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The Perils of Globalizing Mental Health

Photograph of 1944 poster that says "mental health is your concern"

In an age where self-care is a commonly touted virtue, it’s easy to take for granted what a recent development the gradual de-stigmatization of mental illness is. Celebrities constantly come forward with harrowing stories of struggle and recovery, pop-psychology blogs and websites abound, and every day we see more open and honest discussions about the foundations of and treatment options for mental illness.

Perhaps the globalization of this phenomenon is even more surprising. Mental health has truly become a global concern, with researchers and psychiatrists from a diverse array of cultural backgrounds contributing to our understanding of mental illness. Counseling is now considered an essential part of post-disaster relief packages, trauma being an assumed result of natural disasters. In the wake of the earthquake and tsunami that devastated Indonesia in October of 2018, for one recent example, clinical psychiatrists and trained volunteers were deployed by the World Health Organization to administer psychological first aid. These changes seem to signify the end of stigma, indicating more effective approaches to treating nebulous and painful conditions that afflict people around the world.

But despite the growing global concern over mental illness, the West still acts as a dominant force in the discourse around mental health. The DSM, or the Diagnostic and Statistical Manual of Mental Disorders, a handbook of symptoms and treatment options for mental illnesses compiled by the American Psychiatric Association, is considered the gold standard for diagnosing mental illness around the globe.

We rarely stop to ask whether or not applying American understandings of mental health can have a detrimental effect on the way mental illness is treated in non-Western cultures. Our culture has come to consider conditions like depression and schizophrenia solely through a biomedical lens, as illnesses entirely dependent on a complex set of neurological misfirings rather than cultural causes.

But in his book Crazy Like Us: The Globalization of the American Psyche, Ethan Watters examines the ways in which the biomedical approach taken by Western psychiatry can have a negative effect on those suffering from mental illnesses in places with different understandings of what it means to have a unified sense of self. He argues that importing Western cures for mental illness, which are deeply rooted in our own cultural mores, to other nations is unethical.

Watters distinguishes between the pathoplastic and pathogenic causes of mental illness. Mental illnesses don’t function in the same way that diseases like cancer do, where the  expression of the disease is completely independent of cultural context. There are two ways that mental illness can express itself; the pathoplastic causes, which are individualized and culturally-specific, and pathogenic causes, the underlying psychological imbalances.

The difference between pathoplasticity and pathogenicity is explored by novelist Esmé Weijun Wang in her collection of essays The Collected Schizophrenias. She sees a vital distinction between “explanations”, the “spiritual narratives” that color pain and illness with cosmic significance, and “causes”, the neurological reasons for mental illness that are uniform for humans across the board. In other words, the pathoplastic causes of a disease, the explanations can have meaning for the afflicted, whether these explanations are rooted in culturally-specific expressions of pain or find outlets in things like religion.

Most researchers dismiss the pathoplastic causes as irrelevant, but Watters posits that “culture and social setting play a more complicated role in the disease than simply influencing the content of the delusion.” In Western society, we push the narrative that mental illness is biomedical, an illness as removed from cultural influences as cancer, but research suggests that the biomedical approach, taken solely on its own, can be harmful and even heighten stigma against mental illness.

Despite our growing interest in helping the mentally ill, stigma against mental illness in the West has actually been increasing since the 1950’s. According to a 1996 study,

Among adults who associated mental illness with psychosis, the odds of describing a person with mental illness as violent in 1996 were 2.3 times the odds of describing a person with mental illness as violent in 1950 […] Perceptions of dangerousness were associated with causal attributions of mental illness. Causal attributions of genetics or chemical imbalance increased the odds of perceiving a person with schizophrenia as dangerous to themselves and others.

While “perceptions of dangerousness appear to have stabilized” between different illnesses from 1996 and 2006, with “no significant differences […] in the public’s perceptions of dangerousness of adults with schizophrenia or depression,” the perception of dangerousness hasn’t faded from mental illness as a whole. The biomedical perspective on mental illness, the study suggests, has insidiously increased stigmatization by casting the mentally ill as inherently dangerous, helpless prisoners of their own minds. Watters suggests that the Western approach, while offering valuable insights on the underlying causes of disease, can be dehumanizing for the afflicted. It reflects a very Western sense of the body as divorced from culture, a neutral space only affected by genetic predispositions. Watters argues that what we’re actually importing to other cultures is not Western psychiatry but the Western idea of the self, our conception of what it means to be a functioning member of society. In our culture, we tend to have a strongly internal locus of control, meaning most Americans view themselves as completely in control of their lives, whereas other cultures have a more external locus. Our approach towards mental illness reflects this; those with mental illness are often viewed as lacking the willpower to overcome their condition. Despite the biomedical approach most Westerners subscribe to, which should firmly place the cause of mental illness outside of the afflicted, these beliefs persist.

