Paper short abstract:

This paper analyzes the biopolitics of global mental health in terms of two categories: total nosology and total therapy. In this model human distress is managed less in terms of human needs than through a self-referential expert system.

Paper long abstract:

Global mental health (GMH) is a field that has emerged from the wave of new transnational agendas privileging knowledge based on supposed clinical and epidemiological evidence rather than gained from social "evidence" of suffering: that is, from subjective and local experiences and their uneven hybridization with the global metaculture to which GMH belongs. One of its frequent weaknesses is the treatment of human afflictions through a biopolitics organized in terms of two premises: total nosology and total therapy, which reproduce the forms and structures of total institutions in the wider space of a globalized world. Total nosology takes as its point of departure a definition of the patient self as a predetermined entity incompatible with the possibility of a subjective self formed through social action, including the professional cultures of mental health care. In this way, the damaged self is perceived as a psychopathological island, a stable and naturalized entity that responds to therapeutic interventions that are also stable and naturalized: total therapy. This model manages distress in terms of a self-referential expert system and its personified world of disorders and treatments more than in terms of human needs. Centered more on mental illness than on mental health, it is organized through treatment protocols rather than as the outcome of a clinical reflexivity that recognizes in affected persons knowledge born of experience, and is oriented more toward a politics of life than toward a politics for life.