Mental Health: A Silent Epidemic in Latin America
Bindweed on stone.
One of the biggest contemporary crises in Latin America is mental health[1]. It is silent because it is not immediately visible and because it can be hidden. This is, for example, what anorexic people do, hiding their thinness behind loose clothing.
Mental problems can be hidden to a point where they can no longer be hidden. Then they come out in the form of crises like an oxygen bubble when it emerges from the bottom of the water: abruptly. It is in those moments that one goes to seek help from a professional. Some years ago, in my professional practice as a psychologist, I treated very serious cases that could have been treated more easily if they had been started in time, but sometimes one prefers not to face the disease when the symptoms begin. It is preferred to think that the symptoms will disappear if you wait a little, without taking into account that holding on can have a negative and profound impact on the person and those who live around them.
In this essay I will address five factors: stigma, poor health coverage, adolescent depression, substance abuse and different forms of violence, which perpetuate mental problems in Latin America, creating the perfect ground for mental illnesses to develop. This mental health crisis is hidden behind other more “visible” crises such as poverty, inequality, political instability and, of course, violence. Let’s start by answering the question of what does it mean to have good mental health? Good mental health is related to a general well-being that goes through emotions and can be explained from a psychological point of view. That is to say: it is felt, it can be described, but not easily quantified. Most psychologists, psychiatrists and psychoanalysts would agree that there is no perfect mental health that lasts forever. Each person learns to adapt to society with their small or large “emotional and psychological disarray.” We are fragile and our minds weather crises that run parallel to life as it happens. Rather than a healthy/unhealthy binary, it is preferable to understand mental states as a continuum in which the person moves within a range (sometimes better, sometimes worse), which goes from health to mental illness.
At one extreme there is health (or the closest thing to it), then neurosis, and at the other extreme there is psychosis, where more mental deterioration can be noted. The greater the neurosis, the closer one is to psychosis.
A person with a high level of neurosis finds it difficult to relate harmoniously with his peers, with his superiors and with those considered inferior. The person tends to have verbal encounters and bad temper attacks due to frustration, and finds it difficult to be flexible with reality, which is hardly controllable. The neurotic suffers and causes suffering.
The term neurosis appeared in 1777, coined by William Cullen, who wanted to talk about mental illnesses and some physical illnesses that did not have a specific organ to associate the symptoms with, such as palpitations, colic, hypochondria. At the beginning of the 19th century, neurosis took its name from the association with an organ such as cardiac neurosis or digestive neurosis, but it was not until the end of the 19th century that neuroses began to be categorized as a set of symptoms that have consequences on behavior and the type of relationships that the person establishes with the surrounding world.
For Sigmund Freud, neurosis is a manifestation of anxieties that are produced from the unconscious and that are difficult to think about from the consciousness but that are always looking for a way to express themselves. It is related to the individual’s own history and the way in which repressed events and traumatic events manifest themselves later in life. In his 1896 work Heredity and Aetiology of the Neuroses, Freud asserts that it is not heredity but rather the experiences that the person has that cause the symptoms that constitute phobic neuroses, obsessions, and anxiety neuroses. This medical classification will later be reserved for those clinical forms that can be related to phobia, anxiety, and anguish.
Jean Laplanche defines Neurosis as a “Pathological condition whose symptoms are the symbolic expression of a psychic conflict that has its roots in the subject’s childhood history and constitute compromises between desire and defense” (236). Today it is also understood as a personality characterized by negative emotions such as anxiety, rage, and sadness.
On this continuum, borderline personality has a much more difficult time living in a community. They are generally very unstable, impulsive and intense in their relationships in an unhealthy way due to fear of abandonment.
Psychosis, on the other hand, is a combination of symptoms that affect the mind and the way of relating to life, so that during its most critical periods there is a dissociation with reality and it is difficult to maintain a social relationship due to mental instability.
In all these cases, in difficult times the symptoms are exacerbated. It is often others who notice the symptoms first, although sometimes they take a while to discover them because they do not want to see the symptoms. Accepting that something is not right is uncomfortable, as is asking or assuring about the subject of another's mental health, because this involuntary disconnection with reality scares us, we fear not being able to predict the behavior of the person in front of us. Mental health cannot be measured as if the performance of a kidney on dialysis or a heart with a pacemaker can be measured, and this characteristic makes this the most silent problem of all[2].
Mental health programs in Latin America depend in part on the public policies of each country. In most Latin American countries, there is limited access to services in rural areas, and risk factors are related to poverty. It is necessary to add the consequences that the Covid-19 pandemic had on the increase in mental health problems[3]. The report by Pan American Health Organization says that major depressive disorders increased by up to 35% in the region[4]. It is clear that, in Argentina[5], compared to the rest of Latin America, there is a more open view regarding psychoanalysis and the importance of thinking about mental health, even so, it can be generalized by saying that the following five factors must be taken into account when talking about mental health in all Latin American countries.
