Table Of ContentGlobal Mental Health
and Neuroethics
Global Mental Health
and Neuroethics
Edited by
Dan J. Stein
Ilina Singh
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Contributors
Ronald Anguzu Public and Community Health Program, Institute for Health and
Equity, Medical College of Wisconsin, Milwaukee, WI, United States
Anthony Barnett School of Psychological Sciences and Turner Institute for Brain and
Mental Health, Monash University, Melbourne, VIC, Australia
Gillian Bartlett Department of Family Medicine, McGill University, Montréal, QC,
Canada
Adrian Carter School of Psychological Sciences and Turner Institute for Brain and
Mental Health, Monash University, Melbourne, VIC; University of Queensland Centre
of Clinical Research, University of Queensland, Brisbane, QLD, Australia
Veljko Dubljević Science Technology and Society Program, Department of Philosophy
and Religious Studies, North Carolina State University, Raleigh, NC, United States
Jantina de Vries Department of Medicine, University of Cape Town, Cape Town,
South Africa
K.W.M. Bill Fulford Collaborating Centre for Values-based Practice, St Catherine’s
College, and Member of the Philosophy Faculty, University of Oxford, Oxford,
United Kingdom
Wayne Hall Centre for Youth Substance Abuse Research, The University of
Queensland, Brisbane, QLD, Australia; National Addiction Centre, Institute
of Psychiatry, Psychology and Neuroscience, Kings College London, London,
United Kingdom
Karen Herrera-Ferrá Asociación Mexicana de Neuroética, Atizapán, Mexico
Xanthe Hunt Institute for Life Course Health Research, Faculty of Medicine and
Health Sciences, Stellenbosch University, Stellenbosch, South Africa
Judy Illes Neuroethics Canada, Department of Neurology, University of British
Columbia, Vancouver, BC, Canada
xii Contributors
Fabrice Jotterand Center for Bioethics and Medical Humanities, Institute for Health
and Equity, Medical College of Wisconsin, Milwaukee, WI, United States; Institute
for Biomedical Ethics, University of Basel, Basel, Switzerland
Cristina Longo Department of Family Medicine, McGill University, Montréal, QC,
Canada
Alicja Malinowska Department of Psychiatry, University of Cambridge, School
of Clinical Medicine and the Behavioural and Clinical Neuroscience Institute,
Cambridge, United Kingdom
Doug McConnell Oxford Uehiro Centre for Practical Ethics, University of Oxford,
Oxford, United Kingdom
Andrea C. Palk Department of Psychiatry, University of Cape Town, Cape Town,
South Africa
Vasiliki Rahimzadeh Postdoctoral Fellow, Stanford Center for Biomedical Ethics,
Stanford University, Stanford, CA, United States
Barbara J. Sahakian Department of Psychiatry, University of Cambridge, School
of Clinical Medicine and the Behavioural and Clinical Neuroscience Institute,
Cambridge, United Kingdom
Julian Savulescu Oxford Uehiro Centre for Practical Ethics, University of Oxford,
Oxford, United Kingdom
George Savulich Department of Psychiatry, University of Cambridge, School of
Clinical Medicine and the Behavioural and Clinical Neuroscience Institute, Cambridge,
United Kingdom
Ayla Selamoglu Department of Psychiatry, University of Cambridge, School of
Clinical Medicine and the Behavioural and Clinical Neuroscience Institute, Cambridge,
United Kingdom
Abdul R. Shour Public and Community Health Program, Institute for Health and
Equity, Medical College of Wisconsin, Milwaukee, WI, United States
Ilina Singh Department of Psychiatry, University of Oxford, Oxford, United Kingdom
Walter Sinnott-Armstrong Philosophy Department and Kenan Institute for Ethics,
Duke University, Durham, NC, United States
Sarah Skeen Institute for Life Course Health Research, Faculty of Medicine and
Health Sciences, Stellenbosch University, Stellenbosch, South Africa
Contributors xiii
Joshua August Skorburg Philosophy Department and Kenan Institute for Ethics,
Duke University, Durham, NC, United States
Werdie van Staden Philosophy Department and Kenan Institute for Ethics, Duke
University, Durham, NC, United States
Dan J. Stein Department of Psychiatry, University of Cape Town, Cape Town,
South Africa
Mark Tomlinson Institute for Life Course Health Research, Faculty of Medicine
and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; School of
Nursing and Midwifery, Queens University, Belfast, United Kingdom
Kevin Chien-Chang Wu Graduate Institute of Medical Education and Bioethics,
National Taiwan University College of Medicine; Department of Psychiatry, National
Taiwan University Hospital, Taipei, Taiwan
Foreword
Serendipitous discoveries in psychopharmacology have been important in advancing
psychiatric science, but have had only partial success in reducing the burden of disease
associated with mental disorders. Current advances in neuroscience and neurogenetics
hold great promise for improving our understanding of these conditions and for ad-
vancing treatment outcomes. However, with this promise comes important conceptual
and practical issues, which this volumes addresses.
