Week 4 Reflection: Mental Health
Dr. Vikram Patel makes the case that issues of discrimination, hidden suffering, shame, and human rights abuses are characteristics of lowered life expectancy, driven by inequities in global mental healthcare (9:21-12:11 in Patel, 2012). Patel describes it as a human rights crisis, and cites Kleinman, who expresses it as a failure of humanity (Kleinman, 2009). Both ask for a remoralization of mental health, but also ask where the outrage is in the moral imperative to help those who suffer in a world increasingly treating mental illness with pharmaceutical solutions (Patel & Farmer, 2020).
But such remoralizations still ask us to make choices and determine hierarchy, motivated by an exercise of who gets to decide for whom. Patel and Kleinman make an economic appeal to those who might make a difference for sufferers, but frame it as an ethical choice of destigmatization. Their call is directed to those in power. Those with the privilege of making the choice of remoralization. As Fassin describes, "what we're looking at here is the worth of lives versus the value of life" (Fassin in Joiner, 2024). It is a financial critique of those who gain from medication over mitigating suffering, wrapped in the moral outrage of structural violence (Farmer, 1996). As Kleinman describes, the goal of such remoralization is to destigmatize mental health and to improve morale in the patient, but we still return to the central problem of the cost of care (Kleinman, 2009). If we morally assert that all life has value, as Patel argues, then we must also make the economic argument that all lives have worth. The moral argument appeals to an emotionally positive outcome, but still cries out for an economic reconciliation framed by winners and losers.
References:
Farmer, P. (1996). On Suffering and Structural Violence. Daedalus , Winter, 1996, Vol. 125, No. 1. [Digital File]. Retrieved from https://www.jstor.org/stable/pdf/20027362.pdf.
Joiner, M. (2024). Week 4 Required Lecture. [Digital File]. Retrieved from: https://canvas.upenn.edu/courses/1781220/pages/week-4-required-lecture-47-00?module_item_id=29900561.
Kleinman, A. (2009). Global mental health: a failure of humanity. The Lancet. Vol. 374. August 22 2009. Retrieved from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61510-5/fulltext.
Patel, V. & Farmer, P. (2020). The moral case for global mental health delivery. The Lancet. Vol. 395. January 11 2020. Retrieved from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33149-6/abstract.
Patel, V. (2012). Why Mental Health Matters to Global Health. McGill Transcultural Psychiatry. [Video File]. Retrieved from: https://vimeo.com/48897107.
