Thinking Globally About Mental Health
By 2020, depression will be the most burdensome medical issue in developing countries. That’s hardly surprising. Many developing nations are afflicted by war, disease and poverty. Depression compounds those problems, leaving people unable to care for their families or pursue assistance provided by humanitarian organizations.
Why, then, isn’t depression a major focus of the global health agenda? The answers range from fears of imposing Western values to skepticism about testing and sustaining interventions in resource-poor areas.
And yet, treatment is possible. In 2000 and 2005, I was a member of a team led by Paul Bolton of The Johns Hopkins University that studied interpersonal therapy (IPT) in AIDS-afflicted communities in
. There were few local doctors, and anti-depressant medication was prohibitively expensive. Instead, we trained community members to conduct group therapy—a method both cost-effective and well-suited to people who experience themselves primarily as community and family members rather than individuals. Uganda
We felt, going in, that IPT could work. Ugandans do believe interpersonal crises trigger depression. Yet we also knew we had to scale back IPT’s Western emphasis on assertiveness and directness in favor of finding options and advocates.
The results were encouraging. The psychotherapy participants proved better able than control patients to care for themselves and their families, and to earn a living. We believe the sessions broke down social isolation, provided mutual support, increased self-efficacy and improved communication. Those benefits persisted, and the intervention, adopted by local communities and NGOs, continues to this day.
The lessons are valuable: that, to treat any illness, one must first understand how that illness is expressed and understood locally; and, more broadly, that to confront the mental health challenges of the twenty-first century, our field must adapt its methods to local settings and resources.
And there is one other lesson, as well: treating depression is not a luxury that only wealthy societies can afford, but a necessity and a human right.previous page