Situating Global Mental Health: Sociocultural Perspectives

Ross G. White, David M.R. Orr, Ursula M. Read, and Sumeet Jain

Understanding the Emergence of Global Mental Health

Dating back through the millennia, much evidence bears witness to the fascination that humankind has had with endeavouring to understand the reasons for unusual or aberrant behaviour. For example, in the fifth century BCE in Greece, Hippocrates refuted claims that ‘madness’ resulted from supernatural causes and suggested, instead, that natural causes were responsible. In the intervening years, there has been a waxing and waning of various explanations of madness, including humours (i.e., blood, yellow bile, black bile and phlegm), the divine, the diabolical, the biomedical, the psychological and the social. Across time, geography and cultures, different labels and systems of classification have been employed to categorize manifestations of madness.

R. G. White (*)

Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK D.M.R. Orr (и)

Department of Social Work, Wellbeing & Social Care at the University of Sussex, Brighton, UK

U.M. Read (и)

CERMES3, Paris, France

S. Jain (*)

School of Social and Political Science, University of Edinburgh, Edinburgh, UK © The Author(s) 2017

R.G. White et al. (eds.), The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health, DOI 10.1057/978-1-137-39510-8_1

Equally a diverse range of reactions have been bestowed upon those experiencing madness, including the trepanning of skulls, burning at the stake, veneration, provision of asylum, moral instruction, exclusion, incarceration, restraint, compassion, exorcism, spiritual healing, persecution, psychosurgeries, medication and psychotherapy. The diversity of these reactions has been influenced by the multitude of ideologies, doctrines and ethics that have shaped peoples’ lives across different contexts.

Contemporary discourses about ‘mental disorders’ owe much to the emergence of ‘Psychiatry’ as a field of medicine. In the early nineteenth century CE, a German physician named Johann Christian Reil first coined the term ‘psychiatry’ (‘psychiatrie’ in German), which was an amalgamation of Greek words meaning ‘medical treatment of the soul’. The early development of psychiatry centred on the contribution of key protagonists based in Europe (e.g., Freud, Bleuler, Jung). As such, psychiatric theory and practice were strongly influenced by European societal attitudes and sensibilities. However, as psychiatrists began to travel to other parts of the world, interest grew in the potential applications that psychiatry might have in diverse cultural settings. A key example of this came in 1904 when the German psychiatrist Emile Kraepelin visited Java to determine whether the diagnosis of ‘dementia prae- cox’ (a forerunner of what was to become a diagnosis of schizophrenia) existed there. This witnessed the birth of a new field of study that Kraepelin referred to as ‘comparative psychiatry’ (vergleichende psychiatrie). In 1925, Kraepelin conducted comparative psychiatric presentations in Native American, African American and Latin American people in psychiatric institutions in the USA, Mexico and Cuba (Jilek 1995).

Questions regarding the incidence of mental disorders in diverse societies and the universality of psychiatric diagnoses have continued since Kraepelin’s work in the early twentieth century CE. However, international comparative epidemiological studies of any size only began during the 1960s with the World Health Organization (WHO)-sponsored epidemiological studies of schizophrenia (Lovell 2014). To this day, many countries lack nationally representative epidemiological data for both low-prevalence mental disorders (such as schizophrenia) and common mental disorders (such as depression and anxiety disorders) (Baxter et al. 2013). The provision of psychiatric treatment as a part of state-sponsored health care systems has also emerged unevenly, with the bulk of investment and innovations in forms of intervention and organization taking place in high-income countries (as classified by the World Bank). When health care systems were introduced by colonial governments in the nineteenth and twentieth centuries CE, mental health was a very low priority compared to public health and the control of infectious diseases. The few asylums constructed were concerned more with public order than treatment, and there was very limited investment in forms of community-based care (Keller 2001). Since independence, the health systems of many postcolonial governments have suffered from weak economies, fiscal deficit and the effects of structural adjustment. In such conditions, mental health care tended to be neglected (Njenga 2002).

Nonetheless, despite the limited global reach of epidemiological studies and of psychiatric interventions, a growing field of enquiry and practice emerged during this period, which came to be termed ‘transcultural psychiatry’. Though this was and remains a diverse field, two notable aspects were the interests certain anthropologists had in cultural influences on mental disorders and societal responses, and the emergence of psychiatrists originating from the Global South who were trained in Europe and were attempting to apply universal diagnoses to local populations. This confluence of anthropologists and psychiatrists, some of whom had been trained in both disciplines, was strengthened after the 1950s by the beginning of large-scale migration from the former colonies to countries of Europe and North America and the growing numbers of patients from diverse cultures in psychiatric services. Academic departments and courses in transcultural psychiatry began to be established, notably at McGill in Canada and Harvard in the USA, and academic journals such as Transcultural Psychiatry began publication. In 1995, some of the most influential anthropologists in transcultural psychiatry based at Harvard University, including Arthur Kleinman, published a book entitled World Mental Health: Problems and Priorities in Low-Income Countries (Desjarlais et al. 1995). This volume set out the concerns regarding human rights, lack of treatment and rising incidence of mental disorders in terms that in many ways set the agenda for what was later to be termed ‘Global Mental Health’ (GMH). Six years later, the WHO brought renewed attention to mental health by making it the topic of their annual ‘World Health Report’ for the first time in its history (WHO 2001).

The term Global Mental Health was first coined in 2001 by the then US Surgeon General, David Satcher. Reflecting on the publication of the 2001 World Health Report (WHO 2001) and a year-long campaign by the WHO on mental health, Satcher (2001) proposed that the USA should bring mental health onto the global health (GH) agenda by ‘taking a leadership role that emphasizes partnership, mutual respect, and a shared vision of improving the lives of people who have mental illness and improving the mental health system for everyone’ (p. 1697). GMH was given additional visibility through the launch of The Movement for Global Mental Health (MGMH). The MGMH traces its origins back to the consortium of experts that constituted The Lancet Group for GMH (2007, 2011), and who published a range of papers to highlight the need for action to build capacity for mental health services in low- and middle-income countries. The MGMH now has a membership of around 200 institutions and 10,000 individuals ( Over the last 15 years, GMH has evolved from its embryonic roots to establish itself as a field of study, debate and action, which is now latticed by diverse disciplinary, cultural and personal perspectives. This has resulted in the term ‘Global Mental Health’ being employed strategically in different ways, for example, as a rallying call for assembling a movement of diverse stakeholders advocating for equity in mental health provision across the globe (i.e., MGMH); a target for critical debates around the universal relevance of mental health concepts and the globalization of psychiatry; a focus of academic study (such as postgraduate programmes in GMH), and a topic of research that has precipitated dedicated funding streams (e.g., by organizations such as Grand Challenges Canada).

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