In my last blog post, I had briefly mentioned the need for international moral solidarity as a first step in addressing mental health related suffering in developing countries. Here, I will elaborate why international moral solidarity is important in the field of mental health and psychosocial disability.
Let me begin with a short description of a video aired on Channel4 (UK) a few months ago called life in chains: the plight of Somalia’s mentally ill. This film features Abdullahi, who was chained up by his kin for the past 17 years. The story of Abdullahi imbibes the viewer in his pain, his suffering. According to a BBC news report, Somalia has the highest rate of mental illness in the world. In a country where social order and the health care system have been devastated by decades of war, people with mental health problems are the forgotten people.
They cannot enjoy human status. They cannot enjoy the freedoms that even animals can. They are unseen everywhere in society and its social order, all the while physically and mentally in chains in front of our eyes in public spaces. Just like Abdullahi. In Somalia alone, over one hundred thousand people with mental health problems are living their lives in chains.
Somalia is not a stand-alone case. Take Indonesia for another example where over 30,000 people with mental health problems are still inhumanly chained across the country today. No matter — rich or poor — people with mental health problems are the worst victims of abuse, discrimination and social exclusion globally. The nature and degree of the problems are different in different countries but very much there and of their own local nature. While over-medicalization, forced treatment, torture and institutionalization are the major mental health-related problems of developed countries, lack of access to basic social services, medical treatment, chaining, abuse and discrimination are the widespread mental health related problems of low and middle income countries.
Despite the above mentioned evidence of abuse, neglect, discrimination, torture, cruelty, inhuman and degrading treatment of people with mental health problems, the international community, actively involved in the low and middle income countries, is completely overlooking these issues. It is both a shame and surprise to me. Why is the international community failing to show moral solidarity (at the very least) on mental health and psychosocial disability issues in developing countries?
Its answer is not simple. In my observation, it seems ignoring mental health problems in developing countries is a kind of hypocrisy being practiced by the international community. Their failure to notice such widespread mental health related human rights violations in poor countries is a challenge to the moral foundation of their work where they stand and what they preach.
The inhuman and degrading treatment of people with mental health problems are among the most disgraceful acts of our time. On the basis of superstitious beliefs; traditional, social and cultural practice; ignorance about the nature of problems; lack of adequate social and family support; that those suffering are dangerous to self and other, people with mental health problems are being chained, locked up years in jails, and denied basic social and medical care.
After being labeled mentally ill, people loose their social status, community network, and kinship, which is equal to a social death, as explained in this article from The Lancet, ‘Global Mental Health: a failure of humanity’. This label creates permanent inequality in the society. People with mental health problems cannot imagine enjoying their civil and political rights. They are shamed and demoralized. They turn into unequal and forgotten citizen. The suffering of these people however do not get any space at the global or local levels of discourse on human rights, development, social security, health, and others.
In the absence of moral solidarity, moral exclusion takes place. As described by Susan Opotow in her essay, Moral Exclusion and Injustice: An Introduction, “Moral exclusion occurs when individuals or groups are perceived as outside the boundary in which moral values, rules, and considerations of fairness apply. Those who are morally excluded are perceived as nonentities, expendable, or underserving. Consequently, harming or exploiting them appears to be appropriate, acceptable, or just”.
In this context, my point is that the silence of the international community on mental health related problems endorses all kinds of atrocities against people with mental health problems, like Abdullahi. In a battle to challenge and stop such inhuman actions, first, it is important for everyone, including the international community, to acknowledge the prevalent tragedies faced by people with mental health problems in developing countries as unacceptable on humanitarian and human rights grounds.
It is on this humanitarian and human rights ground that I argue the international community must show moral solidarity in addressing mental health-related suffering of people with mental health problems in developing countries. That means we start to value people with mental health problems as equals to care about; as worthy as others to pay attention to, and their suffering as real as others’ to address.
(With support from Bidushi Dhungel)