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The cultural context matters: a self-help group with former gang members in Managua
Nicaraguan psychologist Marta Cabrera says humanitarian organisations must consider and understand the cultural roots of psychological problems. In Latin America for example, machismo triggers subconscious anxiety in women. To treat traumas after violent conflict, it is necessary to carefully analyse local resources and capacities. From Cabrera’s perspective, psycho-social support must empower people politically and enable them to make their own efforts to bring about change.
Stefan Ecks, a medical anthropologist at the University of Edinburgh, agrees that mental health needs to be examined in a culture-sensitive manner. He points out, however, that the WHO considers mental diseases treatable with standardised therapies. According to the WHO, the world’s 140 poorest countries lack about 1.4 million competent professionals in this field. Eck questions these data as they tend to be based on simple assessments and biased studies.
Ecks similarly opposes the WHO’s use of data from national health ministries. According to him, doing so makes sense in the UK, but not in a country like India, where there are no statistics that take into account traditional, culture-specific health practices. Extrapolating data from one small remote village in the hope of understanding an entire country, he warns, results in “absurd conclusions.” In his view, the WHO needs a more solid, scientific basis.
According to Ecks, moreover, the WHO is blind to the trend towards ever more prescriptions of psychopharmaceutical drugs. Especially in poor countries, pharma manufacturers claim their products have no side effects, he says, and general practitioners routinely prescribe powerful drugs, without telling patients they are taking anti-depressants, for example. Price competition is facilitating cheap access
to medication, Ecks acknowledges, but long-term psychotherapy would often be the better alternative. Psychotherapy, of course, is also a profoundly western approach to dealing with suffering.
Mental health problems and globalisation were the topic of a symposium held by medico international, a non-governmental humanitarian agency, in Frankfurt in May. From medico’s perspective, individuals are continuously asked to assume more responsibility, which results in a diminishing sense of social security and more restlessness and exhaustion. Mental illnesses are proliferating, according to medico, because people experience the toll of constant competition for survival as personal shortcomings. At the same time, the NGO argues that pharma companies are interested in marketing their drugs all over the world and neuro-scientifical categories are increasingly used in ever more countries.
Usche Merk from medico says that humanitarian organisations are part of the problem. In conflict and disaster areas, they tend not to consider cultural or political contexts, but rather aim to raise media awareness in donor nations. According to Merk, an uncontrolled market for expertise tends to arise, with agencies imposing a refined menu of context-ignorant therapies. She finds it scandalous that victims of violence and disaster often become objects of neurological studies and serve as test cases for new methods. Many therapists, she insists, are not familiar with the local culture or language. Good professional practice, according to Merk, requires people’s participation.
Medico spokeswoman Katja Maurer says trauma treatment is increasingly disguising as brain research. Meaningful dialogue, in her view, is being replaced with medication, generalised statistics and an obsession with foreign aid workers’ traumas. Psychiatrists have a habit of constantly redefining mental diseases and inventing new diagnoses, she says, so the real challenge is to refute questionable studies and start more cooperative psycho-social support.