Second Workshop: “Cartographies of suffering and mental health in Latin America”

On the 5th and 6th of October, we held our Second Plasma Workshop at the Senate House in London. On both days the rooms were at full capacity with about 150 attendees of very diverse professional and national backgrounds, including service-user / survivors, epidemiologists, anthropologists, sociologists, health professionals, psychologists and psychiatrists from Chile, Peru, Brazil, Colombia, Mexico, United Kingdom, Germany, France and the United States. The rigour and commitment of all the participants move us to sustain and expand this initiative. It was a truly global and interdisciplinary meeting and, as a team, we are extremely happy to have created this space of encounter.

In this (very belated) post we want to go back to the questions that motivated this workshop, to then briefly describe some highlights and ideas for the future.

We held our first workshop in Paris in 2017. This was, in a sense, a collective exploration. We shared a concern with the situation of Latin America in the wake of global mental health (GMH) and, in that context, we wanted to know to what extent the region could be mapped under the emergent parameters or relevance articulated by GMH scholars and campaigners. The goal was not to make Latin America “visible” but to articulate the region, its differences and specificities, vis-a-vis the universalistic ambitions of GMH.

For PLASMA the social sciences have a role in the recognition of this specificity, through their ability to link social, economic and political forces with local experiences of (individual and social) suffering and distress. In this context during 2018, we engaged more directly with these specificities. In our call for proposals we brought back the “social question”, a framework of historical and sociological analysis that encapsulates the “unintended consequences” of the modernisation process in the region and the response(s) of the State, mostly focused on public health and large-scale urbanisation projects but also including  education and basic welfare provisions through the 50s, 60s and 70s. On this basis, we asked: What are the historical and sociocultural roots of contemporary suffering in Latin America? Is psychiatry and the field of mental health, the new – and main – form by which complex social and political phenomena like poverty, exclusion and suffering is being dealt with by the state. How do health institutions, user organisations, academia, and other public and private actors in the mental health field take part in these processes?

Out of 55 submissions, with an independent scientific committee, we chose 20, organising them in four broad themes:

  • Violence and suffering in precarious contexts
  • Challenges in current practices related to transcultural issues
  • The emergence of contested diagnoses in mental health
  • New participatory practices and the need to contest old practices and epistemologies in mental healthcare.

The different roundtables included a variety of topics, ranging from the impact of sociocultural determinants on mental health, such as structural violence and social vulnerability, the importance of transcultural aspects of mental health issues, such as the mental health of indigenous populations, the controversies surrounding the validity of certain psychiatric diagnoses, and the different ways of interpreting suffering and symptoms in different social contexts. There were also presentations on the participation of user and ex-user associations in mental health policy and the current processes of reform of mental health systems in Latin America.

The workshop also included three keynote presentations. On the first day, Angela García presented part of her current project on Mexico’s “anexos”, informal spaces usually located inside a house, where drug users are locked-in, going through unregulated ‘rehabilitation’ processes centred on discipline, isolation and the repetition of tasks, complicating the distinction between ‘care’ and ‘punishment’. These spaces fill a gap left after the closing of state-based residential facilities, in a context where there are no other community responses to a growing social problem.

Based on his ethnographic work on Andean communities in Peru, on the second day, David Orr called for a culturally-respectful approach to global mental health interventions, one that is able to consider the imbrication of historical and cultural meanings in the way communities understand and search for health and wellbeing. David’s analysis echoed many of our concerns as young scholars trying to bridge topics of Global Mental Health with the concrete realities of Latin-America.

Finally, Francisco Ortega made a compelling case for the need to understand how Brazil’s cultural and, especially, multicultural specificities are silenced by models of class stratification. The ways in which recognition and distribution are conceived and theorized can shape our understandings of clinical issues in mental health, having significant implications for mental health policy. The tensions between local collective mental health discourse and the global mental health agenda can be situated in this background.

Lively discussions ensued from each of these talks and papers, fulfilling a key aim of PLASMA which is to connect different audiences and create critical conversations around mental health in Latin America. Conversations that don’t discourage passion and that are open to different perspectives, contexts and scales. Although centred around the work of young researchers, the workshop connected persons who usually circulate through different networks and events, like anthropologists based in Europe, policymakers from Latin America, service-users from the UK, etc. This doesn’t only create conditions for the development of collaborative projects but helps to gain a different, comparative view of mental health problems in the region.

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