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Note: This article was first published on Mad in America on December 27, 2019 and can be accessed here.

A recent article published in Culture, Medicine, and Psychiatry examines the relationship between Global Mental Health (GMH) movements and more local forms of healing. “Hegemonic” structures of psychiatry often mask or replace alternative understandings of sickness and health, contributing to the globalization of mainly western forms of knowledge. This can be accompanied by western “solutions” as well, from the widespread use of psychotropic medications to interpreting all mental phenomena from the lens of psychiatric diagnostic categories. Dr. Roberto Beneduce discusses the hidden contradictions, politics, violence, and more, associated with the rise of GMH.

“Why is global mental health so pivotal yet so contested? What explains the strong ethical and political importance of improving people’s mental health yet our questionable ability to do so? In this commentary, I will raise questions with which I have been engaging in a sort of epistemological duel for some time now. More particularly, I would like to explore the issue of global mental health (GMH) against the background of other healing techniques and knowledge, and to consider the production of suffering and mental disease,” writes anthropologist Dr. Roberto Beneduce.

The Global Mental Health (GMH) movement has sparked several controversies in recent years, from accusations of over-pathologizing everyday human struggles to homogenizing the way that diverse cultures understand sickness and health. Also significant is the GMH’s lack of focus on socio-cultural and economic determinants of suffering, instead privileging the western biomedical model that emphasizes pharmaceutical treatments to problems of supposed individual brain chemistry.

Not everyone is on board with the GMH’s stated humanitarian mission, with many service users banding together to criticize its methodology and aims, as for instance, in response to the UK’s Global Ministerial Mental Health Summit.

The current article explores various dimensions of globalized western psychiatry and its relationship to traditional and local forms of cultural healing. As an anthropologist, Dr. Beneduce focuses on “hidden contradictions,” “hidden unknowns,” “hidden violence,” “hidden politics,” “hidden ontologies,” and “hidden histories” within the GMH movement, pointing to the complexity and some of the problems associated with western psychiatry’s hegemonic grasp over global mental health.

Discussing “hidden contradictions,” Beneduce notes that despite the surge of interest in global patterns of mental health since the 1990s, there have been parallel sociocultural and economic movements that have done a great deal of harm, marked by “programs that imposed on poor countries the devaluation of currency, reductions in government expenditure for basic services, increases in the prices of services, and privatization of essential services, including health.” The author argues that it is in light of these neoliberal and austerity measures that the GMH movement has found so much of a target for its interventions.

In addition, Beneduce calls the stance of organizations such as the World Health Organization, “humanitarian realism,” because these administrative bodies often view “mass rape, other large-scale violence, poverty, hunger, and the destruction of […] social fabric” as opportunities for mental healthcare reform and reorganization. He questions whether these organizations adequately represent the interests and perspectives of those affected by these forces.

Beneduce’s interest in “hidden unknowns” refers to the GMH’s failure to consider alternative explanations of emotional suffering. He sees psychiatry as having a history, dating back to Emil Kraepelin’s transcultural psychiatry in the early 20th century, of denigrating non-western cultures as less sophisticated and in need of western psychiatric intervention.

This leads to a modern-day failure to take mental symptoms seriously, such as the possibility for delusions to have some bearing on reality, as in the case of Algerian women in the 1930s who felt “persecuted” by French men and soldiers. In a second hidden unknown, Beneduce argues that the GMH’s emphasis on “better access to care” too often equates to “better access to psychotropic drugs.”

In terms of hidden violence, Beneduce points to warring understandings of what constitutes mental illness and psychiatric categories. He cites personal experience working in the West Bank in the early 2000s, where a social worker asked for help in learning EMDR (Eyes Movement Desensitization and Reprocessing) therapy, a standard western approach to treating PTSD. Beneduce urges a more critical and socially oriented perspective on diagnostic categories, which may not be as self-explanatory and self-obvious as some believe. Should suffering so clearly connected to sociopolitical turmoil be reduced to psychiatric phenomena, or handed over to psychiatric intervention?

“Is EMDR able to cure traumatic history and the traumatic ongoing present of Palestinian people? Or does it simply veil the violence of history? How helpless did the social worker actually feel and how much had her historical consciousness been colonized by a hegemonic trauma discourse that assumed EMDR could work in Palestine?”

Similarly, in “hidden politics,” Beneduce concludes that psychiatry often masks its agenda, replacing other interpretations of the mental issues it examines. He argues that medicalization can be helpful if it also connects individuals with healthcare workers who are receptive to their experience and allow them to experience themselves differently. So often, however, psychiatric intervention covers alternative understandings. Beneduce references a case in which an Indian woman was diagnosed with depression, even though many of her struggles seem to have begun when her sons were not allowed to come home because of Communist activities in Kerala.

“’I see this time as the breaking point, the origin of a crisis in family ties and of the ‘‘lack of care’’. This perfectly exemplifies how political repression can generate interpersonal conflicts, abandonment, and suffering.”

With “hidden ontologies,” the author points to the fact that psychiatry replicates a specific view of the world. Phenomena such as “states of possession,” and their potential role in healing ceremonies, cannot be accounted for from a psychiatric perspective while also honoring the experience of cultural “insiders.” Beneduce cites other anthropologists, arguing against the “moral arrogance” of western psychiatry in trying to assimilate all ideas and practices into its own “medico-psychological” framework.

In the final section on “hidden histories,” Beneduce discusses “traditional” medicine’s relationship with psychiatric hegemony. However, he notes the need to deconstruct the notion of a unified “traditional medicine,” which is often an outsider’s construction by colonizing mental health workers. The author argues that to “survive in the modern post-colonial state,” traditional healers have had to submit to bureaucratization and professionalization of their practices. Beneduce also states that many countries have an ambivalent relationship with traditional forms of healing, at times criticizing them and, at times, incorporating them as a marginalized approach with relative state sanctioning.

In terms of their relationship to psychiatry, Beneduce believes that skepticism toward some types of traditional healing can provide an opportunity to also criticize harmful elements of western psychiatry, such as “lobotomy, ECT, restraints, unnecessary use of drugs, involuntary hospitalization.”

The author states in conclusion:

“Criticism of GMH stems from the fact that many interventions recently implemented by international agencies continue to adopt standardized scales and Western models of mental health while remaining silent about other urgent issues: organized state violence in modern democracies (torture, the tragedy of ‘‘administrative’’ detention, and so on), humanitarian hypocrisy, and rising discrimination against migrants along nation-state borders (US, Europe).”

“In other words, it is imperative to promote new critical articulations between (politically based) cultural psychiatry or ethnopsychiatry and international collaborative research, by including on the GMH agenda the issue of the devastating impact that technologies of anti-citizenship have on people and their mental health; as does the tragedy of racism, in all its expressions, from ‘‘racial prescription’’ of drugs to the vertigo of racial violence in US and Europe up through what I call the ‘‘crypto-racism’’ of health and other institutions.”

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Beneduce, R. (2019). “Madness and despair are a force”: Global mental health, and how people and cultures challenge the hegemony of western psychiatry. Culture, Medicine, and Psychiatry, 43(4), 710-723. (Link)

MIA Research News Team: Micah Ingle is a doctoral student in Psychology: Consciousness and Society at the University of West Georgia. He has published on therapeutic approaches centering the person-in-context, as opposed to the individualizing medical model, and on the characteristics of people high in empathy. His current interests include the intersection of sociopolitical/economic structures and mental health, individualism in psychology, gender, liberation psychology, and mythopoetic perspectives inspired by Jungian thought.