Writing 122 syllabus

Mt. Hood Community College
WR 122 English Composition: Critical Thinking
Humanities Division – Spring 2015 – 4 Credits
Instructor: Joe Van Zutphen   Email: Joe.VanZutphen@mhcc.edu
Office and mailbox: Humanities Division, AC 1582 Office Hours: 12:00 – 1:00 TTH
Blogspot: http://wr122vanzutphen.blogspot.com/2014/03/writing-122-syllabus.html


COURSE INFORMATION _________________________________________________________________________
MT. HOOD COMMUNITY COLLEGE MISSION STATEMENT
A commitment to the community: Mt. Hood Community College affords all people a knowledge-based education, giving them the ability to make life choices: adapt to change; build strong communities; contribute to and derive benefit from the new economy; and become part of a skilled workforce.
COURSE DESCRIPTION
This four-credit class is designed to focus on specific ways to develop critical argumentative essays.  These essays will be in response to increasingly complex contexts, competing arguments and issues in politics, rhetoric, media, and philosophical issues. The practice and mastery will revolve around concise theses, adept organization, and effective reasoning, while using academically sound grammar and sentence structure. Students will learn to find appropriate, reliable sources in a variety of contexts in order to write research essays.
PREREQUISITE: Completion of WR 121 with C or better

Instructional Methods Used:

Writing 122 is a class best taught by a combination of instructional methods. The method students will encounter most frequently is the class discussion, in which the teacher is not so much a lecturer as a facilitator of student conversation. We will use class discussion to explore the issues we will be writing about. Additionally, students will often evaluate their writing or explore class concepts using small group discussions or workshops. On a few occasions during the quarter I will give formal lectures, particularly to explain grammar or citation concepts. Finally, and most importantly, students will spend a good deal of time writing in class, both as a tool for discovery, for assessment of student ability, and for practicing our writing skills.

Course Requirements:

The bulk of the work for this class will involve reading challenging, college-level essays and articles, as well as writing several essays, summaries, responses, and other writing assignments. More specifically, you will write four essays over the course of the quarter, three of which will be written as take home assignments over a period of roughly two weeks each. The other essay will be in-class writing exams which will occur at midterm and during finals week. Each of these essay assignments will be different, with different length requirements, structures, and topics, though all will require that you analyze the topic critically and respond to it with college-level writing.

In addition to your writing essays and tests, I will ask you to practice your writing with shorter day-to-day assignments. Most of these assignments will be short—summaries, reader responses, and the like—and you will submit them for a quick “check-off” grade. For some assignments, I may ask you to provide evidence of active reading or to fill out a brief grammar exercise, but most of the day-to-day assignments will involve writing. Research (and common sense) suggests that if you want to be a better writer you must write, and these day-to-day assignments offer you an opportunity to practice your skills.

Finally, because good writing depends so much on revision, I will ask you to help one another revise essays by working in peer response groups. These groups will meet several times during the class and you will be graded on the quality of your participation in these groups.

Grading

As you can see by the grade scale below, your work is graded more heavily at the end of the quarter than at the beginning. This is deliberate. It really isn’t very important to me how strong (or weak) a writer and reader you are at the beginning of the quarter; what matters to me is how much you learn in this class and how competently you can write at the end.

Assignment	Points of Final Grade
Take-Home Essay 1	20
Take-Home Essay 2	25
In-Class Essay 3	15
Take-Home Essay 4	45
In-Class Exam 1	10
In-Class Exam 2	10
In-class writing and other homework	25
Peer response, attendance, participation	30 180

I accept no assignments via e-mail.

Each assignment will be graded on a scale of 0-100, corresponding to the following grade scale:

90-100 A

80-89   B

70- 79  C

60- 69  D

Below 60 -- F

Regarding the question of how these assignments will be graded, the end of this syllabus contains a chart of my grading criteria for the essays and day-to-day assignments. I will also post documents soon that describe these grading criteria in greater detail. Your peer response participation grade will depend on the quality and quantity of written comments and suggestions you make on your classmates’ papers during peer response workshops.

All students have the opportunity to turn in any one assignment up to five days late without incurring a grade penalty. There’s a little form to fill out and email to me; you can find it on the class web page (http://wr122vanzutphen.blogspot.com/). Once you have used this permission, though, any other late assignments you turn in will be lowered by a full letter grade for every calendar day (not class day) that they are late. Note that the permission slip is good for turning in a paper up to five days late; papers later than this will receive 1/2 credit. Papers are due at the start of class and an assignment that is turned in later that day is considered a day late. Please understand also that I will always grade assignments which have been turned in on time before I will grade a late assignment; therefore, if you turn in an assignment late, it will not be graded as promptly. Finally, keep in mind that no late assignment may be turned in for any reason after the last regular class day of the quarter.

Texts and Materials

 Required text: Envision. Alfano. ISBN 9780205758470 Publisher Longman. Ed. 4

Other Materials:

You will need to have access to a computer with a word processor and an Internet connection. Don’t despair if you don’t own a computer: there are many computer labs at Clark Collegefor student use. While we’re on the subject, it’s a good idea to save your work in two places, such as on a thumb drive and in an email account: please back up your work frequently, as essays which are erased/virus-infected/eaten by computers are your responsibility.

