Mental health and world peace could enjoy a very intimate relationship. The World Health Organization (WHO) defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” It seems the very definition of mental health describes happiness for just about any culture or society, and does so without judgment on values. Historically the focus on world peace has been from a position of power rather than a perspective of mental health. Perhaps this is the very reason why world peace has proven so elusive. Is it possible that instead of building up military installations, the building up of mental health care would provide a safer and more peaceful world? The stark reality is that military might and wars have done little to attain world peace.
Nearly sixty years ago American political scientist Quincy Wright wrote:
War arises because of the changing relations of numerous variables--technological, psychic, social, and intellectual. There is no single cause of war. Peace is an equilibrium among many forces. Change in any particular force, trend, movement, or policy may at one time make for war, but under other conditions a similar change may make for peace. A state may at one time promote peace by armament, at another time by disarmament, at one time by insistence on its rights, at another time by a spirit conciliation. To estimate the probability of war at any time involves, therefore, an appraisal of the effect of current changes upon the complex of intergroup relationships throughout the world (p. 1284).
Wright’s observation is as true today as it was then. Not long after these immortal words were penned, noted political scholar R.J. Rummel redefined war as an “international conflict.” Perhaps this was from countries such as the United States invading sovereign nations without actually declaring war (e.g. Vietnam). Rummel’s definition became popular in an era of behaviorism, an era where every action was a behavior and every behavior had a stimulus. Rather than say “this is what caused the war,” it was politically correct to say “international conflict behavior” is stimulated by:
· opposing interests and capabilities (specific sociocultural differences and similarities between the parties),
· contact and salience (awareness),
· significant change in the balance of powers,
· individual perceptions and expectations,
· a disrupted structure of expectations,
· a will-to-conflict.
It is aggravated by:
· sociocultural dissimilarity,
· cognitive imbalance,
· status difference,
· coercive state power.
It is inhibited by:
· sociocultural similarity,
· decentralized or weak, coercive state power.
It is triggered by:
· perception of opportunity, threat, or injustice,
These causes, aggravations, inhibitions, and triggers of international conflict behavior have some surprising similarities to the facts surrounding mental health. Like international conflict behavior, so too are mental, neurological and behavioral disorders common to all countries and cause immense suffering. People with these disorders are often subjected to social isolation, poor quality of life and increased mortality. These disorders are also the cause of staggering economic and social costs. There is absolutely no difference between the consequences of conflict behavior and the consequences mental health disorders. Worldwide, hundreds of millions of people are affected by mental, behavioral, neurological and substance abuse disorders every day. For example, estimates made by WHO in 2002 showed that 154 million people globally suffer from depression and 25 million people from schizophrenia; 91 million people are affected by alcohol use disorders and 15 million by drug use disorders. A recently published WHO report shows that 50 million people suffer from epilepsy and 24 million from Alzheimer and other dementias.
Aside from the debilitating disorders, many other disorders affect the nervous system or produce neurological sequelae (any abnormal condition that follows and is the result of a disease, treatment, or injury). Projections based on a 2005 WHO study show that worldwide, 326 million people suffer from migraine; 61 million from cerebrovascular diseases; 18 million from neuroinfections or neurological sequelae of infections. Adding substantially to the burden are 352 million people with neurological sequelae of nutritional disorders and neuropathies, and 170 million people plagued with neurological sequelae secondary to injuries. These numbers reflect millions of very unhappy people that at a bare minimum have cognitive imbalance, a factor that Rummel points out will aggravate conflict behavior.
More importantly, 877,000 people die by suicide every year, 86% of them in low and middle income countries, and more than half are aged between 15 and 44. Billions of dollars are spent each year to further conflict behavior and to kill people whereas just a small fraction of those billions could be devoted to saving millions of lives with increased mental health and in promoting human societies more prone to peace than to war. Consider, one in four patients visiting a health service has at least one mental, neurological or behavioral disorder, but most of these disorders are neither diagnosed nor treated. There is no getting around how mental illnesses affect and are affected by chronic conditions such as cancer, heart and cardiovascular diseases, diabetes and HIV/AIDS. Furthermore, left untreated, they bring about unhealthy behavior, non-compliance with prescribed medical regimens, diminished immune functioning, and poor prognosis. The consequences of ignoring mental health issues are the very facets of life that cause and aggravate conflict behavior. One needs no degree in psychology to know that “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” will be a state that is hard to drive into conflict behavior.
