Psychiatrist Vincenzo Di Nicola recently published an article reviewing how the western world approaches mental health interventions. He argues that the fields of psychiatry and psychology have neglected the knowledge and practices of the Global South, leading to misguided assumptions and problematic treatments. Di Nicola questions assumptions of the Global Mental Health (GMH) movement and presents concepts from the Global South such as conviviality, porosity, and syncretism that could improve both local and GMH interventions.
Di Nicola asks: “How can we transform Northern epistemologies based on categories and neoliberalism to the fluid new epistemologies of the Global South?”
“The adequate recognition of injustice and the possible overcoming of oppression can only be achieved by means of an epistemological break . . . with a Western . . . understanding and transformation of the world as universal as opposed to local and particular.”
The Global South
By Global South, the author not only refers to the Southern Hemisphere, but also to so-called “Third World Countries” (as opposed to the “Developed World”), global population shifts from rural to urban spaces along with other migration trends, groups of people who have been historically excluded, and to practices that foster political consciousness. Preceding the “Black is Beautiful” and “Black Lives Matter” movements in the United States, the “Negritude” and “Critical Education” movements in different countries around the Global South sought to increase self-acceptance and self-understanding, through political awareness that counters racist and classist narratives.
Ivan Ilich created the concept of convivality, that countered the Western notion of individuality, by stating that “individual freedom [is] realized in personal interdependence.” Mental health practitioners from the Global South have historically acknowledged social, political, and economic conditions (including colonialism and slavery) as taking center stage in mental health issues and general wellbeing. As a result, programs in the Global South have worked on changing those conditions as part of their mental health interventions.
The process of globalization assumes a trend towards international connections through shifts in national barriers that incorporate and combine the world into a single society. Yet, these assumptions fail to consider how what is often incorporated are Western customs and beliefs from the Global North. For example, while globalization trends seek to understand things as universal (in other words, that what applies in one context can apply in another), it is essential to differentiate between the global (or universal) and the local (or regional).
Critics of globalization also articulate how the naturalistic notions of economic regulation such as the “free market” and “the invisible hand” fall short as nations in the Global South suffer from disparities in information, means, and resources that place them in a disadvantaged position in relation to the global economy – often due to the aftermath of colonialism. Humanitarian efforts and Human Rights, which have been the primary efforts by the Global North in addressing inequality locally and globally, fail to go beyond legal and participatory forms of justice. They typically do not, for instance, propose economic, distributive, and social forms of justice.
In this way, ideas about globalization and human rights often fail to address historical, social, cultural, and political dynamics that have created and perpetuated global inequality.
On Global Mental Health
Global Mental Health, as influenced mostly by the West or the Global North, often fails to take new perspectives, and at times, even with best intentions, fails to adequately address the issues that create or influence mental health issues in the first place. These mental health practices, developed through exclusively-Northern ways of knowing, serve as a blind spot for practitioners and institutions, stymying social interventions “even in high‑income countries.” For this reason, the author writes:
“Ironically, I want to invoke the conservative American President Reagan in his plea to the Soviet President: “Mr. Gorbachov, tear down this wall!” I plead with my colleagues from North and South to tear down the walls of the institution and get out onto the streets of their communities.”
“This is a call to work outside traditional spaces such as institutions, clinics, laboratories, etc., and to go ‘to the people themselves’ who might not have access to- or have trust in these spaces. It is also an invitation to break the barrier that keeps knowledge and practices from the Global South from penetrating the Global North, which would improve Global Mental Health efforts for both sides of the globe.”
For example, in the Global North, the fields of psychology and psychiatry have mostly focused on how individual biological, experiential, and personality factors relate to people’s distress, suffering, and mental illness. Dr. Di Nicola has us reflect on how it could be different:
“…this begs the question of how we are to imagine the broader notion of health itself against its economic, social, and political contexts. Against the current biologism and reductive neuroscience in mental health, the social determinants of health are more well‑established, more durable, and more salient factors of health, including mental health.”
Research in the Global North has focused on the relationship between the brain and mental health, and how or if brain-based interventions (including psychiatric medicine) work. On the other hand, the Global South has developed psychological and psychosocial interventions through the lens of social determinants of health.
From a Global South perspective health is conceptualized not as an individual trait, but as a social and relational quality. The Global South invites GMH to work locally and regionally instead of only globally or universally. It also invites GMH to attend to social and community issues by using knowledge created by the groups who have fought “against the systemic injustices and oppressions… caused by capitalism, colonialism, and patriarchy.”
The author highlights the emerging concepts of conviviality, syncretism, and porosity as critical concepts to be adopted by GMH. As previously stated, conviviality implies that individual and collective health are interdependent. Syncretism “is the co-contemporaneous practice of different religious traditions such as Catholicism and Afro-Brazilian candomblé to create new syntheses of belief and practice,” and exemplifies how the South more easily invites plurality by synthesizing ideas and beliefs. Finally, porosity implies the fluidity of cultures, which further encourages a dissolving of closed categories such as medicine and politics.
This fluidity allows for creativity and spontaneity for the development of new and context-specific GMH practices, as opposed to solidified, institutionalized, traditional forms of mental health practices. As GMH changes, it must also rethink what it means to change. While Northern notions of change imply linear & hierarchical development – often concerning economic change – the South’s concept of change is based on the ability to become different in the face of new challenges and new circumstances.
These suggestions are necessary for the Global Mental Health practitioners and institutions to take up if they wish to include the Global South in the ever-globalizing world. Additionally, it would serve both global and local mental health interventions to think outside the box and find creative solutions and solve problems they have failed to address.
By thinking both globally and locally, universally and contextually, GMH interventions could better serve different regions by addressing global issues that affect specific geographic areas, while understanding the unique challenges to those areas. GMH must intervene in the sociopolitical and socioeconomic determinants of mental health through social interventions, challenging the individual focus of the North.
Di Nicola, V. (2020). The Global South: An Emergent Epistemology for Social Psychiatry. World Social Psychiatry, 2, 20-26 (Link)