Finally, you’ll need some kind of paper notebook or folder for day-to-day writing. A single spiral bound notebook should be fine.

Class Policies

Attendance: Please come to class and be on time. While I am happy to work with students who must miss a class because of a genuine emergency, students simply will not do well in the course if they make a habit of missing class. You only get one chance this quarter to turn your work in late, and a good share of your final grade corresponds to work you will be doing in class. Also, students are given credit for peer response workshops only if they participate in the workshops during class time. In short, you need to be here regularly if you want to do well. I will be taking attendance to encourage your staying caught up with the challenging class material. Students may miss up to five class days for any reason; after that, each subsequent absence will lower the student’s overall grade by 3%. Students who have missed more than ten class days will automatically receive a final class grade of C- or lower.

The only exception to these rules occurs in the first week of the quarter. During that time, in accordance with English department policy, I will drop any student who misses a class during the first two class meetings and does not get in touch with me.

Class Courtesy: Having a safe and civil atmosphere for learning depends on all of us. When we speak with one another, especially when disagreeing, it is vital that we do so with mutual respect. Students who are disruptive or abusive towards others may be asked to leave the class. On a related note, it is both disruptive and rude to leave your cell phone on in the classroom. Please turn it off when you come to class.

Plagiarism: Students who copy the words or ideas of any other writer without acknowledging the original author of those words or ideas are engaging in plagiarism. Plagiarism is grounds for failing this course. One of the goals of this course is to understand how to use information effectively and ethically in your writing. Once those concepts have been introduced, any instances of plagiarism will result in severe grade penalties for the student. In most cases, these penalties lead to failure of the class.

For more information about the English department’s plagiarism policy, please follow this link:

http://www.clark.edu/Library/PDF/eng_dept_statement_plagiarism.pdf

Americans with Disabilities Act Accommodations:

Please allow the kind and helpful people in the Disabilities Services Office to guide you in documenting your disability and in helping you attain the accommodations that you need to succeed in college. Please do contact this office or stop by to make an appointment.   FOR ADDITIONAL IMPORTANT MHCC POLICIES AND SAFETY INFORMATION, PLEASE VISIT THE FOLLOWING WEBSITE: http://home.mhcc.edu/office_of_instruction/pdf%20forms/syllabus_addendum_Gresham_Bruning.pdf TUTORING Many of you may wish to work with a tutor periodically throughout this course. In some cases, I may require that you do so. FREE tutoring is available through the Learning Success Center in AC 3300 on the third floor above the Library. Call 503-491-7108 for an appointment. Keep in mind that tutors are not there to proofread your work. When visiting with a tutor, please make sure to bring your textbook so the tutor understands what assignment you are working on and try to be as specific as possible as to what you want help with. Also, don’t wait till the last minute to seek out tutoring; the tutoring/learning process doesn’t work if you try to meet with a tutor the day your assignment is due. The LSC also offers individual learning skills consultation and academic success seminars. The LSC Computer Lab is available for individual academic use and has a variety of skill-building software available.

Tentative Schedule

Date		Class Activities		What’s Due?
Week 1		Introduction to the course; discussion of syllabus; discussion of active reading and summaries; introduction to writing process. Essay 1 assigned.		Diagnostic       Writing
Week 2		Sentence grammar review; introduction to peer response; review of paragraphing; discussion of common reading for essay 1. Peer response of essay 1.		Essay 1
Week 3		Review of comma usage; basic citation methods introduced; The Aristotelian Rhetoric; discussion of revision strategies. Essay 2 assigned.
Week 4		The Rogerian argument; discussion of common readings for essay 2; peer response of essay 2.		Essay 2
Week 5		Essay 3 assigned. Discussion of common readings for essay 3. Practice with impromptu writing.		In-Class Exam 1
Week 6		Discussion of common readings for essay 3; peer response for essay 3. Practice with impromptu writing.		Essay 3
Week 7		Essay 4 assigned. Advanced citation methods introduced; evaluating logic; Toulmin analysis. Discussion of common readings for essay 4;
Week 8
	Peer response for essay 4; discussion of logical fallacies; discussion of writing style.
Week 9	Discussion of common readings for essay 4; peer response for essay 4; discussion of logical fallacies; discussion of writing style.		Essay 4
Week 10 Week 11	Review and final revisions; final practice on impromptu writing Final exam		In-class exam 2

What Makes a Good Writing 122 Essay?

Most students can read another student’s essay and tell whether it is good or not so good. Just like teachers, when you read a classmate’s work you get a first impression about whether the essay is strong or weak. However, answering why an essay is strong or weak becomes more difficult. Though this is a difficult question to answer when looking at a classmate’s essay, it is an even tougher question to apply to your own writing.

What follows is a brief list of qualities that make your writing strong. When looking at another student’s writing or evaluating your own, think of the essay in these terms. If you ever wonder why you received a certain grade on an essay in this class, the answer has to do with the qualities listed below.