This issue is part of an important ongoing conversation about the impact of globalization and Western hegemony. In the next century, we’ll see more natural disasters caused by climate change, which will inflict trauma on large populations of those already disenfranchised by poverty and disease. More trauma means more counseling and medication, specifically Western counseling.

Diagnoses can stick, sometimes doing more harm than good. Esmé Weijun Wang remarks that in Western society, “it is easy to forget that psychiatric diagnoses are human constructs, and not handed down from an all-knowing God on stone tablets; to ‘have schizophrenia’ is to fit an assemblage of symptoms, which are listed in a purple book [the DSM] made by humans,” and therefore not infallible. While therapy is undoubtedly useful for many, we should be cautious before applying it as a universal cure-all, and encourage rather than discourage global diversity in the field of mental health.

Is the Global Citizenship Movement the New “White Man’s Burden”?

Photograph of Palais des Nations building with flags in two columns in front of it

In an age of red-eye flights and the ability to communicate digitally across thousands of miles, the world has never felt so small and interconnected. Despite this, the governments of countries across the world remain relatively segregated in regards to policies concerning citizenship and human rights. These issues were discussed at large during the 37th session of the UN Human Rights Council, which took place on March 6 in the Palais des Nations. During the session, many different methods for improving human rights worldwide were discussed, including the concept of Global Citizenship Education. The movement for global citizenship counters the concept of isolationism and advocates for a set of moral standards to apply a global society. Though global citizenship sounds relatively straightforward, the movement is often steeped in questions of justice and national self-determination.

The United Nations Educational, Scientific and Cultural Organization (UNESCO) Program for Global Citizenship Education aims to improve human rights worldwide “by empowering learners of all ages to understand that these are global, not local issues and to become active promoters of more peaceful, tolerant, inclusive, secure and sustainable societies.” But does the call for global citizens risk the erasure of national identity? Are the standards set for development always just? And does the initiative for global citizenship encourage a 21st century “white man’s burden” mentality?

The term global citizen refers to “someone who is aware of and understands the wider world – and their place in it.” Though the concept of global citizenship is not necessarily new, the organized global citizen movement began less than 10 years ago. The organization Global Citizen was founded in 2011 with the mission of empowering individuals and communities to make an impact worldwide on a variety of human rights issues. Though one of Global Citizen’s largest goals is to eradicate extreme poverty, the organization also works toward securing gender equity, environmental health, and civil rights.  

Global Citizen takes steps to empower people at the local level, but is there a danger in redefining certain issues as inherently global? There have been ardent critics of this concept of the sentiments of global citizenship, such as British Prime Minister Theresa May and President Donald Trump. In a speech delivered in October of 2016, May expressed her discontent with the attitude of global elites. She commented, “Today, too many people in positions of power behave as though they have more in common with international elites than with the people down the road, the people they employ, the people they pass on the street.” It’s obvious that May feels that globalization has erased local and national connections. She continued with a more controversial statement, declaring that “If you believe you are a citizen of the world, you are a citizen of nowhere.” Only a few months after May’s comments, Donald Trump expressed a similar sentiment. He proclaimed, “There is no global anthem. No global currency. No certificate of global citizenship,” in a speech given during his presidential victory tour. Trump appealed to the isolationist values of his supporters, promising that “Never anyone [sic] again will any other interests come before the interest of the American people.” For these politicians, and their supporters, global citizenship means abandoning national identity.

Though May and Trump’s comments were blasted as ignorant, uncompassionate, and even sympathetic to fascist values, whether or not one can ethically reconcile nationalism and globalism remains largely unanswered. In an article titled “Global Citizens vs the People,” Jim Butcher of online political magazine Spiked explains how global citizenship does not only contradict conservative ideology, but liberal populist ideology as well. Butcher argues that global citizenship does not necessarily mean renouncing nationalist sentiments, but he notes that global citizenship runs the risk of “seeking respite from democracy” and can in fact be “a way of avoiding having to address the political views and arguments of your fellow citizens.”

But some proponents of global citizenship claim that such criticism fails to acknowledge the difference between soft and critical global citizenship. In her article “Soft versus critical global citizenship education,” Vanessa Andreotti acknowledges the potential harm in global citizenship education, but believes that it can be eradicated by emphasizing critical thinking. It is possible for global citizen education to encourage its proponents to “project their beliefs and myths as universal and reproduce power relations and violence similar to those in colonial times.” This need not be the inevitable result, however, if global citizenship education gives learners the tools to critically assess issues of inequality and injustice, which are skills soft global citizenship fails to provide.

