong Kong to Sri Lanka to Zanzibar to Japan, acclaimed journalist Ethan Watters witnesses firsthand how Western healers often steamroll indigenous expressions of mental health and madness and replace them with our own. In teaching the rest of the world to think like us, we have been homogenising the way the world goes mad.


Like many people living with chronic pain, I have been through periods of depression. Aside from using low-dose antidepressants as painkillers, I have tried to avoid medicating this part of my condition. Something about the inertia of antidepressant usage in the past decade and the varying results amongst patients has tickled my suspicion meter and I have often wondered about the validity of the long term medicating of emotional distress.

Personally, I have found that learning about other cultures and particularly Buddhist principles has helped me to both climb out of periods of depression and also help to ward them off. I have learned to better understand the workings of my mind and the sorts of thoughts that will lead to negative feelings, and how to start changing these. Most importantly, I have learnt that mental processing can be changed, which isn’t something that is emphasised in a Western view of depression.

My inspiration for bettering my own mental health stemmed from practises that grew in the East, so it’s probably not a surprise that I was hungry to learn about how Eastern cultures might have been influenced by the one in which I was born.

Crazy Like Us is divided into four chapters that explore well known Western mental afflictions in non-Western cultures. These instances are: The Rise of Anorexia in Hong Kong; The Wave that brought PTSD to Sri Lanka; The Shifting Mask of Schizophrenia in Zanzibar and The Mega-Marketing of Depression in Japan.

The Rise of Anorexia in Hong Kong is a brilliant opening study for this book. Watters gives a chronological account of how anorexia first presented in Hong Kong and contrasts this with how it is understood today – even giving a statistically distinctive link to the widespread media coverage of young girl’s death from the disease. Interestingly, the symptoms described by early cases of self-starvation differs greatly to the reasoning given by patients suffering in the last couple of decades. Most fascinating to me was that “fat phobia” was not a symptom in early anorexics, it wasn’t a fear of gaining weight that propelled them to stop eating and anorexia presented as more like depression than body dysmorphia. The propelling effects of starvation itself appear to take control of people in a similar manner, regardless of the reported instigation point for the disease.

It is in this chapter that Watters first introduces the idea of emotional distress subconsciously taking forms that society will recognise and respond to at any given point in time. This isn’t to undermine the very real suffering of patients, but is an interesting concept. All sorts of things go on in our brains below our level of conscious functioning and pain itself is a perception, not a sense. It doesn’t seem at all far-fetched to me that a distressed subconscious could quite literally present an individual with particular symptoms that can be understood as needing attention, both by society and the individual themselves.

The Wave that brought PTSD to Sri Lanka explores the rush of Westerners that flocked to Sri Lanka following the devastating 2004 tsunami. Post-Traumatic Stress Disorder is a condition that the Western world has come to recognise in people that have been through and incredibly traumatic experience – such as soldiers returning from war. Following the tsunami in Sri Lanka, many Westerners, convinced that PTSD cases were about to explode in an “underdeveloped” nation sped in and set up counselling services, many with no formal registration, just the promise of help to the people.

The chapter explores the ways in which Western methods of coping with PTSD do not transcend cultural boundaries. Many of the people that they were diagnosing with PTSD and attempting to treat with medication and experimental psychological therapies were not suffering the way that a Western person was expected to suffer following such a disaster. Their cultural beliefs and understanding of emotional distress differ from the West and as such, PTSD does not necessarily exist in the same form that it is understood to by the American DSM-V.

The differences were fascinating, including a difference of opinion as to whether depression is a medical symptom that causes one to withdraw from society, or contrastingly that the removal from society is the actual symptom that causes the feelings of depression and that if the symptom is reversed, recovery from depression will soon follow.

The Shifting Mask of Schizophrenia in Zanzibar follows researchers looking for answers as to why people living in developing nations and diagnosed with schizophrenia appear to have better chances of recovery over time than those in more developed societies. What was most interesting to me in this chapter was the ways in which external stimuli and cultural perception can influence a mental illness that the Western world understands to be a definitive measurable difference in brain chemicals. It made me wonder, how much does one’s understanding and expectations of their condition actually influence these changes in brain function? Was it the chicken or the egg?

