Any of that at all whereas i tend to try to balance might Corporate Media with independent review will like democracy now and you hear all the time on democracy now about soldiers refusing to deploy. I just wondered if you saw any signs of that . Thanks. Thats a great question. The short answer somewhat tellingly is i think in my experience at fort hood and among the folks that i knew there, the short answer is basically no. I had one friend who is involved with a relatively oriented Veterans Advocacy Group and certainly there is in this country a really lively antiwar Veterans Movement made up of a bunch of different organizations doing work that is politically important for those folks and also personally important for a lot of them. One of the things that was really interesting and striking to me in my work was the conventional language that we use and the civilian public being prowar, being antiwar whether in principle in general or with regard to specific policy decisions. Those are old things that soldiers and folks in military communities are completely well aware of ,com,com ma to varying extents just as is the case in the civilian world with a range of opinions just as is the case out here. But the immediate experience of being so directly involved in going to war doesnt necessarily line up with the kinds of stories that those frameworks provide. So that juncture itself is quite interesting to think about. So the kinds of stories that we use in the civilian world to describe what war is about what its for, all of those things at least in my experience are quite recognizable to people in military communities that dont necessarily take account of what their actual daily lived experience is a doing the actual work of going to war. Sometimes that meant that they had critiques of military order of war in general that were much more differently oriented and other times it meant that there was just sort of the sons of kind of failure of communication or a real challenge to think about, how to translate whats important are whats up getting talked about in one area and the other and vice versa. Thats a great question. Yes ,com,com ma in the last couple of years i have read and heard in the news a lot of soldiers being referred to as warriors instead of g. I. S or soldiers as in the past. To me thats quite a different concept and a totally different type of society than we are supposed to live in. What im wondering is if the soldiers themselves are referring to themselves as warriors or not . That is a great question. I have certainly seen that term used a lot in the media and in military language as well. And i would say it varies tremendously by context. I dont know that there is anyone who i was close to in my research you know who identified in that way out right but at the same time the way military culture works is oftentimes through labels and through people strategically for particular reasons identifying really strongly with particular labels. And so i can certainly see how it would be something they could easily take on a lot of significance in particular situations, but its not something i can talk about particularly. [applause] thank you. Thank you, ken. Our final author today is ethan watters, an author, a journalist who has written about psychiatry and social psychology for the past two decades. He is to contribute to the New York Times magazine discover mens journal details wired and this american life. His writing on the new research surrounding genetics was featured in the 2003 best American Science and nature writing series and he is cofounder of the San Francisco writers grotto a work list for poets and journalists. Today he is sharing his most recent look, crazy like us the globalization of the american psyche. Watters suggests americas homogenizing matches the categorization and the treatment of the mentally ill but perhaps more importantly the subjective experience of being mentally ill. For me this book . Wide open western imperialism in regards to the american diagnoses in the form of apology. According to watters with little appreciation of the difference between mind and body we continue our efforts to convince the rest of the world to think like us end quote. Perhaps its time we think our generosity indeed. Please join me in welcoming ethan watters. [applause] thank you so much. One of the joys of finding the book is you get to go around and have conversations and im looking forward to being on the panel with allen and kenneth. I respect their work rightly. Of course you are not really certain what kinds of conversations the book to get you into. After the book came out i was called by a producer on the daily show and asked to go on the show. It was the disorienting and terrifying experience and because im speaking to some authors and soontobe authors out there i thought as dessert for our panel at the end i will give you the top 10 things that you need to know before you go on the daily show so you are fully prepared. [laughter] that will be at the very end of my talk. The book crazy like us is a book about a remarkable body of research. It in fact rises and falls on different cultures and forms every time and the lesson is basically that Mental Illness and their russian and symptomatology are reacted to culture and the conversation of the culture. I find i can get easy agreement on this idea if we look back in history. If we look at things like up look mad travelers that appeared in Victorian Era europe where a young man would walk in a transfer hundreds of miles with no idea of identity or no memory of where he had been. Another example in the mid19th century women by the hundreds of thousands displayed the remarkable signs of hysteria. These were the nervous tics, fainting physical paralysis. How does this happen . How does a discrete Mental Illness exist in one airtime and disappear from the next . In the book i interviewed a medical historian named edward shorter at the university of chandra and he has this notion of what he calls symptom pools. His ideas that pete will give in a moment in history someone in need of expressing psychological suffering have a limited