A minha aula sobre "Saúde Mental Global: O Novo Movimento Transdisciplinar à luz da Globalização" à turma da Residência Integrada Multiprofissional em Saúde Mental Coletiva na Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil, no dia de 2 de agosto de 2017.
Saúde Intestinal - 5 práticas possíveis para manter-se saudável
Saúde Mental Global: O Novo Movimento Transdisciplinar à luz da Globalização - RIS UFRGS, Porto Alegre, RS, Brasil - 2.08.2017
1. Aula
Saúde Mental Global:
O Novo Movimento Transdisciplinar
à luz da Globalização
Prof. Vincenzo Di Nicola, MD, PhD
Universidade Federal
do Rio Grande do Sul
Residência Integrada Multiprofissional
em Saúde Mental Coletiva
Quarta-feira, 2 de agosto de 2017
Às 20 horas
6. Vincenzo Di Nicola
MPhil, MD, PhD, FRCPC, FAPA
vincenzodinicola@gmail.com
Professor titular de Psiquiatria, Universidade de Montreal
Diretor da Psiquiatria infantil, Instituto Universitário de Saúde
Mental de Montreal
Presidente da Filial do Quebec e Leste do Canadá da Associação
Americana de Psiquiatria
Membro do Conselho de Psiquiatria Internacional da Associação
Americana de Psiquiatria
Ex-Presidente e Fundador do Colegiado de Saúde Mental Global,
Associação Americana de Psiquiatria
Ex-Presidente e Fundador da Associação Canadense
de Psiquiatria Social
Professor Honoris Causa, FADOM, MG, Brasil
9. Agradecimentos
Profa. Dra. Sandra
Maria Sales Fagundes
Residência Integrada
Multiprofissional em
Saúde Mental Coletiva
Universidade Federal
do Rio Grande do Sul
Porto Alegre, RS Photo : V Di Nicola
10. Tópicos
Saúde Mental Global
Aspectos internacionais da Saúde mental
Cuidado colaborativo
Colaborações transdisciplinares
Saúde mental comunitária
11. Objetivos
Na conclusão da aula, os participantes devem saber como …
Descrever e definir o Movimento da Saúde Mental Global
(SMG)
Conectar o Movimento SMG aos aspectos internacionais de
saúde mental
Entender o valor do cuidado colaborativo e do trabalho
transdisciplinar
Valorizar a saúde mental comunitária como contexto ideal para
a SMG, o cuidado colaborativo e o trabalho transdisciplinar
12.
13. Parte I:
Definindo Saúde Mental Global
Arthur Kleinman argumenta para um
reequilíbrio da psiquiatria acadêmica,
situando SMG como uma prioridade
emergente
“Global health is now squarely on the agenda
of students, researchers and funders.”
– Kleinman (2012, p. 421)
14. Objetivos
Descrever e definir o Movimento da Saúde Mental
Global (SMG)
Conectar o Movimento SMG aos aspectos
internacionais de saúde mental
15. As raízes do Movimento
da Saúde Mental Global
Psiquiatria Internacional (A Jablensky, N Sartorius)
Psiquiatria Comparativa (E Kraepelin, HBM Murphy)
Epidemiologia Psiquiátrica (M Rutter)
Saúde Pública (M Marmot)
Psiquiatria Social (F Redlich, A Leighton)
Psiquiatria Cultural (RH Prince, A Kleinman)
Determinantes sociais de saúde
(M Marmot, ACE Study)
16. Training and Projects in
Global Mental Health
Training in psychology
(McGill University; Institute of Psychiatry, U London)
Child psychiatric epidemiology (M Rutter)
Medicine (McMaster U)
Ontario Child Health Study (DR Offord)
Paediatrics & Psychiatry (McGill U)
Comparative psychiatry (HBM Murphy)
Social psychiatry (A Leighton)
Cultural psychiatry (RH Prince)
17. Training and Projects in
Global Mental Health
Epidemiological Research
Children’s Food & Mood Study (U London/U Ottawa)
Quebec Children’s Mental Survey (U Montréal)
Syntheses
Cultural Family Therapy (1985-)
Transcultural Child Psychiatry (1991-)
Children & Families in Global Mental Health (2015-)
18. Training and Projects in
Global Mental Health
Community Child Psychiatry
Adolescent Day Programme (U Ottawa)
Community Child Mental Health Clinic (U Montreal)
Shared Care, Collaborative Care
Consultation-Liaison (Queen’s, U Montreal)
Transdisciplinary Collaboration
Research, Teaching, Clinic, Policy
Global Projects
Mission Haïti, Bulgaria, Italia
19. Saúde mental global
Pioneiros
Vikram Patel (Londres, GB)
Eliot Sorel (Washington,DC, EUA)
Samuel Okpaku (Nashville, EUA)
Gabriel Ivbijaro (Londres, GB, Lisboa, PT)
Criticos
China Mills (GB)
Ethan Watters (EUA)
20. Colegiado de Saúde Mental Global da
Associação Americana de Psiquiatria
Co-Fundadores do Colegiado (2013)
Eliot Sorel
Vincenzo Di Nicola
Presidente Indicado
Milton Wainberg (2014-15)
Presidentes Eleitos
Eliot Sorel (2015-16)
Vincenzo Di Nicola (2016-17)
Khurshid R. Khurshid (2017-18)
NB: Mais de 500 membros em 3 anos
21. Saúde Mental Global
SMG é “um campo de estudo, pesquisa e
prática que coloca uma prioridade na
melhoria da saúde mental e atinge equidade
em saúde mental para todos os povos do
mundo”.