“Here is an insight! The entire human drama of love, suffering, ecstasy, and joy, just chemistry.” -D.A. Granger

The final chapter, The Mega-Marketing of Depression in Japan, is both the most sociologically fascinating and personally disturbing section of the book. Watters details the way in which pharmaceutical giant GlaxoSmithKline literally set out to market antidepressants to the Japanese. Japan is one of the most highly populated countries on the planet, how could they resist attempting to tap into such a market?

Many people harbour lingering suspicions that pharmaceutical companies are not to be trusted due to the commercial nature of their trading, however it is still highly disturbing to read stories that both back up these suspicions and introduce new horrors. This chapter explores the study of Japanese people, the ways in which depression, as it is understood in Western terms, could be translated into a condition that the Japanese could relate to. If you want to sell people pills, then first you’d better sell them on the idea that they need them.

Conferences were held and doctors financially encouraged to purport the concept of depression and the promise of relief from medication. Advertisements were used to convince Japanese people that any number of negative symptoms they might be experiencing in life were the result of a chemical imbalance that needed correcting.

Most disturbing was the revelation in this chapter that the very basis for our Western understanding of depression has been manipulated and exploited:

“… it turns out that there is currently no scientific consensus that depression is linked to serotonin deficiency or that SSRIs (Selective Serotonin Reuptake Inhibitors) restore the brain’s normal ‘balance’ of this neurotransmitter. The idea that depression is due to deficits of serotonin was first proposed by George Ashcroft in the 1950s, when he thought he detected low levels in the brains of suicide victims and in the spinal fluid of depressed patients. Later studies, however, performed with more sensitive equipment and measures, showed no lower levels of serotonin in these populations. By 1970 Ashcroft had publicly given up on the serotonin-depression connections. To date, no lower levels of serotonin or ‘imbalance’ of the neurotransmitter have been demonstrated in depressed patients. The American Psychiatric Press Textbook of Clinical Psychiatry states simply, ‘Additional experience has not confirmed the monamine (of which serotonin is a subgroup) depletion hypothesis.’” – from Crazy Like Us by Ethan Watters

This was by far the most jarring paragraph in this book, it left me feeling like I couldn’t trust what I thought I knew, nor can I completely trust this statement because my previous understanding is so ingrained. I will need to conduct further research on the topic, follow up on the studies that Watters has used to compile this evidence and see what I discover for myself.

In short, this book will make you question what you believe about some mental illnesses and why you believe it. It may cause you to question your very beliefs about yourself. This can be confronting, however there is the huge liberation of self understanding at the end of that journey, so don’t be afraid.

I especially recommend this book to anybody currently taking medication from GlaxoSmithKline or Pfitzer (manufacturers of Lyrica, also brought under scrutiny in this book) for chronic pain or other reasons. I have paid both companies dollars galore over my years with CRPS and in all honestly I am doing a Hell of a lot better now that I no longer take Neurontin or Lyrica. I chose to stop taking these medications of my own accord and I am not convinced that they ever offered me more than a brief placebo effect combined with a hindering dulling of my thought processes.

This book is best read with a cup of coffee and an attitude that is open to changing its direction.

Love & Revelations,


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  • 6 thoughts on “In Review: Crazy Like Us by Ethan Watters

    1. Katie from Canada


      It’s really unfortunate that liberals of all ilk are blindly supporting international aid programs that export biological psychiatry. I try not to think about it or else I’ll go…crazy! lol

      If you’re interested in psychiatric reform I would suggest you check out Robert Whitaker’s work and peruse sometime, if you haven’t already. The website has lots of resources on this subject. I would also recommend checking out this great article by Chris Kresser:

      Don’t expect a very engaging counter argument from mainstream mental health workers, though. I’ve only ever encountered the anecdotal and dogmatic: “I’ve seen these tablets work. The science and studies are therefor irrelevant. Why? Because I say so.” or shrieking that I must be a Scientologist. It’s a bit shocking to hear adults continually make this their rebuttal. Many have university degrees and I always have a hard comprehending how they think this is an acceptable argument.

      Are they morally corrupt or just well-meaning delusionals? It’s a question I’ve often asked myself and one that I haven’t been able to draw a conclusion on yet.

      Anywho, one thing is for sure. I’ve come to find that the mental health establishment is not what it espouses itself to be. I’m an ex-psych patient/consumer and this is something I had to learn the hard way- I’m so glad you’re talking about it!

      1. Hayley Cafarella Post author

        Welcome! I am very sorry to hear about your diagnosis. Blogging and reading about others efforts to cope has really helped me along the journey, feel free to write to me if you have any questions! :)

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