For example, while soft global citizenship may frame the solutions to global issues as humanitarian, critical citizenship frames these solutions as a political and ethical. Teaching these critical distinctions keeps the global citizen aware of their own biases and safeguards the global citizen movement from a patronizing mindset. And organizations such as Global Citizen arguably embody critical global citizenship education, with its mission explaining that “everyone from citizens, governments, businesses, and charities have a role – because none of aid, trade nor charity can do this alone.”

But global citizenship is also inherently reliant on globalization. Though critical global citizenship encourages people to think critically about the negative effects of globalization, it assumes that globalization can be used as a positive force. Some might argue that globalization has in fact created a new world hierarchy, specifically in terms of the standards of development. Post-development theory holds that the global crusade for development has failed and that in some cases development operates as a modern form of imperialism that is “a reflection of Western-Northern hegemony over the rest of the world.”

Prominent post-development scholars, such as Wolfgang Sachs, have argued that because development standards often include assimilation to Western lifestyle, “it is not the failure of development which has to be feared but its success.” It is undeniable that development standards are often set and enforced by the Western world, with Western countries holding the majority of power in prominent global organizations working toward development, such as the United Nations and the World Bank. A paper funded by The National Bureau of Economic Research’s Economics of National Security program found that since the UN’s inception, there has been an unwavering power bias in the secretariat in favor of Western countries. Though the UN maintains its mission is to keep peace throughout the world, one could argue that such an imbalance in institutional power is obstructive to this mission and actually reflects the continuation of geographical and racial inequalities spurred by the history of Western imperialism.

However, many supporters of globalization argue that the concrete effects of globalism justify its problematic ideological implications. The United Nations was single-handedly responsible for the eradication of smallpox, with its initiative in the 1960’s and 70’s through the World Health Organization. The UN also touts a variety of achievements through partner organizations like UNICEF, which, between 1990 and 2015, reportedly saved the lives of over 90 million children. The World Bank, an organization working to end worldwide poverty that also grew out of globalization, is responsible for providing essential health services to over 600 million people and providing 72 million with better access to clean water. These achievements are undeniably significant, and would not be possible without a unified effort and collection of people advocating for positive globalization.

Though the struggle for human rights and global economic equality has improved, the problems made apparent by globalization are nowhere close to disappearing. A world of global citizens might just be the solution that marks the 21st century as the century that eradicates extreme poverty and radically improves justice and equality. However, the effects of increasing the global stake in these issues will not be easy to backtrack if such initiatives are unsuccessful or have unintended consequences. We should not underestimate the potential of the global citizen movement to encourage a “developed man’s burden” outlook if it fails to encourage critical and ethical examinations of its followers.


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The 2018 Davos Forum: Plutocratic Gathering or Genuine Discussion?

An image of Davos, Switzerland in the winter.

Donald Trump, Angela Merkel, Narendra Modi, and many other world leaders, CEOs, celebrities, and influencers will gather this week in a beautiful ski resort in Davos, Switzerland to attend the 2018 World Economic Forum. This gathering started in 1971 as a small conference attempting to teach underperforming European companies American management techniques. Since then, the Davos Forum has established itself as the most important world gathering where the world economy is tested, evaluated, and planned.

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Fast Fashion and the Ethics Behind Your T-shirt

A Photo of fashion design mannequins in an empty warehouse.

Can ethics and economics ever work together? This question captures the essence of the sweatshop issue that dominated the majority of media in 2013, especially highlighting Bangladesh. In 2013, according to the Guardian, a garment factory located from the fourth floor to the seventh floor of Rana Plaza collapsed, killing 1,135 people.This was not a natural disaster in any way, but rather was purely man-made. The workers apparently noticed a crack on Tuesday and reported to their manager, which resulted in a supposed Wednesday off for inspection. However, for some reason the building was declared safe to work in later on, and hesitant yet voiceless workers were called back to work, as CNN explains. Unfortunately, the Rana Plaza incident was not the first incident related to garment factories that occurred in Bangladesh. Previously in 2005, reports indicate that there were 70-plus deaths in a garment factory in the same area. Additionally, in 2012 another garment factory fire has already killed more than a hundred people in Dhaka, Bangladesh.

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Brexit: Hyperglobalization and the Globalization of Nationalism

“The specter of Brexit is in all of our societies,” cautions Alexander Betts in a TED talk in July. What is “Brexit”? Brexit was a vote held on June 23rd by the peoples of the United Kingdom (UK) to decide whether their country was to stay or leave the European Union (EU): a political and economic union composed of  28 member states. Voters’ main motivation to leave the EU was due to concerns over immigration, more specifically, their concerns over an increasing amount of refugees entering the UK. In the aftermath of Brexit, the election been labeled as a “rejection of globalisation.” What does this mean?

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