Making space for restoration: epistemological pluralism within mental health interventions in Kinshasa, Democratic Republic of Congo

Abstract

Global health policy makers have recently begun to focus their attention on large levels of untreated mental illness in low- and middle-income countries. They have, in turn, initiated a series of interventions intended to reduce the global “treatment gap” that has emerged between those requiring treatment and those able to access it. Yet critics have challenged the questionable epistemological assumptions embedded in these interventions and have decried the lack of attention given to the translation and implementation of such projects in resource-limited contexts. In this paper, I focus on on-going attempts to diminish the mental health treatment gap in Kinshasa, Democratic Republic of Congo to illuminate how dominant thinking about ameliorating the global treatment gap remains rooted in a reductive biomedical paradigm. Drawing upon interviews conducted with 16 psychiatrists in the city, I show how a series of epistemological assumptions about treatment have affected the success of treatment delivery in two donor-funded interventions. I then contrast the dominant biomedical approach with the perspectives of three younger voices in the city’s psychiatric community. I reveal how an alternative epistemological framework, similar to that of the phenomenological tradition, informs their own successful treatment expansion efforts. This alternative perspective, I propose, challenges practitioners and geographers alike to cultivate new ways of approaching global mental health that acknowledge the value of patient experiences and make possible more responsive forms of treatment and care.