Primum non nocere. The case for a critical approach to global mental health
Open accessAbstract
The Movement for Global Mental Health (MGMH) argues that there is a moral imperative that psychiatric treatments should be made available to all communities across the world. But psychiatric theories, categories and interventions emerged in the Western world are based on a set of assumptions about the nature of the self and society, nature and the supernatural, health and healing that are not universally accepted. In this paper we argue that there is a stronger moral case for caution with regard to the export of psychiatric thinking. Without a critical interrogation of such thinking the MGMH is at risk of doing a great deal of harm to the diverse, and sometimes fragile, systems of care that already exist across the world.
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Several studies convincingly argue that psychopharmaceuticals often work no better than placebo and that recovery rates from mental disorders are higher where no technical treatment is used.
“Several studies convincingly argue that psychopharmaceuticals often work no better than placebo, showing that rates of recovery from mental disorders are higher where no 'technical' treatment is used (Luhrmann et al. 2015;Middleton and Moncrieff 2019;Bracken et al. 2016).”
From Throwing therapy at the problem mental health and humanitarian intervention in Palabek refugee settlement, northern Uganda (2023) · cites this paper as Bracken et al. 2016
The Empirical/therapeutic assumptions section (page not supplied) says that most benefit from antidepressants in drug trials is due to the placebo effect, but it does not say that psychopharmaceuticals generally work no better than placebo. It also reports better outcomes for people with serious mental illness in non-Western countries and substantial improvement without medication at a healing shrine; neither establishes higher recovery rates specifically where no technical treatment is used. (LLM, conf=0.85)
Experimental — accuracy not yet measuredScholars denounce the pharmaceutical industry's role in producing demand for psychiatric medication through marketplace imbrication.
“Indeed, scholars have denounced the role played by the pharmaceutical industry in producing demand for psychiatric medication through their imbrication in the marketplace (Petryna et al. 2006;Raikhel 2013;Bracken et al. 2016).”
From Throwing therapy at the problem mental health and humanitarian intervention in Palabek refugee settlement, northern Uganda (2023) · cites this paper as Bracken et al. 2016
The Empirical/therapeutic assumptions section (page unavailable) criticizes reliance on psychotropic medication in global mental health programmes. It does not address pharmaceutical-industry involvement or the production of demand through marketplace activity; searches for those terms found no passage supporting that attribution. (LLM, conf=0.73)
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Cites
Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008) · PLoS Medicine · doi:10.1371/journal.pmed.0050045 · Cited by 2,442 · see citing works
Grand challenges in global mental health
Collins, P. Y., Patel, V., Joestl, S. S., March, D., Insel, T. R., Daar, A. S., Bordin, I. A., Costello, E. J., Durkin, M., Fairburn, C., et al. (2011) · Nature · doi:10.1038/475027a · Cited by 2,043 · see citing works
Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis
Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010) · JAMA · doi:10.1001/jama.2009.1943 · Cited by 2,009 · see citing works
Scale up of services for mental health in low-income and middle-income countries
Eaton, J., McCay, L., Semrau, M., Chatterjee, S., Baingana, F., Araya, R., Ntulo, C., Thornicroft, G., & Saxena, S. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60891-x · Cited by 698 · see citing works
Psychiatry beyond the current paradigm
Bracken, P., Thomas, P., Timimi, S., Asen, E., Behr, G., Beuster, C., Bhunnoo, S., Browne, I., Chhina, N., Double, D., et al. (2012) · British Journal of Psychiatry · doi:10.1192/bjp.bp.112.109447 · Cited by 474 · cited 2× · see citing works
“The dominant paradigm in psychiatry, and that upon which the MGMH is predicated, is technological (Bracken et al. 2012).”
BackgroundSelf-citationMeaning Medicine and the “Placebo Effect”
Moerman, D. E. (2002) · doi:10.1017/cbo9780511810855 · Cited by 401 · see citing works
Packages of care for depression in low- and middle-income countries
Patel, V., Simon, G., Chowdhary, N., Kaaya, S., & Araya, R. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000159 · Cited by 202 · see citing works
A renewed agenda for global mental health
Patel, V., Boyce, N., Collins, P. Y., Saxena, S., & Horton, R. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61385-8 · Cited by 192 · see citing works
Flagged first, then by citations
Research works printed but not linked: 20
- Angermeyer MC, Holzinger A, Carta MG, Schomerus G (2011). Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. British Journal of Psychiatry 199, 367-372.
- Clark J (2014). Medicalization of global health 2: the medicalization of global mental health. Global Health Action 7, 23998. doi: 10.3402/gha.v7.24000. · DOI
- Cooper M (2008). Essential Research Findings in Counselling and Psychotherapy. Sage Publications: London.
