Need for an Integrative Conceptual Framework for Addressing Mental Health Challenges During the COVID-19 Pandemic

The burden of mental illness across the globe, already significant, has grown dramatically since the onset of the COVID-19 pandemic. This is, in part, due to limitations in the current conceptual frameworks for understanding mental illness and resulting methods of practice. This paper provides an overview of the state of mental health and illness in the world, summarizes the prevailing frameworks and practices, and introduces a potential framework which could guide a response to the mental health challenges of the pandemic.

Islam and mental health

Psychiatry is the branch of medicine that most prominently incorporates the humanities and social sciences in its scientific base and in its treatment of illness. Psychiatry has often needed to go well beyond the world of natural science into the philosophical realm. Psychiatry and religion both draw upon rich traditions of human thought and practice. Mental health providers in developed countries are increasingly treating patients whose backgrounds are very different from their own, so it is important for them to understand cultural belief systems including religious thought and practice that relate to mental health and illness. Psychiatry and religion are parallel and complementary frames of reference for understanding and describing the human experience and human behaviour.

Mental Health and Illness

Anthropological contributions to the study of mental health and illness span diverse literatures and track a wide field of intellectual traditions and debates in their approaches to mental disorder, treatment, and recovery. Much as can be said of anthropology as a discipline more generally, the long history of the anthropological study of mental illness in cross-cultural context has been entwined in large-scale historical processes, including colonialism, racism, migration, war, and globalization. This history has also been shaped by the dynamic dialogue between anthropology, psychology, psychiatry, and global public health, and from which a number of subfields and intellectual traditions have emerged, among them ethnopsychiatry, cultural psychiatry, social psychiatry, and, most recently, global mental health. While certain core themes in the anthropological study of mental disorder that extend back to the early days of anthropology persist today, others have newly emerged in response to contemporary conditions. Collectively, these core themes recognize how mental illness experiences are richly variable and cultural in nature, and that psychiatric diagnosis is itself contingent, involving styles of reasoning and ways of knowing that are culturally informed and shaped by institutional landscapes and translational processes. These core themes include questions regarding psychiatric taxonomy and whether the classification of mental health problems is universal or culturally relative; the structural sources of human distress and suffering; treatment systems and interventions, such as the role of institutions and therapies in shaping the social course and experience of mental illness; the phenomenology of living with mental disorder; and the forms of psychiatric knowledge and practice enacted in contexts ranging from addiction treatment clinics to humanitarian settings. Studies span a wide range of engagement, from cultural critique to intervention studies that position anthropologists as collaborators in the development of effective and accessible interventions. Many studies draw on anthropology’s classic traditions of ethnography and long-term fieldwork, while raising questions and propositions for the relevance of anthropological methods and theories in the face of new ontologies of mental disorder, emergent technological frontiers, changing political and economic contexts, and the global aspirations of mental health treatment. In their complexity, mental health and illness speak to fundamental questions concerning the nature of human experience in changing worlds, making the topic deeply relevant for anthropology.

Introduction

The theory of mentalising and epistemic trust introduced by Peter Fonagy and colleagues at the Anna Freud Centre has been an important perspective on mental health and illness. This book is the first comprehensive account and evaluation of this perspective. The Introduction situates the aims of the book. It highlights the priority given by Fonagy and colleagues to open discussion and clarification of key terms and concepts, and discusses which terms and concepts will be given particular focus over the subsequent chapters. The chapter also introduces Fonagy and his collaborators, and presents a summary of each chapter of the book.

Mentalising and Epistemic Trust

The theory of mentalizing and epistemic trust introduced by Peter Fonagy and colleagues at the Anna Freud Centre has been an important perspective on mental health and illness. This book is the first comprehensive account and evaluation of this perspective. The book explores 20 primary concepts that organize the contributions of Fonagy and colleagues: adaptation, aggression, the alien self, culture, disorganized attachment, epistemic trust, hypermentalizing, reflective function, the p-factor, pretend mode, the primary unconscious, psychic equivalence, mental illness, mentalizing, mentalization-based therapy, non-mentalizing, the self, sexuality, the social environment, and teleological mode. The biographical and social context of the development of these ideas is examined. The book also specifies the current strengths and limitations of the theory of mentalizing and epistemic trust, with attention to the implications for both clinicians and researchers.