Fragile universalisms: Caregiving at the intersection of NGOs, social relations, and Global Mental Health in Mozambique
Ramah McKay (University of Pennsylvania)
Paper short abstract:
This paper examines how Mozambican mental health caregivers negotiate competing global or transnational norms and emphasizes (from the fragile universalisms of Global Mental Health to the emphases of transnational NGOs) while also confronting the skepticism of many patients and families.
Paper long abstract:
In Mozambique, mental health and psychiatric services are few, frequently underfunded and understaffed. Ethnographic work has shown how local forms of healing are preferred and, often, more effective than psychological interventions based in Western or biomedical conceptions of mental illness and healing. Yet institutions of mental health care do exist - from the National Health Services' Mental Health Unit to forms of mental health care and counseling provided by transnational NGOs. In a context where a majority of health funding, even in the public system, is dependant on NGOs and donors, mental health providers work to "link" their efforts to transnational initiatives and global health infrastructures. As a result, caregivers recognize that a Global Mental Health agenda may offer new resources for care, even as they acknowledge how many patients understand their predicaments as material, financial, or social in origin rather than psychological or psychiatric. This paper examines how caregivers negotiate competing global or transnational norms and emphasizes (from the fragile universalisms of Global Mental Health to the emphases of transnational NGOs) while also confronting the skepticism of many patients and families. Drawing on ethnographic interviews conducted with mental health providers in Maputo and Nampula, Mozambique, it highlights how psychologists and psychiatrists navigate this fraught institutional and epistemological landscape. It also draws on analyses of medical care in Africa more broadly to suggest that the universalisms deployed by mental health professionals are not unique to the Global Mental Health agenda but are also resonant with broader definitional and epistemological struggles.
Ethnographic perspectives on 'global mental health'