The movement for global mental health (GMH) has been gaining momentum, targeting the scaling up of psychiatric interventions, particularly in low and middle-income countries or the Global South. However, a recent research paper by Peter Beresford and Diana Rose suggests that the field of Mad Studies is needed to challenge this movement to rethink its approaches and truly decolonize mental health practices.
Peter Beresford, a Visiting Professor at the University of East Anglia and Co-Chair of Shaping Our Lives, and Diana Rose, a Distinguished Honorary Professor at the Australian National University, conducted a detailed analysis of the current dynamics of global mental health. They argue that the prevailing Western-centric model, which medicalizes and individualizes mental distress, may actually exacerbate the problems it aims to address.
“Mad Studies,” Beresford and Rose write, “could be well placed to challenge GMH, because it constitutes such a clear break from it and its colonialist history. It speaks to the observation of the African-American feminist Audre Lorde that ‘the master’s tools will never dismantle the master’s house,’ offering the possibility of an alternative.”
“Mad Studies helps us to see the relations of madness with society, and its maddening effects, as well as the interconnections of ‘mental health’ with colonization.”
The authors question the globalization of Western psychiatry, which gained momentum after the collapse of the Soviet Union. They draw upon the work of China Mills, who raises critical questions about the universalization of Western psychiatric practices. Beresford and Rose suggest that decolonization of mental health is necessary, taking inspiration from Mills and writers from the Global South who advocate for the resurgence of local epistemologies and cultural contexts in understanding and responding to mental distress.
The study highlights examples such as Jessica Horn’s use of African feminist principles to address trauma and Joseph Gone’s work on intergenerational trauma in First Nation communities. These cases demonstrate that Western constructs like Post Traumatic Stress Disorder may not effectively translate across cultural contexts.
Beresford and Rose also emphasize the critical role of activists and knowledge-makers with psychosocial disabilities in the Global South. By shifting the focus from a dominant Western lens to a more diverse perspective, the authors hope to center the voices and experiences of individuals with psychosocial disabilities in the global mental health discourse. They argue that this shift from discussion to action can ignite meaningful change.
The authors also address the broader context of mental health and its relationship to neoliberalism, a dominant political ideology characterized by free-market economics and reduced investment in welfare services. They criticize the individual-centric explanations that dominate psychological understanding and advocate for social interventions rooted in principles of social psychiatry. This perspective counters the trend of pharmaceutical-driven responses to distress, which they see as an alliance between psychiatric approaches and neoliberal politics.
While the globalization of mental health has been praised for its efforts to provide beneficial psychiatric systems to underserved populations, critics argue that it perpetuates the impoverishing tendencies of neoliberalism, particularly in the Global South. In addition, they point out the neo-colonial underpinnings of this endeavor and highlight the effects of colonial legacies, such as violent separations, intergenerational trauma, mental distress, and suicide, which are evident globally.
In parallel, psychiatry in the Global North faces growing scrutiny, with radical and critical practitioners denouncing it as oppressive, discriminatory, and lacking sufficient evidence. The survivor movement, rooted in the 1970s, aligns with other social movements advocating for rights-based social and cultural change, individual and collective self-advocacy, and attention to social context and power.
Through organizations like Survivors Speak Out, survivors of psychiatric systems have put forth demands that include valuing lived experience, non-medicalized crisis support, legal protection, an end to discriminatory practices, and independent monitoring of pharmaceutical use. These demands challenge prevailing neoliberal and psychiatric ideologies in global mental health, and their intersectional and international focus poses a growing challenge to the status quo.
While the survivor movement originated in the wealthier Global North, its influence extends to the Global South. However, it is essential to acknowledge the unique experiences and pressing issues in the Global South and avoid homogenizing the region. Limited psychiatric resources in the Global South necessitate a different kind of resistance and call for an adjusted approach to “Mad Studies,” an academic examination of mental health issues through the lens of lived experience.
Beresford and Rose caution against overlooking the structural violence inherent in psychiatry, such as forced treatments and neglect, and the neglect of racial aspects within the field. The survivor movement rejects the medical model of mental illness and advocates for a social approach that recognizes the diverse social determinants of distress. In the Global South, the term “persons with psychosocial disabilities” is gaining acceptance.
In the quest for decolonization, the article identifies a significant intersection between Mad Studies and survivor approaches to knowledge development, particularly regarding the value placed on “lived experience” and experiential knowledge. This paradigm challenges the traditional emphasis on objectivity and neutrality in research methods. However, the deeply entrenched attitudes in the psychiatric system and academia often discredit experiential knowledge due to perceived subjectivity, leading to epistemic injustice and inequality.
Mad Studies, emerging from the survivor movement, offers a radical departure from conventional attitudes toward mental health and challenges global mental health paradigms and their colonialist history. It centers on survivor-led philosophy and experiential knowledge, promotes collective and social understanding of mental health, and questions the bio-medical model of mental well-being.
The article acknowledges criticisms of Mad Studies, including perceived elitism, an overemphasis on academic perspectives, and the use of the term ‘Mad.’ However, its proponents highlight its evolving nature and recognize the need for continual development, exploration of tensions, and the creation of alternative critical spaces for inquiry and support.
As Mad Studies is adopted in different cultural contexts, particularly in the Global South, it grapples with the complexities of regional differences and the incorporation of indigenous concepts. The article emphasizes the importance of identifying points of connection between Mad Studies and knowledge-making in these regions, critically analyzing Western notions of ‘Recovery’ and appreciating indigenous concepts. The United Nations Convention on the Rights of People with Disabilities (UNCRPD) is also highlighted as a significant influence in the Global South, promoting ideas of independent living, inclusion, and equal rights for disabled individuals.
Advancing Mad Studies requires recognizing regional differences, understanding indigenous concepts, and critiquing Western individualistic discourse. By fostering a more inclusive and equal dialogue between activist movements in the Global North and South, Mad Studies has the potential to redefine our understanding of mental well-being and challenge the existing global mental health paradigm.
Beresford and Rose’s paper makes a substantial contribution to the critical evaluation of global mental health. Its impact will be seen as it influences discussions and actions toward a more culturally sensitive and locally appropriate approach to mental health.
Beresford, P., & Rose, D. (2023). Decolonising global mental health: The role of Mad Studies. Global Mental Health, 1-15. Advance online publication. https://doi.org/10.1017/gmh.2023.21 (Link)