number of symptoms to choose from. When someone unconsciously latches on to the hatred the person is taking troubling in emotions and internal conflicts often indistinct and hard to express and distilling them into a symptom of behavior that at that moment in Human History is a culturally recognized signal of suffering. Symptomatology can be thought of as the language and we speak the language that is understood in that time. Of course this begs the question of where does the symptom pool come from . Who makes a symptom pool . How did these arise over a given time . Shorter points to the experts and this could be priests or shamans or doctors or others. They propose theories of the mind and look for the symptoms to confirm those theories. I think a maritime experts would certainly be part of the creation of the symptom pools. I think journalists such as myself when we love the new disorder we get good placement for pieces if we are the first out with a new disorder and certainly big pharma is part of shaping these symptom pools. He says patients endeavor to produce symptoms that will correspond to the medical diagnostics of their time. The cultural molding of the unconscious happens imperceptibly and follows a large number of cultural cues that the patient is simply not aware of. If you look at symptoms like hysteria we can clearly see the cultural origins of that behavior. We can see the undercurrent of misogyny the mistaken beliefs about womens anatomy fear of womens sexuality notions that female Mental Illness play a part in creating this remarkable widespread disease. Its easy to see when we look back. Its much more difficult to see it in our own time. We often believe that our modern diagnostics of symptomatology is no longer influenced by culture but i would suggest modern symptom ologies are influenced by cultural expectations every bit as much as that of his area over 100 years ago. The point here is not that this cultural shaping makes these behaviors or Mental Illnesses less real. The point is that well only fully understand these homeless is when we begin to understand how culture plays with the expectation of symptomatology. Its hard to tell in an american audience that symptoms are culturally shaped because oftentimes we think of them as not real. They are still real but they are culturally shaped. They are not true for all times and places but they can be churned particular times and places. The book looks at her influence across cultures and we need to understand this because america is the globalizing force in terms of how people think about the diagnosis and how we treated. We need to understand it is we are influencing the rest the world and the huge way. I took four examples and i wanted to ring it down as close as i could so i looked at the rise of anorexia in hong kong in the middle 90s which is one chapter and then i looked at what is probably the most remarkable piece of Cross CulturalPsychiatric Research is a multisite decadelong study of schizophrenia outcomes across cultures and what they found was people diagnosed with schizophrenia in developing countries did better on almost every outcome measure than people in the first world. I traveled as far as zanzibar with an anthropologist to understand what was going on there. Then i wrote about the changing notions of depression in japan before and after the introduction of paxil and how we shape to the notions of depression in japan in a very dramatic way. The fourth example in the book is the one i will talk about today because it dovetails a little with canons work and that is it so relevant in our times with the soldiers coming home and thats the notion of ptsd. To gain some crosscultural perspective on that i wrote about the tsunami in sri lanka. And our effort after that tsunami to provide psychosocial support. We rushed in there with counselors of all stripes. The broad field therapist and scientologists were on the scene Rapid Eye Movement therapist. Dozens if not hundreds to teach the culture about ptsd and to tell them how to heal from it and give them our knowledge about that. We have a great certainty with the notion of ptsd is crosscultural but anthropological work and crosscultural psychiatry work shows that meaning and expectations matter a great deal after traumatic event in cultures around the world indeed have a variety of different reactions to trauma and their symptomatology is very much not the same. For example cambodians fled the khmer rouge would describe their primary psychological symptom is being visited by spirits and intense distress in escaping the country before they were able to perform rituals for the day. Salvadoran women who endured a protected civil war describes the experience of which is often described of a feeling of intense heat to the body and people from afghanistan would describe nervous anger after a germanic event and intense pressure in their body. So it is possible with some hard work to go into another culture and to learn the language of suffering to understand how they combined with local modes of healing. This is exactly what a researcher did in sri lanka. She was a trauma researcher. She was there the day the tsunami happened already doing research on, in a culture and to understand the local meaning of distress what she did was she gathered together people who had all witnessed the tsunami and a set of quizzing them with the ptsd checked list she had them tell her open its stories about who were doing well and people were doing badly and she began to categorize reactions and did a larger scale survey to confirm the results. What she ended up with was what she called the sri lankan index of psychosocial suffering a measure of the local indicators of distress. So how do the symptoms different from local notions . Sri lankans experienced, different from americans in two main ways. They were much more likely to experience trauma as a physical reaction. Aches and pains in their bodies to react to that, as if it were physical blow to their body to cement as i said. There was another think were subtle and interesting reaction which was that sri lankans for the most part did not