– Vikram Patel & Martin Prince. Global mental
health: a new global health field comes of
age. JAMA, May 19, 2010, 303(19): 1976-77.
22. “No Health Without Mental Health”
Não há saúde sem saúde mental
A consciência da saúde mental dever ser
integrada em todos os aspectos das politicas
de saúde e sociais, planejamento de sistemas
de saúde, e o atendimento da saúde geral
primária e secundária”.
– Martin Prince, Vikram Patel, Shekhar
Saxena, et al. No health without mental
health. The Lancet, 370, No. 9590, 8 Sept
2007: 859-877.
23. Saúde Mental Global
Considerando as diferenças culturais e as condições
específicas de cada país, a SMG lida com:
Epidemiologia de transtornos mentais nos diversos
países
Opções de tratamento
Formação em saúde mental
Aspectos políticos e financeiros
Estrutura dos sistemas de cuidado de saúde mental
Recursos humanos em saúde mental
Direitos humanos … entre outros
24. Saúde Mental Global
Estudos-chave contemporâneos:
Global Burden of Diseases Report (Murray & Lopez,
1996)
Carga (prevalência) global de doenças
Social Determinants of Health (WHO, 2003)
Determinantes sociais da saúde
Mental Health Gap Action Program (WHO, 2008) and
mhGap Intervention Guide (WHO, 2010)
Brechas (lacunas) em saúde mental
e de tratamento
25. Saúde Mental Global
SMG definido por cinco critérios – Samuel Okpaku:
Critério universal e transnacional – não só local
Critério de saúde pública – base populacional
Critério de partes interessadas (“stakeholders”) –
composição internacional nos niveis educacional,
científico, governamental e não-governamental
Critério de reconhecer e se responsabilizar pelos
problemas (“problem ownership”) –
reconhecimento e responsabilidade local
Critério de equipe – multidisciplinar
e multipartite
26. Saúde Mental Global
Um passo adiante?
Colecionar dados e
elaboração de políticas
versus
Preocupações clinicas e
compromisso significativo
31. Defining Family Studies
La terapia familiare è il punto di partenza
per lo studio di unità sociali sempre più ampie.
A terapia familiar é o ponto de partida
para um estudo de unidades sociais
cada vez mais amplas.
– Mara Selvini Palazzoli
33. Di Nicola, V. (2004). Famiglie sulla
soglia. Città invisibili, identità
invisibili. In: Andolfi, M. (ed.),
Famiglie immigrate e psicoterapia
transculturale.
Milano, FrancoAngeli (pp. 34-57)
39. Aplicações
Num mundo com amplo fluxo de migrantes e
refugiados instigados por conflitos, desastres,
ou outras razões econômicas e sociais, a
terapia familiar cultural oferece instrumentos
clinicos para entender e tratar famílias
vivenciando severo estresse devido à rapida e
massiva mudança cultural
40.
41.
42. 21st
Century Global Mental Health
Eliot Sorel’s volume, 21st
Century Global Mental Health (2012)
has 5 sections, 16 chapters, 400 pp.
This collection does take children and families and to some
extent culture into consideration.
My wish is to maintain and increase this key sensibility.
