Making space for restoration: epistemological pluralism within mental health interventions in Kinshasa, Democratic Republic of Congo

Abstract

Global health policymakers have recently begun to focus their attention on high levels of untreated mental illness in low-and middle-income countries. They have, in turn, initiated a series of interventions intended to reduce the global 'treatment gap' that has emerged between those requiring treatment and those able to access it. Yet critics have challenged the questionable epistemological assumptions embedded in these interventions and have decried the lack of attention given to the translation and implementation of such projects in resource-limited contexts. In this paper, I focus on ongoing attempts to diminish the mental health treatment gap in Kinshasa, Democratic Republic of Congo to illuminate how dominant thinking about ameliorating the global treatment gap remains rooted in a reductive biomedical paradigm. Drawing on interviews conducted with 16 psychiatrists in the city, I show how a series of epistemological assumptions about treatment have affected the success of treatment delivery in two donor-funded interventions. I then contrast the dominant biomedical approach with the perspectives of three younger voices in the city's psychiatric community. I reveal how an alternative epistemological framework, similar to that of the phenomenological tradition, informs their own successful treatment expansion efforts. This alternative perspective, I propose, challenges practitioners and geographers alike to cultivate new ways of approaching global mental health that acknowledge the value of patient experiences and make possible more responsive forms of treatment and care.

Understanding global mental health: a conceptual review

“…For example, the potential to develop existing frameworks of formal care to accommodate alternative forms of healing, which are more prevalent in LMICs. 54 97 98 Alongside epistemological diversity, the framework emphasises the interdisciplinary nature of GMH and the capacity for potential linkage with other disciplines such as anthropology and geography. 52 54 ⁠ It is necessary that those working in the GMH field better acknowledge where their efforts specifically contribute along the continuum of engagement, therefore referencing the proposed framework may help encourage this.…”

“…Consequently, there is a desire to see the cross-cultural adaptation of classifications and assessments of mental disorders, which are needed to facilitate research in culturally different contexts and allow for a global comparison. [50][51][52][53][54][55][56][57] GMH researchers demonstrate a more integrative, resourceful and pluralistic approach to solving mental health issues shared worldwide by seeking novel ideas and solutions to address them. 15 24 46 GMH is a highly interdisciplinary research area, benefiting from evidence generated from disciplines including epidemiology, geography and anthropology.…”

Unbracketing the multiplicity of trauma in North Kivu, Democratic Republic of Congo

“…A population‐based study conducted in the eastern provinces identified that 40.5 percent of those surveyed met symptom criteria for major depressive disorder, 50.1 percent for PTSD, and 25.9 percent reported suicidal ideation over the previous 12 months (Johnson et al ., 2010). The national healthcare system is poorly equipped to respond to these complex and protracted emergencies with, for example, only 6 public mental health hospitals (with a combined 500 beds) in a country of 68 million people (Taylor, 2017). Access to essential medical supplies is irregular and rarely sufficient to meet complex needs (Taylor, 2020).…”

In the wake: Interpreting care and global health through Black geographies

“…An extensive literature considers the colonial origins of medicine and the many ways in which medicine and the colonial enterprise have interacted with one another (e.g., Arnold, ; Bashford, ; Lock & Nguyen, ; Redfield, ; Sheller, ). A growing literature on critical geographies of global health (e.g., Brown et al., ; Ingram, ; Taylor, ) urges us to “explore multiple temporalities and spatialities, including imperial and colonial historical geographies” (Brown et al., , p. 1183).…”