Mental Health

In: Humanitarianism: Keywords
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Nichola Khan
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The nexus of humanitarianism and mental health has gained traction in regard to environmental, political, and epidemiological situations. Humanitarian frameworks of response, assistance, relief, and aid have been operationalized heterogeneously around disruptions to mental health caused by conflict, war, environmental disaster, climate change impacts, poverty, and displacement. The deleterious effects of these factors on clinical and subclinical forms of suffering have been targeted, and the enhanced ability of health services to deliver care has been sought.

Mental health and humanitarianism foster collaborations between social scientists, medical practitioners, lawyers, politicians, anthropologists, and international development and aid experts. This is important for the framing and practical delivery of mental health needs, for example in recognizing the social and structural origins of mental health, integrating contexts of emergency and crisis into diagnostic practice, and task-sharing in low and high resource situations (Kohrt and Mendenhall 2015). Such collaborations also rightly recognize the complexity of mental health problems in humanitarian situations and the multiple bureaucracies that those seeking mental health care for themselves or others must navigate. The field of medical humanitarianism seeks to harmonize humanitarianism’s quest for universals–particularly around the entwining of humanity and human rights with intellectual innovation, comparison, and programmatic delivery–while simultaneously accounting for elements of state sovereignty, geopolitics, socio-political tensions, violence and militarism, and the psychological distress of affected people, including the mental health problems of humanitarian workers, practitioners, and consultants themselves (Abramovitz and Panter-Brick 2015).

The humanitarianism–mental health nexus originated with 19th-century psychiatrists who introduced humanitarian reforms into the treatment of the criminally insane (Khan 2017). This led definitions of mental illness to emerge and expand. A century on, humanitarian “psy-ences” and new subfields, such as humanitarian psychiatry, have emerged, notably through the ideological ascendancy of the psychiatric classification post-traumatic stress disorder. Critics question the political uses of trauma in governing the structures and borders of the international legal system, military and humanitarian interventions, and policies around military populations, displaced people, refugees, and asylum seekers. They identify the hierarchical assumptions in the ways that traumas are selectively denied or recognized in crisis situations (James 2010). Others criticize the ways in which psychiatry and medicine have become entwined with legal doctrines regarding the right to refuge, family life, and protection from persecution. They also criticize how refugee minds and bodies, diagnosed with physical and psychological trauma, become border tools governing a humanitarian gateway to “Western citizenship,” and restrict doctors’ ability to deliver treatment and care (Fassin and Rechtman 2009). These criticisms show us that collaborations between doctors and lawyers, designed to help people in humanitarian crises, are by no means always beneficial.

Regarding conjunctions with humanitarianism and development, the World Health Organization (WHO) was formed in 1948 as a global unified health body to tackle “international health” crises. This meant the world’s richest countries would help the world’s poorest, according to a crude geography based on first, second, and third worlds. The collaboration built on a historical genealogy that largely began with colonial medicine, through associated forms of tropical medicine and missionary medicine, to international health, global health, and finally global mental health (Farmer, Kim, Kleinman, and Basilico 2013).

Significantly, in 2001, a WHO report highlighting the growing “global burden” of mental disorders stated that “there can be no health without mental health” (WHO 2001). This led to the new Movement for Global Mental Health to urgently call, in 2007, for the scaling-up of mental health services in low- and middle-income countries. Access to health services was framed as a pressing moral imperative, affordable medication as a basic human right, and mental disorders as having universal neurological and biological causes. Critics, on the other hand, have vociferously opposed the increasing overprescription of psychiatric medication, and the neglect of cultural, political, and socio-economic factors involved (Fernando 2014). They raise colonial critiques of Western agenda-setting, the Americanization of distress, and the imperium of Western psychiatry (Watters 2011). In their criticisms of global mental health, anthropologists have made important advances in cultural and global psychiatry, including in the cultural formulation of the world’s largest de facto classification system: the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Debating the relationship between intellectual critique and practical action, academics question the cultural limitations of social science as ameliorative practice. They ask how intellectual and moral ideals can be combined with realistic and pragmatic approaches to suffering and sustain a commitment to humanitarian social reform, especially when health systems, the humanitarian industry, and the languages of psychiatric classification are flawed (Wilkinson and Kleinman 2016).

Overcoming implementation challenges has produced numerous multi-sectoral, multidisciplinary approaches to psychosocial and mental health support programs. Notwithstanding, challenges arise in aligning program priorities across sectors, overcoming coordination challenges, reconciling theories and models of change, and obtaining funding.

References

  • Abramovitz, S. , Panter-Brick, C. eds. (2015) Medical Humanitarianism and Ethnographies of Practice. University of Pennsylvania Press.

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  • Fassin, D. , Rechtman, R. (2009) The Empire of Trauma: An Inquiry into the Condition of Victimhood. Princeton University Press.

  • Farmer, P. , Kim, J.Y. , Kleinman, A. , Basilico, M. eds. (2013) Reimagining Global Health: An Introduction. University of California Press.

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  • Fernando, S. (2014) Mental Health World Wide: Culture, Globalization and Development. Palgrave Macmillan.

  • James, E. (2010) Democratic Insecurities: Violence, Trauma, and Intervention in Haiti. University of California Press.

  • Khan, N. (2017) Mental Disorders: Anthropological Insights. University of Toronto Press.

  • Kohrt, B. , Mendenhall, E. eds. (2015) Global Mental Health: Anthropological Perspectives. Left Coast Press.

  • Watters, E. (2011) Crazy Like Us: The Globalization of the Western Mind. Constable and Robinson.

  • WHO (World Health Organization) (2001) Mental Health. A Call for Action by World Health Ministers. http://www.who.int.

  • Wilkinson, I. , Kleinman, A. (2016) A Passion for Society: How We Think about Human Suffering. University of California Press.

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