First, stigma and discrimination. People with mental problems are afraid to talk about their condition because of the stigma and discrimination associated with it. Cancer or sclerosis are more easily talked about than schizophrenia. Also, in some Latin American cultures, mental illness is often associated with spells, weakness or even possession by evil spirits, increasing the feeling of isolation[6]. If we add to this the possibility of bullying or ridicule in the workplace or at school, the person is even more likely to hide the symptoms. All of this is an impediment when thinking about seeking help. A study by the World Health Organization shows how Latinos with mental problems are more likely to receive discrimination both in the workplace and within educational institutions. In the study, it becomes evident how difficult it is to bear the stigma when establishing social relationships compared to people who do not show or have mental illness. [7]
The second factor in Latin America is the lack of coverage for mental health care. In most countries there is limited access to professionals. In addition, there is the high cost of treatment, which is a barrier when seeking help. But perhaps the biggest problem is the lack of professionals who know how to help the population cope with the consequences of trauma, whether family or social. The Pan American Health Organization (PAHO) reveals in a recent report that the proportion of psychiatrists in this region of the planet is much lower than the standard recommended by international entities[8].
The third factor is the high number of adolescents with depression and the high suicide rates. Considering that adolescence is a time when a person is particularly vulnerable while building their own personality and understanding their mental health, special attention must be paid to this stage, additionally the future brings many questions for these new generations. For adults, being close to young people is a difficult task because adolescents are building their own patterns of behavior different from those of their parents, hence the typical rebellion. Generally speaking, standing out from the previous generation implies a degree of loneliness that was not felt before, and the person wants to belong and be accepted in their age group, generating a lot of insecurity about their thoughts, actions and their own body[9]. With mental illness, life is more difficult, and society must be clear about this in order to take action to help.
Mental health is not obvious, but it can lead to losing a life. The Inter-American Bank reports suicide as the leading cause of death among adolescents in many Latin American countries, stating that depression is a common mental problem among young people in the region[10]. It is a global issue, as the global economy loses nearly US$ 1 trillion a year due to depression and anxiety in the world. [11]
The fourth factor that accompanies mental health is the abuse of psychoactive substances and alcohol. There is great social pressure to take and use drugs and alcohol especially among the youth group, but not only among them. In an environment where poverty and lack of opportunities are the order of the day, drugs and participation in youth gangs become a pastime that few know if they will be able to escape. The United Nations Office on Drugs and Crime confirms that Latin America and the Caribbean has one of the highest rates of drug use in the world[12].
Finally, the fifth factor has to do with the consequences of the different conflicts and their violence, which affect the most vulnerable populations. These events, together with the ineffectiveness of institutions that do not provide real-time help to victims, can generate symptoms associated with post-traumatic stress that make daily life a difficulty[13]. In war, everyone loses, but mental health is always affected and presents its symptoms not immediately, but after the trauma. Experiences of violence, trauma and displacement can have a devastating impact on the mental well-being of the community. In addition, the uncertainty and insecurity associated with political instability create a climate of anxiety and fear, contributing to the development of mental health problems.
Although the mental health crisis in Latin America is complex and multifactorial, it is not insurmountable. Through concerted efforts by governments[14], health care providers, communities and individuals, we can foster a culture of understanding, compassion and support for all people who feel distress or anxiety. Addressing these five key factors requires a comprehensive approach that includes reducing stigma, increasing access to care, promoting conversation about mental health, and addressing underlying social and economic factors. A utopia to dream of and thus build futures where a more resilient Latin America with better mental health prevails.
[1] According to the World Health Organization report in the Americas region, 15.6% of the population has a mental disorder. https://iris.paho.org/bitstream/handle/10665.2/49578/9789275320280_spa.pdf.
See also Barrantes Carrasco, et al in their 2022 work: “El desafío de la política de salud mental en Latinoamérica”.
[2] There is some data such as the increase in the size of the brain amygdala when the person has been under anguish and anxiety for a long time, as well as studies by neuroscientist Richard Davidson on the decrease in the reactivity of the amygdala after meditation training. Sometimes it coincides with the decrease in its size. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6671286/
[3] The comparative study led by Dr. Julianna Dearddoff that measured people before and after the pandemic at the Center for Environmental Research and Community Health (CERCH) at the University of California School of Health says: “During the 2-year time period, depressive symptoms increased while anxiety symptoms decreased. There were no significant stressors by sex interactions; however, exploratory analyses signaled that pandemic-related stressors had stronger mental health effects for young women” https://www.sciencedirect.com/science/article/pii/S1054139X23001167.
Also National Center for Health Statistics, (2024) states: Anxiety or depression total population 21.4, Hispanics 24.1, women 23.8. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm.
