Incorporating
the local
into global mental health
Kenneth Maes, PhD
Department of Anthropology
Oregon State University
Incorporating
the local
into global mental health
How can anthropologists working in global mental
health emphasize the centrality of local cultural
context for understanding psychological suffering and
improving effectiveness of interventions?
What would it take to reliably document, explain,
publicize, and apply local mental health knowledge,
resources, problems, and solutions
…everywhere there is need?
maximal anthropological contribution
A distribution of anthropologists sufficient to
meet local needs, everywhere.
maximal anthropological contribution
A distribution of anthropologists sufficient to
meet local needs, everywhere.
…more researchers from LMICs.
maximal anthropological contribution
A distribution of anthropologists sufficient to
meet local needs, everywhere.
…more researchers from LMICs.
…community health worker-researchers?
maximal anthropological contribution
An “Investment Case”
2015
maximal anthropological contribution
maximal anthropological contribution
Doing what?
Trained how?
Local/Global Mental Health:
A theoretical toolkit
Local/Global Mental Health:
A theoretical toolkit
Four Social Theories for Global Health
“a toolkit”
Kleinman, 2010, The Lancet
Hannah and Kleinman, 2013, Reimagining GH
Local/Global Mental Health:
A theoretical toolkit
- Unintended consequences of social action
- The social construction of reality
- Rationalization and bureacratization
- Social suffering
- Discipline and biopower
Hannah and Kleinman, 2013
Local/Global Mental Health:
A theoretical toolkit
- Biocultural?
-
Local biologies
Life history theory
Genetic and epigenetic variation
Syndemics
Cultural consonance
- Worthman; Armelagos et al.; Singer; Mendenhall;
Dressler; etc.
No theoretical quick fix?
“Compulsive and mindless theorizing”?
When People Come First:
Beyond Technical and Theoretical Quick Fixes in
Global Health
João Biehl 2011
in Peet, Robbins, and Watts’ (Eds.)
Global Political Ecology
Global Mental Health Praxis
Brandon Kohrt and James Griffith
(2015)
Global Mental Health Praxis
• Brandon Kohrt and James Griffith (2015)
Step 1. Assess what dialogical and monological
processes and therapeutic alliances exist (or are
missing) in a given locality.
Global Mental Health Praxis
“Dialogical practices are key to building a therapeutic alliance,
whether between clinician and patient, community health
volunteer and mental health specialist, or health workers in
LMICs and HICs.”
“Dialogical practices would be most beneficial occurring
across multiple ecological levels…. A therapeutic alliance that
involves individuals, families, community agencies, religious
and educational professionals, and government health and
social welfare ministries multiplies the relationships that can
be activated to initiate [and maintain] change.”
Brandon Kohrt and James Griffith (2015)
Global Mental Health Praxis
• Brandon Kohrt and James Griffith (2015)
Step 2. Find ways and means to create dialogical
processes involving mutual respect, and to forge
therapeutic alliances… at multiple levels.
Incorporating the local
into global mental health.
Local ≠ down
Photo credit: Ethiopian Federal Ministry of Health (FMOH 2007)
Photo credit: UNICEF Ethiopia/2014/Ayene
Photo credit: Kenny Maes
Methodology:
Comparative cross-cultural
research
Discussion questions
• What would maximal anthropological
contribution look like? Is an investment case
possible?
• CHW-researchers?
• Theoretical toolkit – how to implement?
– How to avoid “mindless theorizing”?
• What to assess? Dialogical/monological
processes and much more…
• Methods – wolf packs and comparative study?
What to assess?
Interests, desires, meanings, problems, power,
inequality, discrimination, strategic groups and
alliances (therapeutic or otherwise), resistance,
cooperation, competition, conflict, exploitation,
dialogical and monological processes, negotiation,
resources, agency, tradeoffs, unintended
consequences, governance, activism,
organizing…and local biologies.
Thank you!
Contact: [email protected]