A historical perspective on structural-based mental health approaches in Latin America: the Chilean and Brazilian cases

ABSTRACT

The growth of identity struggles and intersectional debates has presented challenges for public health services in Chile and Brazil. In this context, researchers, stakeholders, health practitioners, and activists have recently brought contemporary debates on professionals’ competency to the fore. Debate in Chile and Brazil has primarily centered on US-based discussions on cultural and structural competency. However, emerging concerns regarding identity, intersectionality, and mental health among vulnerable or marginalized groups have confronted local health traditions with the need for specific interpretations of concepts such as ‘culture’ and ‘structure’. In this commentary, we delve into the recent history of psychiatry and public health in Chile and Brazil to reveal how ideologies and politics have influenced local traditions in mental health practice and their interaction with ongoing identity struggles and intersectional debates. We argue that recent historical and sociopolitical factors in both countries have shaped a structural-based approach to mental health practice. The introduction of gender and multicultural policies in public health has contributed to a more complex understanding of Otherness and power relationships in recent decades. Although this understanding largely aligns with those prevalent in the USA and UK, there is a strong emphasis on class in identity struggles and intersectional debates in public health, providing a distinctiveness to Latin American debate. Understanding professional competencies requires consideration of broader sociopolitical processes. Rather than a de-contextualized understanding of ‘culture’ and ‘structure’, the history of psychiatry demonstrates how these categories interact within specific political and ideological contexts.

KEYWORDS:

• Inequalities
• politics
• identity

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. There are various contributions in this field. In addition to those already cited, we recognise the work of Taylor (2003), Kleinman and Benson (2006), and Yates-Doerr (2018).

2. Structural competency discussions are mainly US-based debates. The literature outside the US is scarcer. Two special issues of the journal Global Public Health – on ‘Structural competency in global perspective’ (Piñones-Rivera, Martínez-Hernáez, Morse, Ferral, et al., 2023) and ‘Global voices for global justice expanding right to health frameworks’ (Piñones-Rivera, Martínez-Hernáez, Morse, Nambiar, et al., 2023) – broaden the discussion at an international level. In US work of structural competency, racism is viewed as a primary driver of health inequalities, and racialization monopolizes discussion of these issues.

3. These feminist demonstrations, also known as the Chilean feminist wave or the Chilean feminist revolution, correspond to a series of mass protests rallies, marches and art interventions against the government and violence against women in Chile.

Additional information

Funding

This work was supported by the ANID Becas-Chile scholarship, the ERC Starting Grant project Decolonising Madness (DECOLMAD 851871), and the Center for Culture and the Mind (CULTMIND) - Danish National Research Foundation (DNRF171).