The" World Mental Health" Framework: Dominant Discourses in Mental Health and International Development (original) (raw)
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PubMed, 2003
This institutional ethnographic work uses the first author's experience as an international development worker, educator, and community mental health nurse in West Africa to illustrate how official research and policy on mental health services reflect Western academic, corporate, economic, and cultural dominance. Focusing on a critical textual analysis of a survey intended to support funding applications to international aid/lending agencies, the authors show how official processes privilege Western policies/research approaches and subordinate local perspectives. If nurses, researchers, and policy-makers are to be effective in carrying out development work in Africa, they must learn to appreciate the subtle exertion of dominance inherent in Western approaches. The authors propose that understanding local knowledge be foregrounded rather than backgrounded to the complex global interpretive frames for international research and international development policy.
2003
Ce travail ethnographique institutionnel s'appuie sur l'expérience de la première auteure en tant qu'intervenante en développement international, éducatrice et infir mière en santé mentale communautaire en Afrique occidentale, pour illustrer comment la recherche of cielle et les politiques portant sur les services de santé mentale re ètent la domination occidentale sur le plan académique, corporatif, économique et culturel. S'appuyant sur une analyse textuelle critique d'un questionnaire utilisé dans le cadre de demandes de subvention adressées à des agences d'aide internationale et de prêts, les auteures démontrent comment les processus of ciels privilégient les politiques et les approches de recherche occidentales et supplantent les perspectives locales. Pour être ef caces dans leur travail de développement en Afrique, les in rmières, les chercheurs et les décisionnaires doivent apprendre à reconnaître les attitudes de domination subtiles inhérentes aux approches occidentales. Les auteurs proposent que la recherche internationale et les politiques de développement international mettent en priorité la compréhension des connaissances locales plutôt qu'une approche privilégiant des cadres d'interprétation complexes et généraux.
International Journal of Mental Health, 2019
Ethiopia is one of the ancient countries inhabited by well over a hundred million people of diverse cultures and languages. Such diversity requires mental health training and services to be tailored to those diverse needs of the people. Consequently, there are important implications for mental health training and services. The gap in mental health knowledge is attributed perhaps to a lack of trained professionals in relevant fields in awareness and understanding of advances made in global mental health (GMH) and blended with indigenous wisdom. Training is Western orientated and lacks integration with local culture and wisdom. The study intends to explore the extent to which mental health training and services have customized Western mental health traditions into the indigenous knowledge, skills, and practices of Ethiopia. The study employed an exploratory design, and data was collected through focus group discussions (FGD) from a total of eighteen faculty, alumni, and practitioners working at the University of Gondar. Data was collected using semi-structured interview guides from the different groups. Mental health knowledge in our training and service providers is perceived to be culture specific rather than universal. However, it is highly influenced by the Western culture diffused through various media. This has resulted in faculty and practitioners being dependent on Western resources without adapting them into indigenous wisdom and cultures. This has prevented them from exploring and practicing what is available in our specific cultures and traditions, such as books written by the religious scholars and traditional healers.
“WHO’s MIND, Whose Future? Mental Health Projects as Colonial Logics,”
This paper examines the Mental Health Improvements for Nations Development of the World Health Organization (WHO), or what it refers to as its MIND project, as it produces versions of human and human suffering. Arising at approximately the same time as decolonization began to occur, the WHO can be read as reflective of colonial history as well as a colonizing force in postcolonial times. Through an analysis of the WHO’s publicly available material, we shall show how the MIND project is not only a product of, but also helps to produce the power of coloniality. In the WHO MIND project, professional disability knowledge is used to identify an emergent mental health crisis in need of Western medical intervention. Guided by Fanon’s call to notice how assistance makes a subject ‘thoroughly fit into a social environment of the colonial type,’ we examine the role of disability knowledge in the production of people ‘fit’ to survive in environments that reproduce coloniality. We show how the WHO MIND project can be read so as to reveal the restrictive and exclusive versions of the human that have arisen from the colonial past as our way to attempt to disrupt the developmental trajectory of the coloniality of the present. Keywords: interpretation; World Health Organization; mental health and illness; postcolonial theory
Culture, Medicine, and Psychiatry