The salient point here is that cost-effective treatments exist for most disorders, and if correctly applied, could enable most of those affected to become functioning members of society. Unfortunately, the strongest barriers to implementation of mental health services include a failure of awareness on the seriousness of mental illness and lack of understanding about the benefits of services. Stringent policy makers, insurance companies, and health/labor policies, along with the public at large, have instilled discriminate practices between physical and mental problems. It is this type of agenda that Rummel’s conflict behavior causes speak to on status difference and coercive state power. Most resources are devoted to urgent physical care, and the preventive power of mental health is marginalized. Indeed, most middle and low-income countries devote less than 1% of their health expenditure to mental health. As a result, mental health policies, legislation, community care facilities, and treatments for people with mental illness are not given the priority they deserve, which is a clear case of the conflict behavior cause of sociocultural dissimilarity. WHO is presently pushing for more global support of mental health, especially in developing countries; however, the connection to conflict behavior has been overlooked.
Stepping back to look at the two things that Rummel contends inhibit conflict behavior: 1.) sociocultural similarity; and, 2.) decentralized or weak, coercive state power; we have to ask if increasing mental health for all people would actually lead to these phenomena. WHO finds the facts. Nearly half of all mental disorders begin before the age of 14 (untreated family members contributing). Close to 20% of the world's children and adolescents are estimated to have mental disorders or problems, with similar types of disorders being reported across all cultures. Yet, regions of the world with the highest percentage of population under the age of 19 have the poorest level of mental health resources. This astounding social fact exemplifies the conflict behavior cause of perception of opportunity, threat, or injustice. Most of the low and middle income countries have only one child psychiatrist for every 1 to 4 million people. There is no sociocultural similarity in these facts. The highest suicide rates are found among men in eastern European countries known for coercive state power, yet mental disorders are one of the most prominent and treatable causes of suicide. Stigma about mental disorders and discrimination against patients and families prevent people from seeking mental health care. In South Africa, a public survey showed that most people thought mental illnesses were related to either stress or a lack of willpower rather than to clinical disorders. Contrary to expectations, levels of stigma were higher in urban areas and among people with higher levels of education, which gives rise to Rummel’s conflict behavior cause of lack of awareness and the trigger of surprise. Human rights violations of psychiatric patients are routinely reported in most countries. These include physical restraint, seclusion and denial of basic needs and privacy. Few countries have a legal framework that adequately protects the rights of people with mental disorders. The largest sociocultural inequity is in the distribution of skilled human resources for mental health across the world. Shortages of properly educated and trained psychiatrists, psychiatric nurses, psychologists and social workers are among the biggest hurdles to providing treatment and adequate care in low and middle income countries. WHO reports that low-income countries have 0.05 psychiatrists and 0.42 nurses per 100 000 people; whereas, the rate of psychiatrists in high income countries is 170 times greater and for nurses is 70 times greater.
WHO contends that are there are five key barriers that need to be overcome in order to increase the availability of mental health services: 1.) the absence of mental health from the public health agenda and the implications for funding; 2.) the current organization of mental health services; 3.) lack of integration within primary care; 4.) inadequate human resources for mental health; and 5.) lack of public mental health leadership. These five barriers to worldwide mental health are the exact things that Rummel argued would inhibit conflict behavior if overcome. This would mean that governments, donors and groups representing mental health workers, patients and their families need to work together to increase mental health services, especially in the low and middle income countries. WHO explains that the financial resources needed are relatively modest, as little as $2 per person per year in low-income countries and $3-4 in lower middle-income countries. In contrast, the Stockholm International Peace Research Institute (SIPRI) reports a world military expenditure in 2010 at an estimated $1.62 trillion in current dollars which represents a 1.3% increase in real terms since 2009 and a 50% increase since 2001.That comes to about 2.6 % of the world gross domestic product (GDP), or approximately $236 for each person in the world.
