As a teacher of psychiatry to medical students in Zimbabwe, I find Tina Rosenberg’s account of the work of Vikram Patel overly glossy (The long read: Busting the myth that depression doesn’t affect poor countries, 30 April). At issue is the globalisation of western psychiatry, for which Patel is a prominent salesman.

In claiming that a local idiom of distress – “thinking too much” – is really depression, he is asserting the universalist supremacy of western frameworks and categories. This is indeed cultural hegemony, brushing aside non-western mentalities and understandings of distress. Moreover, a poverty-haunted Zimbabwe has enough problems of its own without the importation and promotion of “depression”, with its assumptions of mental pathology.

Rosenberg also mentions the “friendship bench” project in Zimbabwe. This may be a useful social initiative but that does not mean that it is treating “depression”.

I might add that there is no category being applied so indiscriminately in western countries than “depression”: witness the rise in the UK of antidepressant prescriptions from around 9m per year two decades ago to 70m now.
Derek Summerfield
Honorary clinical senior lecturer, Institute of Psychiatry, Psychology and Neuroscience, King’s College London

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