What's in the 'treatment gap'? Ethnographic perspectives on addiction and global mental health from China, Russia, and the United States

Med Anthropol. 2014;33(6):457-77. doi: 10.1080/01459740.2013.877900.


Recent years have seen the emergence of a 'global mental health' agenda, focused on providing evidence-based interventions for mental illnesses in low- and middle-income countries. Anthropologists and cultural psychiatrists have engaged in vigorous debates about the appropriateness of this agenda. In this article, we reflect on these debates, drawing on ethnographic fieldwork on the management of substance use disorders in China, Russia, and the United States. We argue that the logic of 'treatment gaps,' which guides much research and intervention under the rubric of global mental health, partially obscures the complex assemblages of institutions, therapeutics, knowledges, and actors framing and managing addiction (as well as other mental health issues) in any particular setting.

Keywords: addiction; global mental health; harm reduction; medicalization; substance use disorders; therapeutics.

MeSH terms

  • Anthropology, Medical
  • China / ethnology
  • Humans
  • Mental Health / ethnology*
  • Public Health*
  • Russia / ethnology
  • Substance-Related Disorders* / ethnology
  • Substance-Related Disorders* / therapy
  • United States / ethnology