Cox Nigel, Webb Lucy
Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, UK.
Sociol Health Illn. 2015 Jun;37(5):683-97. doi: 10.1111/1467-9566.12230. Epub 2015 Feb 13.
The World Health Organization's Mental Health Action Plan 2013-2020 identifies actions for all member states to alleviate the global burden of mental ill health, including an obligation for mental healthcare to be delivered in a 'culturally appropriate' manner. In this article we argue that such a requirement is problematic, not least because such pronouncements remain framed by the normative prepositions of Western medical and psychological practice and their associated ethical, legal and institutional standpoints. As such, when striving to export Western mental health expertise, different paradigms for evidence will be necessary to deliver locally meaningful interventions to low and middle income countries. Our discussion highlights a number of philosophical concerns regarding methodologies for future research practice, including those relating to representation and exclusion in the guise of epistemic injury, presumptive methodologies arising from Western notions of selfhood, and related ethical issues.
世界卫生组织《2013-2020年精神卫生行动计划》为所有成员国确定了减轻全球精神疾病负担的行动,其中包括以“文化上适宜”的方式提供精神卫生保健的义务。在本文中,我们认为这样的要求存在问题,尤其是因为此类声明仍然受到西方医学和心理学实践的规范性前提及其相关的伦理、法律和制度立场的限制。因此,在努力输出西方精神卫生专业知识时,需要不同的证据范式,以便为低收入和中等收入国家提供具有当地意义的干预措施。我们的讨论突出了一些关于未来研究实践方法的哲学问题,包括那些以认知伤害为幌子的代表性和排斥性问题、源于西方自我观念的推定方法以及相关的伦理问题。