The convergence of a historic conflict would hopefully lead to developments
By Ronan McCabe
The cliché of globalisation has harkened to the dawn of a new age in Global Health. Once restricted to the area of infectious, or communicable, diseases other areas of affliction have since come to the fore. One of the most recent and underrepresented is that of mental health.
The field of Global Mental Health soared to the top of the Global Health initiative in 2007, where it garnered unprecedented attention and was imbued with a new sense of urgency. Behind the stir of 2007 was a series published in the Lancet journal in September of that year. The series highlighted the inequity, injustice, and suffering that prevails over mental wellbeing globally.
It is thought that up to 450 million people suffer from a mental illness worldwide with nearly 1 million suicides each year. Mental disorders account for 14% of the global disease burden and constitute 4 of the 6 main causes of years lived with a disability. Along with both social and economic costs, those who suffer are often subjected to discrimination, stigmatisation, and abuse that in many cases amount to a total disregard of human rights. The most striking inequity, often referred to as the ‘treatment gap’, is that despite being home to 80% of the world’s population, only 20% of mental health resources reside in low- and middle-income countries.
The focus of the field has not been on closing the treatment gap because it has been encumbered by a more fundamental conflict – how do we understand mental health? Global Mental Health has been shaped by a historic conflict that emerged a number of decades prior. This conflict concerns two differing perspectives: universalism and relativism.
Universalism takes the view that our common biology translates into a universal experience of disease i.e. depression has a biological mechanism and expression that is the same across differing cultures. Relativism proposes that mental illness is both experienced and expressed relative to the surrounding culture i.e. depression has a biological mechanism that is the same across cultures, but its expression shows clear variation. The two viewpoints manifest as opposing stances on how health issues are approached. The former focusing on a mechanistic cure, while the latter focusing on preventative environmental strategies.
But the two perspectives need not be mutually exclusive; would it not make sense to draw from both views and take into account cultural setting when devising a medical intervention?
The convergence, while constructive, is not and will not be a smooth one. While a biomedical definition of a disease can ‘legitimise’ a sufferer’s illness, a big question remains over how biology meshes with the local culture. If a schizophrenic person is seen as cursed by spirits how do practitioners engage in treatment and post-treatment rehabilitation?
It is hard to say if any other significant gains have been made since 2007. The Lancet series was immensely positive in attracting attention and funding in support of continuing projects and interventions in low- and middle-income countries. It has also bolstered research in the area. Despite this, partly due to the invisibility of such diseases, there remains persistent governmental apathy and disproportionate underfunding. More work is needed to remind both governments and their populations that significant suffering can also manifest in apparently less ‘physical’ forms and that this has a great impact on the overall all wellbeing of a society. Hopefully, as the conflict converges within the field, minds will be concentrated on improving the situation. Because, as the saying goes, ‘there is no health without mental health’.
(1) Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, Wasserheit
JN, Consortium of Universities for Global Health Executive Board.
Lancet. 2009 Jun 6; 373(9679):1993-5.
First published in print in Medicor 2016 #4