Researcher Critically Examines Movements for Global Mental Health

China Mills raises concerns that global mental health movements obscure social determinants of health and naturalize Western mental health concepts.

Zenobia Morrill
22
900

Dr. China Mills, researcher and author of the book “Decolonizing Global Mental Health: the Psychiatrization of the Majority World,” takes a critical approach toward recent attempts to globalize mental health diagnoses and treatments. By prioritizing Western psychiatric understandings of suffering, such movements disregard local knowledge and locate problems within individuals, she argues. As an effect, the focus is shifted from ameliorating harmful social policies and patterns, such as poverty, to treating individuals’ biochemistries.

Mills argues that this approach to global mental health, “obscures and naturalizes structural determinants of distress, disablement, and impoverishment; … and narrowly frames global populations as amenable to the increasingly globalized knowledge systems and practices of the psy-disciplines (psychiatry, psychology and psychotherapy) and psycho-pharmaceuticals.”

Photo Credit: Flickr

The recent inclusion of mental health priorities within UN development goals comes after criticisms that mental health has been excluded and overlooked as an impediment to development. Addressing mental health went from being an invisible development issue to one of pressing importance, explicitly outlined as urgent.

While Mills acknowledges the benefits of this inclusion in the UN’s Sustainable Development Goals (SDG), she also argues that a more nuanced examination of its drawbacks is necessary.

“The successful inclusion of mental health within the SDGs should be celebrated for bringing much-needed policy attention to mental health,” she writes. “However, it is important to take this opportunity to engage critically with both mental health and development so as not to reproduce the power inequalities and harmful practices each has been associated with at a global scale.”

In her paper, Mills outlines how mental health came to be at the forefront of development goals initiatives. She takes a nuanced approach to deconstructing their content (e.g., how suffering and solutions are predominantly described through psychiatric frameworks) as well as the harmful implications that may arise from these initiatives.

Within these globalizing movements, such as “The WHO’s Comprehensive Mental Health Action Plan 2013-2020,” “mental disorders” are framed as disabling to individual productivity and to national and international development. The argument made is that development initiatives ought to invest in mainstreaming mental health interventions and strategies on a global scale to reduce stigma and lessen the economic burden of mental disease.

Yet, what Mills points out is that these interventions and strategies have been derived from Western, psychiatric contexts. Namely, that suffering is understood as an “illness” or a “problem.” Little room is dedicated to exploring the limitations of Western conceptualizations and strategies, or the benefits to privileging local ones.

“The language/s available within a culture provide the conceptual tools with which to name, understand and act on experiences, and are thus central to discussions of what comes under the rubric of psychological or emotional well-being,” Mills explains. “Thus, how an experience is named, for example as ‘illness’ or as ‘distress’, has material effects on possibilities for action.”

“Many critics writing from the global South emphasize that the export of understandings of mental health (and associated models of service) from North to South damage the social fabric of local ecologies of care and support by discrediting and diverting resources away from localized, culturally valid forms of healing.”

One important consideration involves asking: Does using a medical explanation of suffering help to decrease stigma and thereby promote social support and healing? Mills highlights research demonstrating that this is not the case. Biological and brain-based explanations may actually increase the stigmatization of people experiencing distress compared to explanations that emphasize suffering caused by social circumstances or trauma.

While mental health is described in mostly medical terms within these initiatives, “development” is a word used throughout, that also contains various definitions, none of which are clearly defined throughout the campaigns. This is significant, argues Mills, because development goals have historically been criticized as promoting Western ideals too, such as the privileging of capitalism and neoliberal economics that seek to privatize resources and enable the perpetuation of neocolonial practices.

Mills makes a case that these critiques need to be considered before these initiatives begin hastily applying psychiatric frameworks on a global scale. She examines the conflation within these campaigns between neurological disorders, such as epilepsy and dementia, with so-called “mental disorders,” such as depression and anxiety; the claim that “mental illness” is chronic and debilitating, requiring life-long management; and, importantly, the underlying argument that depression, and other mental disorders, are threatening productivity and constituting a costly economic burden.

Additionally, Mills further examines the connections drawn between mental health and poverty.

“The positive association between poverty and mental health problems is ‘one of the most well-established in all of psychiatric epidemiology’ and key to making the case for the inclusion of mental health within the SDGs. Yet, despite this, there is little conclusive evidence about the nature, direction and mechanisms of the relationship between mental health and poverty, which is usually conceptualized as a vicious cycle.”

When SDGs and similar movements frame poverty as a risk factor to mental disease or as an outcome of mental disease, a deeper analysis that might urge systemic reforms is lost when the emphasis is placed on individual treatment for pathology. Mills illustrates this point:

“A central implication of this is that interventions tend to steer towards treating mental disorder to reduce poverty, rather than toward making the structural changes that would eradicate poverty.”

Alternatively, Mills suggests that we consider policies directed toward addressing income inequality, but also those acknowledging the various ways in which “living and working conditions disable people through the production of impairment (injuries, exhaustion, stress).”

