How scientifically valid is the knowledge base of global mental health?BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39513.441030.AD (Published 01 May 2008) Cite this as: BMJ 2008;336:992
- Derek Summerfield, honorary senior lecturer
- 1Institute of Psychiatry, King’s College, London SE5 8AF
- Accepted 26 January 2008
Global mental health now has its own academic units, literature, study, and training courses and the World Health Organization is a major articulator of this work. Last September, a series on global mental health in the Lancet asserted that mental disorders now represent a substantial “though largely hidden” proportion of the world’s overall disease burden, that every year up to 30% of the global population would develop some form of disorder, and that there was strong evidence for scaling up mental health services worldwide.1 2 In this article I examine the evidence for these claims and challenge the assumption that Western frameworks can generate a universally valid knowledge base.
Classification and diagnosis
Psychiatric research and practice rest on empiricist convention rather than on timeless discovery. The principal classification systems, the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM), are shaped by contemporary notions about what constitutes a real disorder, what counts as scientific evidence, and how research should be conducted. They are Western cultural documents par excellence.3
The diagnostic categories within these classifications are essentially conceptual devices emerging from committee decisions. The authors of both of these classifications are careful to point out that “there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no disorder.”4 Despite this, in everyday practice these categories have been effectively accepted as if they were unequivocal diseases like, say, tuberculosis.
Claims for the universality of a particular psychiatric category would be compelling if a straightforward biological cause had …