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Is the agenda for global mental health a form of cultural imperialism?
  1. Gavin Miller
  1. Correspondence to Dr Gavin Miller, School of Critical Studies, University of Glasgow, 4 University Gardens, Glasgow G12 8QQ, UK; gavin.miller{at}glasgow.ac.uk

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The contemporary agenda for global mental health has met with sustained criticism from some commentators. This article evaluates one important strand of such appraisal: that in which the dissemination of Western mental health expertise is disparaged as a form of cultural imperialism. Derek Summerfield has vigorously criticised the contemporary global mental health agenda—a manifesto exemplified by WHO's 2008 document mhGAP, an ‘action programme developed for countries especially with low and lower middle incomes for scaling up services for mental, neurological, and substance use disorders’.1 The programme proposes interventions designed to close various ‘treatment gaps’ between high income countries and low or middle income countries (LMICs). mhGAP cites, for example, a survey showing that around 80% of people with serious mental, neurological and substance abuse disorders in so-called ‘less-developed countries’ had received no treatment in the previous 12 months, set against a proportion of ‘35–50%’ for the same group in ‘developed countries’ (p. 7).1 Summerfield stringently criticises this kind of manifesto, arguing that such ‘psychiatric universalism risks being imperialistic’.2 Scaling up psychiatric services to close the presumed gap in mental health provision extinguishes local ways of expressing and dealing with distress, replacing them with particularly Western ways: ‘in globalising Western mental health, we are globalising a contemporary Western way of being a person’ (p. 5).2

In a similar vein, Ethan Watters objects to the spread of Western psychiatric models: Americans have been industriously exporting their ideas about mental illness. … they've failed to foresee the full impact of these efforts. It turns out that how a people in a culture think about mental illnesses—how they categorize and prioritize the symptoms, attempt to heal them, and set expectations for their course and outcome—influences the diseases themselves. In teaching the rest of the world to think, they have been, …

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