China Mills

Psy-expertise, therapeutic culture and the politics of the personal in development

Abstract Expertise stemming from the psy disciplines is increasingly and explicitly shaping international development policy and practice. Whilst some policy makers see the use of psy expertise as a new way to reduce poverty, increase economic efficiency, and promote wellbeing, others raise concerns that psychocentric development promotes individual over structural change, pathologises poverty, and depoliticises development. This paper specifically analyses four aspects of psy knowledge used in contemporary development policy: child development/developmental psychology, behavioural economics, positive psychology, and global mental health. This analysis illuminates the co-constitutive intellectual and colonial histories of development and psy-expertise: a connection that complicates claims that development has been psychologized; the uses and coloniality of both within a neoliberal project; and the potential for psychopolitics to inform development.

Social isolation and its relationship to multidimensional poverty

Abstract While the multidimensionality of poverty is well-recognised, one dimension of poverty which has been often overlooked is weak social connectedness. This paper draws on conceptual, participatory and measurement literatures to show that social connectedness appears to be an important missing ingredient of multidimensional poverty analyses, with social isolation being a feature which exacerbates the condition of poor persons. To provide contextual detail as to its impact on persons in marginalized communities, we present qualitative primary data from South Africa and Mozambique and review pertinent studies of the First Nations of Canada and among persons with disability. A policy challenge for social isolation is that it is often seen as stemming from an individuals’ capacity rather than resulting from the broader social context. The closing section outlines areas for policy.

Shame, Humiliation and Social Isolation: Missing Dimensions of Poverty and Suffering Analysis

While people living in poverty talk about isolation, shame, and humiliation as being key aspects of their lived experiences of suffering, until recently, there has been no international data on these aspects – making them “missing dimensions” within poverty analysis and within research into suffering. Drawing upon international fieldwork and datasets from Chile and Chad, this chapter examines the relevance of social isolation, shame and humiliation in contexts of poverty, to research on suffering. The chapter suggests that the use of particular indicators of shame, humiliation, and social isolation can better recognize distributions of suffering. It can also help identify individuals and sub-groups within those living in multidimensional poverty – or of the general population at large – that are affected by concrete and particularly hurtful situations. Consequently, they can help to identify levels of suffering which are higher within a specific population. We argue that these types of indicators could form the basis of more refined measures that help generate more concise data on suffering.

‘Dead people don’t claim’: A psychopolitical autopsy of UK austerity suicides:

One of the symptoms of post financial crisis austerity in the UK has been an increase in the numbers of suicides, especially by people who have experienced welfare reform. This article develops and utilises an analytic framework of psychopolitical autopsy to explore media coverage of ‘austerity suicide’ and to take seriously the psychic life of austerity (internalisation, shame, anxiety), embedding it in a context of social dis-ease. Drawing on three distinct yet interrelated areas of literature (the politics of affect and psychosocial dynamics of welfare, post and anti-colonial psychopolitics, and critical suicidology), the article aims to better understand how austerity ‘kills’. Key findings include understanding austerity suicides as embedded within an affective economy of the anxiety caused by punitive welfare retrenchment, the stigmatisation of being a recipient of benefits, and the internalisation of market logic that assigns value through ‘productivity’ and conceptualises welfare entitlement as economic ‘burden’. The significance of this approach lies in its ability to widen analytic framing of suicide from an individual and psychocentric focus, to illuminate culpability of government reforms while still retaining the complexity of suicide, and thus to provide relevant policy insights about welfare reform.

‘Global Mental Health Spreads Like Bush Fire in the Global South’: Efforts to Scale Up Mental Health Services in Low- and Middle-Income Countries

‘Scaling up access to mental health services globally, and particularly in low- and middle-income countries (LMIC), is a central priority within current global mental health advocacy. This chapter asks a number of pertinent questions aimed at facilitating critical reflection and exploration of the complexities of efforts to scale-up mental health services in LMIC. The questions to be considered include: Is the validity of psychiatric diagnosis being over-emphasised? Is a preoccupation with eliminating symptoms of illness obscuring understanding about what constitutes ‘positive outcomes’ for individuals experiencing mental health difficulties? Is the ‘treatment gap’ in LMICs as large as it is reported to be? Are alternative forms of support being neglected? Are social determinants of mental health being sufficiently considered? Is the evidence base for GMH sufficiently broad, and has the efficacy of ‘task-shifting’ been sufficiently demonstrated?

