The Cultural Politics of Mental Illness: Toward a Rights-Based Approach to Global Mental Health
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The Cultural Politics of Mental Illness: Toward a Rights‑Based Approach to Global Mental Health Lisa Cosgrove1 · Zenobia Morrill1 · Justin M. Karter1 · Evan Valdes2 · Chia‑Po Cheng1 Received: 2 August 2020 / Accepted: 1 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The movement for global mental health (MGMH) has raised awareness about the paucity of mental health services, particularly in low- and middle-income countries. In response, policies and programs have been developed by the World Health Organization and by the Lancet Commission on global mental health, among other organizations. These policy initiatives and programs, while recognizing the importance of being responsive to local needs and culture, are based on Western biomedical conceptualizations of emotional distress. In the paper, we discuss how a rights-based approach can promote the voice and participation of people with lived experience into the MGMH. We argue that a human rights framework can be enhanced by incorporating the conceptual approaches of critical inquiry and community mental health. We also discuss how rights-based approaches and service-user activism can productively reconfigure Western psychiatric conceptualizations of distress and provide both a moral and empirical justification for a paradigm shift within the MGMH. Keywords Global mental health · Community mental health · Rights-based approach · Community psychiatry The 2018 publication of the Lancet Commission’s Report on global mental health (GMH) and the associated forum on “Accelerating Country Action on Mental Health,” have reinvigorated interest in and debates about the movement for global mental health (MGMH). Advocates of the MGMH maintain that early detection and treatment of mental disorders—particularly in low- and middle-income (LMIC) countries—are pressing human rights issues (Patel et al. 2007). They argue that there is a mental health gap, and we must ‘scale-up’ the diagnosis of and treatment for mental disorders. Narrative descriptions of people with mental illness being stigmatized and shunned, together with visual depictions of people being shackled, are used to emphasize the lack of mental health literacy in poor and middle-income countries (Shukla et al. 2012). Proponents also argue that there is a strong and unequivocal demand for increased access to mental health services. Critics of the MGHM, on * Lisa Cosgrove [email protected] 1
Department of Counseling and School Psychology, University of Massachusetts Boston, 100 William T. Morrissey Blvd, Boston, MA 02125, USA
School of Psychology, Massey University, Auckland, New Zealand
2
the other hand, argue that the movement is heavily grounded in Western psychiatric taxonomy (i.e., the Diagnostic and Statistical Manual of Mental Disorders [DSM]) and Western models of treatment, particularly psychopharmaceuticals and psychotherapy (Kirmayer and Pedersen 2014; Summerfield 2013). They point to the constructed and culturally bound nature of distr
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