Focus: A well-focused essay speaks about one main topic, called the thesis, and does not stray from it. In the case of short 101 essays, this main topic can often be identified in a single statement in the essay, called the thesis statement. Even when there is no single explicit thesis statement, however, the essay should be focused around a single idea. The main topic of the essay is not so broad that you cannot explore it fully in your paper; also, it is not so narrow that you cannot develop it (for more on development, see below). Though you may write an essay of many paragraphs with many different arguments and pieces of evidence, everything in the essay should ultimately support your main idea.

Development: An essay is well developed when every claim you make is supported by evidence of some kind, as well as by a sound and logical argument. This evidence should be appropriate to the argument you are making, relevant to the case at hand, and reputable. In addition, a good writer uses logic that is sound and well thought-out. A well-developed essay does not claim anything to be true without offering evidence to show why or how it is true.

Audience Awareness: Good writers tailor their essays towards the needs of the audience, or reader. For example, a good writer chooses a tone that does not insult or talk down to the reader; similarly, good essays are written at a level that the audience is likely to be able to comprehend. In other words, a writer with good audience awareness writes in a style that is readable and which sounds natural. In all communication, what we mean to say and what we actually do say can be very different things; however, good writers work hard to minimize this difference. A writer with good audience awareness also does not make unfair assumptions about the reader’s gender, race, religion, class, sexuality, or value system.

Organization: Strong essays are well organized into paragraphs. Each paragraph focuses on a single idea—often this one idea can be conveyed in a single topic sentence—and displays a logical strategy for conveying its information. Each paragraph should be unified by intelligent use of transitions and key words. Similarly, a good writer uses transitions to link paragraphs into a sequence. This sequence of paragraphs should be logical and should serve to support the essay’s thesis.

Correctness: Strong essays display correct sentence grammar, punctuation, sentence unity, agreement, syntax, and spelling. While it is normal for English 101 students to make grammatical mistakes once in a while, by the time you finish this class you should have pretty strong control over sentence structure and sentence form.

Research and Citations: When it’s called for, students should know how to find outside information to support their arguments. They should also know how to cite this outside information correctly, giving proper credit wherever another writer’s words were used.
STUDENT LEARNING OUTCOMES:

1. Academic Discourse and Conventions
A. Engage in and value a respectful and free exchange of ideas.
B. Practice active reading of challenging college-level texts, including: annotation, cultivation/development of vocabulary, objective summary, identification, and analysis of the thesis and main ideas of source material
C. Participate in class discussion and activities; speak, read, respond, and listen reflectively, recognizing self as part of a larger community and the stakeholders in an issue
D. Appreciate and reflect on challenging points of view through reading and writing; fairly and objectively measure a writer’s viewpoint against personal experience and assumptions and the experience of others
E. Identify, explain, and evaluate basic structural components of written arguments such as claims, support, evidence, rebuttal, refutation, and final appeal
F. Evaluate elements of argument such as logic, credibility, evidence, psychological appeals, and fallacies, and distinguish differences among observations, inferences, fact, and opinion
G. Use appropriate technologies in the service of writing and learning. For example: use word processing tools to prepare and edit formal writing assignments (spell check/grammar check, find and replace); understand the limitations of such tools; locate course materials and resources online; and use online communication tools such as e-mail
H. Word process and format final drafts with appropriate headings, titles, spacing, margins, demonstrating an understanding of MLA citation style
I. Demonstrate the ability to use Edited Standard Written English to address an academic audience
J. Use a writer's handbook and/or other resources with increasing sophistication for style, grammar, citation, and documentation

2.. Organization, Thesis and Development
A. Use argument as a means of inquiry as well as persuasion
B. Try more than one organizational strategy in essay drafts considering multiple implications of various claims
C. Write well-focused and logically organized essays, using introductions, transitions, discussion, and conclusions in which the relationship of ideas to one another is clear
D. Support conclusions with evidence by using appropriate outside sources, presenting good reasons, showing logical relationships, clarifying inferences, choosing appropriate language, and using the most convincing evidence for the target audience
E. Use the elements of formal argumentation
F. Select appropriate methods for developing ideas in paragraphs and essays, such as analysis, facts, explanations,
examples, descriptions, quotations, and/or narratives
G. Thoroughly develop and support an argumentative thesis with a balanced and insightful presentation of evidence

3. Audience, Purpose, and Voice
Apply rhetorical competence:
a. Evaluate the effectiveness of audience analysis in written arguments
b. Assess audience’s knowledge, assumptions, beliefs, values, attitudes, and needs and respond with appropriate
c. voice, tone, and level of formality
d. Assess and question personal knowledge, beliefs and assumptions
e. Make conscious choices about how to project oneself as a writer
f. Articulate varying points of view, particularly opposing ones, in a fair and objective way
g. Anticipate and prepare for reactions to written work by audiences outside the classroom