Psychopharmaceuticals as ‘Essential Medicines’: Local Negotiations of Global Access to Psychotherapeutic Medicines in India

This chapter seeks to trace the social life of psychopharmaceuticals on their journey from being framed as global ‘essential medicines’ to their distribution locally. It is concerned with how the global framing of drugs as essential medicines is interlaced with the ways that drugs come to be seen as essential to grassroots and localised forms of care, and particularly with how drugs come to dominate mental health work at a grassroots level in India. Engaging with interviews with the staff of mental health Non-Governmental Organisations (NGOs) in India, this chapter highlights the ambivalence that many people feel towards psychopharmaceuticals, despite NGOs facilitating and negotiating the social life of psychopharmaceuticals in nuanced ways. Despite nuances, the chapter concludes that serious concerns still remain about the validity and ideology of global mental health advocacy, and about the individual and socio-political effects of the psychopharmaceuticals that it constructs as “essential”.

Mental Health and the Mindset of Development

The concern that mental health is both absent within international development agendas and an obstacle to the achievement of development goals lies at the heart of current advocacy calling to mainstream mental health within development. This chapter traces the ways in which mental health is framed as a ‘problem’ within development, focussing specifically on the need for more nuanced understandings of both development and mental health that move beyond sometimes simplistic assumptions that mental health is a ‘problem’ for development, and development is a ‘solution’ for mental health. Drawing upon literature within the field of global mental health, alongside fieldwork by the author in India (in 2011), I argue that the problematisation of both mental health and development is increasingly occurring through ever more psychological and psychiatric registers that enable clinical, therapeutic, and pharmaceutical approaches to development. Concern is raised that this potentially diverts attention from (a) structural contributors to distress; (b) the politics of psychiatric diagnosis; and (c) the potentially detrimental effects of some development initiatives on (mental) well-being.

The Psy-Security-Curriculum ensemble: British Values curriculum policy in English schools

ABSTRACT Framed as being in response to terrorist attacks and concerns about religious bias in some English schools, ‘British Values’ (BV) curriculum policy forms part of the British Government’s Counter-Terrorism and Security Act, 2015. This includes a Duty on teachers in England to actively promote British Values to deter students from radicalisation. This paper, first, traces the history of Britishness in the curriculum to reveal a prevalence of nationalistic, colonial values. Next, an ensemble of recent policies and speeches focusing on British Values is analysed, using a psycho-political approach informed by anti-colonial scholarship. Finally, we interrogate two key critiques of the British Values curriculum discourse: the universality of British Values globally, and concerns over the securitisation of education. Findings indicate that the constitution of white British supremacist subjectivities operate through curriculum as a defence mechanism against perceived threats to white privilege, by normalising a racialised state-controlled social order. The focus is on ‘British’ values, but the analytic framework and findings have wider global significance.

The Psy-Disciplines Go to School: Psychiatric, Psychological and Psychotherapeutic Approaches to Inclusion in One UK Primary School.

ABSTRACT A growing body of research, largely from the global North, and particularly from North America, highlights the increasing psychiatrisation, medicalisation and psychologisation of children and childhood, and suggests that schools and educators play a key role in these processes. This increasing diffusion of psy-expertise within educational spaces signifies a cultural shift that has profound effects on teacher and student subjectivity, and on institutional and professional practices. Educators in many countries are said to be on the ‘front-line’ in identifying mental health issues, recommending treatment pathways, and sometimes helping to administer psychopharmaceuticals. The alacrity with which educators engage in these practices varies internationally, with reported occurrence being much higher in the United States and Canada, compared to the United Kingdom, where there is a lack of research. Drawing upon a case study in a UK primary school, this paper makes an original and timely contribution to research into UK teacher’s perceptions of inclusion in relation to social, emotional and behavioural difficulties and, in particular, attention-deficit hyperactivity disorder, as they navigate the interface of psychology and education. Contrary to some previous research, the educators in this study viewed the distribution of psychopharmaceuticals negatively, and showed a preference for psychotherapeutic approaches to inclusion. This research provides much needed empirical findings to a growing but largely theoretically informed body of research exploring whether, and if so then how, educators are implicated in the mobilisation of psy-expertise within children’s lives.

The construction of mental health as a technological problem in India

ABSTRACT This paper points to an underexplored relationship of reinforcement between processes of quantification and digitisation in the construction of mental health as amenable to technological intervention, in India. Increasingly, technology is used to collect mental health data, to diagnose mental health problems, and as a route of mental health intervention and clinical management. At the same time, mental health has become recognised as a new public health priority in India, and within national and global public health agendas. We explore two sites of the technological problematisation of mental health in India: a large-scale survey calculating prevalence, and a smartphone app to manage stress. We show how digital technology is deployed both to frame a ‘need’ for, and to implement, mental health interventions. We then trace the epistemologies and colonial histories of ‘psy’ technologies, which question assumptions of digital empowerment and of top-down ‘western’ imposition. Our findings show that in India such technologies work both to discipline and liberate users. The paper aims to encourage global debate inclusive of those positioned inside and outside of the ‘black box’ of mental health technology and data production, and to contribute to shaping a future research agenda that analyses quantification and digitisation as key drivers in global advocacy to make mental health count.