Migration in the era of globalisation

Globalisation not only leads to migration of individuals across national boundaries: the borders themselves are ‘disappearing’ because of the internet. Globalisation is seen as the intensification of global interconnectedness (Reference Inda, Rosaldo, Inda and RosaldoInda & Rosaldo, 2002). This leads to an itinerant capitalism that demands the cheap production of goods, which in turn results in the industrialisation of nations that have the workforce but not the infrastructure to cope with it. The consequent rural-to-urban migration brings with it a series of problems and expectations. Reference Blue, Ducci, Jaswal, Hanpham and BlueBlue et al(1995) have elegantly demonstrated increased rates of common mental disorders in the urban slums of India, Brazil and Chile. This increase is related to social factors – poor housing and its related infrastructure and economic problems. The loss of social support resulting from migration to urban areas brings its own problems.

There is considerable evidence to suggest that migrants are prone to particular psychiatric illnesses (Reference BhugraBhugra 2001; Reference Bhugra and JonesBhugra & Jones, 2001). The acculturation due to globalisation may lead to loss of original cultural identity, thereby giving rise to certain psychiatric conditions.

We know that ‘culture shock’ and conflict of cultures also lead to increased psychological morbidity. Kelly places poverty at the top of the list for increase in morbidity, but increasing awareness of discrepancy between what individuals thought that they could achieve as a direct or indirect result of globalisation and what they actually attain is more likely to produce alienation and hopelessness.

Urbanisation and industrialisation

The urbanisation and industrialisation arising from globalisation both lead to a loss of personal identity. The individual and cultural voice of the ‘other’ expected to provide the labour of globalised industry is lost. Reference Gupta, Ferguson, Inda and RosaldoGupta & Ferguson (2002) enquire about the identity of the ‘we’ as well as of the ‘other’. A cultural landscape for and of tourists and the presence and worries of the migrants, the refugees, the exiles and the guests affect nation states and the national character.

It is unfortunate that Kelly did not focus more on the impact of political abuse on the migrants forced to flee when the interference of world superpowers allows tyrants take control. The new global cultural economy has to be seen as a complex, overlapping, disjunctive order that can no longer be understood in terms of existing centre–periphery models (Reference Appadurai, Inda and RosaldoAppadurai, 2002), but in the total cultural context. The centralised sources of economic and social power are now giving way to a model in which power and goods move across nation states. The globalisation of culture is not the same as homogenisation.

Impact on mental health

The altering patterns of culture as a consequence of globalisation and media homogenisation have been illustrated by Reference Becker, Burwell and GilmanBecker et al(2002), who found that rates of eating disorders in Fiji went up as a result of the introduction of television. To make sense of what Reference Appadurai, Inda and RosaldoAppadurai (2002) calls ethnoscapes, mediascapes, technoscapes, financescapes and ideoscapes, the long-term impact of globalisation on the human psyche must be studied by psychiatrists in conjunction with economists, geographers, anthropologists and sociologists. Appadurai's ‘scapes’ can be understood at both the individual and the collective level, and the world view of individuals and of groups is likely to change with globalisation. Clinicians must be prepared for this.

Reference MahadeviaMahadevia (2002) highlights an important factor relating to urbanisation by suggesting that the loss of public space to private owners contributes to urban stress.

Another danger of globalisation worth bearing in mind is the drive to homogenisation that derives from the culture of consumerism (Reference Moreiras, Jameson and MiyoshiMoreiras, 1998). Clinicians must also be aware of the relocation of languages in cultures as a result of globalisation (Reference Mignolo, Jameson and MiyoshiMignolo, 1998). The links between languages and the boundaries of humanity have shaped the ideas of literature, the cultures of scholarship and civilisation itself. The articulation of languages and their cultures have reduced barriers to communication. The growing ‘Anglicisation’ of the world is obvious. It is possible that such globalisation may be causing cultures to become more fundamentalist and restrictive, which might in itself contribute further to stress and psychological morbidity.

Conclusion

Kelly is right to caution us that human rights should be a priority, but as Reference GhodseGhodse (2003, this issue) points out, he is offering a Eurocentric view. The attack on New York's ‘Twin Towers’ was not a result of globalisation. Kelly also proposes that the loss of social capital resulting from increased globalisation might be inducing a wave of anomie in Western populations. However, he says little regarding the positive implications of globalisation for world mental health. The international action that the World Health Organization recently took to control the spread of severe acute respiratory syndrome (SARS) shows just how globalisation can benefit people. The dissemination of preventive and public health medicine is clearly a positive aspect of globalisation. Nevertheless, the impact of globalisation on individual migrants is likely to be long lasting in both economic and psychological terms.