4. Writing Process
A. Explore the ideas of others in both informal and formal writing
B. Recognize that strong organization, thesis, and development result from a recursive writing process
C. Define and focus original and specific topics that reflect curiosity and interest
D. Develop substantial essays through a flexible writing process, making controlled rhetorical choices at all stages, from exploration, research and invention, through drafting, peer review, revision, editing, and proofreading
E. Work effectively and collaboratively with other writers to evaluate and revise essays, sharing work in process and providing constructive feedback to others according to established guidelines
F. Reflect on own problem solving process and use self-assessment to improve writing
G. Work through multiple drafts of several longer pieces of writing with time to separate the acts of writing and revising and improve essays through revision
H. Revise essay drafts to emphasize a claim, considering what support is appropriate to the purpose of essay
I. Develop discipline and organizational skills necessary to pursue an in-depth writing and research project
K. Use available writing assistance

5. Research and Documentation
A. Use library resources, online databases, and the internet to locate information and evidence, recognizing that there are different resources available for different purposes/subjects
B. Use some advanced research techniques to locate sources (subject indexes, Boolean search terms, etc.)
C. Record and organize information resources to track the research process
D. Demonstrate an ability to summarize, paraphrase, and quote sources in a manner that distinguishes the writer's voice from that of his/her sources and that gives evidence of understanding the implications of choosing one method of representing a source's ideas over another
E. Demonstrate the ability to evaluate source material for authority, currency, reliability, bias, sound reasoning, and validity of evidence. These abilities may include but are not limited to: distinguishing between observation, fact, inference; understanding invalid evidence, bias, fallacies, and unfair emotional appeals; distinguishing between objective and subjective approaches
F. Assemble a bibliography using a discipline-appropriate documentation style

The One-Time-Only Due-Date Extender

Instructions: Fill in your name, the date, and the name of the assignment you’d like to turn in late or make up. Then attach the form to the same email that you are using to turn in your assignment.

 I am requesting permission to turn in the attached assignment, or make up a missed test, up to three calendar days late with no grade penalty. I agree not to ask for extensions on any other assignments I may turn in for this class, and I understand that any other assignment I turn in after the class period in which it is due, for whatever reason, will not be accepted.

 Note: no assignments will be accepted for any reason after the last regular day of classes (i.e. no assignments are accepted during finals week).

 ___________________________________

Name of assignment

 ___________________________________

Name of student

 ___________________________________

Date:

HW for April 29

HW: Google or go to MHCC database and get “The Caging of America” by Adam Gopnik.

Print it, read it, annotate it, read it again. Then type a works cited entry for the article. Bring the annotated article to class Monday.

Essay #2 due Monday.

Assignment for April 16

HW: 1. Respond to the claim (1/2 page typed single-spaced)

2. On the same page, type the titles of three possible sources for your essay; for each, include a few sentences on what the article is about and a few sentences on why the article will be good support for your thesis.

