Global Mental Health and the Demolition of Culture

September 27, 2016 |   By Renato D. Alarcón, MD, MPH

That the world is currently going through a complex and critical phase in its history is an understatement. The background is multifaceted: violence of all types with a different kind of war (but war anyway) at its peak, large migrations in all regions, religion transformed in terrorist codes and strategies with tragically massive sequelae, and politics in many countries (starting with the US) reaching levels of cheap TV shows or grotesque deformity by the words and actions of some of its protagonists. And the main victim, in addition to all the innocent lives of those who died or were injured (physically and emotionally) is humanity itself, the essence of its raison d’etre—culture—as both the repository of history and the expression of our human identity.

Culture is being demolished by grenades, guns, and incendiary speeches. And the world’s mental health is being threatened as never before by viruses of hatred, fanaticism, frivolousness, and a technology-based infectious chain. The challenges to psychiatry as the clinical armour of mental health, and to cultural psychiatry as its vanguard platoon, are indeed enormous in these dramatic and confusing times.

The preceding may sound exaggerated but an objective and close examination of worldwide events these days, conveyed by the media, social networks, or word-of-mouth, confirm the seriousness of the situation. Almost daily attacks by unknown assailants in malls, train stations, bars, churches, or in the streets reflect the contagious nature of violence—be that the result of dysmorphic preaching or the action of “lonely wolves.” Religious and even ethical principles used as reasons to kill, dressed up by coward anonymity, have used European and American cities as worldwide stages. A re-invigorated racism and its mixed-up dialectics play with fear, apprehension, or sheer ignorance to make public places or dark neighborhoods scenarios of death, invoking at times the name of the law. Homicide and suicide-related deaths have increased as a consequence.

The cultural and mental implications of all these behaviors cannot be neglected. Migration within countries or regions has been a phenomenon present for centuries around the world. To mostly socio-economic and occupational needs as main causes of migration, others have been added in the last several decades: prolonged internal political conflicts, religious wars, cruel political persecutions, bloody massive expulsions, or voluntary exile.

Psychiatry can help to alleviate, contain, and eventually prevent demolition of culture and health. That’s how powerful it is.

The other big differences are the size and frequency of the migratory waves, particularly between the Middle East and European countries, in the African continent, and the ever-present flow of Hispanics into the US.

International bureaucratic and professional organizations (World Health Organization, World Psychiatric Association, World Association of Cultural Psychiatry) have made strong pronouncements, urging governments and other agencies to study, plan, and intervene in the alleviation and prevention of the health and mental health consequences of migrations, clinical pictures of which fragilities, rejection, resentment, and uncertainties are substantial ingredients.

Moreover, we cannot deny that the political picture of the most powerful country in the world presents evidences of circus and polarization, showmanship and distrust, that make it “different.” The problem is that the “difference” now is not ideological or doctrinal; particularly on one side of the current campaign, it is the accentuation of hate,

the use of stereotypes and insults as arguments, the not-too-disguised lies or the not-too-subtle incitements to overt violence. And this fact, violence, is precisely where all the occurrences in today’s world (war, terrorism, migrations, politics) converge and show their shared umbrella.

Violence, without distinctions of age, gender, ethnicity, civil status, socio-economic level, nationality, religious or cultural features, permeates these processes. Violence—be it domestic, collective, verbal, physical, sexual, emotional, or political—is one of the most demonstrative manifestations of social as well as psychological/mental instability.

It corrodes the spaces of tolerance and reason, the roots of dialogue and communication, the capacity to judge and opine. It takes away the visions of future and progress converting them into weak presentism and facile demagoguery. Violence kills people, demolishes buildings, cities, monuments . . . and the whole of culture.

In clinical terms, the mental health consequences of this global socio-political climate affect individuals, groups, communities and the society at large. To the well-known posttraumatic stress manifestations per se, those of depression, anxiety, psychosis, substance use, as well as dissociative, somatic, conversion, and personality disorders, can be triggered or exacerbated by violence, making it the final common pathway of a variety of conditions, the overcrowded catalogue of disorganization, fright, and confusion.

It is also fed by denial, the oldest of what are known as “defense mechanisms;” by duplicities, sophisticated versions of multiplied lying, rationalism, or sloganized justifications. In the cultural realm, again, individual and group/community/ethnic identities are deformed; beliefs and traditions are betrayed or simply set aside; faith is lost. Contagiousness is, many times, an atypical collateral of violence.

In short, violence engenders more violence.

What to do under these circumstances? What can psychiatry and its allied disciplines do to alleviate, contain, and eventually prevent or avoid the demolition of culture and health? A systematic, consistent, tireless call to reason that must include an honest assessment of history and its changes, should constitute the core of a public education campaign.

An analysis of the roots of each problem, the public health/mental health response to the realities of the situation, direct invitations to and active participation in civilized dialogues with government authorities, public citizens, and political groups and academic institutions; an unequivocal protection of civil liberties and human rights, and fostering of preparedness and preventive vigilance from and for all population segments. Concomitant tasks of teaching, learning and training at all levels—students, professionals and public—strengthened by available mental health care infrastructure.

