by Emma Mathias
“Madness has been and remains an elusive thing … it is equally possible to think in terms of the manufacture of madness, that is, the idea that labelling insanity is primarily a social act, a cultural construct” (Porter, 1987, p. 8)
The World Health Organisation (WHO) (2014) estimates that one in four people across the globe will experience mental health problems at some point in their lives, with an estimated 80% of these people living in developing countries (Jacob and Patel, 2014). With the recent inclusion of mental illness in the Sustainable Development Goals (SDGs), an opportunity has arisen for these individuals to receive increased assistance. The WHO (2001; 2013) estimates that up to 85% of people in developing countries do not receive any treatment for mental illnesses, and has called for international action in order to effectively implement their recommendations on mental health legislation, policies and programmes. There is talk of ‘scaling up’ services with a ‘one-size-fits-all’ applied to mental health services and policies, often without due consideration for the appropriateness of the services that are to be implemented (Fernando, 2016). There is currently a lack of adequate guidelines as to how mental health resources should be utilized in developing countries, and a lack of understanding of mental illness in non-Western cultures in general, making this a difficult task.
There has been a dearth of research to date into the different ways in which mental health is conceptualised in different cultures across the globe. Large discrepancies in the accumulation of knowledge on Global Mental Health issues are glaringly obvious when we consider that approximately 90% of all research is conducted with 10% of the population, mainly within Western cultures (Kirmayer et al., 2014; Sharan, Levav, Olifson, de Francisco & Saxena, 2007). Presuming that the results of studies conducted with Western populations are directly transferable to those from different cultural and social backgrounds may lead to inappropriate service interventions if research is not counterbalanced with a substantial amount of high quality studies in non-Western contexts (Fernando, 2014; Mills, 2014).
A number of researchers (e.g. Fernando, 2014; Mills, 2016; Oloyede, 2002; Ventevogel, Jordans, Reis & de Jong, 2013) have recently argued that a global approach to mental health service provision is likely to do more harm than good, as mental health is socially and culturally determined. Therefore, mental health services need to be developed within the cultural and social settings in which they occur (Fernando, 2014; Mills, 2014). Mental illnesses as we understand them in the West are based on psychiatric concepts that have been developed in the US and Europe since the early 1900’s (see Bleuler, 1913; Kraepelin, 1919). We may be dealing with a ‘basic error of validity’ by assuming that mental health is conceptualised in the same way across all cultures, and this may be counter-productive in efforts to attempt to address the issue (Berg, 2003; Kleinman & Good, 1985; Ventevogel et al., 2013).
The majority of researchers investigating mental health in developing countries have taken a universalist approach, however, starting from the presumption that categories of mental illness are applicable across the globe, and have presumed a biochemical basis for mental illnesses. Many of these studies have attempted to adapt psychological measurement scales to assess the incidences of mental illnesses in developing countries. However, other researchers argue that transferring measurement scales for use in a completely different context may render them inaccurate and of little value if there is doubt about whether they are testing what they claim to be (e.g. Mendenhall, Yarris & Kohrt, 2016; Summerfield, 2008).
Results from researchers working from a more relativist position indicate that different cultural explanations are given for mental illnesses in various different cultural settings, and that distress is often expressed in different ways across cultures. These studies provide invaluable insights into the ways in which mental health is conceptualised amongst members of non-Western cultures, and give us clues as to how best to address these issues. These results have significant consequences for the delivery of mental health services across the globe, emphasising the necessity of culturally appropriate mental health assessments and service provision that will address the unique needs of different populations accordingly. Expanding on research studies such as these will be essential to designing the most appropriate mental health services for individuals in developing countries to ensure that SDG 3.4 to “reduce by one-third pre-mature mortality from non-communicable diseases (NCDs) through prevention and treatment, and promote mental health and wellbeing” (United Nations, 2016) is reached by 2030.
Emma Mathias is a PhD Candidate at the Centre for Sustainable Development Studies, UCD, and an Assistant Lecturer in Applied Psychology in the Institute of Art, Design and Technology (IADT). Emma holds a BA in Psychology and an MSc in Development Studies, and has over 15 years’ experience working in the field of Mental Health and Intellectual Disability. She is currently working on an interdisciplinary PhD project entitled ‘Exploring the Phenomenology of Mental Illness in sub-Saharan Africa: A Case Study of Ghana’, bridging her expertise in the area of mental health and international development.
This blog is posted in advance of her SPIRe seminar on ‘Exploring the Phenomenology of Mental Illness in sub-Saharan Africa: A Case Study of Ghana’, discussant Tobias Theiler, on Wednesday, 25th April at 2pm.