Finally, she touches upon what she refers to as “the emerging market of ‘mental disorder,’” calling attention to criticism of the uncritical promotion of pharmaceutical interventions above others. This is particularly concerning when the global South has been identified as an “untapped and emergent” opportunity for promising pharmaceutical sales growth.

“The huge financial incentive to frame distress as ‘mental disorder’ treatable by medications, alongside the widely documented unethical practices of the pharmaceutical industry — including concealing adverse effects of drugs found in clinical trials and testing potentially harmful new products on people living in poverty — marks a central area of contention for calls to mainstream mental health within development and warrants further exploration.”

Overall, Mills’ work adds to ongoing conversation and debate surrounding the complexities involved in globalizing psychiatric frameworks. She summarizes:

“The article highlights the urgent need to foster a more nuanced understanding of the interplay between mental health and development, and shows how, at times, interventions in the two fields work together in producing reductionist, economistic, individualized and psychologized responses to poverty.”

“Now is the time for multiple stakeholders to engage in critical interdisciplinary debates about mental health and development, avoiding the often simplistic take up of one by the other.”

 

****

Mills, C. (2018). From ‘invisible problem’to global priority: the inclusion of mental health in the Sustainable Development Goals. Development and Change49(3), 843-866. (Link)

22 COMMENTS

  1. I rejected psychiatric terminology, because this is not a psychology, this is just empty nominalism, and fixation over the brain, flesh, without psychological background, which is the essence, This flesh preoocupations is a dangerous NAZI heirloom. I really do think that every kid in USA or Europe should read James Hillman Re – visioning psychology.
    There is no psyche without mythical reality. If apollonians will ignore hades traits, and treat it as a LETHAL danger to the material reality, Hades will destroy it, as a consequence. And believe me that state is sth which can be destroyed by psychosis the same way ego is being destroyed. Apollonian reality is easy to break, because the psychosis is a psychological rape. And the psychological rape is the essence of the psychosis, and this is far more dangerous than depression.

    Hades can rape state, the same way he raped naive and brainless Persephone. Europe is in psychosis now, we have lost ground, psychological roots, identity. F 33 will not help if psychiatry/society will reject the phenomenological truth behind diagnosis. Mental health in contemporary meaning is a very dangerous ideology, this is sort of antipsychological fixation. Psychological racial purity. Normalcy is not sth noble. Never was, I guess.

  2. One of the fundamental problems of Africa is the lack of electricity: how do you want to develop a business if at any time there can be a power cut? It is the same for all infrastructure components: road networks, digital networks, financial networks, commercial and industrial relations: capitalism develops in synergy, all elements are interdependent and develop organically, most often centrally around of the state, in a planned way.

    And during this time, mentally deficient psychiatry tell us: “And if we drugged 10% of the population as in the North, maybe Africa would develop better?”

    This illustrates the utter stupidity, opportunism, predation and sufficiency of the psychiatric industry. In a country that lacks infrastructure, what should you invest in? In the drugs, of course!

    But look at this band of racist colonialists, who tell us that if Africa has not developed properly, it’s because of a gang of degenerate madmen who slow down production! The psychiatric spirit is a veritable mental deficiency, which prevents the very understanding of the most basic foundations of the economy. If only we could give all their pills to these idiots, not only would it rid us of an endemic overproduction of the pharmaceutical industry, but in addition it would definitively reduce them to silence, which would do us the greatest good!

    Psychiatry is a real plague that is about to sweep over Africa and the “emerging” countries. There is overproduction of drugs! If the pharmaceutical industry wants to continue to grow, it has to export its model abroad. It’s that simple! And what does it matter if it produces legions of drug addicts who wander the streets or are locked up in psychiatric hospitals. As if Africa needed this!

  3. Mental health disorders are godsend for mental health treatment workers. What is one to expect? Even if you aren’t selling drugs as treatments, you are selling mental health treatment, and the prerequisite for mental health treatment is a mental health disorder. You have to sell that, too. Sell chronicity, and job security is taken care of. What will you call it? I don’t know. How about the human condition? Yeah, especially as it pays. Uh, it pays mental health workers anyway.

    • Frank, are you not being overly cynical about the expertise of mental health professionals? Might it be worthwhile considering if they want to be ‘treating’ their ‘patients’ effectively and maybe more qualified to know and as often as not equally disgusted at the exploitation of people’s vulnerabilities which drive up Bad Pharmas profit margins. In my extensive experience psyche professionals avoid trying to sell anything, they don’t see themselves as businesspeople but rather as professional carers. If we can take the profit orientation out of psychiatry and allow the experts to do their work we might be all the better for it.
      Of course as a sometime Libertarian DemocraticSocialist I want the enactment of Social-Democratic policies that reduce the possibility of damage occurring to people in the first place and offer resources and support workers who work with people to solve their problems. Broadly equalitarian dispensations being to be proven as more effective than any others tried so far.

        • Boans, I don’t know the meaning your trying to impute, but simply put it seems to me (from examine the evidence) that profit-motives are bad for health and education, justice, welfare, low-cost housing, independent media, research, politics, psychiatry and all sorts of other areas to!

          • Got no issue on the profit motive.