Most importantly, the restoration of cultural consciousness, of the texture of identity and genuine faith (respecting differences and welcoming coincidences), of the force of ideas and practices carrying out genuine understanding, solidarity, and teamwork. The ultimate objective is, of course, the elimination of violence as a resource, the reconstruction of culture as a unifying force, a chalice of diversity.

Globalization is far from being a comprehensive concept, in spite of its etymology. Global health and global mental health are still at the beginning of their conceptual articulation, their presence felt as undeniably strong but their entities still uncertain. Culture is being threatened worldwide, but its perpetual, basic configuration throughout millennia becomes the basis of the most important factor against its destruction: hope, the same quality that Jerome Frank intuited as the most powerful ingredient of all psychotherapies. Hope as a source of action and positive responses, as a pillar of protection and resilience for individuals and nations. Hope as a tool for the survival of human culture.


I was born in Arequipa, the second largest city in Perú, and graduated from medical school in Lima. My parents were both high school teachers and always voiced their wish to have “a doctor” among their 3 children. I confess I liked letters and humanities but, in the end, I “compromised” by choosing psychiatry as my specialty: I am very happy because I know psychiatry is the last bastion of Humanism in medicine, and because I enjoyed the work and wisdom of great teachers. Let me just mention two: Honorio Delgado (1892-1969), a Peruvian philosopher and researcher who met and worked with giants like Freud; Jaspers; the Schneiders; Gregorio Marañón or Pedro Lain-Entralgo, who is considered the greatest Latin American psychiatrist of the 20th century; and Jerome Frank (1909-2005), an accomplished, compassionate and inspiring Hopkins academician, the first and most solid psychotherapy researcher in the world.

Trained in the US, I worked back in Lima for 8 years before returning in 1980 to work at the University of Alabama in Birmingham, Emory and, finally, the Mayo Clinic. I have always kept in close touch with Latin American psychiatry and have its visibility around the world as, perhaps, the fundamental objective of my career. In a globalized world, it is only fair to recognize the contributions of developing countries and continents. I am gratified for having helped a number of Latin American young colleagues, medical students, and residents to come to the US and enjoy learning experiences in American academic centers. I have also assisted in the organization of international events where experience-sharing, teaching, and learning from each other are substantial didactic resources. And, certainly, I plan to continue doing so for as many years as possible.

I love classical music, Latin boleros, and Peruvian waltzes. I used to play soccer and was an adolescent sports anchorman and journalist in my hometown. I lost my brother Javier, an idealist of the left, one of the 80,000 desaparecidos or victims of the “dirty war” of the 1980s in Perú; in his memory, social and political reconciliation are frequent themes of my reflections from the cultural and social psychiatry perspectives. I feel moved by Cesar Vallejo’s poetry; Hemingway’s life and novels; Bertrand Russell’s thinking; Elie Wiesel’s, M.L. King’s, or Octavio Paz’s social militancy. And count The Room, Schindler’s List, and To Kill a Mockingbird among my favorite movies.


Dr. Alarcón is Emeritus Professor and Consultant in the department of psychiatry and psychology at Mayo Clinic College of Medicine in Rochester, MN,


Peter @ Sun, 2016-10-02 19:11

Is psychiatry really so powerful in order “to help alleviate, contain, and eventually prevent demolition of culture and health”? If that is so, how can we really measure, evaluate or discern this kind of helpfulness without incurring in another romantic case of

irremediable wishful thinking? Call me pessimist or disenchanted, but after four decades working as a clinical psychiatrist in my beloved and violent Mexico, my guess is as Paul Auster declared during the Príncipe of Asturias Award Ceremony “A book has never put food in the stomach of a hungry child. A book has never stopped a bullet from entering a murder victim’s body. A book has never prevented a bomb from falling on innocent civilians in the midst of war” (not even a psychiatry textbook or article). Nevertheless, I still do think that Dr. Alarcón words are beautiful, thoughtful and even inspiring.

Dr. Moisés Rozanes

The concept of culture is very important especially because culture and race have been misused as concepts. Most of what people call ‘race’ is culture. We live in a time of huge cultural change including the globalization of music, art, sports, and fashion. Language which communicates culture is globalizing. The internet has brought about these changes and the internet is being fought over as to which global player will control this agent of change. The danger for psychiatry is that psychiatry has too often been on the wrong side of cultural change and has supported the insider powerful over the people in past issues such as psychiatry’s shameful support of Eugenics and psychiatry’s calling being gay illness. The Populist Movement as shown by the Brexit and the Trump campaign must not be demonized by organized psychiatry and instead , need to be seen as the People culturally taking power and rejecting the mostly self-appointed ruling elite. Psychiatry needs to accept it does not have a mandate to call culture illness. Psychiatry must carefully separate culture and illness and clearly demonstrate that psychiatry can be trusted to be a medical specialty and that psychiatry will never again abuse people in the name of the powerful political elites.

