Mental Health Worldwide examines the concepts of the mind, illness and health and how this varies around the world. Drawing on examples of different cultures, traditions and countries, Suman Fernando highlights the different idioms of distress, forms of expression including language used and culturally established methods people use to facilitate their recovery and healing. It is apparent that what would be considered as a mental health issue according to western psychiatry would not be perceived as a mental health issue in the majority of non-western countries. A central theme in the book is challenging the assumption that there is a universalized model of psychiatry.
Fernando explores the foundation of western psychiatry in attempting to resemble the pure sciences, which led to mental illness being defined in diagnostic terms despite there being no objective criteria by which to identify them. The understanding of the mind stemmed from the study of madness. In contrast, Asian and African psychologies stemmed from spirituality and personal introspection, combining knowledge from both religion and philosophy and adopting a holistic approach.
Mental Health Worldwide analyses the course of development of western psychiatry during different time periods, taking into account contextual factors and the impact of wider influences upon psychiatry, such as colonization, globalization, culture and racism. The book explores the nature of colonial psychiatry and challenges the racist psychiatric literature from the time of slavery that fuelled stereotypes and myths about people considered non-white, contributing to current institutional racism in psychiatric practice. Mental Health Worldwide explains the damaging effects of colonization, the application of cultural imperialism by European nations, how colonial psychiatry was introduced and the impact this had on local people. Indigenous healing systems were actively suppressed by colonizers, and European psychiatric asylums were established in colonized areas which typically were not embraced by local people.
Drugs-based psychiatry became prominent during the 1960s to the 1990s, with a focus on drug-based treatments built on the assumption that mental illness was caused by a chemical imbalance in the brain. Social and cultural elements of mental illness were neglected, feelings and emotional states became medicalized. The symptoms or the diagnosed illness were the treatment focus, not the patient as an individual or the problems they encountered. The collusion between psychiatry and the pharmaceutical companies and the criticisms of the bio-medical (western) psychiatric approach are examined. Fernando critiques the credibility of psychiatry as a scientific endeavour and the potential damaging effects of prolonged drug treatments are having upon individuals and wider society.
Western psychiatric concepts and diagnostic approaches have been imposed on non-western countries, reflecting the presence of western imperialism. Local knowledge and indigenous practices have been neglected. Mental Health Worldwide identifies the processes involved in spreading the diagnostic approach towards mental health in low- and middle-income countries (LMICs). Fernando discusses the international politics of mental health and psychiatry and the lack of action taken to tackle social determinants contributing to people's distress. A critical perspective is provided on the western psychiatric bias focused on evidence-based interventions, drug-based treatments and the use of western diagnostic categories in non-western countries, as reflected in the changing policies of the World Health Organization.
Realistic suggestions are offered for the future development of mental health services in LMICs and high income countries (HICs). For HICs some suggestions include focusing on well-being and recovery as a model for service provision and readdressing inequalities, such as racism. Suggestions proposed for LMICs involve a political component to address social determinants of health including mental-health (e.g. a top down approach to reducing poverty) and an operational practical component that is on the ground and aims to relieve mental distress. Fernando considers what would be helpful for locals when planning services and he identified key areas, such as developing community-based services that are home grown, ethical, sustainable and based on local knowledge and addresses human rights. Service planning needs to prioritize indigenous systems of care and help.
Mental Health Worldwide successfully provides a critical perspective on the assumption that psychiatry can be universally applied. Mental Health Worldwide provides much needed depth and understanding to the complex topic and debate around global mental health in an easy to read, accessible book. It is a thought provoking and engaging read, making it recommended reading for those who have an interest in mental health.