3. First best draft essay due: April 21.

Throwing Like a Girl link

http://www.theatlantic.com/magazine/print/1996/08/throwing-like-a-girl/306152/

Essay 2 reading -- Mental Illness

January 10, 2010

The Americanization of Mental Illness

By ETHAN WATTERS

AMERICANS, particularly if they are of a certain leftward-leaning, college-educated type, worry about our country’s blunders into other cultures. In some circles, it is easy to make friends with a rousing rant about the McDonald’s near Tiananmen Square, the Nike factory in Malaysia or the latest blowback from our political or military interventions abroad. For all our self-recrimination, however, we may have yet to face one of the most remarkable effects of American-led globalization. We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness. We may indeed be far along in homogenizing the way the world goes mad.
This unnerving possibility springs from recent research by a loose group of anthropologists and cross-cultural psychiatrists. Swimming against the biomedical currents of the time, they have argued that mental illnesses are not discrete entities like the polio virus with their own natural histories. These researchers have amassed an impressive body of evidence suggesting that mental illnesses have never been the same the world over (either in prevalence or in form) but are inevitably sparked and shaped by the ethos of particular times and places. In some Southeast Asian cultures, men have been known to experience what is called amok, an episode of murderous rage followed by amnesia; men in the region also suffer from koro, which is characterized by the debilitating certainty that their genitals are retracting into their bodies. Across the fertile crescent of the Middle East there is zar, a condition related to spirit-possession beliefs that brings forth dissociative episodes of laughing, shouting and singing.
The diversity that can be found across cultures can be seen across time as well. In his book “Mad Travelers,” the philosopher Ian Hacking documents the fleeting appearance in the 1890s of a fugue state in which European men would walk in a trance for hundreds of miles with no knowledge of their identities. The hysterical-leg paralysis that afflicted thousands of middle-class women in the late 19th century not only gives us a visceral understanding of the restrictions set on women’s social roles at the time but can also be seen from this distance as a social role itself — the troubled unconscious minds of a certain class of women speaking the idiom of distress of their time.
“We might think of the culture as possessing a ‘symptom repertoire’ — a range of physical symptoms available to the unconscious mind for the physical expression of psychological conflict,” Edward Shorter, a medical historian at the University of Toronto, wrote in his book “Paralysis: The Rise and Fall of a ‘Hysterical’ Symptom.” “In some epochs, convulsions, the sudden inability to speak or terrible leg pain may loom prominently in the repertoire. In other epochs patients may draw chiefly upon such symptoms as abdominal pain, false estimates of body weight and enervating weakness as metaphors for conveying psychic stress.”
In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.
That is until recently.
For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders — depression, post-traumatic stress disorder and anorexia among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.
DR. SING LEE, a psychiatrist and researcher at the Chinese University of Hong Kong, watched the Westernization of a mental illness firsthand. In the late 1980s and early 1990s, he was busy documenting a rare and culturally specific form of anorexia nervosa in Hong Kong. Unlike American anorexics, most of his patients did not intentionally diet nor did they express a fear of becoming fat. The complaints of Lee’s patients were typically somatic — they complained most frequently of having bloated stomachs. Lee was trying to understand this indigenous form of anorexia and, at the same time, figure out why the disease remained so rare.
As he was in the midst of publishing his finding that food refusal had a particular expression and meaning in Hong Kong, the public’s understanding of anorexia suddenly shifted. On Nov. 24, 1994, a teenage anorexic girl named Charlene Hsu Chi-Ying collapsed and died on a busy downtown street in Hong Kong. The death caught the attention of the media and was featured prominently in local papers. “Anorexia Made Her All Skin and Bones: Schoolgirl Falls on Ground Dead,” read one headline in a Chinese-language newspaper. “Thinner Than a Yellow Flower, Weight-Loss Book Found in School Bag, Schoolgirl Falls Dead on Street,” reported another Chinese-language paper.
In trying to explain what happened to Charlene, local reporters often simply copied out of American diagnostic manuals. The mental-health experts quoted in the Hong Kong papers and magazines confidently reported that anorexia in Hong Kong was the same disorder that appeared in the United States and Europe. In the wake of Charlene’s death, the transfer of knowledge about the nature of anorexia (including how and why it was manifested and who was at risk) went only one way: from West to East.
Western ideas did not simply obscure the understanding of anorexia in Hong Kong; they also may have changed the expression of the illness itself. As the general public and the region’s mental-health professionals came to understand the American diagnosis of anorexia, the presentation of the illness in Lee’s patient population appeared to transform into the more virulent American standard. Lee once saw two or three anorexic patients a year; by the end of the 1990s he was seeing that many new cases each month. That increase sparked another series of media reports. “Children as Young as 10 Starving Themselves as Eating Ailments Rise,” announced a headline in one daily newspaper. By the late 1990s, Lee’s studies reported that between 3 and 10 percent of young women in Hong Kong showed disordered eating behavior. In contrast to Lee’s earlier patients, these women most often cited fat phobia as the single most important reason for their self-starvation. By 2007 about 90 percent of the anorexics Lee treated reported fat phobia. New patients appeared to be increasingly conforming their experience of anorexia to the Western version of the disease.
What is being missed, Lee and others have suggested, is a deep understanding of how the expectations and beliefs of the sufferer shape their suffering. “Culture shapes the way general psychopathology is going to be translated partially or completely into specific psychopathology,” Lee says. “When there is a cultural atmosphere in which professionals, the media, schools, doctors, psychologists all recognize and endorse and talk about and publicize eating disorders, then people can be triggered to consciously or unconsciously pick eating-disorder pathology as a way to express that conflict.”
