How Western Psychiatry Harms Alternative Understandings of Mental Health

An anthropological look at the Global Mental Health (GMH) movement suggests several ethical problems and contradictions in its mission.

Micah Ingle, MA
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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.

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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)

12 COMMENTS

  1. There was never any need to spread Christianity to all “those” heathens, and so there is no need to spread more moral garbage, again to those uneducated heathens.
    We are all going to pay sooner or later for always knowing what is best for everyone else.
    It says in the bible, for man to have dominion over all creatures of the earth.
    But then it was written after man had already done so and psychiatry and politicians took it one step further, to include those men who crawl on their knees.

  2. Yes, but who gonna understand this? The psychiatrists have already chosen to be on one of the two side, the side of Truth or side of Falsehood. Unfortunately, the majority for the latter.

    The public has sort of religious trust in doctors, falling to their manipulation.

    I’m sorry to say, but such message as the one of this article has little good ending, as it addresses the reason, which most people avoid to use.

    Unfortunately, it seems to me that the way things can be changed is by constant demonizing of the psychiatry and psychiatric science. Only this way people will start realizing there is something wrong with this discipline

  3. I’m glad there are “professionals” speaking out against the insanely stupid idea of exporting worldwide, today’s failed, “invalid,” “unreliable,” and “bullshit” DSM psychiatric paradigm.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
    https://www.wired.com/2010/12/ff_dsmv/

    There are lots of excellent points in this blog, relating to the flaws of the current psychiatric paradigm, and why it should be eliminated, rather than exported and magnified. I’d like to add to these “problems associated with western psychiatry’s hegemonic grasp over global mental health.” The fact that the theorized two “most serious DSM disorders,” “bipolar” and “schizophrenia,” are both likely primarily iatrogenic illnesses, created with the psychotropic drugs. The ADHD drugs and antidepressants can create the “bipolar” symptoms. And the neuroleptics/antipsychotics can create both the negative and positive symptoms of “schizophrenia,” via NIDS and anticholinergic toxidrome.

    https://www.alternet.org/2010/04/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america/
    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
    https://en.wikipedia.org/wiki/Toxidrome

    And as you point out, psychiatry regularly denies depressing events can cause depression, and instead they blame their clients’ brains, via their debunked “chemical imbalance theory.” And this is particularly true when the issues include social atrocities such as “mass rape, other large-scale violence, poverty, hunger, and the destruction of […] social fabric.”

    But their cover up of child abuse and rape is a huge societal problem, given that today “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).”

    The psychologists have been systemically profiteering off of covering up child abuse and rape for over a century, too.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo

    And all this psychological, psychiatric, social workers, and therapist child abuse covering up is by DSM design.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    Our “mental health” workers’ systemic, illegal, child abuse covering up has, of course, aided, abetted, and empowered the pedophiles. Resulting in Western civilization now having enormous pedophile and human trafficking run amok problems.

    https://www.nytimes.com/2018/04/11/us/backpage-sex-trafficking.html
    https://worldtruth.tv/putin-the-west-is-controlled-by-satanic-pedophiles/
    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT
    https://community.healthimpactnews.com/topic/4576/america-1-in-child-sex-trafficking-and-pedophilia-cps-and-foster-care-are-the-pipelines

    America really should not export our multibillion dollar, primarily child abuse and rape covering up, “mental health” system. We should fix, or wiser yet, eliminate our bad – and actually scientifically irrelevant – “mental health” system instead.

    • It is that Rachel.
      Or else it would not invade every part of the government services.
      It is quite the costly enterprise they have going on. It has nothing to do with health of a nation or it’s people.
      I think inside the government are people who realize, just as some within psychiatry does.
      But like highschool, it is always more important for them to think they hold some importance/status, and their paycheque.
      I never realized the amount of callous people in this world, until I got older.

    • There has always been an element of that.

      I did a tour of the old Aradale psychiatric hospital and the adjacent prison for the criminally insane. It interested me to see that the “Cheif Psychiatrist” was very much a part of a power clique along with senior police and the senior forensic pathologist.

      However, for all that a few get involved in power games- that is only a tiny minority. I’ve had to see psychiatrists since a first onset of hypomania at age 27- so I have had close relationships with many psychiatrists, both as a patient and as a referring doctor. Most of them are highly skilled professionals, and I would be in a much worse position but for their professionalism, so I do not think it is right to demonise “psychiatrists” as a set.

  4. Thanks for the article, it is a very helpful read.
    One section stood out for me:
    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?”

    The impairments associated with PTSD are well known- especially in areas of family and work history.
    If it is left untended it has the capacity to cause serious harms, so when we see a patient we are obligated to do the best that we can to minimise their symptoms and maximise their function.

    EMDR is also a powerful tool, one which does not require medications, and one that can be used safely and effetively.

    To me, the biggest question is how we can make it stick in a currently traumatising environment, to the point where our client is calm and functional in the environments that he/ she has to confront in their life.

    EMDR does not seek to cure traumatic history, it seeks to stabilise harmful reactivity in a client whohas not been able to do it for himself.
    The trap here is the nature of the traumatising environment. Even after an effective course of EMDR- ending them out back into a traumatising environment with the risk of retraumatsation.

    In that scenario, EMDR therapy would not be complete without some work on ego strengthening.

    • “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.”

      Perhaps the belief in healing is more important in the one affected. I find belief fascinating. I find it fascinating that we advertise something to someone, even though we might not have used a product.
      Some years back I went to another talk therapy and in her office I saw she was an EMDR practitioner and I tried it and wound up with a searing brain headache. it was different than any headache I ever experienced.
      It felt like a massive inflammation and I could not seem to impress upon her, just how bad it had been.
      So I dropped the EMDR.
      I did a lot of research online, forums, users experiences and therapists experiences and came to the conclusion that most likely I might not want someone to ‘mess’ with my brain.
      There was always part of me that actually went to therapists to hear the words that I was okay.
      I needed confidence that I was okay, yet always felt pressured to say I was not okay, after all I was at a “therapist”.
      There is a belief spread, that if I am not comfortable, it must be within me and to a degree that is true, yet so black and white.
      All kinds of theories are out there, and we use those theories on people’s brains.
      Obviously if I attend a healing circle in a vulnerable state, and everyone dances around me in grass skirts beating drums, in order to heal me, it will have an effect on me. But all it might do is further the “belief” that I need to be healed.
      The belief stemming from a discontent, an uncomfortable feeling, and a construct in society that supports my belief of illness.
      I could come up with my own theories that involve someone sitting in my office and use my theories upon that person, but it does not equate to no harm.
      I can go to a school and see a 6 year old child being discontent, “misbehaved”, different, sad and give my labels upon that child and start treating that child with mild risperadol, Ritalin, EMDR. Some might say we should also treat the parents.
      The reason we do this is because if 10 people act or feel one way, the problem must arise out of that one who is different. But to act in a “therapeutic” manner upon another, with therapies that are all really just experiments and a lot with ABSOLUTE harm, is simply witch doctoring, and in today’s day and age, should be seen as unethical.
      We must continually ask WHY we have so many more ill, and so many theories and treatment and IF in fact they “worked”, it would not be this way.
      So is the belief in illness the real issue? I believe that it is the environment of beliefs and the one who is apart from the system of those beliefs that create more discontent.
      Throughout history, which by the way has shaped us, society’s beliefs have been horribly damaging for many people, and we discover later that societal beliefs were wrong. A belief should never end up in more damage, THAT is how I distinguish a false paradigm from a helpful one.
      For every proponent of a theory or fix, we can find it’s opposite.

      http://tara-miller.com/emdr-trauma-treatment/

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