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.
- Mental Health
- Traditional Healing
- Mental Health Practitioner
- Global Mental Health
- Medical Pluralism
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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).
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.
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.
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.’
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.
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.
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).
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).
For that matter, the main goal of ritual may be the avoidance of further misfortune rather than cure.
See Mills & White (this volume) for more on this.
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.
Abbo, C. (2011). Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda. Global Health Action, 4. doi:10.3402/gha.v4i0.7117.
Ae-Ngibise, K., Cooper, S., Adiibokah, E., Akpalu, B., Lund, C., Doku, V., & the MHAPP Research Programme Consortium. (2010). ‘Whether you like it or not people with mental problems are going to go to them’: A qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana. International Review of Psychiatry, 22(6), 558–567.
Baer, H. (2011). Medical pluralism. In M. Singer & P. Erickson (Eds.), A companion to medical anthropology (pp. 405–423). Oxford: Wiley-Blackwell.
Benoist, J. (1996). Conclusion: Prendre soins. In J. Benoist (Ed.), Soigner au Pluriel: essais sur le pluralisme médical. Paris: Éditions Karthala.
Bentall, R. (2003). Madness explained: Psychosis and human nature. London: Allen Lane.
Bindi, S. (2012). L’événement de la maladie entre pratiques et structures: Analyse dialogique d’un épisode de maladie en Uttarakhand. Mondes Contemporains, 2, 13–33.
Brodwin, P. (1996). Medicine and morality in Haiti: The contest for healing power. Cambridge: Cambridge University Press.
Burns, J. K., & Tomita, A. (2014). Traditional and religious healers in the pathway to care for people with mental disorders in Africa: A systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50(6), 867–877.
Calabrese, J. (2008). Clinical paradigm clashes: Ethnocentric and political barriers to native American efforts at self-healing. Ethos, 36(3), 334–353.
Callan, A. (2012). Patients & agents: Mental illness, modernity & Islam in Sylhet, Bangladesh. Oxford: Berghahn.
Cohen, A. (2014). A nuanced perspective? British Journal of Psychiatry, 205, 329.
Crandon-Malamud, L. (1991). From the fat of our souls: Social change, political process, and medical pluralism in Bolivia. Berkeley: University of California Press.
de Menil, V., & Iemmi, V. (2014). Have your say on the treatment gap in Global Mental Health. Retrieved June 8, 2015, from http://mhinnovation.net/blog/2014/aug/8/have-your-say-treatment-gap-global-mental-health#.VXVpmkZ2X_5
Desjarlais, R. (1992). Body and emotion: The aesthetics of illness and healing in the Nepal Himalayas. Philadelphia: University of Pennsylvania Press.
Doku, V., Ofori-Atta, A., Akpalu, B., Osei, A., Read, U., Cooper, S., & the MhaPP Research Programme Consortium. (2011). Stakeholders’ perceptions of the main challenges facing Ghana’s mental health care system: A qualitative analysis. International Journal of Culture and Mental Health, 4(1), 8–22.
Ecks, S. (2014). Eating drugs: Psychopharmaceutical pluralism in India. New York: New York University Press.
Egbe, C., Brooke-Sumner, C., Kathree, T., Selohilwe, O., Thornicroft, G., & Petersen, I. (2014). Psychiatric stigma and discrimination in South Africa: Perspectives from key stakeholders. BMC Psychiatry, 14, 191. doi:10.1186/1471-244X-14-191.
Gold, C. L., & Clapp, R. A. (2011). Negotiating health and identity: Lay healing, medicinal plants, and indigenous healthscapes in highland Peru. Latin American Research Review, 46(3), 93–111.
Greene, S. (1998). The shaman’s needle: Development, shamanic agency, and intermedicality in Aguaruna Lands, Peru. American Ethnologist, 25(4), 634–658.
Halliburton, M. (2004). Finding a fit: Psychiatric pluralism in South Asia and its implications for WHO studies of mental disorder. Transcultural Psychiatry, 41(1), 80–98.
Halliburton, M. (2009). Mudpacks and Prozac: Experiencing ayurvedic, biomedical and religious healing. Walnut Creek: Left Coast Press.
Incayawar, M., Wintrob, R., Bouchard, L., & Bartocci, G. (2009). Psychiatrists and traditional healers: Unwitting partners in Global Mental Health. Oxford: Wiley-Blackwell.
Jacorzynski, W. (2006). The war of the spiders: Constructing mental illnesses in the multicultural communities of the highlands of Chiapas. In H. Johannessen & I. Lazar (Eds.), Multiple medical realities: Patients and healers in biomedical, alternative and traditional medicine (pp. 163–182). Oxford: Berghahn.
Johannessen, H. (2006). Body and self in medical pluralism. In H. Johannessen & I. Lazar (Eds.), Multiple medical realities: Patients and healers in biomedical, alternative and traditional medicine (pp. 1–17). Oxford: Berghahn.
Kapferer, B. (1988). Gramsci’s body and a critical medical anthropology. Medical Anthropology Quarterly, 2(4), 426–432.
Kirmayer, L. (2012). Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism. Social Science & Medicine, 75, 249–256.
Kleinman, A. (2009). Global mental health: A failure of humanity. The Lancet, 374, 603–604.
Kohn, R., Saxena, S., Levav, I., & Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of the World Health Organization, 82(11), 858–866.