43. 21st
Century Global Mental Health
Overview of the contents from a child, adolescent and family
perspective:
Section 2: Determinants of Health and Mental Health
Family, psychosocial, and cultural determinants of health (my chapter,
Di Nicola, 2012)
Section 3: Health and Mental Health of Populations
child mental health
– global disasters mentions child friendly spaces
•Section 4: Evaluating and Strengthening Health and Mental
Health Systems
– integrating mental health into primary care mentions depression and
early childhood development
44. 21st
Century Global Mental Health
Index:
•attachment – 2 mentions child mental health – 19 mentions
•childhood, as a social construct
•childhood conduct disorder, as a risk factor
•children, as special populations
•family intervention
•family therapy – 5 mentions
•relational approach relational disorders
Note: No mention of adolescent, youth
45.
46. Essentials of Global Mental Health
• Samuel Okpaku’s (2014), Essentials of Global
Mental Health, has 8 sections, 44 chapters,
465 pp.
• Both children and family relationships are
addressed (with some gaps)
47. Essentials of Global Mental Health
Overview of the contents:
•Section 4: Special Populations
– poverty and perinatal morbidity
– materal mental health
– children’s services
– child abuse
– child soldiers
– adolescent alcohol and substance abuse
•Section 5: Gender and Equality
– In spite of the section name, all chapters are about women’s mental
health, none address men’s issues or LGBT issues, nor the problems
facing single-parent and LGBT families and adoption
•Section 6: Human Resources and Capacity Building
– child mental services in Liberia
48. Essentials of Global Mental Health
Index:
•attachment disorders
•family members, family structure, family systems practice,
family-level approaches to treatment
•marital violence
•marriage
•relational perspective on women’s mental health
•Relationships
Note: No mention of adolescents, youth, or couple and family
therapy
49.
50. Global Mental Health:
Principles & Practice
• In the volume edited by Vikram Patel and associates (2014),
Global Mental Health: Principles and Practice, there are 20
chapters, 512 pp.
• Just two of them address child and adolescent mental health
and women’s mental health.
• Its strength is in articulating principles including
epidemiology, culture and mental health, social determinants
of health, and health promotion. Key chapters on practice
address stigma and promoting political commitment for
mental health.
51. Global Mental Health:
Principles & Practice
• On balance, this volume is stronger on principles than as a
guidebook for practice in GMH.
• In spite of the enthusiastic blurb from the editor of The
Lancet, Global Mental Health is somewhat less than “global”
in its reach and something less than affirmative and
embracing in its scope.
52.
53.
54. Crazy Like Us – Loucos Como Nós
Ethan Watters, Crazy Like Us: The Globalization of the American
Psyche (2010)
•Critica a noção da esportação das idéias nortamericanos de saúde
e de doença atravès do mundo, pondo uma critica chave com o
seu titulo provocativo e polêmico.
•Concordo que toda noção de saúde e bem-estar, sofrimento e
doença tenham uma distinta história humana e uma geografia
cultural. Por isto, quero dizer que essas noções não são
meramente dados biológicos, desenvolvendo atravès dos tempos
e tomando formas diferentes sob a influência dos determinantes
sociais e culturais.
55. Crazy Like Us – Loucos Como Nós
Ethan Watters, Crazy Like Us: The Globalization of the American
Psyche (2010)
•Enquanto eu lia esse livro com interesse, fiquei
decepcionado ao não encontrar capítulos sobre
adolescentes, crianças, jovens, ou famílias.
56.
57. Decolonizing Global Mental Health
Descolonizando a Saúde Mental Global
China Mills (2013), Decolonizing Global Mental Health:
The Psychiatrization of the Majority World (2013)
•Critica a SMG colocando-a numa perspectiva global, incluindo
as perspectivas da teoria critico-politica e pós-colonialismo
•Ela menciona muitos pensadores criticos e radicais das
ciências, politica e colonialismo, p.ex., o psiquiatra e
revolucionário caribenho Frantz Fanon
•Mills é especialmente critico da noção-chave de ”brechas de
saúde e de tratamento”
58. Decolonizing Global Mental Health
• Nonetheless, and again surprising for critiques that aim at
more embracing and inclusive perspectives, there are no
chapters on adolescents, children and youth, or families.
• The index to this volume includes references to: “child-like”
and “children, and ECT, and medication, colonialism.”
• There are no citations for adolescents, youth, families,
marriage, attachment or relationships in any form.
