Salud Mental Colectiva y Determinación Social: Posibilidades Paradigmáticas / Collective Mental Healthand Social Determination: Paradigmatic Possibilities

En la presente revisión teórica exploro posibilidades para la construcción de un paradigma de salud mental colectiva. Lo hago tomando distancia de miradas positivistas, funcionalistas, bio-médicas e individualistas, y subrayando el rol fundamental de procesos de determinación social comprendidos de forma crítica, intercultural y transdisciplinaria. El procedimiento supuso una revisión exploratoria de fuentes tituladas “salud mental colectiva” (2016-2021) y la inclusión de publicaciones clave adicionales. Losresultados señalan la importancia de teorizar la salud mental de forma compleja y dialéctica, contextualizar ecológicamente los sufrimientos, accio-nar estrategias de bienestar y procurar reflexividad permanente en torno a la interculturalidad y las relaciones de poder. Las posibilidades exploradas resaltan el aporte esencial de la epide-miología crítica latinoamericana, en diálogo constante con otros valiosos saberes. Desde dicha construcción dialógica, un paradigma de salud mental colectiva emerge como unapotente al-ternativa para abordar sufrimientos mentales en el contexto de sistemas sociales que nos en-ferman. (AU)

In this theoretical review, I explore possibilities for the construction of a collective mental health paradigm. I conduct such review by distancing myself from positivist, functionalist, bi-omedical and individualist perspectives, while emphasizing the fundamental role of social de-termination processes conceived from a critical, intercultural and transdisciplinary stand-point. The procedure involved an exploratory review of sources entitled “collective mental health” (2016-2021) and the inclusion of additional key publications. Results indicate the im-portance of theorizing mental health in ways that are complex and dialectical; conducting an ecological contextualization of suffering; activating wellness strategies; and making perma-nent efforts towards reflexivity around interculturality and power relations. Explored possibil-ities highlight the essential contribution of Latin American critical epidemiology, in constant dialogue with other valuable knowledge. From such dialogic construction, a collective mental health paradigm emerges as a powerful alternative to address mental suffering in the context of social systems that make us ill. (AU)

The ethical-political dimension of social and community praxis: The case of Ecuador's early response to COVID-19.

Around the globe, millions of people have experienced suffering and death related to COVID-19, an infectious disease caused by the SARS-CoV2 virus. In Ecuador,the painful impact of the pandemic elicited early responses by the government and by local communities. This critical, positioned and exploratory case study analyses such responses, underscoring the fundamental ethical-political dimension of any academic and professional praxis aimed at the construction of healthier societies worldwide. While critical traditions are familiar with this stance, the inequalities and ideological mechanisms made visible by COVID-19 responses may enable the wider community of researchers and practitioners to join ongoing collective ethical-political efforts. Findings from Ecuador underline the potentially harmful role of neoliberalism and issues of democratic legitimacy, significant problems before and during the pandemic shock, and official discourses, which blame communities for their own suffering and death. Neutrality and depoliticized notions of scientific evidence are notoriously insufficient in these scenarios. We need to engage more deeply with diverse forms of global and local community resistance, in times of COVID-19, and beyond. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

History, violence and collective memory: Implications for mental health in Ecuador.

National histories of violence shape experiences of suffering and the ways that mental health professionals respond to them. In Ecuador, mental health literature addressing this crucial issue is scarce and little debated. In contrast, local psychiatrists and psychologists within the country face contemporary challenges that are deeply rooted in a violent colonial past and the perpetuation of its fundamental ethos. This paper critically reviews relevant literature on collective memory and historical trauma, and focuses on Ecuador as a case study on how to incorporate history into modern mental health challenges. The discussion poses key questions and outlines possible ways for Ecuador to address the link between history and mental health, including insights from countries that have struggled with their violent pasts. This paper contributes to ongoing international debate on the role of cultural history in mental health with implications for social scientists and practising clinicians in former colonised nations.