The problem becomes especially worrisome in a time of globalization, when symptom repertoires can cross borders with ease. Having been trained in England and the United States, Lee knows better than most the locomotive force behind Western ideas about mental health and illness. Mental-health professionals in the West, and in the United States in particular, create official categories of mental diseases and promote them in a diagnostic manual that has become the worldwide standard. American researchers and institutions run most of the premier scholarly journals and host top conferences in the fields of psychology and psychiatry. Western drug companies dole out large sums for research and spend billions marketing medications for mental illnesses. In addition, Western-trained traumatologists often rush in where war or natural disasters strike to deliver “psychological first aid,” bringing with them their assumptions about how the mind becomes broken by horrible events and how it is best healed. Taken together this is a juggernaut that Lee sees little chance of stopping.
“As Western categories for diseases have gained dominance, micro-cultures that shape the illness experiences of individual patients are being discarded,” Lee says. “The current has become too strong.”
Would anorexia have so quickly become part of Hong Kong’s symptom repertoire without the importation of the Western template for the disease? It seems unlikely. Beginning with scattered European cases in the early 19th century, it took more than 50 years for Western mental-health professionals to name, codify and popularize anorexia as a manifestation of hysteria. By contrast, after Charlene fell onto the sidewalk on Wan Chai Road on that late November day in 1994, it was just a matter of hours before the Hong Kong population learned the name of the disease, who was at risk and what it meant.
THE IDEA THAT our Western conception of mental health and illness might be shaping the expression of illnesses in other cultures is rarely discussed in the professional literature. Many modern mental-health practitioners and researchers believe that the scientific standing of our drugs, our illness categories and our theories of the mind have put the field beyond the influence of endlessly shifting cultural trends and beliefs. After all, we now have machines that can literally watch the mind at work. We can change the chemistry of the brain in a variety of interesting ways and we can examine DNA sequences for abnormalities. The assumption is that these remarkable scientific advances have allowed modern-day practitioners to avoid the blind spots and cultural biases of their predecessors.
Modern-day mental-health practitioners often look back at previous generations of psychiatrists and psychologists with a thinly veiled pity, wondering how they could have been so swept away by the cultural currents of their time. The confident pronouncements of Victorian-era doctors regarding the epidemic of hysterical women are now dismissed as cultural artifacts. Similarly, illnesses found only in other cultures are often treated like carnival sideshows. Koro, amok and the like can be found far back in the American diagnostic manual (DSM-IV, Pages 845-849) under the heading “culture-bound syndromes.” Given the attention they get, they might as well be labeled “Psychiatric Exotica: Two Bits a Gander.”
Western mental-health practitioners often prefer to believe that the 844 pages of the DSM-IV prior to the inclusion of culture-bound syndromes describe real disorders of the mind, illnesses with symptomatology and outcomes relatively unaffected by shifting cultural beliefs. And, it logically follows, if these disorders are unaffected by culture, then they are surely universal to humans everywhere. In this view, the DSM is a field guide to the world’s psyche, and applying it around the world represents simply the brave march of scientific knowledge.
Of course, we can become psychologically unhinged for many reasons that are common to all, like personal traumas, social upheavals or biochemical imbalances in our brains. Modern science has begun to reveal these causes. Whatever the trigger, however, the ill individual and those around him invariably rely on cultural beliefs and stories to understand what is happening. Those stories, whether they tell of spirit possession, semen loss or serotonin depletion, predict and shape the course of the illness in dramatic and often counterintuitive ways. In the end, what cross-cultural psychiatrists and anthropologists have to tell us is that all mental illnesses, including depression, P.T.S.D. and even schizophrenia, can be every bit as influenced by cultural beliefs and expectations today as hysterical-leg paralysis or the vapors or zar or any other mental illness ever experienced in the history of human madness. This does not mean that these illnesses and the pain associated with them are not real, or that sufferers deliberately shape their symptoms to fit a certain cultural niche. It means that a mental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions — the idiosyncratic cultural trappings — of the mind that is its host.
EVEN WHEN THE underlying science is sound and the intentions altruistic, the export of Western biomedical ideas can have frustrating and unexpected consequences. For the last 50-odd years, Western mental-health professionals have been pushing what they call “mental-health literacy” on the rest of the world. Cultures became more “literate” as they adopted Western biomedical conceptions of diseases like depression and schizophrenia. One study published in The International Journal of Mental Health, for instance, portrayed those who endorsed the statement that “mental illness is an illness like any other” as having a “knowledgeable, benevolent, supportive orientation toward the mentally ill.”
Mental illnesses, it was suggested, should be treated like “brain diseases” over which the patient has little choice or responsibility. This was promoted both as a scientific fact and as a social narrative that would reap great benefits. The logic seemed unassailable: Once people believed that the onset of mental illnesses did not spring from supernatural forces, character flaws, semen loss or some other prescientific notion, the sufferer would be protected from blame and stigma. This idea has been promoted by mental-health providers, drug companies and patient-advocacy groups like the National Alliance on Mental Illness in the United States and SANE in Britain. In a sometimes fractious field, everyone seemed to agree that this modern way of thinking about mental illness would reduce the social isolation and stigma often experienced by those with mental illness. Trampling on indigenous prescientific superstitions about the cause of mental illness seemed a small price to pay to relieve some of the social suffering of the mentally ill.
But does the “brain disease” belief actually reduce stigma?
In 1997, Prof. Sheila Mehta from Auburn University Montgomery in Alabama decided to find out if the “brain disease” narrative had the intended effect. She suspected that the biomedical explanation for mental illness might be influencing our attitudes toward the mentally ill in ways we weren’t conscious of, so she thought up a clever experiment.
In her study, test subjects were led to believe that they were participating in a simple learning task with a partner who was, unbeknownst to them, a confederate in the study. Before the experiment started, the partners exchanged some biographical data, and the confederate informed the test subject that he suffered from a mental illness.
