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