59. A Necessidade de um Modelo Relacional
• No volume, 21st
Century Global Mental Health (2012) – “Saúde
Mental Global no Século 21” – eu examinei os determinantes
familiares, psicossociais e culturais da saúde (Di Nicola, 2012)
• Esses são os aspectos essenciais e críticos que demandam
estudo e inclusão em uma perspectiva compreensiva da
saúde
• Não poderemos ter um verdadeiro movimento global de saúde
mental sem reconhecer os problemas em nossos modelos
atuais de saúde e de doenças (“illness”) que dão forma aos
nossos modelos de atendimento em cuidado de saúde sem
incluir culturas e sistemas locais e tradições de cura
60. A Crítica da Perspectiva Familiar
da SMG
• Nós que trabalhamos com questões de saúde mental
de uma perspectiva familiar accreditamos que
ver indivídos isoladamente é limitante e ignora,
minimiza ou descarta a importância das relações
enquanto recursos para a saúde e como fatores de
risco
61. • The work on attachment (which is theoretically important and
clinically fertile) and belonging (its counterpart in social and
cultural psychiatry, addressing aspects of affiliation, identity,
and social cohesion) demonstrates that relationships in
general are avenues for treatment from both a family therapy
perspective and the social determinants of health perspective
(Di Nicola, 2012).
• This is the systems or relational approach to health. Relational
means seeing families as the bearers of the cultures they
come from and their own unique cultures (Di Nicola, 1997,
2011).
62. Category vs context
(Relational, social, and cultural contexts)
• From a family perspective, the Global Mental Health
Movement appears as a regressive step to the usual Western
health categories that focus on individuals as bearers of larger
issues in the family, community, society and culture.
• These larger envelopes are addressed in the impersonal way
of categories—e.g., child abuse, substance abuse, violence,
and treatment gaps—rather than from the relational, social
and cultural perspectives that define mental health and illness
more fully, meaningfully, and realistically.
63. • These aspects of GMH may deepen the practitioners’
perception of public health and epidemiology and their
international organizations as being removed from clinical
concerns and from their meaningful relational contexts.
• Without such notions as attachment and belonging, ignoring
the most significant of human relationships based on the
family and community, GMH risks creating another
disembodied field divorced from our lived experience as
communal and relational beings.
66. – Com mais de um bilhão de migrantes globais, o século 21 começou
como o século do migrante.
– Desacordos sobre fronteiras demandam que nossa maneira de
pensar e lidar com migrantes e fronteiras seja revisada.
– Isto tem implicações para a antropologia e a geografia, politica e
filosofia, e não menos para a medicina e a psiquiatria.
– A psiquiatria deve redefinir como lidamos com migrantes e
refugiados, seus deslocamentos e traumas potenciais, sem falar
do lugar deles no mundo.
– As implicações são enormes para a teoria e a prática da
psiquiatria, para a SMG, e para a politica e o planejamento de
serviços, bem como terapêuticas.
Source: APA Symposium, San Diego, CA, USA, May 2017
Global Migrantess Globais, Fronteiras
e Saúde Mental
67. Theory of the Border – Teoria da Fronteira
Thomas Nail (2016)
• “The border is a process of social division”
A fronteira é um processo de divisão social
• “Social motion is divided” –
Moção social é dividida
• Coralled … territorial fences … politically expelled
… juridically confined by identification
documents … detention centers … market,
police, security and informational borders
68. Theory of the Border – Teoria da Fronteira
• The fence, the wall, the cell, the checkpoint, the
frontier, the limit, the march, the boundary …
O que tem em comum é divisão e bifurcação
• A fronteira existe no entremeio, na soleira
(limologia)
• A fronteira está em moção
(kinopsicologia)
69. The Figure of the Migrant – A Figura do Migrante
Thomas Nail (2015)
• “The migrant is the political figure of our time”
O migrante é a figura política de nosso tempo
• “At the turn of the twenty-first century, there were
more regional and international migrants than ever
before in recorded history. Today, there are over
1 billion migrants and each decade the global
percentage of migrants and refugees grows. Political
theory has yet to take this phenomenon seriously.
… doing so requires political theory to alter its
foundational presuppositions.”
70. • “It requires a whole new theoretical starting point
that does not begin with stasis and the state, but
with the more primary social movements that
constitute the state, as well as the social alternatives
that arise from those same movements.”