Alan @ Fri, 2016-09-30 17:15

Excellent article but I wonder what is the role of culture triggering the contemporary situation? We are conditioned by our culture and use it as a reference against other social groups. I am not free from my conditioning although I can be aware of it, then a transformation takes place and I become compassionate and less violent. The other social group see my attitude and now (they seems to) listen opening the door for communication. The role of psychiatry is tainted by the damage done by it; our pseudo-diagnostic manual, Pharma and the psychotropic drugs. We are part of the problem and only after we see it there will be hope…and compassion and healing.

Manuel @ Fri, 2016-09-30 10:34

This portrayal of current cultural situation in the world is excellent, but please don’t tell me the answer is “hope”.

Psychiatry’s role should be EDUCATION, secular/Scientific education and in a good many number of years this “cultural demolition” would start to respond to treatment, I believe.

Dr. Pistone, MD Psychiatrist

Daniel @ Fri, 2016-09-30 00:04

It takes quite a bit of hubris, or delusion, to think that the times in which we live are unique or somehow special or especially threatening to culture or civilization. The world and civilization have endured fascism, the Holocaust, “Mongol hordes”, the Fall of the Roman Empire, extermination of native peoples, colonization, the Black Death, the Opium Wars, slavery, the Inquisition, ad nauseam throughout recorded history, and most certainly before. ISIS, Hillary Clinton, and Donald Trump are hardly the worst things that might “demolish” world culture.

Quentin @ Thu, 2016-09-29 10:32

My thoughts exactly. There is nothing new under the sun. The Middle Ages were far worse, especially for women and children. The Crusaders put us to shame when it comes to violent murder in the name of God. There is less violence in the streets today than in the past. Civil rights are stronger today than in the past. This is not to say, of course, that we should not be horrified about the tenor of the political climate, or the divide between those fearful who lean toward xenophobia and those who envision an open, multicultural society where every person who wants one is given a fair shot to live a safe, authentic life. “Give me your tired, your poor, your huddled masses…the wretched refuse of your teeming shore” should not be just words on a statue.

Dana @ Thu, 2016-09-29 11:23

Is not the comparison with the tranquil (civilized?) peace of America’s (e.g.) 50’s against current events in the USA? I may get eaten alive for being simple but the “world” (America) seems much more violent than even the 70’s and 80’s. I don’t believe the author was comparing today’s society against the holocaust, etc. I found the article to be interesting and a provider of Hope.

Dana @ Thu, 2016-09-29 11:12

I think the 50’s were really great for straight white folks. Otherwise, not so much.

Dana @ Thu, 2016-09-29 12:57

I think the key word is “seems” In fact, there is less violence today than in those decades. It is simply that we have access 24/7 to the sensationalized news reports about the violence that is being perpetrated today, so we are left with the impression that there is more violence when in fact there is less. It is safer to walk on city streets today than in the 70’s and 80’s. There are studies that show this.

Denise @ Thu, 2016-09-29 11:31

I think of that intermittently but not consistently enough. That’s an excellent point. Thank you for your response. I would be interesting in finding a study to reinforce my thinking. * reply

Dana @ Thu, 2016-09-29 12:59

I’m not sure I understand the context of your post. I interpreted the essay to be a commentary on current affairs and identified social trends not a look backward comparing today’s events with all recorded events since the mass extinction of mammoth and giant sloth.

If the argument is that reporting by news media is so pellucid and unreliable that current events are virtually unknowable being disinformation but that written histories are a reliable and superior source of knowledge about the world today, then I would lean toward assurance that finished and complete knowledge is enough.

Societies are being transformed. No one can argue that the world is not changing in ways unique to our times. How the people of the world interpret the transformation may not be determinative in the end, but it is important for the curious-furious to develop perspective on forces and powers influencing the future of all cultures. It’s an unusual opportunity for scholars; those with a focus on psychiatry or no.

Richard Anthony @ Thu, 2016-09-29 21:19

Reading this article reminded me the vision outlined by Jerome D. Frank in his book “Sanity and Survival”. Truly wonderful essay. John M. de Figueiredo

John @ Thu, 2016-09-29 10:23

I do not recall who said that “civilization was started by the first man who used word instead of a club to work out a disagreement.” it was well said.

Melvin @ Thu, 2016-09-29 10:21

Your words speak volumes. Working at the public school level I see first hand the “trickle down” effect the issues of this world are having on children. We must be vigilant, in continuing to address the issues you discussed, for the future of society as a whole. Thank you.

Cheryl @ Thu, 2016-09-29 10:17

Well said! Eloquent and on target.

Jennifer @ Thu, 2016-09-29 10:03

I couldn’t agree more. Listening to the political and event news feels like a daily assault to my mental health, which is generally good. I try to stay informed, but I am not allowing myself to be involved in the 24 hour / day news cycle. Quiet walks alone seems to be a good respite for me from the daily stressors of life (job, family…), but more importantly the political and global stressors (politics of hate / division, terrorism, economics, wars, climate change with devasting weather events…). It is no wonder that there is an increase in mental health issues and a growing need for medications to assist people with coping with life.

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