Author:Hanna Kienzler (King's College London)
Paper short abstract:
This paper questions standardized approaches to mental health care in post-war development contexts arguing that available treatment options rather than symptoms determine diagnoses and care. Normative assumptions about standardization, evidence and ethics will be questioned and critically discussed.
Paper long abstract:
Mental health and psychosocial treatment approaches are increasingly transported to post-war development contexts as part of capacity building initiatives. These foresee the training of local health providers by foreign psychiatrists and psychologists in standardized diagnostic approaches and evidence-based treatment strategies. Underlying this is a well-accepted biomedical logic which assumes that if symptoms are correctly identified, they can be translated into discrete mental disorders, and the disorders into forms of treatment. In this talk, I will turn this logic on its head arguing that in resource poor settings available treatment options drive the establishment of matching diagnoses to which symptoms are then retrospectively assigned. I will illustrate this argument with ethnographic examples Kosovo where the poorly functioning health system and the limited treatment options forced practitioners to frame their patients as predominantly traumatized while ignoring the everyday stressors that affected their mental health and wellbeing. This forceful framing was achieved through a "civilizing rhetoric" that allowed practitioners to cast their patients as ill informed and lacking insight into the causes of their distress. Thereby, diagnostic personas emerged that justified through an argumentum e contrario the application of available psychiatric treatments. Taken out of context such decisions and psychiatric practices appear not only inadequate, but also unprofessional and ethically questionable. Yet, they were not taken in the abstract, but within a context of lack, structural inadequacies and political insecurity all of which, I shall argue, shape therapeutic encounters and possibilities for providing care in very practical ways.
Movement of medical knowledge & practice: crossing borders and constructing boundaries in a global world