The confederate then stated either that the illness occurred because of “the kind of things that happened to me when I was a kid” or that he had “a disease just like any other, which affected my biochemistry.” (These were termed the “psychosocial” explanation and the “disease” explanation respectively.) The experiment then called for the test subject to teach the confederate a pattern of button presses. When the confederate pushed the wrong button, the only feedback the test subject could give was a “barely discernible” to “somewhat painful” electrical shock.
Analyzing the data, Mehta found a difference between the group of subjects given the psychosocial explanation for their partner’s mental-illness history and those given the brain-disease explanation. Those who believed that their partner suffered a biochemical “disease like any other” increased the severity of the shocks at a faster rate than those who believed they were paired with someone who had a mental disorder caused by an event in the past.
“The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms,” Mehta wrote. “We say we are being kind, but our actions suggest otherwise.” The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events. “Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.”
In other words, the belief that was assumed to decrease stigma actually increased it. Was the same true outside the lab in the real world?
The question is important because the Western push for “mental-health literacy” has gained ground. Studies show that much of the world has steadily adopted this medical model of mental illness. Although these changes are most extensive in the United States and Europe, similar shifts have been documented elsewhere. When asked to name the sources of mental illness, people from a variety of cultures are increasingly likely to mention “chemical imbalance” or “brain disease” or “genetic/inherited” factors.
Unfortunately, at the same time that Western mental-health professionals have been convincing the world to think and talk about mental illnesses in biomedical terms, we have been simultaneously losing the war against stigma at home and abroad. Studies of attitudes in the United States from 1950 to 1996 have shown that the perception of dangerousness surrounding people with schizophrenia has steadily increased over this time. Similarly, a study in Germany found that the public’s desire to maintain distance from those with a diagnosis of schizophrenia increased from 1990 to 2001.
Researchers hoping to learn what was causing this rise in stigma found the same surprising connection that Mehta discovered in her lab. It turns out that those who adopted biomedical/genetic beliefs about mental disorders were the same people who wanted less contact with the mentally ill and thought of them as more dangerous and unpredictable. This unfortunate relationship has popped up in numerous studies around the world. In a study conducted in Turkey, for example, those who labeled schizophrenic behavior as akil hastaligi (illness of the brain or reasoning abilities) were more inclined to assert that schizophrenics were aggressive and should not live freely in the community than those who saw the disorder as ruhsal hastagi (a disorder of the spiritual or inner self). Another study, which looked at populations in Germany, Russia and Mongolia, found that “irrespective of place . . . endorsing biological factors as the cause of schizophrenia was associated with a greater desire for social distance.”
Even as we have congratulated ourselves for becoming more “benevolent and supportive” of the mentally ill, we have steadily backed away from the sufferers themselves. It appears, in short, that the impact of our worldwide antistigma campaign may have been the exact opposite of what we intended.
NOWHERE ARE THE limitations of Western ideas and treatments more evident than in the case of schizophrenia. Researchers have long sought to understand what may be the most perplexing finding in the cross-cultural study of mental illness: people with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations.
This was the startling result of three large international studies carried out by the World Health Organization over the course of 30 years, starting in the early 1970s. The research showed that patients outside the United States and Europe had significantly lower relapse rates — as much as two-thirds lower in one follow-up study. These findings have been widely discussed and debated in part because of their obvious incongruity: the regions of the world with the most resources to devote to the illness — the best technology, the cutting-edge medicines and the best-financed academic and private-research institutions — had the most troubled and socially marginalized patients.
Trying to unravel this mystery, the anthropologist Juli McGruder from the University of Puget Sound spent years in Zanzibar studying families of schizophrenics. Though the population is predominantly Muslim, Swahili spirit-possession beliefs are still prevalent in the archipelago and commonly evoked to explain the actions of anyone violating social norms — from a sister lashing out at her brother to someone beset by psychotic delusions.
McGruder found that far from being stigmatizing, these beliefs served certain useful functions. The beliefs prescribed a variety of socially accepted interventions and ministrations that kept the ill person bound to the family and kinship group. “Muslim and Swahili spirits are not exorcised in the Christian sense of casting out demons,” McGruder determined. “Rather they are coaxed with food and goods, feted with song and dance. They are placated, settled, reduced in malfeasance.” McGruder saw this approach in many small acts of kindness. She watched family members use saffron paste to write phrases from the Koran on the rims of drinking bowls so the ill person could literally imbibe the holy words. The spirit-possession beliefs had other unexpected benefits. Critically, the story allowed the person with schizophrenia a cleaner bill of health when the illness went into remission. An ill individual enjoying a time of relative mental health could, at least temporarily, retake his or her responsibilities in the kinship group. Since the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity.
For McGruder, the point was not that these practices or beliefs were effective in curing schizophrenia. Rather, she said she believed that they indirectly helped control the course of the illness. Besides keeping the sick individual in the social group, the religious beliefs in Zanzibar also allowed for a type of calmness and acquiescence in the face of the illness that she had rarely witnessed in the West.
The course of a metastasizing cancer is unlikely to be changed by how we talk about it. With schizophrenia, however, symptoms are inevitably entangled in a person’s complex interactions with those around him or her. In fact, researchers have long documented how certain emotional reactions from family members correlate with higher relapse rates for people who have a diagnosis of schizophrenia. Collectively referred to as “high expressed emotion,” these reactions include criticism, hostility and emotional overinvolvement (like overprotectiveness or constant intrusiveness in the patient’s life). In one study, 67 percent of white American families with a schizophrenic family member were rated as “high EE.” (Among British families, 48 percent were high EE; among Mexican families the figure was 41 percent and for Indian families 23 percent.)
