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Thursday, January 29, 2015

Drug Companies, Developing Countries, and Psychiatric Neocolonialism


Dennis Nissim-Sabat recently reviewed China Mills’s Decolonizing Global Mental Health: The Psychiatrization of the Majority World for PsycCRITIQUES. In his review, Nissim-Sabat points out that huge profits are accessible to those drug companies that can successfully convince millions of citizens and their health care providers in developing countries such as India that they need to take psychotropic medications with the same enthusiasm and frequency found in more developed countries such as the United States.  A similar point is made in Wade Pickren’s (2010) PsycCRITIQUES review of Ethan Watters’s book Crazy Like Us.  

Do psychologists—and especially international psychologists working in majority countries—have an ethical obligation to oppose “psychiatric neocolonialism”?  If so, what form should this opposition take?


Pickren, W. (2010). Should the world be as apple as American pie? [Review of the book Crazy like us: The globalization of the American psyche, by E. Watters]. PsycCRITIQUES, 55(46).
Read the Review
ReviewPsychiatric Imperialism in India
By Denis Nissim-Sabat
      PsycCRITIQUES, 2014 Vol 59(49)


Judith Schlesinger, PhD

Fascinating. I'm always glad to see another expose of the greed and arrogance of the medical model. But Loren Mosher was not the president of the APA when he resigned; he was a prominent activist psychiatrist who'd been fired from the NIMH for his radical views, and was expressing his ongoing disgust with where his profession was headed. Thanks to Nissim-Sabat for providing the link to this articulate document, which is just as disturbing and relevant in 2015 as it was in 1998.

Denis Nissim-Sabat

Judith, Thank you for your comments and pointing out the error in my stating that Loren Mosher was president of the American Psychiatric Association. China Mills had made that claim in her book and my fact check was not thorough enough.

Russell Searight

Excellent review and very interesting issue. I have been following this effort to spread psychiatry to non-Western countries with interest.

I spent part of this past summer as a visiting professor at Shaoxing University in China--it is a university of about 20,000 and is 2 hrs from Shanghai. Clinical Psychology was not well recognized in the university. Most of the psychology students were planning to become teachers. There was interest in clinical psychology among the students after I described it in a lecture/discussion--many did not seem to be familiar with the profession previously.

However, I also visited a large psychiatric hospital and spoke at some length with the psychiatrist who was in charge. He showed me training material that he was about to present to staff psychiatrists--it was about the DSM-5 which the hospital was going to adopt; I got the impression that this was their initial adoption of the DSM system.

I have spent much of my career in primary health care. One of the things that really struck me in Shaoxing was the view that mental health was not at all the province of PCPs. I had been asked to informally "consult" while there. I was not at all comfortable ethically but did suggest that they consult their family physician/pediatrician as a first step (common advice I give in the U.S.). It was made very clear that primary care docs don't deal with behavioral/mental health issues--at least in this region of China. This was confirmed by the psychiatrist who told me that even SSRIS were rarely prescribed by anyone other than a psychiatrist. This may not be the case in cities such as Shanghai or Bejing--I was in a city of about 4 million which the locals called a "small town."

Several years ago, I had read Kitanaka's (2012) book about how Major Depressive Disorder became more accepted in Japan. She points out that depression in Japan was often equated with severe melancholia. She goes on to describe how MDD became re-labeled to make it more acceptable to seek treatment--specifically SSRI pharmacotherapy and suggests that the pharmaceutical industry aided in relabeling MDD as a "cold of the soul." As a result, prescriptions for SSRIs increased significantly.

I wonder if a similar process will occur in China. There are already data indicating that SSRI prescriptions are exponentially increasing in China. I wonder if there will be an effort to get PCPs on board and include overt mental health issues as part of the scope of practice. There is a growing market for psychiatric meds but relatively few psychiatrists in China. I am watching this with interest. I do agree with Mills about the growing "psychiatric imperialism;" I am of the opinion that it is almost inevitable in the developing world.

Cicilia Chettiar

As a practicing psychologist and as an academician since the past decade in Mumbai, India, I agree with the points raised here. One of the biggest problems in battling this issue is that we do not have a licensing authority for psychologists. There is one body that provides a regn number (RCI), but it's authority to do so has been questioned by many including me. Further, the new govt has significantly cut the health budget (same story all across) which means the efforts to raise awareness about the need for psychological care will be further hampered. Add to it the complication of the stigma associated with visiting a mental health professional, and we have a recipe for psychological disaster. It is frustrating for most of us who are trying to battle voodoo on the one hand and psychiatry on the other while trying to provide effective psychological health services to the 1.2 billion population.


Iam a counselling psychologist and Ihave gone through cases were they feel better only while taking medicine and the patient faces side effects of the medicine.If the damage is only at the beginning stage it can be treated by counselling itself but medicines are given for them also and it triggers the problem more.

Andrew Stock

It's not like the drug companies are playing by the rules either. 3bn yuan is a slap on the wrist for them. The medical model is well and truly entrenched into the way psychological and emotional distress is conceptualised in the US, and is slowly but surely working its way into developing countries, and as you can see from the attached URL, China is a huge focus for them. I imagine India is, as well. I lived in Shanghai for two years and am now pursuing my doctorate in clinical psychology in Hong Kong, delivered by an American university, which has many great things about it, but is similarly exporting the disease model of mental illness, and perhaps unwittingly playing right into Big Pharma's hands.

Andrew Stock

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Editor of PsycCRITIQUES

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College of Medicine,
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