Historical and ethnographic perspectives on the emergence of global mental health
12-15 juin 2017
Villa Finaly, Florence, Italy
Organizers: Anne M. Lovell, Claudia Lang, Ursula Read
This workshop brings together historians and anthropologists to analyze the processes through which psychiatric disorders have come to occupy a major place within the global health agenda and how the activities and interventions of global mental health networks today translate into practical knowledge in particular contexts.
In the period following World War II, tropical diseases and worldwide infectious disease epidemics dominated the nascent World Health Organization's agenda and international aid efforts. Early interest in mental illness outside the global North largely constituted a sort of "epidemiological primitivism". The emerging discipline of transcultural psychiatry examined culturally variant expressions of aberrant behavior in so-called ‘simpler’ societies, from which was culled the construct of ‘Culture-Bound Syndromes’ which still holds currency today. The colonial legacy of the asylum remained intact in much of the developing world, although scattered "developing-developed world" encounters in Africa and Asia focused on the potential of local healers, family care, and the ‘psychiatric village’. Much of this history and what was at stake for whom has yet to be uncovered.
By the early 1960s, the development of an international psychiatric epidemiology at the WHO and the subsequent schizophrenia and other epidemiological studies provided a language and an institutional visibility through which psychiatry could become incorporated into international health policies and practices. Yet despite such international research and the marketing of pharmaceuticals as targeting specific mental disorders, mental health ranked low among WHO’s priorities. In a decolonizing world, a more pragmatic stream of knowledge-production centered on adapting psychiatric treatment to the contexts of "developing countries", through low-cost innovations such as the invention of traditional healers as collaborators and the delivery of treatment through primary health care. These approaches reflected the rejection of institutional care and a view of the 'community' as a "natural" locus of support. In some regions biomedical psychiatry and psychoanalysis encountered pre-existing medical traditions. However, the productive friction engendered and the involvement of psychiatrists and scientists from the global South in the production of knowledge and policy internationally remain understudied.
In the 1990s the advent of a new metrics - the Global Burden of Disease - propelled mental disorders to the top of international disease rankings with depression, in particular, ranked among the leading causes of the collective ‘disease burden’. This visibility, alongside the epidemic view of mental illness, the expansion of psychiatric diagnoses, and public awareness campaigns, generated new sites for intervention and expanded markets for psycho-pharmaceuticals. At the same time, the notion of ‘well-being’ has become linked to the language of the economy and generated new forms of ‘self-care’. More generally the era of ‘global health’ since the 1990s is characterized by shifts in goals, perspectives and organizational actors. With the increasing influence of the World Bank, mental health has become absorbed into a broader concern with improving health as an economic good through scalable, cost-effective and evidence-based interventions.
The primary provider of health care has shifted from the state to multilateral government and public-private partnerships and public funding is giving way to corporate philanthropy and donor aid. Domains of expertise formerly limited to scientific and administrative experts now legitimate non-governmental organizations and civil society groups as actors in mental health policy, funding, and service delivery. Across these three hypothesized periods, experimentality at the intersection of North and South has contributed to the construction of psychiatric knowledge, with differential impacts on psychiatric traditions in the global North and on modernizing forms of older traditions such as Ayurveda and Chinese medicine. Each of these periods is also traversed by the problematics of psychiatric classification and debates regarding the best approach to treatment. Within global disease metrics, psychiatric categories are taken as if they have stable referents, despite ongoing critiques. Likewise, concerns are expressed regarding the standardization of treatment, the increasing medicalization of emotional life, and a disregard for structural context. The vision of ‘community mental health’ has scarcely been fulfilled, hampered by the weakness of health systems in many parts of the globe, as well as insufficient interrogation of what ‘community’ might mean in different settings, particularly in contexts of urbanization, rising migration, family dispersal, and increasing pressures on household budgets. More recently, efforts to apply a rights-based agenda have promoted new forms of solidarity as persons with ‘psychosocial disabilities’, as well as reinvigorated longstanding controversies over involuntary psychiatric treatment.
The present century has witnessed the materialization of something called ‘global mental health’, defined by shared practices, principles, tools, and models of biomedical and psychosocial treatment. Yet the multi-directional movement of actors, knowledge, tools, therapeutics and models of practice redefines positions and hierarchies, peripheries and centers, expertise and patient-hood, creating resistance and critique as much as homogenizing difference. We aim to explore and analyse the processes through which mental health is made visible over time in diverse settings, and the translations, improvisations, hybridisations and rejections which reshape global mental health as it travels.
This workshop welcomes papers exploring these themes, including:
(a) historical processes, what was at stake, for whom, and with what outcomes;
(b) intersections of colonialism and post-colonialism with the regimes of international health and global mental health
(c) the relationship of psychiatric epidemiologies or "epidemiological styles of thought" and new health metrics to these processes;
(d) materialization of regimes of psychiatric knowledge and practice in different localities, regions and virtual spaces, and processes and practices of hybridization, improvisation, translation and resistance.
(e) specific therapeutics and systems of mental health care delivery, including the pharmaceuticalization of treatment, different uses of "traditional" therapeutics, the objects of standardization, the actors of mental health (patients, clinicians, nurses, social workers, volunteers, peer workers etc.)
(f) the economies of global mental health (moral economies, constructions of cost-effectiveness, scalability)
(g) the changing status of the person (moral, empirical, psychological) under the different regimes of mental health governance