Social context and mental health, distress and illness: critical yet disregarded by psychiatric diagnosis and classification

Abstract

Social change is ubiquitous and associated with mental distress and illness worldwide. To argue that social change has a differential impact in low and middle-income countries requires evidence, yet unavailable. Any effort at serious comparison to obtain such evidence is limited by current psychiatric approaches, which have decontextualized psychiatric diagnosis. Current psychiatric diagnosis and classification do not take into consideration personal and social stressors as causal, even when present and contributory to distress and illness. Euro-American psychiatry has decontexualized psychiatric diagnosis, medicalized social and personal distress, focused on treating individuals and diminished the role public health approaches in keeping with capitalistic economic and political thought. The altered framework disregards social stressors and hence does not document the universality and impact of social and economic pressures on mental health. It paves the way for a shift of responsibility onto individuals and away from society and governments. International psychiatry has completely bought into their approach and to argue otherwise is considered “unscientific”. Social changes affect humans and most differences documented across countries are due to skewed measurement, decontextualized diagnostic systems and the biomedical theoretical frameworks employed.