Contingent universality: The epistemic politics of global mental health

Abstract

The field of global mental health (GMH) has undergone profound changes over the past decade. Outgrowing its earlier agenda it has performed a reflexive turn, broadened towards a social paradigm and developed new modes of knowledge production, all of which reshaped ‘mental health’ as a global object of knowledge and care, and the epistemic politics of the field. Drawing on long-term ethnographic fieldwork among GMH experts and recent agenda-setting publications, I discuss how GMH advocates and critical observers alike have created conceptual and practical middle-grounds between different forms of mental health knowledge – across culture, epistemic power, lived experience, policy platforms and academic disciplines – framing their dynamic encounters as dialogue, adaptation, participation, co-production or integration. Ultimately, I argue, GMH today is focusing less on establishing mental health as a universal problem than on managing its inherent multiplicity through alignment and integration across different bodies of knowledge. Global knowledge, so conceived, is fluid and malleable and produced in open-ended knowledge practices, governed by what I call ‘contingent universality’. It is not new that the concepts and practices of the psy-disciplines are malleable and multiple, internally and externally contested, rapidly changing over time and not easily transferrable across space. What is new is that within the increasingly heterogenous epistemic space of GMH, these features have become assets rather than liabilities. GMH knowledge achieves both global reach and local relevance precisely because ‘mental health’ can be many things; it can be expressed in a wide range of idioms and concepts, and its problems and solutions align easily with others, at many scales. These fluid and integrative knowledge practices call for renewed empirical, critical and collaborative engagement.

Depression and Global Mental Health in the Global South: A Critical Analysis of Policy and Discourse

“…The analysis, for instance, did not examine in detail how the mhGAP guidelines are applied in practice within a variety of contexts; it did not examine the wider epistemic infrastructure within which the guidelines operate; and, crucially, it failed to consider the impact its diagnoses and recommendations may have on the lives and subjectivities of those affected. Despite these limitations, however, this article argues that the universality of mental disorders is contingent and partial, and the different strategies employed in GMH to address depression can be seen as "contingent universals" 85,87 upon which its main thesis is based. Most importantly, although the GMH agenda has placed significant emphasis on expanding services to reach all those who meet diagnostic criteria for common mental disorders, many of them do not consider themselves to need or want such treatment.…”

“…11,15,61 However, the universality achieved through the implementation of the mhGAP guidelines is always partial and contingent. [85][86][87][88] Moreover, it is pertinent to note that international guidelines are embedded and circulated within the broader GMH assemblage (crafted using rhetorical global metrics [burden], funding, EBM, etc. ).…”

Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories, and South Africa

“…This contributed to the ‘reframing’ of global mental health from a focus on the ‘treatment gap’ to mental health as a ‘global public good’ in line with the Sustainable Development Goals. In addition, a growing emphasis on decolonisation, pluralistic interventions, and an “all of society approach” to mental health care within the field of global mental health invites fundamental changes in the ways in which the problems and solutions of mental health may be conceptualised and actioned [ 9 ]. Community health systems is a term developed by Schneider and Lehman, who define them as “the set of local actors, relationships, and processes engaged in producing, advocating for, and supporting health in communities and households outside of, but existing in relationship to, formal health structures”[ 10 ].…”