- Fernando S (2014). Mental Health Worldwide. Culture, Globalization and Development. Palgrave Macmillan: Basingstoke.
- Foucault M (1980). Truth and power. In Power/Knowledge. Selected Interviews and Other Writings, 1972-1977 (ed. C Gordon), pp. 109-133. Harvester Wheatsheaf: New York.
- Hacking I (1995). Rewriting the Soul: Multiple Personality and the Sciences of Memory. Princeton University Press: Princeton.
- Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, Sanislow C, Wang P (2010). Recovery Domain Criteria (RDoC): towards a new classification framework for research on mental disorders. American Journal of Psychiatry 167, 748-751.
- Jablensky A, Sartorius N (2008). What did the WHO studies really find? Schizophrenia Bulletin 34, 253-255.
- Jenkins J, Kleinman A (1991). Cross-cultural studies of depression. In Psychosocial Aspects of Depression (ed. J Becker and A Kleinman), pp. 67-99. Lawrence Erlbaum Associates: Mahwah, New Jersey.
- Kirmayer L (2011). Unpacking the placebo response: insights from ethnographic studies of healing. Journal of Mind-Body Regulation 1, 112-124.
- Kirmayer L, Gold I (2012). Re-socializing psychiatry: critical neuroscience and the limits of reductionism. In Critical Neuroscience: A Handbook of the Social and Cultural Contexts of Neuroscience (ed. S Choudhury and J Slaby), pp. 307-330. Wiley-Blackwell: Chichester.
- Lewis B (2009). Obsession: a history, and: the loss of sadness. How psychiatry transformed normal sorrow into depressive disorder, and: shyness: how normal behaviour became a sickness, and: bipolar expeditions: mania and depression in American culture (review). Literature and Medicine 28, 152-171.
- Mills C (2014). Decolonizing Global Mental Health: The Psychiatrization of the Majority World. Routledge: Abingdon.
- Obeyesekere G (1985). Depression, Buddhism, and the work of culture in Sri Lanka. In Culture and Depression: Studies in the Anthropology and Cross-Cultural Psychiatry of Affect and Disorder (ed. A Kleinman and B Good), pp. 134-152. University of California Press: Berkeley.
- Porter R (2002). Madness: A Brief History. Oxford University Press: Oxford.
- Rasmussen K (2009). Sham electroconvulsive therapy studies in depressive illness: a review of the literature and consideration of the placebo phenomenon in electroconvulsive therapy practice. Journal of ECT 25, 54-59.
- Read J, Bentall R (2010). The effectiveness of electroconvulsive therapy: a literature review. Epidemiologia e Psichiatria Sociale 19, 333-347.
- Schweder R (2003). Why do Men Barbecue? Recipes for Cultural Psychology. Harvard University Press: Massachussetts.
- Shukla A, Philip A, Zachariah A, Phadke A, Suneetha A, Davar B, CEHAT, Srinivasan C, Mankad D, Qadeer I, Kalathil J, Lalita K, Sajaya K, Jacob KS, Balimahabal K, Gupte M, Rao M, Salie M, Prakash P, Chatterjee P, Baru R, Melkote R, Shukla R, Galtonde R, Bisht R, Duggal R, Khanna R, Priva R, Srivatsan R, Timimi S, Sarojini NB, Sathyamala C, Ashtekar S, Fernando S, Tharu S, Shatrugna V (2012). Critical perspectives on the NIMH 'Grand Challenges to Mental Health'. Indian Journal of Medical Ethics 9, 292-293.
- White R, Sashidharan SP (2014). Towards a more nuanced global mental health. British Journal of Psychiatry 204, 415-417.
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Torre, C. (2023) · London School of Economics and Political Science (LSE) · doi:10.21953/lse.00004557
- Authors
- Bracken, P., Giller, J., & Summerfield, D.
- Affiliations
- Bantry General Hospital (IE)
- King's College London (GB)
- Corresponding author
- Bracken, P.
- Venue
- Epidemiology and Psychiatric Sciences
- Publisher
- Cambridge University Press (CUP)
- Published
- 2016-08-15
- Volume
- 25
- Issue
- 6
- Pages
- 506-510
- ISSN
- 2045-7960 (ISSN-L)
- 2045-7979
- PMC
- PMC7137661
- OpenAlex
- W2509925876
- Cited by
- 53
- References
- 8
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 7 · 2023: 4 · 2022: 4 · 2021: 9 · 2020: 6 · 2019: 8 · 2018: 6 · 2017: 4 · 2016: 2
- FWCI
- 10.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Epidemiology and Psychiatric Sciences (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
- Keywords
- global mental health, moral imperative, cultural context of mental illness, psychiatric intervention, self and society, health and healing
- MeSH terms
- Humans, Mental Health, Psychotherapy, Global Health
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