• “Instead of starting with a set of preexisting citizens,
kinopolitics begins with the flows of migrants and the
ways they have circulated or sedimented into citizens
and states …”
The Figure of the Migrant – A Figura do Migrante
71. • Across disciplines – anthropology, geography,
philosophy, political science – the migrant was
treated as an exception to the rule of existing
theoretical frameworks
• The migrant is rather the constitutive condition of
contemporary politics
• Migration is historically constant – sedentary
societies are the exception to this rule
The Figure of the Migrant – A Figura do Migrante
72. Implicações para a
Saúde Mental Global
“O migrante é a figura global de nosso tempo.”
De uma vez estranho e familiar, perto e distante,
somos agora um mundo de “estranhos íntimos”
– Vincenzo Di Nicola
73. Implicações
• Para SMG e a psiquiatria internacional
(teorética)
• Para elaboração de politicas e planejamento
de saúde
(administrativa)
• Para terapêutica
(clínica)
74. Implicações
• Para SMG e a psiquiatria internacional
(teorética)
• A nova ciência de limologia e kinopsycologia
baseada no migrante e no residente
impermanente (“sojourner” )
– Carga mundial de doenças
– Determinantes sociais de saúde
– Brechas de tratamento
75. Implicações
• Para elaboração de politicas e planejamento
de saúde (administrativa)
– Quem é cidadão?
– Quem tem acesso ao cuidado?
– Quem é um migrante ou um refugiado?
– Quem define e controla a fronteira?
– O que pode significar direitos e dignidade no
mundo aonde o migrante, a fronteira e o estado
de exceção estaõ tornando-se a regra?
76. Implicações
• Para terapêutica
(clínica)
• Uma nova abordagem à terapia
– “Gente da soleira” (limologia)
– Aculturação, identidade (psiquiatria do evento)
• Vivemos no mundo de “estranhos íntimos”
79. Objectivos
• Entender o valor do cuidado colaborativo e do
trabalho transdisciplinar
• Valorizar a saúde mental comunitária como
contexto ideal para a SMG, o cuidado
colaborativo e o trabalho transdisciplinar
80. “Estranhos íntimos”
Eu vejo a humanidade como uma
família que apenas se encontrou.
– Theodore Zeldin
Uma Íntima História da Humanidade
81. Bibliografia
• Di Nicola, Vincenzo. A Stranger in the Family: Culture,
Families and Therapy. New York: W.W. Norton & Co., 1997.
• Di Nicola, V. Letters to a Young Therapist: Relational Practices
for the Coming Community. New York: Atropos Press, 2011.
• Di Nicola, V. Family, psychosocial, and cultural determinants
of health. In: Sorel, Eliot, ed., 21st
Century Global Mental
Health. Burlington, MA: Jones & Bartlett Learning, 2012, pp.
119-150.
• Di Nicola, V. Forum: Defining global mental health and
psychiatry. Global Mental Health & Psychiatry Newsletter,
January 2016, I (2): p. 11.
82. Bibliografia
• Joshi, Paramjit T. and Lisa Cullins, eds. Global Mental Health
Issue. Child and Adolescent Psychiatric Clinics of North
America. January 2016.
• Kleinman, Arthur. Editorial: Rebalancing academic psychiatry:
why it needs to happen – and soon. British Journal of
Psychiatry Dec 2012, 201 (6): 421-422.
• Marmot, Michael. The health gap: the challenge of an
unequal world. The Lancet, Vol 386, Issue 10011: 2442–44.
• Mills, China. Decolonizing Global Mental Health: The
Psychiatrization of the Majority World. East Sussex, UK & New
York: Routledge, 2013.
83. Bibliografia
• Okpaku, Samuel O., ed., Essentials of Global Mental Health.
Cambridge, UK: Cambridge University Press, 2014.
• Nail, Thomas. The Figure of the Migrant. Stanford, CA:
Stanford University Press, 2015.
• Nail, Thomas. Theory of the Border. 2016. Oxford, UK: Oxford
University Press, 2016.
• Patel, Vikram, Harry Minas, Alex Cohen, Martin J. Prince, eds.
Global Mental Health: Principles and Practice. Oxford, UK:
Oxford University Press, 2014
84. Bibliografia
• Patel, Vikram & Martin Prince. Global mental health: a new
global health field comes of age. JAMA, May 19, 2010,
303(19): 1976-77.
• Prince, Martin, Vikram Patel, Shekhar Saxena, et al. No health
without mental health, The Lancet, 370, No. 9590, 8 Sept
2007: 859-877.
