Abstract
As ‘psychosocial interventions’ continue to gain traction in the field of global mental health, a growing critical literature problematises their vague definition and attendant susceptibility to appropriation. In this article, I recast this ill-defined quality as interpretive flexibility and explore its role in processes of translation occurring at the frontlines of care in rural Nepal. Drawing from 14 months of ethnographic fieldwork among community-based psychosocial counsellors, I consider how the broad and flexible notion of the ‘psychosocial problem’ operates as a ‘boundary object’ in transnational mental health initiatives—that is, how it facilitates the collaboration of service users, clinicians, donors, and policymakers in shared therapeutic projects without necessarily producing agreement among these parties regarding the nature of the suffering they address. I suggest that psychosocial interventions may be gaining popularity not despite but precisely because of the lack of a unitary vision of the problems psychosocial care sets out to alleviate. In closing, I reflect on what distinguishes ‘psychosocialisation’ from medicalisation and highlight the limitations of the latter as a critical paradigm for the anthropology of global mental health.
Highlights
As I waited at a crowded bus stop with Kalpana—Ashrang’s first and only psychosocial counsellor—a middle-aged woman nearby struck up a conversation
Nepal is widely described in the global mental health (GMH) literature as suffering from a dire shortage of mental healthcare resources, with only a single public mental hospital and an estimated 110 psychiatrists and 15 clinical psychologists serving a population of 29 million (Sherchan et al 2017)
A Kathmandu-based psychiatrist began visiting a pharmacy in a nearby town once a month to perform consultations, and three primary care doctors working in another nearby town received training modelled on the World Health Organization’s (WHO) mhGAP Intervention Guide and a supply of psychotropic drugs
Summary
As I waited at a crowded bus stop with Kalpana—Ashrang’s first and only psychosocial counsellor—a middle-aged woman nearby struck up a conversation. The dialogue quickly slipped into a familiar groove. Social science critiques of GMH have drawn heavily on well-worn Foucauldian tropes, often adopting ‘the usual frame of the battle between medicalization and its discontents, experts and patients, and the colonizing reach of disciplines and the insurgencies beating them back’ (Béhague and MacLeish 2020, 10; see Ecks 2020; Cooper 2016) In this vision, GMH catalyses the mass medicalisation of mental suffering across the Global South, undermining local cultural knowledge and deflecting attention away from social and structural determinants; the field is often described as an extension of or complicit with various wider efforts at social and economic control (e.g., Clark 2014; Das and Rao 2012; Mills 2014; Mills and Fernando 2016; Kottai and Ranganathan 2020; Watters 2010; Fernando 2011; Summerfield 2012). My analysis asks: how might these accounts challenge, exceed, or refine the critical frames through which we approach the GMH project?
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