Psychosocialization in Nepal: Notes on Translation from the Frontlines of Global Mental Health

Abstract

As ‘psychosocial interventions’ continue to gain traction in the field of global mental health, a growing critical literature problematises their vague definition and attendant susceptibility to appropriation. In this article, I recast this ill-defined quality as interpretive flexibility and explore its role in processes of translation occurring at the frontlines of care in rural Nepal. Drawing from 14 months of ethnographic fieldwork among community-based psychosocial counsellors, I consider how the broad and flexible notion of the ‘psychosocial problem’ operates as a ‘boundary object’ in transnational mental health initiatives—that is, how it facilitates the collaboration of service users, clinicians, donors, and policymakers in shared therapeutic projects without necessarily producing agreement among these parties regarding the nature of the suffering they address. I suggest that psychosocial interventions may be gaining popularity not despite but precisely because of the lack of a unitary vision of the problems psychosocial care sets out to alleviate. In closing, I reflect on what distinguishes ‘psychosocialisation’ from medicalisation and highlight the limitations of the latter as a critical paradigm for the anthropology of global mental health.

Opening up the ‘black-box’: what strategies do community mental health workers use to address the social dimensions of mental health?

“…For example, CHWs tailored their interventions and relationship building to account for local context and power relations within communities. Chase [ 9 ] discusses this in relation to lay psychosocial counsellors in Nepal. She illustrates how these workers flexibly use the concept of ‘psychosocial’ in their practice.…”

“…In contextualizing our findings, this paper engages with published studies that examine the ways that CHWs use their local and contextually informed understanding of social and structural health determinants, to promote and support psychosocial wellbeing and mental health (e.g. [ 9 , 25 ]). We argue that greater attention should be given to the ways that CHWs operate and the strategies and mechanisms they deploy to improve mental health (following [ 2 , 11 , 25 ]).…”

“…Our study examines the types of skills and strategies to address social dimensions of mental health used by community health workers (CHWs) working together with PPSD in a non-governmental project in north India. Unlike earlier ethnographic studies [ 9 , 11 , 23 , 25 ] we draw primarily on interviews with CHWs, secondary data (case notes, care plans) and limited observation. This allows us to also develop initial insights into (mental health) outcomes of CHW interventions.…”

Grupos reflexivos com estudantes de medicina da liga de saúde mental como estratégia de mudanças

“…Um campo de estudo, pesquisa e propostas de intervenção denominado Saúde Mental Global (SMG) tem se estruturado desde meados dos anos 2000, visando fortalecer as questões em tor-no da saúde mental, ocupando-se da formação de práticas e conhecimentos, a partir de estudos em escala global [3][4][5][6][7][8] .…”

“…A pandemia por SAR-CoV-2 aumentou a visibilidade do mal-estar coletivo, denunciando o caráter social dos sintomas psíquicos, geralmente decorrentes de estilos de vida desfavoráveis à produção de saúde. Já há algum tempo diferentes aspectos da saúde mental tem sido investigados 2 , desenvolvendo estudos que se dirigem a diferentes públicos e faixas etárias, sejam eles no plano social, individual ou global [3][4][5][6][7][8] .…”