Does this high level of “expressed emotion” in the United States mean that we lack sympathy or the desire to care for our mentally ill? Quite the opposite. Relatives who were “high EE” were simply expressing a particularly American view of the self. They tended to believe that individuals are the captains of their own destiny and should be able to overcome their problems by force of personal will. Their critical comments to the mentally ill person didn’t mean that these family members were cruel or uncaring; they were simply applying the same assumptions about human nature that they applied to themselves. They were reflecting an “approach to the world that is active, resourceful and that emphasizes personal accountability,” Prof. Jill M. Hooley of Harvard University concluded. “Far from high criticism reflecting something negative about the family members of patients with schizophrenia, high criticism (and hence high EE) was associated with a characteristic that is widely regarded as positive.”
Widely regarded as positive, that is, in the United States. Many traditional cultures regard the self in different terms — as inseparable from your role in your kinship group, intertwined with the story of your ancestry and permeable to the spirit world. What McGruder found in Zanzibar was that families often drew strength from this more connected and less isolating idea of human nature. Their ability to maintain a low level of expressed emotion relied on these beliefs. And that level of expressed emotion in turn may be key to improving the fortunes of the schizophrenia sufferer.
Of course, to the extent that our modern psychopharmacological drugs can relieve suffering, they should not be denied to the rest of the world. The problem is that our biomedical advances are hard to separate from our particular cultural beliefs. It is difficult to distinguish, for example, the biomedical conception of schizophrenia — the idea that the disease exists within the biochemistry of the brain — from the more inchoate Western assumption that the self resides there as well. “Mental illness is feared and has such a stigma because it represents a reversal of what Western humans . . . have come to value as the essence of human nature,” McGruder concludes. “Because our culture so highly values . . . an illusion of self-control and control of circumstance, we become abject when contemplating mentation that seems more changeable, less restrained and less controllable, more open to outside influence, than we imagine our own to be.”
CROSS-CULTURAL psychiatrists have pointed out that the mental-health ideas we export to the world are rarely unadulterated scientific facts and never culturally neutral. “Western mental-health discourse introduces core components of Western culture, including a theory of human nature, a definition of personhood, a sense of time and memory and a source of moral authority. None of this is universal,” Derek Summerfield of the Institute of Psychiatry in London observes. He has also written: “The problem is the overall thrust that comes from being at the heart of the one globalizing culture. It is as if one version of human nature is being presented as definitive, and one set of ideas about pain and suffering. . . . There is no one definitive psychology.”
Behind the promotion of Western ideas of mental health and healing lie a variety of cultural assumptions about human nature. Westerners share, for instance, evolving beliefs about what type of life event is likely to make one psychologically traumatized, and we agree that venting emotions by talking is more healthy than stoic silence. We’ve come to agree that the human mind is rather fragile and that it is best to consider many emotional experiences and mental states as illnesses that require professional intervention. (The National Institute of Mental Health reports that a quarter of Americans have diagnosable mental illnesses each year.) The ideas we export often have at their heart a particularly American brand of hyperintrospection — a penchant for “psychologizing” daily existence. These ideas remain deeply influenced by the Cartesian split between the mind and the body, the Freudian duality between the conscious and unconscious, as well as the many self-help philosophies and schools of therapy that have encouraged Americans to separate the health of the individual from the health of the group. These Western ideas of the mind are proving as seductive to the rest of the world as fast food and rap music, and we are spreading them with speed and vigor.
No one would suggest that we withhold our medical advances from other countries, but it’s perhaps past time to admit that even our most remarkable scientific leaps in understanding the brain haven’t yet created the sorts of cultural stories from which humans take comfort and meaning. When these scientific advances are translated into popular belief and cultural stories, they are often stripped of the complexity of the science and become comically insubstantial narratives. Take for instance this Web site text advertising the antidepressant Paxil: “Just as a cake recipe requires you to use flour, sugar and baking powder in the right amounts, your brain needs a fine chemical balance in order to perform at its best.” The Western mind, endlessly analyzed by generations of theorists and researchers, has now been reduced to a batter of chemicals we carry around in the mixing bowl of our skulls.
All cultures struggle with intractable mental illnesses with varying degrees of compassion and cruelty, equanimity and fear. Looking at ourselves through the eyes of those living in places where madness and psychological trauma are still embedded in complex religious and cultural narratives, however, we get a glimpse of ourselves as an increasingly insecure and fearful people. Some philosophers and psychiatrists have suggested that we are investing our great wealth in researching and treating mental illness — medicalizing ever larger swaths of human experience — because we have rather suddenly lost older belief systems that once gave meaning and context to mental suffering.
If our rising need for mental-health services does indeed spring from a breakdown of meaning, our insistence that the rest of the world think like us may be all the more problematic. Offering the latest Western mental-health theories, treatments and categories in an attempt to ameliorate the psychological stress sparked by modernization and globalization is not a solution; it may be part of the problem. When we undermine local conceptions of the self and modes of healing, we may be speeding along the disorienting changes that are at the very heart of much of the world’s mental distress.

Ethan Watters lives in San Francisco. This essay is adapted from his book “Crazy Like Us: The Globalization of the American Psyche,” which will be published later this month by Free Press.

This article has been revised to reflect the following correction:
Correction: January 24, 2010
A biographical note for the author of an article on Jan. 10 about the influence of American ideas on the treatment of mental illness abroad misidentified the publisher of his new book. Ethan Watters’s ‘‘Crazy Like Us: The Globalization of the American Psyche’’ was just published by Free Press, not Basic Books. The article also gave an outdated name for a patient advocacy organization that has supported a biomedical view of mental illness. It is the National Alliance on Mental Illness, no longer the National Alliance for the Mentally Ill.