No sovereign remedy: distress, madness, and mental health care in Guyana

This dissertation is an ethnographic examination of how mental distress is read and understood in Guyana. Through semi-structured qualitative interviews, site observations, media analysis, and document analysis (primary, secondary, tertiary, and grey literature), this research investigates (i) competing and complementary discourses and etiologies of distress; (ii) diverse care pathways and practices utilized by Guyanese to address and ease distress; (iii) and the histories, legacy of empire, and socio-politico-economic factors that inform and spring from this exploration. This research commenced in response to deaths and incidents of violence against women and girls who were labelled “mad”, “mentally ill”, and “demon possessed” in Guyanese news reports. These cases signalled the polyvalent, intersectional, and fluid ways in which Guyanese make sense of and respond to mental distress; thereby prompting research questions on belief systems, modalities of care, and the social relations that are produced, organized, and practiced as Guyanese attend to mental distress on their own terms.

Interviews were conducted in Guyana with 37 helping practitioners, inclusive of medical doctors, nurses, social service agents, civil society/NGO actors, government officials at Guyana’s Ministry of Health, and religious/spiritual practitioners belonging to various faiths. Observations were carried out at the country’s National Psychiatric Hospital – informally known as the “Madhouse”. Participants emphasized how mental distress is colloquially and primarily perceived through the stigmatized and meaning-centred language of “madness”. They reported that the general public seldom uses the clinical terms “mental illness”/“mental disorder”, which reference the dominant, Western biomedical model of psychiatry. Instead, participants revealed how mental distress is expressed through an array of perceived explanatory models: biomedical; socio-economic/structural; (inter)personal; and supernatural. A major point of consensus among all 37 participants is how perceived supernatural causality is viewed as an intelligible landscape for understanding distress among the public; therefore, there is a propensity for religious/spiritual practitioners to act as first responders. Per participant accounts, Guyanese appear to embrace plurality and refuse either/or models of care. Consequently, these findings present crucial implications for theory, research, policy, and practice aimed at addressing and reducing mental distress experienced by Guyanese and fostering safe, comprehensive, responsive, and accountable public health systems.