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doi:10.1136/bmj.331.7507.37
BMJ 2005;331;37-39
Sami Timimi
health
Effect of globalisation on children's mental
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Education and debate
Effect of globalisation on children’s mental health
Sami Timimi
Globalisation is resulting in inappropriate domination of the Western view of mental health as well
as of economic approaches.Western child psychiatrists have much to learn from child rearing
practices in other countries
Children’s behaviour is influenced by child rearing
philosophies and cultural socialisation processes.1 2
Globalisation is imposingWestern culture and views of
mental health around the world with the assumption
that they are superior to those in non-Western cultures.
Although there are numerous examples of problematic
child rearing beliefs in many non-Western cultures
(such as female circumcision), many practices are
effective and should be preserved. Indeed, child
psychiatrists in the West could gain new knowledge
from examining childcare practices across the world.
Child rearing and culture
Freedom is one of the dominant ideologies of the
Western market economy. At an emotional level the
appeal for freedom can be understood as an appeal to
rid us of the restrictions imposed by authority (such as
parents, communities, and governments).3 This results
in a value system built around the idea of looking after
the wants of the individual, who should be free from
the impingements, infringements, and limitations that
other people represent. However, individuals can
end up being so insulated that they see obligations to
others and harmony with the wider community as
obstacles rather than objectives.
Domination of market values has led to a consumerism
that drives an obsession with growth, whereby
perpetual growth and expansion are necessary for
proper functioning of the global economy.4 Despite
several decades of sustained economic growth, we are
no happier. Growth not only fails to make people contented,
it destroys many of the things that do bring
contentment by weakening social cohesion.4 Thus a
hallmark of Western market economies is that it
promotes individualism while weakening social relationships.
Globalisation is helping export this economic
and moral value system worldwide.
Children are cultured into a value system by living
within a society’s institutions and being exposed daily
to its discourse (for example, through television). In the
West, children are not only socialised into a system that
promotes individualism, competitiveness, and inequality
and rejects forms of authority but also have to live in
the unstable family structures such an ideology
produces. Rates of psychosocial problems (such as
crime, anxiety, unhappiness, and substance misuse)
have increased sharply among young people in
Western societies,5 with many studies documenting an
association between poverty, marital disruption, and a
wide range of deleterious effects in children’s
behaviour and emotional state.6
Studies of the images of childhood in popular media
in the West show that children are viewed as either
victims (of abuse and manipulation) or dangerous
perpetrators of antisocial and criminal behaviour.1 This
polarisation suggests ambivalence towards children,
probably because a human who is so utterly dependent
on others will inevitably cause a rupture in the individualist
goals of theWestern free market value system.7
Many non-Western cultures don’t have this cultural
ambivalence towards childhood. Instead, they welcome
children into stable, nurturing extended family
structures where duty and responsibility over-ride individualism
as the dominant value system. Anthropological
studies have commented on the ability of family
centred cultures to produce happier, easier to control
CAROLINE PENN/PANOS
Family centred cultures produce happier, more manageable children
Lincolnshire
Partnership NHS
Trust, South
Rauceby, Sleaford,
Lincolnshire
NG34 8QA
Sami Timimi
consultant child and
adolescent psychiatrist
stimimi@talk21.com
BMJ 2005;331:37–9
BMJ VOLUME 331 2 JULY 2005 bmj.com 37
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children.7–9 The communal ethic seems to promote
psychiatric wellbeing by ensuring a degree of joint
responsibility for children.10
Problem of colonialism
Problematic Western attitudes and beliefs on child
rearing are being exported to countries conceptualised
as underdeveloped (in moral, ethical, and knowledge
terms as well as economic spheres). Western ideas are
taken up by local professionals, many of whom understandably
believe they are getting something better
than traditional practices. For example, the Handbook of
Asian Child Development and Child Rearing Practices,11 by
Thai child development experts, is highly influenced
by Western medico-psychological ideology. The book
sets out to assimilate Western child development
theory into a developing world context with little
evidence of taking the local perspective into account.
Thus the authors suggest that many of the traditional
beliefs and practices of Asians prevent them from
seeking and using new scientific knowledge in child
rearing. They go on to argue, in line with Western
thinking, that children should be given more
independence with less use of power and authority by
the parents.
