Examining Global Mental Health, Bio-Politics and Depression in Ethiopia: A Critical Ethnography Study.
Abstract
Depressive disorder stands as a significant global health challenge and recognized as the primary cause of disability worldwide. Collaborating with the World Health Organization (WHO), Global Mental Health (GMH) initiatives have devised tailored international guidelines and intervention programs for low- and middle-income countries (LMICs) in response to this crisis. Despite concerted efforts, depressive disorder often remains underdiagnosed and undertreated in LMICs. However, our global understanding of depression is predominantly based on Western nosology, potentially limiting its universality. Consequently, existing clinical research and practices may fail to capture culturally relevant and salient aspects of depression.
Utilizing qualitative ethnographic methods, including Foucauldian critical discourse and document analysis, in-depth interviews, field notes, and observations, the study explored the conception(s) of depression among diagnosed individuals and healthcare providers and its cultural shaping in Bahirdar City, Northern Ethiopia. Specifically, it aimed to understand how patients diagnosed with depression conceptualize their condition and whether these local conceptions align with international definitions outlined in DSM-5 (APA, 2013). Additionally, through (re) reading global mental health as a biopolitical discursive practice (Foucault, 2008), the dissertation examined how a specific body of knowledge about depression was constructed and circulated and reshaping the landscape for psychiatric subjects in LMICs (Ethiopia).
Thirty-five in-depth interviews, involving purposively selected patients with depression (n=20) and mental health care workers (n=15) from two major psychiatric units were conducted. Findings revealed that patients perceive depression as a complex syndrome with cognitive, emotional, and physical symptoms. They attribute its origins to psychosocial, economic, and spiritual factors, highlighting the inseparable link between the mental and the social. While many symptoms align with DSM-5 criteria, five frequently mentioned symptoms do not conform, highlighting limitations in global diagnostic paradigms. Healthcare providers describe challenges in defining, diagnosing, and treating depression within a cultural context influenced by local beliefs.
The biopolitical discursive analysis of GMH intervention guidelines revealed power dynamics, operate as part of knowledge-power processes, materializing in certain forms rather than others, and shaping mental health discourse. The analysis identified several resistive discourses and suggested reconceptualizing the treatment gap for common mental disorders. This dissertation contributes to global mental health literature, stressing contextually grounded interventions in LMICs. By targeting social, cultural, and structural determinants of mental health(depression), policymakers, researchers and practitioners can work towards more equitable and effective mental health systems worldwide.