Conflict, poverty and instances of social injustice can provide the context within which a person develops mental health issues. And yet, while studying to become a creative/psychomotor therapist, I learned very little about this.
I didn’t question it at the time, because mental health is a personal issue, right? My time in a counselling centre in Uganda last summer showed me that the answer to this question is, in fact, a clear no.
I volunteered as a psychomotor therapist in the Bishop Asili Counselling, Rehabilitation and Community Centre in Ngetta, northern Uganda. The local population living here suffered badly during the Lord’s Resistance Army insurgency.
More than a decade after the end of the war, I came to Uganda with a stack of books on trauma and post-traumatic stress, ready to do creative therapeutic interventions that might help women cope with their war-time experiences.
Very quickly, it became clear to me that the conditions these women lived in asked for something different. Something more.
Sister Florence, an Ugandan psychologist who founded and runs the counselling centre, reminded me that next to their history of war, “there are so many [other] sources of trauma, so many, so many, so many”.
Women in Ngetta face many challenges. The patriarchal context leaves women with few, to zero, rights.
They have no right to land or any kind of ownership, and the moment a woman marries, her new husband acquires rights over her sexuality and reproductive ability.
Ellen, one of the women I worked with in the counselling centre, described the patriarchal culture: “I was now in the hands of my husband and I was now under authority of my husband. I need to respect him and do everything he tells me.”
Her words reflect the complex power dynamics and hegemonic masculinity that undermine women’s social status and power. On top of this, many women struggle to feed their families every day, while often their husbands drink away the little money there is. Other women have lived through (often multiple) more recent traumatic events, such as emotional and physical abuse by a husband or brother.
It made me wonder how much help my therapeutic interventions focused on (individual) war-trauma could be.
Recognizing the unequal social position of women, I needed to have a clear feminist ideology underlying my therapy. This meant focusing on women’s social position and equality.
Our sessions were related to resilience, visibility and communication, grounding techniques, personal boundaries, and more. Work related to the strive for equality for women was essential. However, paying attention to – and ultimately challenging – violent and unjust structures is not often included in mental health interventions in the Global South.
The importance of women’s mental health for general health is widely recognized. Mental health in international contexts is slowly becoming more of an acknowledged topic within the field of international development. This is really good news, especially considering the fact that only a small minority of the 450 million people suffering from mental or behavioural disorders worldwide receive treatment.
In 2013, the World Health Organization published their Mental Health Action Plan: 2013-2020. It is an ambitious action plan that understands ‘the essential role of mental health in achieving health for all people’. Global Mental Health (GMH) is thus an emergent topic in which more and more people are currently working. However, with this renewed focus on mental health, many critiques have emerged, some of them accusing GMH of being a colonial practice.
GMH is accused of globally enforcing biomedical systems, which are characteristic of the Global North’s approach to health. The biomedical framework locates illness, including mental illness, within a person. Though psychological and social principles are sometimes taken into account, biological variables are the most central.
Issues of social injustice and structural violence (such as poverty, conflict, sexism, racism) are not taken into account, despite their significant impact on women’s mental health.
Very important work is being done in the field of GMH. Organizations like SOS Children’s Villages or Action for Child Trauma International are great examples of a rights-based approach to trauma.
We must be careful to avoid new forms of imperialism in which the Global North enforces its biomedical approach to health on all cultures. We should work towards locally-informed care which approaches mental health not as an individual issue, but as something to be addressed on personal, community, national and global levels.
Mental health should be seen as a social issue.
This would allow us to challenge discriminating structures, both globally and nationally, while also focusing on community and personal struggles.
In order to achieve mental health for all, there is an essential role for work towards an equal world, and this work is should be integrated in the field of Global Mental Health.