The problem of imposing Western cultural child
rearing beliefs on developing countries is evident in
United Nations policy. For example, the UN convention
on the rights of the child recognises the child’s
capacity to act independently, bestowing not just
protective but also enabling rights, such as the right to
freedom of expression and association.12 The convention
has been accused of having a strong interest in
spreading the values and codes of practice devised in
the West to poorer countries. The view that childhood
is a fixed notion, determined by biological and psychological
facts rather than culture or society, is implicit.
This has been criticised by many non-industrialised
countries.13 For example, when the Organization of
African Unity drew up its charter on the rights and
welfare of the child,14 it was framed in terms of responsibilities
and duties of children and families rather than
the rights and needs of the child. Thus the charter
states that every child has responsibilities towards their
family and society, a duty to work for the cohesion of
the family, and to respect their parents, superiors, and
elders.
Mental health
The West is also imposing its problematic notions of
mental health problems on developing countries, both
for adults and children. Economically and politically
powerful groups, such as doctors and the pharmaceutical
industry, have enabled Western medicine to push
back its frontiers of influence.
In children’s mental health, this has resulted in the
creation of not only new diagnostic categories but
whole new classes of disorder such as developmental
neuropsychiatry. These new disorders are defined
using Western cultural ideas about the boundaries and
expectations of normal childhood and are viewed as
having a biological or genetic cause, with the broader
context being considered only as a trigger or modifier
of the disease process.7 15 16 The consequence has been
a rapid growth in the numbers of children diagnosed
with conditions such as attention deficit hyperactivity
disorder and autism together with an equally rapid
growth in the use of (largely untested) psychotropic
drugs in children.17 Prescription of these drugs to children
is also increasing in many non-Western
countries.17 Individualising children’s suffering runs
the risk of not only undermining local ways of solving
children’s problems but also masking the real life
circumstances (such as poverty and exploitation) those
children may face.
New perspectives
Western professionals’ lack of knowledge about
non-Western approaches to children is depriving the
West of a rich source of alternative strategies.18 New
ideas to help enrich child psychiatric theory and practice
can be found in three key areas:
x The work of culture in defining a problem
x Different cultural approaches to solving problems
x Different cultures’ beliefs, values, and practices
promote and curtail certain types of behaviours and
experiences.
Defining problems
Different cultures see different behaviours as problematic.
For example, compared with the West, many non-
Western cultures place fewer expectations on infants
and younger children with regard to their behaviour,
emotional expression, and self control, but older
children are expected to accept adult physical responsibilities
earlier.7–9 19 20 A model of child development
that recognises that different cultures have different,
equally healthy, versions of child development has the
potential to reduce the amount of pathologising of
childhood in current Western medical practice. This
requires the profession to question the universal validity
of the concepts in child psychiatry and the rating
questionnaires.7 16
Solving problems
Western culture has many methods of treating
childhood problems, including family therapy, cognitive
behaviour therapy, psychodynamic psychotherapy,
and drugs. In addition, all communities have valuable
resources, including spiritual or religious ones. For
many non-Western cultures, the family not the
individual is regarded as the basic social unit. Families’
strengths and capacity to heal or comfort children can
be recognised and promoted.7 10
Ideas from other systems of medicine may be useful.
For example, Ayurvedic medicine sees illness as a
disruption in the delicate somatic, climactic, and social
system of balance. Causes are not located as such but
seen as part of a system out of balance, with symptoms
viewed as part of a process rather than a disease
entity.21 Such an attitude based on balance with nature
(as opposed to controlling it) has resonance with new
approaches that include lifestyle interventions such as
diet, exercise, and family routines.7
Cultural influence on behaviour
As socially respected practitioners, we have a responsibility
to understand that we bring a cultural value
system into our work. Our actions will ripple out into
the wider local community. For example, if we calm a
Education and debate
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child’s behaviours with drugs, the child’s school may
refer more children for this treatment. With regard to
policy we should support more family friendly policies
such as fighting global child poverty, encouraging family
friendly business practices, and criminalising
wilfully absent parents.
Implications
Globalisation is happening in an era when the power
relation between the world’s rich and poor nations is
glaringly unequal. We see this in the arena of health,
with grossly disproportionate funds available to rich
and poor countries. We also see it in the ideas that
shape global approaches to health policy—for example,
the World Health Organization continues to advocate
theWestern model of distress and mental illness as
suitable for all countries and cultures22—and to
childhood.