report reactions to trauma with the internal states of anxiety fear and numbing in the legs and ptsd checked list. Rather sri lankans intended tendency the negative social roles and relationships. The people that were doing badly were the people that became isolated from the social network who were not fulfilling their social role and in short they conceived of the damage done by the tsunami is occurring not inside their mind that outside themselves in the social environment. Sri lankans to the point where the two literally could not he teased apart. Because the western conception of ptsd assumes the problem of the breakage is primarily in the mind of the individual that largely overlooks the salient symptoms from the sri lankans those that do not exist in the psychological but in the social realm. So the problem is this. Its when we rush into other cultures with ptsd checked as we rarely take the time to understand local modes of distress on western counselors know that your reaction, the best way to heal they are often disconnected with local people from modes of suffering which are always tied to local modes of healing. I think it does take a willful blindness to believe other cultures need our framework for understanding the human reactions to, or a medical anthropologist at harvard gave me at quote on this. He said most of the disasters in the world happen outside of the west yet become men and and pathologies their reactions and we say you dont know how to live with the situation. We take away their cultural narratives and we impose ours. Its a terrible example of dehumanizing people. I think once one conferencconferenc e the cultural differences in the psychological reactions to trauma the efforts of the western trauma colleges to russias disaster zones in a few days notice without knowing the language and without a deep understanding of religions and without understanding the modes of mourning and the rituals for grieving it becomes deeply problematic. To drive his this point home one researcher asked me to imagine it in the reverse. He said imagine after 9 11 if a shaman from mozambique came to america and began knocking on doors of the survivors and said i need to lead you through some rituals to help separate the spirit of your loved one from the living. Would that make any sense to us and of course it wouldnt. It doesnt seem to stop us from doing the exact opposite and i think i know why. I think we think what we offer is based on science and its universally human and we figured this out. Our ptsd is not culturally shaped. I would fundamentally disagree. I think its culturally shaped and all those other notions of trauma that i listed. You can even actually see, even if you took a subset of western soldiers over time you can see the cultural differences in ptsd overtime pay or if you are a british soldier and you had a negative reaction to it from a battle you are likely to complain of joint pain and muscle weakness. Those were the conditions that doctors at the time called debility syndrome. If you are a soldier and American Civil War and you have a negative reaction to, a tool uber liked to complain of pathological homesickness and a week hard beat and the feeling of pain in your chest. This was called dacosta syndrome. The First World War soldiers experienced shell shock. This was expressed through nervous tics, spotty movements and physical paralysis. Does that sound like something i said earlier on . Hysteria. Very parallel with hysteria because its the same cultural notions about how the mind works and how those wires can be freed and that expresses those symptoms. I think even in our lifetime we can see the shaping of ptsd. It was originally called the postvietnam syndrome and it began in this interesting way. It began in these hothouse rap sessions between antiwar psychoanalysts and Vietnam Veterans against the war. They got together and began to shape this notion of postvietnam syndrome. Early descriptions are interesting because they often dont talk a lot about the moment on the battlefield for a soldier was traumatized. There was a psychoanalyst who wrote an oped in the New York Times in 1972 describing this idea and heres how he described it. These sessions had been deceived used and betrayed by the military and society at large so the diagnosis of postvietnam syndrome was intended to highlight the psychological cost of participating in a word that Many Mental Health professionals and some soldiers perceived as unjust. So a generation later the concept of ptsd has come a long way from the early notion of postvietnam syndrome with this overt meaning. It has evolved away from postvietnam syndrome into its more clinical forms. Ptsd has left behind for the most part a quest for social being. We have clinical iced it. We have isolated the trauma in the individual and we think we have scrubbed the culture in doing that. I think that is really problematic for a soldier. I think this narrative about ptsd has isolated those struggling in the aftermath of trauma. Just think in contrast to this angry socially engaged vietnam war veterans. The frustrations and angers of the modern soldier has been moved from the social where one might find moral anger or justification or religious meaning to justify the sacrifice to the bio cycle medical. I think this is explanation for the psychological reaction of the soldier often leaves the soldier to borrow a marketing slogan feeling like an army of one. I think what is true is i think we are globalizing our categories of Mental Illness and we are exporting them and i think ptsd in our time is really one of our prime exports in that way. I think its perhaps as we look at it, the modern notion of ptsd is perhaps a rip action of our modern securities. Without a full range of religious and social narrative to rely on todays trauma we become become increasingly vulnerable and fearful. We are investing a great wealth and research in treating this disorder because we have rather suddenly lost other Belief Systems that gave context to suffering. Many have pointed out we are now a culture that has a suspicion of resilience. Eric somerfield of Kings Col