Book Review

World Mental Health: Problems and priorities in low-income countries

N Engl J Med 1995; 333:1227-1228November 2, 1995

Article

World Mental Health: Problems and priorities in low-income countries
By Robert Desjarlais, Leon Eisenberg, Byron Good, and Arthur Kleinman, with contributions from 11 others. 382 pp. New York, Oxford University Press, 1995. $39.95. ISBN: 0-19-509540-5

There have been worldwide declines in mortality and fertility and increases in life expectancy and the control of infectious diseases, accompanied by economic changes and social upheavals. These major demographic changes, as well as ethnic conflicts, the movement of refugees, and internal displacement, have increased the incidence of mental and behavioral problems in low-income countries.

This book is a call to action to improve the mental health of people throughout the world. Supported by the Carnegie Corporation of New York, the MacArthur Foundation, the Milbank Memorial Fund, and the Rockefeller Foundation, it is the fruit of a two-year collaboration by the authors, with contributions from a distinguished international advisory board of some 31 professionals and 89 consultants, whose areas of expertise range widely, from reproductive health in low-income countries to the economic and political forces affecting mental health in developing countries.

The authors provide scholarly documentation of the epidemiology, anthropology, and consequences of the major mental health and behavioral problems that form an increasing part of the health burden around the world. Disorders of mental health (including self-inflicted injuries) account for 8.1 percent of lost years of quality life. The book first reviews the demographic, social, economic, and political forces contributing to the increase in mental illness, particularly in low-income countries. Succeeding chapters discuss the range of mental disorders and behavioral problems and the challenges they raise for special populations.

Major problems — suicide, substance abuse, violence, dislocation, and the problems of children and youth, women, and the elderly — are treated in separate chapters. At the same time, these conditions are recognized as typically found in clusters. The general format for the discussion of each topic is a review of the scientific data available on individuals, the community, and society; the magnitude, relevant causes, and impact of the problem are described. A series of recommendations are made for research, training, the provision of services, and policy; conclusions follow. Narrative and ethnographic descriptions of particular problems and interventions within countries or communities are presented in boxes. Throughout, the book emphasizes the need to recognize and be sensitive to the role of culture and local institutions. The arguments and calls to action are hortatory but logical and convincing, and they follow from the material presented.

One illustration of this approach is the chapter on women. The need to consider women's lives beyond the areas of reproduction and maternal and child health is highlighted by data on patterns of psychiatric disorders and psychological distress; the social origins of distress, hunger, work, and sexual, reproductive, and domestic violence; and the downside of development. Ethnographic vignettes present the ramifications of the quality of women's lives and of their physical and mental health. For example, a section entitled “Domestic Violence in Mexico” briefly describes the worldwide epidemic of domestic violence; the experience of one Mexican woman; initiatives in Mexico that brought increased awareness of the issues of rape and domestic violence; and the need for research, action, policies, and programs.

Because each chapter is self-contained, the book can be read starting at any point, depending on one's interests. Whether readers are oriented quantitatively or qualitatively, they can enjoy and be informed by any or all of the chapters.

The book is well written and carefully documented, with extensive notes and references. The index seems adequate. Who will profit from reading it? Practically anyone — scholars, students, laypersons, service providers, psychiatrists, anthropologists, social scientists, economists, program directors, and policy makers.

Grace Wyshak, Ph.D.
Harvard School of Public Health, Boston, MA 02115