Global. Mental. Health.

It was our first day of the first class of the world’s first Master’s-level program in global mental health. Needless to say, we had a lot of questions. But the question I remember most clearly did not come from any of the students. It was from our Course Director Alex Cohen.

“What is ‘global mental health’? Let’s not even go into the ‘global’ part just yet. What is ‘mental health’?” Dr. Cohen divided us into groups and asked us to discuss several terms: “mental illness”, “mental disorder”, “mental well-being”.

I remember sitting on the floor next to a classmate, a British-Malaysian psychiatrist, while she led our group in a discussion of the WHO’s definition of “health” and the general clinical criteria for “disorder”.  I felt dizzy. Is “mental health” nothing but the absence of “mental disorder”? “Mental illness” simply its presence? Is “mental well-being” a flabby indicator of sub-clinical “illness”, or a goal of “health” promotion?

The discussion quickly grew out of hand, which seemed to please Dr. Cohen greatly. The point of the exercise, he explained, was to confuse us. There is great imprecision in the language we use in this field, and many of our most basic terms mean different things to different people. “Mental health” is never neutral.  Put this muddle on a global scale, and you’re bound to create controversy.

Global v. Local has been part of social science discourse for about as long as anthropologists have been wearing Birkenstocks. When it’s invoked by academics talking about global mental health, it usually sounds more like Biomedicine v. Culture (a debate far too large and too fraught to describe here). So later in the year, when students in our course began interrogating the “global” in “global mental health”, I braced myself for yet another iteration of this debate, with “global” portrayed as an evil code word for “biomedical”, “Western”, “imperialistic”.

I was surprised when, during a discussion over pizza with Dr. Cohen, a classmate from Sweden asked, “When we say ‘global’, do we only mean ‘low- and middle-income’?” She made the point that her own country could learn from the community mental health interventions in South Asia and Sub-Saharan Africa that we so often study. To her, “global” didn’t mean “Western”; rather, it omitted high-income settings entirely.

Later, during our last term of the year, the former WHO Director of Mental Health Dr. Benadetto Seraceno gave us a lecture in which he lamented his own role in branding this field “global”. As he remarked, “Everything is ‘global’ now, but things happen at the local level.” And of course, “local” can be anywhere—India or Nigeria or yes, even Sweden. “We need to be more careful in using these words,” he warned.

I appreciate the spirit of scrutiny and self-reflection that has been cultivated by the students and teachers of this MSc. I imagine very few degree courses both start and end with the question, “What is our field?” But I also have to remind myself to value the words we use for what they do, not just what they might signify.

No matter what each of these words means to us individually, or how confusing they can be in combination, when you put them together, something special happens. You get a movement, a discipline, a debate. Maybe some of us will address “mental illness”, and others “well-being”, and who knows where we will find ourselves working in the years to come? But when you put these three words together, you get twenty students from around the globe staking their careers on the hope that some of the world’s most vulnerable populations can be treated better.

That—to me at least—is global mental health.

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