In the ever-changing landscape of global mental health (GMH), researchers from the University of Copenhagen, Denmark, and Diego Portales University, Chile, urge us to pause and look back.
In a new article, “Toward a new relationship between history and global mental health,” published in July 2023 in SSM-Mental Healtha group of historians, anthropologists, and practitioners argue that “thorough historical analysis” can help the field radically reinvent itself and move beyond its current colonizing psychiatric norms.
The authors, Ana Antic, Gabriel Abarca-Brown, Lamia Moghnieh and Shilpi Rajpal, emphasize the importance of understanding mental health through a historical perspective:
“History can offer much more than just a critique of power relations, and is not just about questioning the values and ethics of practitioners. Most importantly, it is not intended to paralyze practitioners who engage in valuable mental health care by reminding them of historical examples of psychiatric abuse or the colonial past of global mental health. Quite the contrary, our historical perspective invites us to reimagine a new future for health and healing by drawing attention to alternative practices of illness and healing in many sites around the world. A source of alternative ideas and initiatives in mental health and madness, the story can foster a new imagination for global mental health that moves beyond existing frameworks of psychiatric representations and toward truly radical and egalitarian projects and relationships .
The newly published article highlights the vital connection between historical context and current challenges in global mental health (GMH). It highlights the often overlooked but deeply intertwined history of psychiatry and its implications for modern practice. The authors suggest that a comprehensive understanding of history is essential to resolving existing dilemmas in global mental health.
This nuanced perspective can not only broaden discussions around core concepts such as illness, suffering, care, and culture, but also help address the power imbalances inherent in colonial and postcolonial dynamics. The short communication briefly addresses four topics.
“Historizing global mental health: refocusing the history of patients, actors and expertise beyond the countries of the North.”
The authors argue that global mental health, while frequently grappling with its history, fails to conduct in-depth and comprehensive historical analysis to be truly meaningful. Instead, GMH only refers to its past as a “cautionary tale”, something to be avoided, rather than something to learn from and build on, which should remain present in daily practice GMH professionals.
“A deeper historical perspective has the capacity to broaden the debate about the creation of GMH. It draws new relationships between social institutions, care practices and actors, developing new analytical constellations likely to disrupt traditional psychiatric, clinical and public health frameworks.
Historical analysis of global mental health often presents a linear narrative, setting aside the deeper historical nuances and implications of colonial-era psychiatry. Traditional research on the GMH has been criticized for its overly simplistic historical context, drawing disturbing parallels with colonial oppression. A holistic historical approach can reveal the complex interplay between institutions, care practices and stakeholders, thereby challenging conventional views. It has become increasingly important to focus on the experiences of patients, promoting their role as full contributors to the understanding and development of psychiatric care. Additionally, the contributions of mental health professionals outside the Global North are increasingly recognized, debunking the myth of one-way knowledge transfer. Adopting this broader historical perspective can foster a richer and more diverse global understanding of mental health.
“Decolonial Histories: Politics and Power in Global Mental Health”
A deeper historical approach to global mental health (GMH) can help the field identify and move away from colonizing foundations by reframing the field. The authors suggest that instead of attempting to remain apolitical, GMH actors need to understand how their global political views have been shaped by a history that has harmed people with mental illnesses and psychosocial disabilities in the majority world (South). Therefore, they ask GMH practitioners and scholars who aim to bridge the “therapeutic gap” to consider this question.
“By closing the ‘gap’, does this also reproduce problematic (colonial) political legacies through Western notions of personhood, culture, spirit and suffering?
Colonial histories significantly influence global mental health (GMH), particularly in relationships between the world’s north, south, east and west. Despite its efforts to combat inequality, the GMH Movement often reflects ideas from the colonial era. Historical insights, such as the shift in psychiatry after World War II, highlight the continuing impact of colonial perspectives in current GMH discourse. It is crucial for GMH to recognize its political roots and critically evaluate whether it unintentionally perpetuates colonial biases.
“Rethinking cultural difference in mental health”
In this section, the authors explore how legacies of colonialism exist across cultures and how some cultures and scholars have attempted to resist these legacies in the past.
For example, “…Lesser-known Eastern European psychiatrist Vladimir Jakovljevic attempted in the 1960s to counter the colonial legacy of psychiatry and medicine in Guinea by introducing Marxist psychiatric and psychoanalytic concepts to Guinean mental health trainees. »
An in-depth analysis of the role of “culture” in global mental health reveals its complex implications, from barriers to access to symptom expression. Some efforts to incorporate cultural perspectives risk oversimplifying or echoing colonial biases. Historical examples, such as the blending of Western psychiatry and local traditions, offer insight. To gain a holistic view, researchers should probe the colonial connotations of “culture” and understand its historical power dynamics in health. This approach can pave the way for patient-centered healing.
“History as a source of alternative reconfigurations of illness and recovery”
The fourth and final topic emphasizes the importance of history in driving innovation and radical thinking within GMH. The authors note that historical analysis should not hinder GMH’s progress but can help it move forward and avoid repeating past mistakes. Additionally, story can do even more than that, as it can help GMH become:
“…an inspiring and creative exercise that highlights alternative (and forgotten) solutions, geographies and ways of thinking – which allow the field to engage with actors, ideas and structures outside the boundaries of the psychiatry. This opens new horizons for understanding mental illness, healing and its relationship to culture, social/political equality, justice and well-being.
Delving into history can provide new perspectives on current global mental health challenges. By studying various previous treatments, such as the experiments of Frantz Fanon or the community health projects in Chile, we can discover new tools and perspectives. Instead of repeating old mistakes, a historical perspective reveals alternative solutions, promoting a holistic approach to mental health that takes into account cultural, social and political dimensions.
Global Mental Health Sorely Needs radical change. To go beyond medicine And psychiatric interventionswe must integrate the perspectives of Global South. This change cannot come soon enough, as GMH still faces challenges in meeting the social and structural determinants distress and effectively scaling His efforts.
****
Antic, A., Abarca-Brown, G., Moghnieh, L. and Rajpal, S. (2023). Towards a new relationship between history and global mental health. SSM-Mental Health100265 (Link)
