Somatosphere has a fantastic account of the debates rocking the world of global mental health – the still nascent field that aims to make mental health a world priority.
The idea itself is sound in the general sense, but there is still a lot of argument about what it means to promote mental health and much discussion about whether ‘global mental health’ is just a means of exporting Western ideas and diagnoses in a sort of 21st century globalisation of the mind.
I am always a little struck by the fact that the ‘global mental health’ movement seems mainly to focus on Asia and Africa.
For example, the lack of participation of Latin American mental health professionals and advocates is striking in both the headline-making publications and the key conferences.
This is a pity as Latin America has developed a unique perspective on mental health that, by reading the debates covered by Somatosphere, would be very relevant.
If you want to get your head into the space of this particular Latin American approach, have a think about this analogy.
How would you react if instead of supporting the American civil rights movement in the 1960s, you were told the major problem was that people were being affected by a mental illness called ‘post-discrimination stress disorder’?
I’m sure it would be possible to come up with a valid and reliable ‘PDSD’ diagnosis that could be agreed upon and would genuinely predict behavioural and psychological distress and impairment – the experience of racism is known to predict mental health problems and the discrimination of the civil rights era was extreme.
Arguing for more resources to be put into treating ‘post-discrimination stress disorder’ when the civil rights movement was almost at breaking point in the 1940s and 50 would lay you open to accusations of ‘putting up a smoke screen’ and ‘making a distraction’ when what was needed was social change, not an attempt to pathologise black people.
The question that you may be asking, and many Latin American psychologists have asked, is whether we should be instead focussing on inequality and violence to improve mental health.
The Western focus on disorders, they argue, can distract and blind us to societal problems. Instead of preventing oppression, we pathologise its victims.
This approach was born out of a field called liberation psychology that made exactly this point.
One of the founders was a remarkable chap called Ignacio Martín-Baró who was a Spanish priest who trained as a psychologist and worked in El Salvador during the Salvadoran civil war.
He was eventually murdered by a government death squad because of his theories, which at least shows their power if not their popularity.
Unfortunately, liberation psychology has become heavily politicised and you often hear variations of “Martín-Baró’s work means you must support my left-wing views” from proponents.
This is a shame because Martín-Baró’s work was often making a more profound and over-arching point – that there is no such thing as an apolitical act in mental health, and, indeed, in health care in general.
For example, the West’s understanding of the victims of war, torture and displacement in terms of PTSD and other diagnostic labels is largely due to the experience of treating refugees who have fled these horrible situations.
In this context, PTSD makes sense in the West because it has the implicit assumption that the person is now safe (after all, it’s post-traumatic stress disorder) and that the experiences and reactions described in the diagnosis are, therefore, inappropriate.
However, if you live in a war zone, intrusive thoughts, feeling on edge and avoiding reminders of danger could be considered quite a reasonable reaction to the constant experience of death and violence.
When you meet people who do live in war zones, who would clearly meet the criteria for PTSD, they rarely complain about their mental state. They’re usually more concerned about the actual dangers.
They’re concerned about torture, not intrusive thoughts about being tortured – the threat of rape, not rape-related anxiety.
So, the hard question becomes: are we really helping by sending professionals and training locals to recognise and treat people with, for example, PTSD?
And this is where Martín-Baró drew his inspiration from. The way we understand and treat mental health problems, he argued, is always political. There is no absolute neutrality in how we understand distress and those that think so are usually just blind to their own biases.
And this is what the global mental health movement is wrestling with. And needless to say, there are plenty of biases to overcome.
Big Pharma pushes theories as adverts for its medication. Western mental health professionals can see themselves as healers of people who don’t necessarily need healing.
Researchers see an untapped gold mine of data and local scientists see a way out of what seems like a limiting and unglamorous academic life distant from the shining lights of Northern Hemisphere High Science.
So when we talk about ‘mental health literacy’ are we talking education or propaganda? It’s not an easy question to answer or, for many, to even think about.
The Somatosphere piece is one of the best guides to this debate I’ve yet read. Essential reading.
Link to Somatosphere on ‘Global Mental Health and its Discontents’