Paper short abstract:

I consider the new ethical dilemmas and fields of intervention opened up for medical humanitarianism by the growing authority and prominence of Global Mental Health discourses. In particular, I explore the debates sparked by the implementation of a pilot psychiatry program at a small clinic serving poor and war-wounded patients in rural Sierra Leone.

Paper long abstract:

In this paper, I consider the new ethical dilemmas and fields of intervention opened up for medical humanitarianism by the growing authority and prominence of Global Mental Health (GMH) discourses. The paper examines the social dynamics of collaboration between a university global health program and an American-funded NGO that runs a clinic and community health programs for the poor and war-wounded in rural Sierra Leone. In particular, I explore the debates, discomforts, and relational fractures triggered by the implementation of a pilot "community psychiatry" program--inspired in part by a reading of Vikram Patel's "Where There Is No Psychiatrist"--intended to diagnose and medicate psychosis in a handful of local patients living in poverty. The controversies sparked by the program throw into relief the often sharply divergent moral and epistemological grounds that motivate the engagement and collaborative styles of the actors involved, and highlight the ways in which the notion of "humanitarian emergency" may be mobilized to legitimate troubling forms of experimentality in contexts of limited public health infrastructure and accountability. Attempts to implement the GMH agenda raise difficult questions about how to reconcile careful consideration of local cultural contexts and structural constraints with the urgent tone of calls to mitigate treatable suffering even in the absence of trained mental health professionals. Above all, such charged negotiations underline the high stakes for target communities, who are more often considered and addressed through abstract moral categories than in their complex and ambiguous humanity.