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Medical Pluralism and Global Mental Health

Abstract

Global Mental Health (GMH) initiatives unfold within contexts of medical pluralism, where people experiencing mental health difficulties may be faced with diverse therapeutic options. In this chapter, David Orr and Serena Bindi discuss how GMH interacts with other forms of healing with which it comes into contact. Focusing primarily on ‘traditional healing,’ a problematic but influential concept within GMH literature and World Health Organisation policies, Orr and Bindi go on to explore three factors that shape its relationship with GMH. These are the contrasts in epistemological frameworks, notions of effectiveness, and political power and social prestige that characterise these different approaches to mental health. The chapter reviews the debates to which these factors give rise and the importance for GMH planners of engaging closely with them.

Keywords

  • Mental Health
  • Traditional Healing
  • Mental Health Practitioner
  • Global Mental Health
  • Medical Pluralism

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Notes

  1. 1.

    Complementary and Alternative Medicine (CAM) is the obvious—though not the only—example of this, where the therapeutic options on offer in high-income countries often seem to take their inspiration from the very regions consigned to the ‘treatment gap’ (e.g., Ayurvedic healing from India and shamanic healing from several regions of the globe).

  2. 2.

    In any chapter of this length, it is impossible to capture the breadth and variety of global practices and philosophies implied by the term ‘medical pluralism.’ Faith healers within a range of different religious traditions, empiric herbalists, shamans, acupuncturists and a host of others, who practise with varying degrees of independence, regulation and professionalisation, could be considered. For any tentative generalisation that it is possible to make about forms of healing in one country or culture, counter-examples from elsewhere (or exceptions from the same setting) could be found. The approach we take is therefore to survey issues and principles with brief reference to examples, rather than going deeply into specifics; we beg readers’ indulgence where this has meant apparent over-simplifications or excessive generalisations.

  3. 3.

    Indeed, the understudied but common phenomenon of self-medication (Ecks 2014, p. 176) indicates how unconcerned people may be with the ‘system’ underlying their treatment.

  4. 4.

    The field of mental health has arguably been more receptive to this than other biomedical specialties, with understanding derived at least partially from traditional healing featuring heavily within the various strands of cultural and ethnopsychiatric approaches and even receiving some limited acknowledgement in the Fourth and Fifth Editions of the American Psychiatric Association’s Diagnostic and Statistical Manual in the form of the ‘Glossary of cultural concepts of distress.’

  5. 5.

    These developments mirror the adoption in the social sciences of similarly nuanced ways of discussing ‘culture,’ as it has become increasingly difficult to maintain the fiction of distinct, internally consistent ‘cultures’ that can be somehow separated out from each other and made to stand apart.

  6. 6.

    It is worth noting that—apart from the use of traditional healers in screening and referral roles—the focus of many efforts was primarily ethnopharmacological, driven by the idea that the plant-based knowledge held by traditional healers could be mapped and refined for use in alliance with biomedicine; practices and cosmologies that might accompany, encompass or substitute for herbal lore were often downplayed or dismissed.

  7. 7.

    Kirmayer (2012) argues that even the wealth of research available on mental health in the USA neglects the extent of cultural diversity there and bases its studies on samples that do not reflect the general population. It seems likely that the much smaller volume of research on mental health in LMICs suffers from the same issue (Orr and Jain 2014).

  8. 8.

    Not all traditional healers share this concern to provide diagnoses or explanations, with some (e.g., Q’eqchi healers in Guatemala) affording it little priority at all (Waldram 2013).

  9. 9.

    For that matter, the main goal of ritual may be the avoidance of further misfortune rather than cure.

  10. 10.

    See Mills & White (this volume) for more on this.

  11. 11.

    Similar concerns regularly erupt in professions such as clinical psychology or social work that the core values of the discipline risk becoming too subjugated to the medical model. Negotiations over the relative power and positioning of any group of therapeutic practitioners are always an ongoing and dynamic process.

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Orr, D.M.R., Bindi, S. (2017). Medical Pluralism and Global Mental Health. In: White, R., Jain, S., Orr, D., Read, U. (eds) The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-39510-8_15

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