What Watters is implying is that when a person is suffering mental distress, the way the person communicates his/her distress is suggested by cultural clues that help insure that this distress will be recognized and taken seriously. In Watters’s view the symptoms expressed become a mechanism for crying out in pain in a language easily understood.
From this perspective, psychiatry and mental health diagnosis looks like an iterative collaboration between the tormented and those who would help the tormented. The very act of defining a set of symptoms that are representative of a particular mental illness, suggests to those in mental distress how to construct their cry for help in a way that will be easily interpreted.
To illustrate this point, Watters reminds the reader that in the late nineteenth century the diagnosis of "female hysteria" was quite common.
These symptoms were consistent with what women were told about themselves, and consistent with what doctors believed about women:
This form of mental illness eventually disappeared. It vanished not because of some miracle drug or treatment; it vanished because it became unpopular. The symptoms were no longer satisfactory to women as a demonstration of suffering, and psychiatrists were developing a new set of symptoms that they were more willing to recognize. If one wishes to receive help, one has to communicate in the language the help-givers understand.
Watters can’t quite bring himself to recognize a logical conclusion that can be drawn from the history he has provided. If "female hysteria" disappeared for non-medical reasons, then it could not have been a mental illness in the sense of representing a brain malfunction.
If cultural cues induced the symptoms that women suffering from hysteria demonstrated, and then, at a later time, made them disappear, how can one differentiate between medical fads and mental illness?
If cultural cues induce symptoms, and symptoms define the mental illness, then why can’t cultural cues induce the illness itself?
If mental illness is related to a chemical imbalance or a neurological malfunction, then how can its symptoms be induced and eliminated by cultural signals?
If psychiatrists and drug companies claim that mental illness can be "cured" by drug therapy, doesn’t that create an environment where people with difficult problems to address will find it easier to declare themselves mentally ill in search of a simple pill-based solution rather than attempt to resolve their problems by addressing them directly?
Consider depression. Everyone suffers from sadness, grief, anxiety, and apprehensions. This is all perfectly normal—up to the point at which it is no longer normal and becomes mental illness. Is there some physical transition that takes place, or are we mainly dealing with culturally defined (and thus arbitrary) norms that define the transition? Clearly there are some people with symptoms so severe that medication is called for to alleviate the symptoms, but how many would be better served by socializing their mental distress and seeking traditional forms of support from family, friends, and counselors? 10%? 50%? 90%?
It is rather easy to conclude that clinical depression might be a greatly over diagnosed condition based on cultural factors, but what about a more complex illness such as schizophrenia?
Tanya Marie Luhrmann discusses mental illness in general, and schizophrenia in particular, in an article in the Wilson Quarterly: Beyond the Brain. The title is meant to convey the notion that what we refer to as mental illness is more complex than a mere brain malfunction that can be addressed by appropriate drugs.
She provides this introduction to modern thought on schizophrenia:
"Yet the outcome of two decades of serious psychiatric science is that schizophrenia now appears to be a complex outcome of many unrelated causes—the genes you inherit, but also whether your mother fell ill during her pregnancy, whether you got beaten up as a child or were stressed as an adolescent, even how much sun your skin has seen. It’s not just about the brain. It’s not just about genes."
The incidence, severity, and probability of relief from symptoms seem to depend on social and cultural factors.
"Schizophrenia has a more benign course and outcome in the developing world. The best data come from India. In the study that established the difference, researchers looking at people two years after they first showed up at a hospital for care found that they scored significantly better on most outcome measures than a comparable group in the West. They had fewer symptoms, took less medication, and were more likely to be employed and married."
The better outcomes in India seem to be derived from a firmer belief that the illness can be overcome and sufferers will be able return to a normal life. If your belief is that your brain is damaged and requires medical treatment, you will tend to wait around for treatment to come and help—something that rarely happens. Cultural cues are extremely important.
Luhrmann suggests that the notion that social factors can be both disease activating and disease curative is becoming more widely accepted. She refers to several patient-driven organizations who are dedicated to self-help approaches to illnesses rather than depending on medications. One such group is called the Recovery Movement. Perhaps the most intriguing approach to dealing with the issues of schizophrenia is provided by the "Hearing Voices" movement.
Dealing with mental illness in a proper fashion is critical. In the past mental illness was rare and episodic. Somehow our society and our science have managed to make it common and chronic.
Something has gone terribly wrong!