The World Mental Health Missionaries?

By Neuroskeptic | March 3, 2012 12:41 pm

Is research on the global distribution of mental health problems a kind of modern-day missionary work?

Maybe, says Australia’s Dr Stephen Rosenman in a provocative paper: Cause for caution: culture,sensitivity and the World Mental Health Survey Initiative.

The World Mental Health Survey (WMHS) is a huge World Health Organization project that aims to measure the rates of various psychiatric disorders in countries around the world. The WMHS has produced a great deal of data, but Rosenman points out that this assumes that people all over the world suffer from the same psychiatric disorders (and display them in the same ways) as the Americans and Europeans about whom the diagnostic manual was originally written.

The surveys translated the diagnostic criteria into the local languages, of course, but that doesn’t mean they were appropriate to the local cultures.

He suggests that all this is a bit like missionaries who went around translating the Bible and trying to convince people to read it –

Looked at with a less admiring eye, the [WMHS] resembles in some ways the missionary movements of the last two centuries. Like the missionaries, the organisers are committed, selfless people of extraordinary goodwill who have come to poor countries from cultures at the apogee of their wealth, prestige and intellectual power.

They bring an evolved and highly developed system of thought. They set about delivering the fruits of that to the people. The survey initiative has engaged the leaders of the profession in the countries and, in a sense, has converted them to this view of psychopathology.

It is difficult to know if their success is due to the power of the ideas they brought, or the power and prestige of the cultures they came from, or from their technique of taking over both the centre and the contours of the beliefs of a culture. Missionaries brought a ‘colonisation of consciousness’… etc.

He does goes on to say though, “I do not want to push the missionary analogy too far” which is wise I think; there are important differences and other analogies are equally apt.

The paper’s a good read though. It refers to Crazy Like Us, a book I’m fond of.

Although Rosenman doesn’t cite another important source (cough cough): he points out that the WMHS national estimates of rates of depression don’t correlate at all with national suicide rates, which is seriously odd –

According to the CIDI [the psychiatric interview used in the WMHS], Japan, for example, has one-third the rate of mood disorders (3.1%) seen in the USA (9.6%). At the same time, Japan’s suicide rate (20.3/100,000) is twice that of the USA (10.8/100,000). Suicide rates seem to have almost no relationship with CIDI diagnoses of affective disorder… Suicide, of course, is complexly shaped by the culture but are we to believe that answers to the CIDI are any less culturally determined and which is to be considered the better index of disorder?

I made the very same point using the very same datasets in 2009 (although I looked at ‘all mental illness’ rather than ‘mood disorders’).

ResearchBlogging.orgRosenman, S. (2012). Cause for caution: culture, sensitivity and the World Mental Health Survey Initiative Australasian Psychiatry, 20 (1), 14-19 DOI: 10.1177/1039856211430149

  • Romeo Vitelli

    The relationship between depression and suicide has always been hard to determine even in Western cultures. That's likely to hold true worldwide given the cultural stigma that is often attached to suicide and mental illness and the difficulty in collecting accurate statistics.

  • Anonymous

    Is there any evidence that mental illness even exists in people below the age of, say, 30? Intuitively, it should appear in roughly the same prevalence as physical illness (if not significantly less due to the blood-brain barrier). More than that and you're looking at a twisted cultural narrative. Would be very dangerous indeed, and much like early Christian missionaries, to spread such a narrative.

  • Neuroskeptic

    Romeo: That's certainly all true. But Rosenman's point (and mine) is that, while the lack of a correlation between 'illness' and suicide rates surely does partly reflect cultural factors in a) recorded suicides and b) the relationship between suicide & illness, that doesn't mean we can ignore c) the possibility that 'illness' is being poorly measured by these surveys.

  • omg

    Survey ? So what are they gonna do? Trek to Mongolia ? Arid Saudi Arabia ? Wait a minute they're only allowed to run surveys on UN signatories. Of course they couldn't go to Pyongyang which would inevitably skew datasets anyway. WHO harvest health data from govts anyway ? Don't the white man trust the native man's data? What a waste of funds. They must be running out of ideas.

  • omg

    Has USA ratified UN ? I can see a pic of USA but I don't think they're allowed to survey that land mass. Isn't that national security breach ? Has this data collection been updated since Bush took USA out of UN ?

    I've clicked on links to try and get the data but they're either independent firms funded to publish useless journal articles I don't have open access to or in obscure percentages and stat boxes with no dates or research information.

    It wouldn't be logistically possible to undertake data collection of that magnitude per year unless they source it out to third party marketing surveyors in the private sector which would explain where they've been coffering funds most likely in cohort with big pharma so they can distribute their mental meds to developing countries.

    'As an alternative to MyData, you can now use Facebook or Google to sign in to ICPSR. Either use your existing Google or Facebook account or create a new one.'


  • Steindór J. Erlingsson

    Wilkinson and Pickett discuss the suicide issue in the Spirit Level (2009, 2010, p. 175):

    “The only social problem we have encountered which tends to be more common in more equal countries … is, perhaps surprisingly, suicide. First, in some countries suicide is not more common lower down the social scale … Second, suicide is often inversely related to homicide [USA at the top, Japan at the bottom]. There seems to be something in the psychological cliché that anger sometimes goes in and sometimes gout out: do you blame yourself or others for things that go wrong? In chapter 3 we noted the rise in the tendency to blame the outside world — defensive narcissism — and the contrasts between the US and Japan”.

  • Neuroskeptic

    Steindór J. Erlingsson – Yeah, I remember thinking “but what about suicide!?” when I read The Spirit Level, and I didn't find their answers convincing. It's just a post-hoc story. I was actually quite impressed by the rest of the book.

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Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.


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