Lang, C., & Jansen, E. (2013). Appropriating depression: Biomedicalizing ayurvedic psychiatry in Kerala, India. Medical Anthropology, 32(1), 25–45.
Langwick, S. (2008). Articulate(d) bodies: Traditional medicine in a Tanzanian hospital. American Ethnologist, 35(3), 428–439.
Langwick, S. (2011). Bodies, politics, and african healing: The matter of maladies in Tanzania. Bloomington: Indiana University Press.
Last, M. (1981). The importance of knowing about not knowing. Social Science and Medicine, 15(3), 387–392.
Leslie, C. (1976). Introduction. In C. Leslie (Ed.), Asian medical systems (pp. 1–17). Berkeley: University of California Press.
Lévi-Strauss, C. (1963). The effectiveness of symbols. In C. Levi-Strauss (Ed.), Structural anthropology (pp. 186–205). New York: Basic Books.
McMillen, H. (2004). The adapting healer: Pioneering through shifting epidemiological and sociocultural landscapes. Social Science & Medicine, 59, 889–902.
Mental Disability Advocacy Center/Mental Health Uganda. (2014). “They don’t consider me as a person”: Mental health and human rights in Ugandan communities. Kampala: MDAC.
Mills, C. (2014). Decolonizing Global Mental Health: The psychiatrization of the majority world. London: Routledge.
Nuffield Council on Bioethics. (2002). The ethics of research related to healthcare in developing countries. London: NCB.
Orr, D. (2012). Patterns of persistence amidst medical pluralism: Pathways toward cure in the Southern Peruvian Andes. Medical Anthropology, 31(6), 514–530.
Orr, D., & Jain, S. (2014). Making space for embedded knowledge in Global Mental Health: A role for social work? European Journal of Social Work, 18(4), 569–582.
Partnerships for Mental Health Development in Sub-Saharan Africa (PAM-D). (2013). The research component. Retrieved October 5, 2015, from http://www.pam-d.org/research/
Patel, V. (2011). Traditional healers for mental health care. Global Health Action, 4, 7956. doi:10.3402/gha.v4i0.7956.
Patel, V. (2014). Why mental health matters to global health. Transcultural Psychiatry, 51(6), 777–789.
Patel, V., Kleinman, A., & Saraceno, B. (2012). Protecting the human rights of people with mental illnesses: A call to action for Global Mental Health. In M. Dudley, D. Silove, & F. Gale (Eds.), Mental health and human rights: Vision, praxis, courage (pp. 362–375). Oxford: Oxford University Press.
Patel, V., & Saxena, S. (2014). Transforming lives, enhancing communities—Innovations in Global Mental Health. New England Journal of Medicine, 370(6), 498–501.
Quack, J. (2012). Ignorance and utilization: Mental health care outside the purview of the Indian state. Anthropology & Medicine, 19(3), 277–290.
Quack, J. (2013). ‘What do I know?’ Scholastic fallacies and pragmatic religiosity in mental health-seeking behavior in India. Mental Health, Religion and Culture, 16(4), 403–418.
Ranganathan, S. (2014). Healing temples, the anti-superstition discourse and global mental health: Some questions from the Mahanubhav temples in India. South Asia, 37(4), 625–639.
Romanucci-Ross, L. (1969). The hierarchy of resort in curative processes: The Admiralty Islands, Melanesia. Journal of Health and Social Behavior, 10, 201–209.
Sax, W. (2014). Ritual healing and mental health in India. Transcultural Psychiatry, 51(6), 829–849.
Scull, A. (1993). The most solitary of afflictions: Madness and society in Britain, 1700–1900. New Haven: Yale University Press.
Sorsdahl, K., Stein, D. J., Grimsrud, A., Seedat, S., Flisher, A. J., Williams, D. R., & Myer, L. (2009). Traditional healers in the treatment of common mental disorders in South Africa. Journal of Nervous and Mental Disease, 197(6), 434–441.
Summerfield, D. (2008). How scientifically valid is the knowledge base of Global Mental Health? British Medical Journal, 336, 992–994.
Thornicroft, G., & Patel, V. (2014). The importance of trials for Global Mental Health. In G. Thornicroft & V. Patel (Eds.), Global Mental Health trials. Oxford: Oxford University Press.
Wahlberg, A. (2007). A quackery with a difference—New medical pluralism and the problem of ‘dangerous practitioners’ in the United Kingdom. Social Science & Medicine, 65, 2307–2316.
Waldram, J. B. (2000). The efficacy of traditional medicine: Current theoretical and methodological issues. Medical Anthropology Quarterly, 14(4), 603–625.
Waldram, J. B. (2013). Transformative and restorative processes: Revisiting the question of efficacy of traditional healing. Medical Anthropology, 32(3), 191–207.
West, H., & Luedke, T. (2006). Healing divides: Therapeutic border work in Southeast Africa. In T. Luedke & H. West (Eds.), Borders and healers: Brokering therapeutic resources in Southeast Africa (pp. 1–20). Bloomington: Indiana University Press.
Whitley, R. (2015). Global Mental Health: Concepts, conflicts and controversies. Epidemiology and Psychiatric Sciences, 24(4), 285–291.
World Health Organization. (1978). The promotion and development of traditional medicine: Report of a WHO meeting. Geneva: World Health Organization.
World Health Organization. (2013). WHO traditional medicine strategy 2014–2023. Geneva: World Health Organization.
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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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Online ISBN: 978-1-137-39510-8