Injustices, crime, and conflict……. How can psychiatry work in their shadow?

By guest contributor Dr Hena Jawaid

Psychiatry is a domain of clinical sciences, in which biological, psychological, and social aspects of mental health are integrated for diagnosis, treatment, and intervention purposes¹. It uses a variety of classification systems to guide a treating professional about the likelihood of diagnostic category thus informing treatment approaches. Psychiatric practices should ideally have an emphasis on consistency, stability, predictability, and routine – especially in light of the fact that are we currently living in an unstable, and divided world. A world, which is overwhelmed with injustices, polarization and inequality – unfolding grim realities every day, presenting new challenges, and creating platforms of complex biopsychosocial, and cultural dynamics. These factors are largely lacking in diagnostic catalogues, booklets, and guiding principles².

The world is riddled with challenges of capitalism, colonialism, and unequal distribution of power and wealth. As such, there are very poor opportunities for education and employment, especially in low-income countries. This imbalance perpetuates the existing divides between low and high-income countries in terms of access to healthcare³. This system of unequal accessibility and resources is causing mass unemployment, migration, displacement, conflict, war, and poverty globally and indeed, this inequality is a prominent social determinant of both physical and mental health⁴ . I feel that the rule of economic fundamentalism⁵ is ensuring that the circle of hegemonic countries remains impenetrable and oppressive, causing distress and turmoil to millions of people – affecting their daily life and mental health⁶.

In light of the aforementioned, I call for therapeutic approaches such as Eye Movement Desensitization and Reprocessing (EMDR), trauma-focused Cognitive Behavioral Therapy (CBT), psychodynamic psychiatric interventions and pharmacological treatment modalities to be offered to victims of abuse, war, hunger, and oppression as standard. If this was possible and if efforts were focused on making this happen, then how fruitful it would be! The first step is to call for psychiatry to alter its focus of practices beyond bookish description and instead align itself with the harsh and bitter realities of life today. Psychiatry as a discipline needs to advance its understanding beyond biomedical models. It needs to consider social changes, which are rapidly unfolding in the contemporary world.  Transcultural psychiatry demands vigorous research in domains of social sciences, spirituality and value systems, which can be studied and used to provide education where needed, and to introduce and shape community-based programs that use awareness of psychosocial functions and its effect on human behavior. A greater understanding about psychosocial dimensions would increase the possibility of treatment options and healing modalities. A person in a mental health care system can be affected at various levels from macro (international and national levels – policies and its impact), to meso (community level – racism, marginalization, belonging, migration etc.) to micro (individual and family levels – mental health conditions, domestic violence and parental discord etc.). A systems approach in psychiatry can help a physician to see a person in their precise setting and therefore devise personalized treatment plans accordingly.

The first step is to call for psychiatry to alter its focus of practices beyond bookish description and instead align itself with the harsh and bitter realities of life today

Psychiatry must adapt and see the context of the world in which we live today. It is more than an interplay of disturbed neurochemicals, hormones, personality and traits, or personal circumstances such as poverty, divorce, loneliness. It is also the effect of global phenomena where people are being abused daily because of polarization, racism, vulnerable identities, poor resources and socio-economic disadvantages secondary to the postmodern distribution of resources.

I call for Psychiatrists to dare to be political and think out-of-the-box – to see and react to the social, political, and cultural. To see the effects of a neo-liberal economic system, modernization and industrialization. Marginalization is further widening the gap of equality and injustice across the globe.

In the absence of this context-based psychiatry growth, the field will be reduced to a redundant set of diagnostic tools, treatment and intervention which can only be useful and/or offered to a minority of people.

REFERENCES

• 1. Perry, B. I., & Singh, S. P. (2017). Psychiatry unlocked. The Lancet Psychiatry, 4(4), 261
• 2. Yankovskyy, S. (2016). Political and economic transformations in Ukraine: The view from psychiatry. Transcultural Psychiatry, 53(5), 612–629. https://doi.org/10.1177/1363461516660900
• 3. Williams, D. R. (2018). Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-related Stressors. Journal of Health and Social Behavior, 59(4), 466–485
• 4. Clark, F. (2014). Is psychiatry being used for political repression in Russia? The Lancet, 383(9912), 114–115. https://doi.org/10.1016/S0140-6736(13)62706-3
• 5.Hopkin, J. (2017). When Polanyi met Farage: Market fundamentalism, economic nationalism, and Britain’s exit from the European Union. The British Journal of Politics and International Relations, 19(3), 465–478.
• 6. Raseef 22. (2023). How to stay strong under the psychological toll of watching the Gaza genocide. Raseef22. https://raseef22.net/english/article/1095553-how-to-stay-strong-under-the-psychological-toll-of-watching-the-gaza-genocide

About the author:

Dr Hena Jawaid MBBS, FCPS (Psychiatry), GCMH, MSW, obtained her Bachelor of Medicine in Pakistan and later pursued a fellowship in clinical psychiatry. Upon moving to Australia in 2017, she shifted the scope of her practice from clinical to academic as a Mental health advocate, psychotherapist, and a writer. In 2023, she resumed her career as a psychiatrist. She is an avid reader and researcher, especially interest in the intersection of social sciences and psychology with respect to different cultural and religious orientations.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS or PLOS Mental Health