Modern psychiatry in low-resource settings

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Rab reflects on similarities between the treatment of mental disorders in low-resource countries today and in Britain two or three centuries ago.


I have often talked to both academic scientists working on the mind and to clinicians dealing with patients suffering mental ill-health, as part of my historical research. Understanding modern medical approaches is essential to appreciate just how debilitating it can be to have a mental condition and the sorts of therapies modern pharmacology has provided.

Recently, I had a particularly fascinating talk to two Edinburgh-based authorities, one a professor, the other an NHS consultant with a special interest in promoting the development of psychiatry in low-resource environments and particularly the Scotland Malawi Mental Health Project. Europe has 100 psychiatrists for every million people whereas sub-Saharan Africa has 0.5 per million.

The discussion ranged widely, but I was struck by the similarities between a country like Malawi and Britain two or three centuries ago. With few specialists, people used a wide variety of therapies such as folk remedies and even witch doctors. When those with serious mental disorders come to the attention of psychiatrists in Malawi they have usually been suffering for much longer than is the case in the developed world. Again, that is like the past, when there were very few effective chemical treatments and when people wore the appearance (and mde the sounds) of madness much more openly.

The discussion was eye-opening for me. In turn, I hope that I can help modern specialists like these, better to appreciate the history of what they do and the experience of the people they help.

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