The Public and Private Lives of Psychopharmaceuticals in the Global South

Despite attempts by global mental health and the WHO to distance themselves from over-reliance on psychotropic medications, pharmacological treatment remains a frequently employed therapeutic pathway in global mental health interventions.

“Despite attempts on the part of both the global mental health and the WHO to distance themselves from over-reliance on psychotropic medications (Ecks 2017), pharmacological treatment remains a frequently employed therapeutic pathway in global mental health interventions.”

The first WHO EML included antidepressants, antipsychotics, tranquilizers, antiepileptics, and mood stabilizers, and was updated every two years.

“Psychiatric medications mentioned in this first WHO EML included antidepressants (amitriptyline), antipsychotics (haloperidol, fluphenazine, chlorpromazine), tranquilizers (diazepam), antiepileptics, and mood stabilizers (lithium carbonate) (WHO 1977); the list was updated and expanded every two years, with every subsequent version of the document (Ecks 2017).”

Over the past two decades, prescription and use of psychopharmaceuticals in low- and middle-income countries across the Global South has undergone unprecedented expansion.

“If the circulation of psychopharmaceuticals in the Global South is not an entirely new phenomenon, however, over the past two decades the prescription and use of these medications in low-and middle-income countries across the Global South has been undergoing an unprecedented expansion (Ecks 2017;Petryna et al. 2006).”

In the Global South, deinstitutionalization of limited psychiatric care often coincided with neoliberal defunding of public health infrastructures, configuring care as individual self-medication through pills and shifting therapeutic responsibility onto individuals.

“In the Global South, processes of deinstitutionalization of limited psychiatric care, which attempted to scale-down the role of psychiatric hospitals in favour of communitybased settings, have often coincided with neoliberal defunding of public health infrastructures (Ecks 2017), configuring the management of care on individual self-medication through pills and increasingly shifting therapeutic”

Ecks showed a sharp increase in private sector prescriptions of psychotropic drugs in India.

“For example, Ecks (2014Ecks ( , 2017) ) showed a sharp increase in private sector prescriptions of psychotropic drugs in India.”

Ecks distinguishes between the public life of psychopharmaceuticals, emphasized in global policy discourse, and a private life that reflects the real circulation of psychiatric medication.

“Ecks (2017) has distinguished between the 'public' life of psychopharmaceuticals -emphasized in global policy discourse -and a 'private' one, which instead reflects the real circulation of psychiatric medication.”

Critiques of psychopharmaceuticals have carried limited weight in global mental health practice; according to Ecks, they significantly affected only the field's public and policy discourse.

“These critiques, however, have carried limited weight as far as global mental health practice is concerned; rather, as Ecks (2017) notes, the only aspect they managed to significantly affect was the field's public and policy discourse.”

Despite their quasi-invisibility in policy discourse, psychopharmaceuticals lead intense private lives in the Global South.

“Despite their quasi-invisibility in policy discourse, therefore, psychopharmaceuticals lead intense 'private lives' (Ecks 2017) in the Global South.”

According to Ecks, global mental health's apparent shift away from psychopharmaceuticals does not necessarily reflect on-the-ground realities but is a strategic policy response to pushback against psychoactive medications.

“He points out that global mental health's apparent shift away from psychopharmaceuticals does not necessarily reflect the 'on the ground' realities of interventions, but rather a strategic policy response to vocal pushback against psychoactive medications.”