There is little truth in the cliché that history repeats itself, simply because so many variables in the world are in constant flux. However, themes in history do repeat themselves, and striving for peace through conflict behavior is one of the most resilient. From looking at the facts, peace is indeed an equilibrium between many forces. History has demonstrated that conflict behavior will not be inhibited by anything less than sociocultural similarity (equal opportunity at a minimum), and a decentralized or weak, coercive state power (democracy in some flavor). A relatively inexpensive way to achieve both and also provide “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community,” is to further efforts that implement mental health, equally, on a global agenda. It is time to own up to the fact that conflict behavior adds little to peace and harmony, yet comes at a huge expense to resources. When we add to that knowledge the fact that happy people are easier to work and live with, then exploring an alternative such as expanded mental health in a world peace strategy becomes a little more attractive. For the bean counters, it seems like a hand down win. Rather than spend $236 per person on conflict behavior, maybe just $232 and give $4 to WHO for implementation of its global mental health plan. That seems like a very small price to pay for something that has such huge possibilities, especially since the money is being spent anyway.
There are two important considerations in the argument for investing in an extension of the mental health agenda. First and foremost is that this urging does not call for an immediate lying down of arms. The world is such that military peace keepers are indeed required. This would be a peace strategy that would be implemented in the long term and may well be a generation away from bearing fruit. But if we look back at the tens of thousands of years of conflict behavior, a strategy that takes a generation to implement does not seem so unreasonable. The point is that military spending can be significantly reduced and those resources better spent. The second consideration is that mental health is relative to individual needs. A popular field of research has emerged in “positive psychology.” We tend to think of only the destitute afflicted with mental health issues when that is not the case at all, as the stigma from the South African survey clarifies. Functioning people can suffer from mental health issues just as much as the destitute. In fact, the functioning can at times actually be more of a threat to world peace than the dysfunctional (e.g. Hitler), especially in a society with restricted mental health care. The goal is to lift the stigma and extend the view that going to a mental health center is the same as going to the gym. The only difference is that one keeps the body in shape and the other keeps the mind in shape. Take for example the manner in which the field of psychology not only boomed during World War II, but split. Prior to the great wars psychology was largely viewed as a clinical domain for the unstable. The realization came in the early 1900s that psychology had another function as well and that was the ability to determine an individual’s abilities and capabilities, or strengths and weaknesses. This helped military trainers assign troops to what they were best at, or discharge the person altogether.
After WW II, returning troops were in dire need of counseling services, not as much for trauma as for aptitude testing and job/education placement. Thus a new branch of psychology emerged as counseling psychology. The focus of counseling psychology is to assess people and direct them toward what the assessment warrants. It may be some form of treatment, but is often just informing the person of their strengths and weaknesses and what might work best for them, or what type of environment they may expect to thrive in. Many contemporary education and employment placement procedures fall under this domain of mental health services. Mental health is no longer an exclusive domain of psychologists. Mental health embraces all forms of helping professionals including social workers, certified counselors in numerous areas from weight loss to job placement, and family counseling. It is these types of social services that lift a society up more than dropping bombs on their infrastructure.
Beyond the conflict behavior argument, there is a clear employment agenda built into the mental health strategy. Millions of people worldwide will find employment on all levels, from the construction crews and architects that construct the facilities to the helping professionals that staff them, and the technology industry that equips them. Not only are the employable provided opportunities, but those suffering from mental health issues become employable through counseling and/or treatment. This strategy does not leave out the egos that enjoy winning wars, it merely has shifted who the enemy is. Mankind has a penchant for picking fights it can win; we now have one.
 Virot, P. WHO urges more investments, services for mental health., 2012. Retrieved March 26, 2012 from http://www.who.int/mental_health/who_urges_investment/en/index.html
 Wright, Quincy, The escalation of international conflict. The Journal of Conflict Resolution, Vol. 9 (December, 1965). 434-449.
 Rummel, R.J. Understanding Conflict and War: Vol. 4: War, Power, Peace, Beverly Hills, CA: Sage Publications, 1979
 UCDP/Human Security Centre Dataset. Retrieved March 26 from: http://www.humansecuritygateway.com/showRecord.php?RecordId=34079
 Shah, Anup. World Military Spending. Global Issues: Social, Political, Economic and Environmental Issues That Affect Us All. May 02, 2011. Retrieved March 26, 2012 from: http://www.globalissues.org/article/75/world-military-spending