Book Review: Global Mental Health: Anthropological Perspectives

Global Mental Health: Anthropological Perspectives. Brandon Kohrt and Emily Mendenhall, eds. Walnut Creek, CA: Left Coast Press, 2015, 389 pp.

Global mental health is becoming a rich field of inquiry for academics and practitioners across a variety of disciplines. Anthropologists are contributing to this corpus of research by emphasizing the need to consider local idioms of distress, actively integrate context in diagnostic practice, and understand that treatment for mental illnesses is more complex than simply disseminating medication. Anthropologists argue for a more holistic approach to understanding mental health—one that is conscious of the linkages between biology and culture and individuals and society. They are also interested in understanding how these interconnections can inform evidence- based care in culturally compelling ways.

Anthropologists Brandon Kohrt and Emily Mendenhall present these issues in their robust 2015 edited volume Global Mental Health: Anthropological Perspectives. Based on almost three decades of fieldwork conducted by anthropologists and non-anthropologists in Africa, Asia, Latin America, Europe, and North America, this book emphasizes ethnography as a valuable methodological tool to studying global mental health. The content of this volume is brought to life through its people-centered approach and in-depth focus on context, which the authors state, goes hand in hand when studying mental illness.

The book starts off with a powerful foreword by cross-cultural psychiatrist and spear-header of the global mental health movement, Vikram Patel. Patel’s commentary sets the tone for the rest of the volume, which offers innovative ways of thinking about “psychiatric diagnoses, healing and health systems, and the personal and social experience of mental illness across cultures” (p. 8).

Readers can think of this volume as a compilation of mini-ethnographies or ethnographic case studies that act as a heuristic against large-scale clinical and public health interventions that are neatly categorized into three sections: (1) Social and Structural Origins of Mental Illness in Global Context; (2) Treatment Approaches and Access to Care in Low-and High Resource Settings, and (3) Task-Sharing and Alternative Care Models. Each section is separated into parts, which unearth the intricate relationships between patients and their family and community members, clinicians, medical, and traditional health care institutions.

The first section of this book (parts 1–2) sets the scene by introducing the reader to the topic of mental health as an issue that is impacting individuals, societies, and health systems in pressing ways globally. The second chapter is crucial as it clearly illustrates what ethnography is. The thoughtful explanation about what it means to conduct ethnographic work not only educates non-anthropological audiences about the rigor of the method, but also showcases how other data collecting methods such as surveys and biomarkers can be coupled with ethnography to “bolster understandings of certain phenomena and to speak across disciplines to various audiences (p. 37).

Readers are also privy to a diverse range of peoples’ voices (parts 3–19), including those of children, caregivers, refugees, medical doctors, and community health workers throughout the volume. This highlights the array of actors involved in combatting mental health at micro and macro levels.

The contributors’ decision to represent peoples’ experiences with mental illness from an array of countries such as Nepal, Bolivia, Ethiopia, and the United States epitomizes the growing interest and need to conduct cross-cultural research in this field and the substantial role anthropologists play in this narrative. At the same time, by putting culture at the center of its analysis, the case studies highlight the multifaceted manner in which mental illnesses are perceived, diagnosed, prevented, and treated. Mental illness, as Kohrt and Mendenhall put forth, cannot be targeted from a purely clinical perspective. There is more at play. For example, just as diagnoses do not exist in a vacuum, neither do prevention strategies. Both are inextricably tied to context, social networks, economic status, stigma, and identity, among others.

One of the most compelling qualities of this book is the contributors’ ability in recognizing peoples’ agency with regard to mental health. The people in this book— whether living with a mental illness or caregiving for a family and/or community member with a mental illness—are portrayed as active agents, who, despite living in resource-constrained environments, are able to navigate their social worlds in specific ways.

Many anthropologists who work at the intersection of anthropology and global health are avid proponents of the ethnographic method and its use by students and scholars from other disciplines. Still, at various points, it seems as if the contributors go too far in trying to justify the importance of ethnography in the study of mental health to their readers.

Almost every part—whether it is the introduction where the reader is transported to the social world of Naresh, an 11-year-old Nepali boy living in Kathmandu, whose family grapples with his “mental illness,” to the final part, in which 27-year-old American clinical psychologist Jeremy attempts suicide—is framed with anecdotes. This may leave some readers feeling overwhelmed. At various points throughout the volume, I also felt that the contributors came across as trivializing ethnography as a solely context-setting and/or story-telling method, as opposed to a method that generates theory and advances critical thinking in social science research. Furthermore, there is limited mention of the challenges of conducting ethnographic research. In my view, this makes it seem that ethnographic research is easy to conduct, both by anthropologists and non- anthropologists.

Rather, it is well known that being an ethnographer is an extremely demanding task. Many anthropologists work in remote and resource constrained regions of the world. They witness how people navigate and negotiate resources under duress and they undergo intensive language training so that they can effectively communicate with their participants.

Anthropologists are also aware that various members in the communities in which they work may not want to share their experiences openly. While it is clear that the authors of this book embody these qualities and enlighten readers about the positive aspects of ethnographic research, they fall short in explaining the complexities, sensitivities, and/or hindrances they faced when collecting ethnographic data during their research on mental health problems.

Despite such minor criticisms, the contributors of Global Mental Health deserve wide applause for their commitment to “addressing the daunting and rapidly growing burden of mental illness worldwide” (p. 14). By shedding its theoretically thick skin and heavily peopling its narrative, this book makes itself available to a multidisciplinary audience without compromising on its rigor and dedication to telling the human story with compassion and solidarity. It poignantly calls attention to the need to value local opinions and cultural forms of self-help, so that state institutions and international aid organizations do not do more harm than good in their efforts to address populations’ mental health needs.

While the primary theme of this volume is mental health, the contributors write about the topic in the context of changing family dynamics, differential gender relations, and burdens of migration and social inequalities, making it relevant to a wide readership. Potential audiences might include graduate students with interests in cross-cultural psychiatry and mental health, social scientists, clinicians, public health professionals, and others doing applied work (e.g., those working in humanitarian aid organizations). Policy makers would also do well to read this book, as it emphasizes the importance of designing case-specific and evidence- based mental health interventions, as opposed to following the predominant one-size-fits-all model.

With pithy prose and an articulate message, this edited volume offers a comprehensive analysis of anthropology’s engagement with the study of mental illness. Its use of ethnography as a method that can both be used to generate descriptive accounts of individuals’ lived experiences and design and inform interventions sets it apart from existing anthropological scholarship on mental health.

Global Mental Health lays an exemplary foundation for cross-disciplinary, collaborative, and multi-method research on mental health, while also asserting the relevance of anthropology in the study of mental illness. It is also bound to spark new debates about the relationship between theory and practice, the interrelations between the global and the local, and individuals and societies.

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