Derek Summerfield - Against "Global Mental Health" (ASI 2012)

Psychiatry has no answer to the question "what is a mental disorder?", and instead exalts a way of working it has devised: if there are sufficient phenomena at sufficient thresholds, a mental disorder is declared to exist! Nonetheless, an emergent global mental health field, including the WHO, claims that annually up to 30% of the global population develops a mental disorder, representing a substantial "though largely hidden" proportion of the world's overall disease burden. Are these figures credible? What exactly is "global mental health"? Can any definition or standard of mental health be definitive universally? This paper will critique the knowledge base for global mental health in light of the routine use of methodologies not validated for the populations under study, largely non-Western. To assume that Western knowledge is universal, whereas indigenous knowledge is local, casts culture as an obstacle and ignores the plight of huge numbers of non-Western peoples mired in bare survivalist ways of life. This is a form of imperialism, with global mental health workers as the new missionaries. The paper asks whether it is axiomatic that mental health services are a good thing worldwide, albeit with adaptations in culturally diverse, resource-poor settings. Or, is the question still open as to whether non-Western societies do need mental health services at all as we recognise them in the West?