• Sorel, Eliot, ed., 21st
Century Global Mental Health. Burlington,
MA: Jones & Bartlett Learning, 2012.
• Watters, Ethan. Crazy Like Us: The Globalization of the
American Psyche. New York: Free Press, 2010.
• Williams, Raymond. Keywords: A Vocabulary of Culture and
Society. London: Croom Helm, 1976.
To speak to the heart of the matter:
In a bold editorial in a leading psychiatric journal, noted cultural psychiatrist Arthur Kleinman argued for a rebalancing of academic psychiatry, citing global mental health (GMH) as an emerging priority: “Global health is now squarely on the agenda of students, researchers and funders.” (Kleinman, 2012, p. 421). Community, psychosocial, and cultural aspects, as well as “social, moral and economic” factors are duly mentioned. Nowhere do the words family and relationship appear.
While we debate the best way to capture just what it is we want to accomplish with GMH, I want to ask: Where is the family in GMH?
This question, which is particularly salient for my work as a child and adolescent psychiatrist and family therapist, arose in a dialogue with Dr. James Griffith, Chair of Psychiatry at George Washington University. Child and adolescent psychiatrists are already taking GMH seriously and taking stock of its import (see Joshi, et al., 2016).
One way I set about to answer this question about the family is to examine three foundational texts in GMH along with two articulate critiques of this new field.
Eliot Sorel’s volume, 21st Century Global Mental Health (2012) has 5 sections, 16 chapters, 400 pp. In my reading, this collection does take children and families into consideration. My wish is to maintain and increase this key sensibility. My chapter in this volume addresses GMH from a child, adolescent and family perspective:
Section 2: Determinants of Health and Mental Health
Family, psychosocial, and cultural determinants of health (Di Nicola, 2012)
Samuel Okpaku’s (2014), Essentials of Global Mental Health, has 8 sections, 44 chapters, 465 pp. Both children and family relationships are addressed, with some gaps.
In the volume edited by Vikram Patel and his associates (2014), Global Mental Health: Principles and Practice, there are 20 chapters, 512 pp.
Just two of them address child and adolescent mental health and women’s mental health.
Its strength is in articulating principles including epidemiology, culture and mental health, social determinants of health, and health promotion. Key chapters on practice address stigma and promoting political commitment for mental health.
On balance, this volume is stronger on principles than as a guidebook for practice in GMH.
In spite of the enthusiastic blurb from the editor of The Lancet, Global Mental Health is somewhat less than “global” in its reach and something less than affirmative and embracing in its scope.
There are many other valuable volumes in the burgeoning literature on GMH. This one by Gabby Ivbijaro focuses on global mental health in primary care.
There are two thoughtful and well-researched books critical of GMH.
American journalist Ethan Watters’ Crazy Like Us: The Globalization of the American Psyche (2010) criticizes the notion of exporting US notions of health and illness around the world, posing a key critique with his his provocative and polemical title. I agree that all notions of health and wellbeing, illness and disease have a distinct human history and cultural geography. By this I mean that these notions are not merely biological givens, evolving over time and taking different shapes under the influence of social and cultural determinants. So, while I read Watter’s book with interest, I was disappointed to find no chapters on adolescents, children, youth, or families.
The index has references to: “adolescents” (several mentions), “children” (numerous mentions), and “Children’s Impact Events Scale.”
There is no mention of attachment, family, community, network, or youth.
Two thoughtful and well-researched books critical of GMH.
Two thoughtful and well-researched books critical of GMH.
China Mills’ (2013) more scholarly critique, Decolonizing Global Mental Health: The Psychiatrization of the Majority World, raises similar problems by placing GMH itself in a global perspective, including the perspectives of critical political theory and post-colonialism.
There are many mentions of radical critical thinkers in the social sciences, politics, and colonialism, e.g., the Caribbean psychiatrist and revolutionary Frantz Franon is amply discussed.
Nonetheless, and again surprising for critiques that aim at more embracing and inclusive perspectives, there are no chapters on adolescents, children or youth, or families.
The index to this volume includes references to: “child-like” and “children, and ECT, and medication, colonialism.”
There are no citations for adolescents, youth, families, marriage, attachment or relationships in any form.
Mills is especially critical of a key GMH notion of “health gaps,” but that is a separate issue which I have addressed elsewhere.
Let me conclude this preliminary study of the family in GMH with an affirmation …