The author suggests to consider some important hidden connections in Global Mental Health (GMH) discourse and interventions, above all the political meaning of suffering and symptoms, the power of psychiatric diagnostic categories (both Western and traditional) to name and to occult at once other conflicts, and the implicit criticism expressed by so-called local healing knowledge and its epistemologies. These issues, by emphasizing the importance to explore other ontologies, help to understand the perplexity and resistance that GMH and its agenda meet among many scholars and professionals, who denounce the risks of reproducing and globalizing Western hegemonic values concerning health, illness, and healing. Keywords ''Palimpsest nature'' of psychiatric disorders Á Hegemonic dimensions of psychiatric diagnostic apparatus Á Crypto-racism Á Indocile suffering Á ''Minor'' and ''subjugated'' (healing) knowledge
Global mental health and its discontents: An inquiry into the making of global and local scale
Transcultural Psychiatry, 2014
Global Mental Health’s (GMH) proposition to “scale up” evidence-based mental health care worldwide has sparked a heated debate among transcultural psychiatrists, anthropologists, and GMH proponents; a debate characterized by the polarization of “global” and “local” approaches to the treatment of mental health problems. This article highlights the institutional infrastructures and underlying conceptual assumptions that are invested in the production of the “global” and the “local” as distinct, and seemingly incommensurable, scales. It traces how the conception of mental health as a “global” problem became possible through the emergence of Global Health, the population health metric DALY, and the rise of evidence-based medicine. GMH also advanced a moral argument to act globally emphasizing the notion of humanity grounded in a shared biology and the universality of human rights. However, despite the frequent criticism of GMH promoting the “bio”-medical model, we argue that novel logics have emerged which may be more important for establishing global applicability than arguments made in the name of “nature”: the procedural standardization of evidence and the simplification of psychiatric expertise. Critical scholars, on the other hand, argue against GMH in the name of the “local”; a trope that underlines specificity, alterity, and resistance against global claims. These critics draw on the notions of “culture,” “colonialism,” the “social,” and “community” to argue that mental health knowledge is locally contingent. Yet, paying attention to the divergent ways in which both sides conceptualize the “social” and “community” may point to productive spaces for an analysis of GMH beyond the “global/local” divide.
Genealogies and Anthropologies of Global Mental Health
Culture, Medicine and Psychiatry, 2019
Within the proliferation of studies identified with global mental health, anthropologists rarely take global mental health itself as their object of inquiry. The papers in this special issue were selected specifically to problematize global mental health. To contextualize them, this introduction critically weighs three possible genealogies through which the emergence of global health can be explored: (1) as a divergent thread in the qualitative turn of global health away from earlier international health and development; (2) as the product of networks and social movements; and (3) as a diagnostically- and metrics-driven psychiatric imperialism, reinforced by pharmaceutical markets. Each paper tackles a different component of the assemblage of global mental health: knowledge production and circulation, global mental health principles enacted in situ, and subaltern modalities of healing through which global mental health can be questioned. Pluralizing anthropology, the articles include research sites in meeting rooms, universities, research laboratories, clinics, healers and health screening camps, households, and the public spaces of everyday life, in India, Ghana, Brazil, Senegal, South Africa, Kosovo and Palestine, as well as in US and European institutions that constitute nodes in the global network through which scientific knowledge and certain models of mental health circulate.
Embodied in the very concept of Global Mental Health (an area that is emerging as both a field of study and a global movement), mental health is conceptualised as being 'global'; mental disorders are constructed as having 'a physical basis in the brain….they can affect everyone, everywhere' and are understood to be 'truly universal' (WHO, 2001a:x, 22). The construction of 'mental disorder' as universal is used to draw attention to inequalities in access to mental health care and treatment globally-the 'treatment gap'-and to push to scale up mental health services in low and middle-income countries (LMICs) based on those in high-income countries (HICs). This push arises from two separate, yet interrelated, arenas; the World Health Organization (WHO), and the Movement for Global Mental Health (MGMH) (www.globalmentalhealth.org). Such a view-reducing complex matters of living, behaving and thinking to 'mental' health and disorder developed in a particular socio-cultural context-is strongly contested by groups of service users and survivors of psychiatry, or those who identify as psychosocially disabled, in the global North and South; by academics and professionals in the field of transcultural psychiatry; and by members of the Critical Psychiatry Network (CPN) (http://www.criticalpsychiatry.net/) (see Fernando, 2014; and Mills, 2014). Even more importantly, this drive to export mental health systems from HICs to LMICs is occurring at a time when serious questions are being asked about the utility and validity of psychiatric diagnoses. More specifically, there is a) concern that such psychiatrization constructs human experience (for example, emotional distress, problems of living, conflicts in relationships and social suffering) as 'mental disorder' treatable by drugs (e.g.