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Rethinking Diabetes: entanglements of trauma, Poverty, and HIV

In Rethinking Diabetes, Emily Mendenhall investigates how global and local factors transform how diabetes is perceived, experienced, and embodied from place to place. Mendenhall argues that the link between sugar and diabetes overshadows the ways in which underlying biological processes linking hunger, oppression, trauma, unbridled stress, and chronic mental distress produce diabetes. The life history narratives in the book show how deeply embedded these factors are in the ways diabetes is experienced and (re)produced among poor communities around the world.

Rethinking Diabetes focuses on the stories of women living with diabetes near or below the poverty line in urban settings in the United States, India, South Africa, and Kenya. Mendenhall shows how women's experiences of living with diabetes cannot be dissociated from their social responsibilities of caregiving, demanding family roles, expectations, and gendered experiences of violence that often displace their ability to care for themselves first. These case studies reveal the ways in which a global story of diabetes overlooks the unique social, political, and cultural factors that produce syndemic diabetes differently across contexts.

From the case studies, Rethinking Diabetes clearly provides some important parallels for scholars to consider: significant social and economic inequalities, health systems that are a mix of public and private (with substandard provisions for low-income patients), and rising diabetes incidence and prevalence. At the same time, Mendenhall asks us to unpack how social, cultural, and epidemiological factors shape people's experiences and why we need to take these differences seriously when we think about what drives diabetes and how it affects the lives of the poor.

"Emily Mendenhall's rich case studies—introducing each chapter in Rethinking Diabetes—offer forceful illustrations of the interplay of social and biological worlds."

- Lenore Manderson, The University of the Witwatersrand, and author of Surface Tensions

"Emily Mendenhall critically explores how global health is confronting the rising prevalence of diabetes in the face of poverty, crippled health care systems, and HIV/AIDS. Her approach transcends epidemiological associations and paves the way for consideration of similar entanglements of disease, poverty, and local experience."

- Janet McGrath, Case Western Reserve University 

"Emily Mendenhall's insightful and innovative analysis of the growing global pandemic of diabetes using syndemic theory is an important contribution to medical anthropology and global health. The comparative cross-cultural case studies are persuasive and powerful."

- Peter J. Brown, Emory University, and author of Foundations of Global Health

Syndemic Suffering: Social Distress, Depression, and Diabetes among Mexican IMmigrant WOmen

In a major contribution to the study of diabetes, this book is the first to analyze the disease through a syndemic framework. An innovative, mixed-methods study, Emily Mendenhall shows how adverse social conditions, such as poverty and oppressive relationships, disproportionately stress certain populations and expose them to disease clusters. She goes beyond epidemiological research that has linked diabetes and depression, revealing how broad structural inequalities play out in the life histories of individuals, families, and communities, and lead to higher rates of mortality and morbidity. This intimate portrait of syndemic suffering is a model study of chronic disease disparity among the poor in high income countries and will be widely read in public health, medical anthropology, and related fields.

"This excellent and readily accessible study provides a compelling account of how social, psychological, and biological factors act synergistically to trigger a diabetes-depression syndemic characterized by a pernicious biosocial feedback loop. This is far more than an account of co-morbidity, which is the consequence of poverty and a difficult life. There are many trajectories leading to both diabetes and depression. One key lesson of the VIDDA Syndemic documented here is that social processes will need to be addressed in order to treat this pathogenic state, not just medicines and health education. This book is an excellent teaching resource for both undergraduate and graduate courses of anthropology and public health."

--Mark Nichter, University of Arizona

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Global Mental Health: Anthropological Perspectives

While there is increasing political interest in research and policy-making for global mental health, there remain major gaps in the education of students in health fields for understanding the complexities of diverse mental health conditions. Drawing on the experience of many well-known experts in this area, this book uses engaging narratives to illustrate that mental illnesses are not only problems experienced by individuals but must also be understood and treated at the social and cultural levels. The book -includes discussion of traditional versus biomedical beliefs about mental illness, the role of culture in mental illness, intersections between religion and mental health, intersections of mind and body, and access to health care; -is ideal for courses on global mental health in psychology, public health, and anthropology departments and other health-related programs.

“At BasicNeeds we run programmes for mentally ill people in 12 low income countries and the challenges we face daily are uncannily similar to those described in this powerful book. We identify people who need support, who struggle for treatment and who in the end contribute productively to their homes and community. None of this would be possible without a deep respect for the diverse cultures we work in and this book perfectly balances these imperatives of working with a community based approach and culture. Deeply sensitive, insightful and practical.”
—Chris Underhill MBE, founder/President, BasicNeed

“This book is truly global in its focus on both high- and low-income countries’ mental health services, thus addressing issues that affect all health systems. The contributions range from psychiatric residents in Boston and peer providers in Chicago to nurses in Liberia and community health workers in Haiti. Through the narratives of patients and health-care providers, the chapters taken together demonstrate a range of barriers to accessing care.”
—From the foreword by Vikram Patel

“This outstanding collection of studies shows the vigor and promise of anthropological approaches for advancing global mental health. The editors have assembled a new generation of scholars who address the social structural origins of mental health problems and novel treatment approaches to improving access to culturally appropriate care. Special attention is given to the dominant strategy of task-shifting as well as to alternative models of care that incorporate indigenous concepts of distress and healing practices. The book is truly global in scope—touching on issues distinctive to urban and rural, wealthy and low income settings.”
—Laurence J. Kirmayer, McGill University

Global Mental Health is not only for anthropologists but should be read by mental health professionals more generally and mental health policymakers in particular. The field of mental health is in need of a strong anthropological perspective. This would provide a balance of views and a more holistic approach to mental health in both knowledge and intervention.”

—Michael J. Kral, American Journal of Human Biology