            But if I say God exists, and that he has written in this book here that I am an expert in that you should give me all your money. Would you believe me? I mean, there’s the proof in the book, and your talking to an expert? Or maybe you might want some proof as to the existence of God first?
            Show me a mental illness.

          • So Boans, are you saying that you accept individuals and corporations exploiting human misery in order to profit from such tragedies? Surely such conditions can only motive them to cause such tragedies and misery, don’t you agree? What would you like to happen someday by way of intervention when run over by the proverbial bus?

          • Seen it done whatuser. I have a letter here from our Chief Psychiatrist stating that mental health professionals can travel through time and space, and have the ability to read minds. I had no idea they had such powers.
            I realise you don’t know what I was subjected to, but in order to get me injected with drugs I didn’t need for an illness I didn’t have, a zealot needed to subject me to the use of torture, and then use the response to that as justification to kidnap me.
            Once they had provoked the illness, now they were free to begin ‘treatment’. And he received the full support of his colleagues in this. And what a keffuffle when I still had the proof after they had distributed fraudulent documents and slandered me to anyone who tried to assist me.
            My behaviour at this time was consistent with the vile treatment I was subjected to. Flipping the script is standard operating proceedure where I live.

          • Hi Boans, I am wondering about the sort of activities you engaged in to earn such treatment? But nonetheless you don’t deny that you are happy someone made lot’s of money from the procedure do you? Having been subject to similar procedures myself your upset is understandable but probably misdirected and misplaced.

          • And wonder you may about my activities, suspicion breeds confidence as they say. But while you and others ponder that, there is a crew of organised criminals operating in our hospital, and they have public officers doing their dirty work for them.
            Its a long story anyway, and just one in a huge line of failures on the part of our professionals. The only expertise I saw that day was in the use of negligence, fraud and slander to achieve predetermined outcomes. How could I become a patient before even being seen? Oh thats right, minus doing that it would all be part of a criminal conspiracy to stuoefy and commit an indictable offence, namely kidnapping.
            Or should I say was operating in our hospitals. They are down one as a rwsult of me being ‘switched’ for one of their own (rip) and are playing a double game which can only lead to their demise one would imagine.

          • Am I happy someone made money out of the procedure? Mmmm more that they picked up some valuable resources, and I hope they are used for the right purposes. Vulpes pillum mutat non mores.
            My anger is understandable given those in a position of trust neglect their duty. Negligence is an extreme thing. It was only that I was angry that stopped me from acting, given that I may have misdirected or misplaced that anger. Unto Caesar what is Caesars.
            My delusional belief that I lived in a Nation with a rule of law, and with a social contract where wrongs would be righted as best as possible made me a target for a knife in the back. It will regress and my hope is that they correct their errors. I see no sign of this occuring at this point in time.

      • The “mental ill health” epidemic we are experiencing does nothing but grow. No, I don’t think I’m being overly cynical. If the mental health professional caste were effectively treating their colonized charges, the numbers would go down that do little besides rise. We have, at this point, a “mental illness” manufacture industry operating, and I’m not the person to encourage these types of corrupt and fraudulent business practices. The “mental health” movement is not a “mental health” movement, and it never was a health movement. It is a “mental health” treatment movement. If you equate “mental health” with “mental health” treatment, you are deceiving yourself. The prerequisite, as I said, for treatment is a “mental disorder”. Many of these contemporary mental disorders are little more than inventions of the pharmaceutical industry, and we’ve seen how the largest lawsuits in human history are nothing special to this growing chemical oil rig industry run, of course, by 1 percenters.

        • Thank you Frank. The forces sustaining “mental health treartment”s continued rise are indeed sustained by the current neo-liberal consensus, prioritising profit over people’s needs, wants and ignoring human rights as it does. Sorry for doubting, you are obviously reflecting such cynicisms rather than generating them. My point was merely attempting to respect the intentions of social care employees who might be assumed to respect as much as possible the wellbeing of people attending their clinics for ‘treatment’ – The reasons they find themselves there being of another import. And indeed the profit-motive seems to see recommendations for ‘treatments’ which sustain people in ‘treatment’ pointlessly. It would be a sad day indeed if we damage those systems trying to support people who need such support and end up buying into the marketing scams of anyone responsible for causing and/or sustaining people’s troubles in order to profit from selling ‘treatments’ of dubious provenance!

  4. Excellence article explaining the failure to address the fraudulent epidemic of “mental illness”. Hopefully this finds it’s way to Dr. Darius (UN- SR) who might consider elaborating on the facts, rather than simply making a comment on the need to consider power-imbalances over chemical imbalances and leaving it at that. 

    Its long past time to address the affects of the Social Determinate of Health (SDOH) being mislabeled as “mental diseases’ and the well documented science proving that real diseases caused by poverty, lack of access to decent food, housing, jobs and education are the root cause of the SYMPTOMS being misdiagnosed as if they brain diseases in order to profit from mistreating them and maintaining “medical control” over the lives of millions of people who are psychiatrized because they are suffering from bona fide diseases … the rates of which are increasing across the globe as more and more people are unable to afford to properly care for their most basic human needs (which are also human rights.)