Pluralistic Therapy Meets Global Mental Health
Lynne Gabriel, Christine Kupfer, John McLeod, Kate Smith and Mhairi Thurston
A group of members of the pluralistic network recently participated in a two-day on-line conference on Pluralizing Global Mental Health Care: crisis, and critique, hosted by the University of Edinburgh Centre for Medical Anthropology. We presented two papers – one on how pluralistic counselling and psychotherapy might contribute to global mental health, and the other on its relevance in relation to mental health impacts of the climate crisis. For most of us, this was our first involvement in the field of Global Mental Health. What we discovered is an area of theory, research, and practice that could have a great deal of relevance for the future development of a pluralistic approach. Work on Global Mental Health seems to comprise two separate but interconnected types of activity. At one level, there are projects that analyse the provision of mental health care across the world. For example, one of the papers at the conference reported on a major Lancet review of how services in low-income and middle-income countries responded to the mental health needs of people in the first phase of the COVID-19 pandemic. This study found a wide range of flexible, innovative and effective services, even in countries not normally associated with high quality mental health care, such as Lebanon and Ghana. By contrast, mental health support in high income countries in the global North were in many instances slower to respond, and seemed to be more locked in to bureaucratic systems that were resistant to change.
At a different level, the field of Global Mental Health encompasses studies by social anthropologists of how different communities around the world experience, and deal with, mental health problems. From a pluralistic therapy perspective, many of these studies describe activities that would be categorised as cultural resources. An advantage of the kind of very detailed observation and analysis carried out by ethnographic researchers is that it provides insights into recovery processes that are outside of routine therapy practice, and as a result helps the reader to appreciate new possibilities. An example of this kind of investigation is a study of the experience of people who engage in distressing compulsive body-focused behaviours such as hair-pulling. This particular piece of research looked at how individuals who suffer from such behaviour overcome the disinterest or lack of awareness of their local counsellors and health providers by becoming part of a global on-line community that offers support and a positive sense of identity. Another interesting ethnographic study looked at how a long-established faith-based type of support for people with mental health problems, provided by a widely-used Hindu healing temple in Rajasthan, India, was increasingly threatened by the imposition by government authorities of standards for mental health interventions imported from Western countries with very different cultural traditions. [A, accessible full-text copy of this paper is available through Google Scholar]. Taken together, these two studies illustrate critical issues in mental health care that become more visible from a global perspective, in terms of a tension between the profound creativity of people in finding ways to support each other, and the stifling effects of power differences in who is able to define some support strategies are legitimate and others are not.
We encourage pluralistically-oriented colleagues to find ways to engage with the kinds of debate and evidence that exist within the field of Global Mental Health. There are many possibilities for enriching pluralistic practice by learning from colleagues in other countries. It is also possible that some of our own experience and skills may be of some value in other global contexts.