The challenge for both the theory and practice in
child and adolescent mental health is daunting, but
there will be rich pickings if it can be met. We must
critically re-examine the narrow basis on which current
theory and practice has developed. This will help not
only other culture’s children but also children in the
West. Increased knowledge will also make it easier to
engage with multi-ethnic communities that have
different faith traditions and cultural beliefs from the
host society.
Contributors and sources: ST studies and writes articles and
books on social, cultural and political aspects of children’s
mental health.
Competing interests: None declared.
1 Prout A, James A. A new paradigm for the sociology of childhood? Provenance,
promise and problems. In: James A, Prout A, eds. Constructing and
re-constructing childhood: Contemporary issues in the sociological study of childhood.
London: Falmer Press, 1997:7-33.
2 Stephens S. Children and the politics of culture in “late capitalism.” In:
Children and the politics of culture. Princeton: Princeton University Press,
1995:3-49.
3 Richards B. Visions of freedom. Free Association 1989;16:31-42.
4 Hamilton C. Growth fetish. Crows Nest: Allen and Unwin, 2003.
5 Rutter M, Smith D. Psychosocial disorders in the young: time trends and their
causes. Chichester: John Wiley, 1995.
6 McMunn AN, Nazroo JY, Marmot MG, Boreham R, Goodman R.
Children’s emotional and behavioural well-being and the family environment:
findings from the Health Survey for England. Soc Sci Med
2001;53:423-40.
7 Timimi S. Naughty boys: anti-social behaviour, ADHD, and the role of culture.
Basingstoke: Palgrave Macmillan, 2005.
8 Kakar S. The inner world of the Indian child. New Delhi: Oxford University
Press, 1994.
9 LeVine RA, Dixon S, LeVine S, Richman A, Leiderman PH, Keefer CH,
et al. Child care and culture: lessons from Africa. Cambridge: Cambridge
University Press, 1994.
10 Hackett L, Hackett R. Child rearing practices and psychiatric disorder in
Gujarati and British children. Br J Social Work 1994;24:191-202.
11 Suvannathat C, Bhanthumnavin D, Bhuapirom L, Keats DM. Handbook of
Asian child development and child rearing practices. Bangkok: Srina Kharinwirot
University, Behavioural Science Research Institute, 1985.
12 United Nations General Assembly. Adoption of a convention on the rights of
the child. New York: United Nations, 1989.
13 Boyden J. Childhood and the policy makers: a comparative perspective
on the globalization of childhood. In: James A, Prout A, eds. Constructing
and reconstructing childhood. London: Falmer Press, 1997:190-230.
14 Organization of African Unity. The African charter on the rights and welfare
of the child adopted by the 26th ordinary session of the assembly of heads of state
and government of the OAU. Addis Ababa:OAU, 1990.
15 Morss JR. Growing critical: alternatives to developmental psychology. London:
Routledge, 1996.
16 Timimi S. Pathological child psychiatry and the medicalization of childhood.
London: Brunner-Routledge, 2002.
17 Wong IC, Murray ML, Camilleri-Novak D, Stephens P. Increased
prescribing trends of paediatric psychotropic medications. Arch Dis Child
2004;89:1131-2.
18 Goonatilake S. Mining civilizational knowledge. Bloomington: Indiana University
Press, 1998.
19 Fernea EW. Children in the Muslim Middle East. Austin: University of Texas
Press, 1995.
20 Hamilton A. Nature and nurture: Aboriginal child rearing in north-central
Arnhem Land. Canberra: Australian Institute of Aboriginal Studies, 1980.
21 Obeyesekere G. The theory and practice of psychological medicine in
Ayurvedic tradition. Culture Med Psychiatry 1977;1:155-81.
22 World Health Organization. Mental health global action plan: close the gap,
dare to care. Geneva: WHO, 2002.
www.who.int/mental_health/media/en/265.pdf (accessed 15 June 2005).
(Accepted 14 June 2005)
Summary points
Children’s mental health may be adversely
affected by a Western value system that promotes
individualism, weakens social ties, and creates
ambivalence towards children
Values such as duty, responsibility, and a
community orientation found in many
non-Western cultures may promote psychiatric
wellbeing
Exporting Western child rearing beliefs and
psychiatric practice to developing countries is
undermining local values, beliefs, and practices
Non-Western culture can provide new ideas to
enrich child psychiatric theory and practice
forthwith. (BMJ 1905;ii:202)
Education and debate
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