Read the chapters in this book and feel, carry, resist, fight the weight, the heavy yoke of tragedy. Mass violence has been part of the human experience for as long as recorded history and weighs us down to this day. In the American Civil War 750,000 soldiers on both sides lost their lives, and the subsequent decades were dominated by national preoccupation with suffering, loss, and grief (Faust, 2008). Colonialism introduced mass violence to all the continents, with slavery accounting for a huge toll of human misery and death. In the meat grinder of trench warfare during World War I, millions of British, French, and German soldiers were killed and millions more wounded. The Battle of the Somme alone cost the British 450,000 casualties, 50,000 on the first day. That war ended with European societies expressing revulsion against all forms of mass violence, and yet just twenty years later a Second World War killed more than 50 million men and women (most of whom were noncombatants) and displaced hundreds of million more. The war embedded the Holocaust, still the symbol of mass violence as an institutional product of evil. Historians claim that the former Soviet Union may have killed even more people than the Nazis. And this outline of mass violence is only a preliminary to the many and different more recent forms of mass killing described in the chapters that follow.

Whatever the human cost of such immense and continuing destruction it must be staggering. China’s Great Leap Forward famine, which killed 30 million rural Chinese, was the unintended consequence of one of the most destructive social policies in human history, but no one knows its toll on families and networks in Chinese villages. The same can be said for the Cultural Revolution (Kleinman et al., 2011). And that is true of much of mass violence. We simply do not know what effect, especially over the long term, it has had on society, on interpersonal bonds, on local moral worlds, and on subjectivity.

Introduction

Over the past several decades, political conflicts, economic volatility and large-scale cultural and social changes have strongly influenced not only global health problem and solution frameworks, but the very way we conceive of global health as a public good. As politicians, business people and cultural elites employ the language of global health to shape discourse and policies focused on displaced and migratory peoples, they have perhaps unwittingly broadened the classic public health agenda. As a consequence, that agenda now includes violence and its traumatic consequences, the health (and mental health) impact of natural and social catastrophes, other health-related problems from obesity to substance abuse, and the effect of pharmaceutical and digital technology innovations not previously considered to be core public health issues. They expand and reformulate the traditional spheres of public health, and challenge classic public health values.

As a result, debates shaping global health research, ethics, policy and programs have developed along two parallel tracks. One can be characterized as a neo-liberal approach combining economics (liberalization of trade and financing; new mechanisms for product development for diseases of poverty involving public–private partnerships; cost-effectiveness analysis), disease-specific and biotechnology programs and security concerns. The other has focused on human rights, social justice and equity frameworks with a broader, more inclusive model of the determinants of health. This perspective calls for a transformation of the current fractured system of global health governance into a transparent and accountable system, better equipped to address the world's global health agendas.

Schizophrenia is the defining problem for psychiatry. In the nineteenth century, American psychiatry first projected onto schizophrenia the images of treatment that it inherited from European medicine: strait-jackets, hydrotherapy, bloodletting, herbal compounds, and, of course, the asylum. Then it was moral therapy, which held up until the ethnic mix of American society changed so significantly that America could no longer project a single moral world, and contesting multicultural influences that challenged the presumptions of this “our crowd” therapeutic approach. Latterly, social Darwinism, eugenics, and social science reinvigorated a fin de siecle organic image of the deranged mind based in the brain tainted by degeneracy.

The twentieth century was the hothouse of psychological models, with Freudianism coming to dominate the image of what mental illness was. Side by side with psychodynamic projections, somatic treatments evolved – if we can call such a stop-and-go, recursive, and controversial process by this term – from insulin shock and electroconvulsive therapies through psychosurgery to what we now think of as modern psychopharmacology. The broken brain has become the dominant professional (and popular) image in America. Today's world of biological psychiatry claims schizophrenia as its own, even though the genetic contribution to the transmission of schizophrenia has gotten more and more complex and uncertain, and there is still no biological marker in everyday clinical practice that can be used to diagnose and follow the course of the disorder.