A first question concerns how we ensure that the benefits of clinical neuroscience
have global impact? Global mental health has appropriately focused on addressing
the treatment gap across the world; advances in implementation science will be key in
ensuring this important goal is attained. There is also a need for diverse populations
from around the world to be included in clinical neuroscience research, in order to
ensure that the benefits of discovery science in fields such as neurogenetics reach all
communities. Priority settings exercises in mental health have correctly emphasized
the importance of both discovery and implementation science across the globe. These
are big, hard issues, but it is essential that they be raised.
We also have to ask how we ensure that as clinical neuroscience is used for assess-
ment and treatment in a range of different settings it is done so ethically. More specifi-
cally, how can the growing field of neuroethics shed light on global mental health, and
its approach to clinical research? Global mental health has been informed primarily by
a communitarian ethics of justice: there is a need to ensure that mental health services
are accessible to all. In contrast, neuroethics has been informed primarily by individ-
ualistic ethical concerns, including the importance of autonomy and privacy. These
perspectives seem complementary, and both need to be addressed.
Stein and Singh’s volume tackles these key issues at this intersection of global
mental health and neuroethics. Contributors from a range of different disciplines and
geographic regions address three important sets of questions. First, they discuss con-
ceptual questions about the nature of mental disorder, and of psychiatric research and
practice. Contemporary developments in global mental health and neuroethics provide
a fresh perspective on perennial questions at the heart of the philosophy of psychia-
try. Second, the contributors address the ethics of new neurotechnologies in a global
context, providing interesting new arguments and insights. Finally, they address ques-
tions relevant to specific illnesses and populations, building on intersections between
global mental health and neuroethics to provide new resources to address a variety of
problems.
xvi Foreword
Global mental health and neuroethics are two novel and valuable approaches that
can significantly advance our approaches to mental disorders and mental health. This
volume is the first to bring these key disciplines into dialog; by doing so it provides
novel insights into a range of conceptual and practical questions that will be key to the
future of psychiatry and clinical neuroscience.
Harold Kincaid
Introduction 1
Dan J. Steina, Ilina Singhb
aDepartment of Psychiatry, University of Cape Town, Cape Town, South Africa,
bDepartment of Psychiatry, University of Oxford, Oxford, United Kingdom
Global mental health and neuroethics are two relatively new and highly influential
transdisciplinary fields that are based on a solid foundation of prior work, and that
have built on this foundation in novel and creative ways. Global mental health has built
on earlier work in psychiatric epidemiology, cross-cultural psychiatry, and human
rights, in order to emphasize the importance of addressing mental illness and well-
being throughout the world. In short shrift, it has become a key approach to rethinking
mental health. Neuroethics has built on moral philosophy, philosophy of science, and
bioethics, developing key intersections between neuroscience and ethics, including
both the ethics of neuroscience and the neuroscience of ethics. Again, although a new
discipline, by focusing on these intersections, neuroethics has asked a range of import-
ant questions, and provided resources for addressing them.
This volume aims to develop a dialog between global mental health and neuro-
ethics. Any such dialog must again draw on a range of earlier work that has been
undertaken at the intersection of psychiatry, neuroscience, and ethics. Philosophy of
psychiatry and psychology, psychiatric ethics, and philosophy of neuroscience have
all made significant contributions to our understanding of the nature of mental disor-
der, our concepts of brain and mind, and our appreciation of the values entailed by
psychiatric research and practice. With the advent of new ways of conceptualizing
and approaching mental health and well-being around the world, and with advances in
thinking through the relationships between neuroscience and ethics, it is now timely to
bring global mental health and neuroethics into closer juxtaposition.
Global mental health and neuroethics are both exciting and productive transdisci-
plinary areas of investigation, that are asking and answering a range of overlapping
questions. A dialog between them therefore has the potential to make substantial con-
tributions to a number of long-standing debates as well as more recently emerging
controversies about the nature of mental disorders and the mechanisms that underlie
these conditions, and about the ethics of mental health research and intervention, par-
ticularly when considered in a global context. In this volume, three different sets of
questions are addressed by a number of leading clinicians, public health practitioners
and philosophers, who work in a range of different contexts around the world, and
who bring a spectrum of disciplinary backgrounds to bear on the relevant debates and
controversies.
A first set of questions are conceptual in nature. Psychiatry has long witnessed
a debate between those who regard the field as a scientific endeavor that is making
steady progress toward understanding and treating mental disorders, and those who
Global Mental Health and Neuroethics. https://doi.org/10.1016/B978-0-12-815063-4.00001-0
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