[4] Oliveira e Souza Renato. Salud Mental en la región de las Américas. Organización Panamericana de la Salud. https://orasconhu.org/sites/default/files/Renato%20Oliveira_Salud%20Mental.pdf
[5] The World Health Organization in 2016 says that the number of psychologists per 100,000 inhabitants in Argentina is 222.6, ranking first in number of psychologists in all of America; Costa Rica is second with 142. The United States is number 14 on the list with 29.86. Although there is no data available, the conditions of the pandemic have changed the system of therapies and access to psychotherapeutic help.
[6] Mental illness can cause shame in the person’s close circle. In Argentina, compared to the rest of Latin America, there is a more open view regarding the importance of mental health.
[7] “A New Agenda for Mental Health in the Americas: Report of the Pan American Health Organization High-Level Commission on Mental Health and COVID-19.” Washington, D.C.: PAHO, -1, 2023. https://iris.paho.org/handle/10665.2/57508.
[8] Mental Health in America Region, 2018. https://iris.paho.org/bitstream/handle/10665.2/49578/9789275320280_spa.pdf.
[9] Girls are under special pressure to become desirable bodies. They are also more susceptible to depression. See for example Anne Petersen's work: “Adolescent Depression: Why More Girls?” (1991).
Suicide is seen as a way out of these two ideals of women (perfect body) and men (extreme masculinity, says Jean Franco) that are not realistic, as confirmed by sociologist Emile Durkheim when he defines suicide as an individual phenomenon that responds to social causes. Albert Camus begins his text on the myth of Sisyphus by saying that there is only one truly serious philosophical problem, which is suicide. Working on these concepts with young people is necessary.
[10] Inter-American Development Bank. (2016). Youth Mental Health in Latin America and the Caribbean: A Call to Action.
[11] World Health Organization. (2022). Mental health at work. https://www.who.int/es/news-room/fact-sheets/detail/mental-health-at-work.
[12] United Nations Office on Drugs and Crime. (2023). World Drug Report 2023.
[13] Governments may have mental health programs, but they are pachydermic because they are slow, outdated and insufficient. American Psychological Association. (2018). Mental Health and Disaster. https://www.apa.org/topics/disasters-response.
[14] Governments must ensure that they assist victims-survivors of social tragedies or traumas, by having programs for the prevention of mental disorders, protecting fundamental rights and having strategies for the care of people affected by mental illness.
About the Author
Professor Beatriz L. Botero has a PhD in Contemporary Hispanic American Literature from the University of Wisconsin-Madison and a PhD in Psychoanalysis in which she received a Summa cum laude from the Department of Psychology at the Autonomous University of Madrid Spain. She specializes in Latin American novels, psychoanalysis and cultural studies. She is the author of Identidad Imaginada: Novelística Colombiana del Siglo XXI. (Pliegos Editores, 2020) and editor of Women in Contemporary Latin American Novels. Psychoanalysis and Gender Violence. (Palgrave Macmillan, 2018). Botero’s research places special emphasis on identity, the body, and social conflict. Also has worked on these issues in relation to contemporary visual art.
Her last publication: Botero, Beatriz L. “Latin American Violence Novels: Pain and the Gaze of Narrative.” The Cambridge Companion to Literature and Psychoanalysis, edited by Vera J. Camden, Cambridge University Press, Cambridge, 2021, pp. 128–144. Cambridge Companions to Literature. For more information please visit Professor Beatriz L. Botero (blbotero.wixsite.com)
Additionally, she works with women weavers, both in Colombia (Red de Pro-Tejedores de la Memoria - Linked to the Centro de Memoria Histórica) and in the United States (Memory Cloth Circle). In both groups, the fabrics and textiles refer to personal history linked to social history, not necessarily coinciding with official history.
From her work with poetry, she has translated poetry in Spanish or even from indigenous languages into English to reach other audiences. https://communityaltar.wisc.edu/virtual-exhibitions/bilingual-anthology/
Works Cited
“A New Agenda for Mental Health in the Americas: Report of the Pan American Health Organization High-Level Commission on Mental Health and COVID-19.” Washington, D.C.: PAHO, -1, 2023. https://iris.paho.org/handle/10665.2/57508
American Psychological Association. (2018). Mental Health and Disaster. https://www.apa.org/topics/disasters-response
Barrantes Carrasco, J. C., Adrianzén Guerrero, R. E., Carranza Guerrero, B. E., & Bravo Gonzáles, K. E. (2022). El desafío de la política de salud mental en Latinoamérica. Ciencia Latina Revista Científica Multidisciplinar, 6(3), 2613-2634. https://doi.org/10.37811/cl_rcm.v6i3.2406.
Deardorff, Julianna, Stephen Rauch, Katherine Kogut, Brenda Eskenazi, “Changes in Young Latino Adults' Depressive and Anxious Symptoms During the COVID-19 Pandemic and Related Stressors”, Journal of Adolescent Health, Volume 73, Issue 1, 2023, Pages 201-204.
Durkheim, Emile. Suicide: A study in sociology. New York, The Free Press: (1897/1951).
Freud, Sigmund La herencia y la etiología de las neurosis (1896). Madrid: Biblioteca Nueva, 1981
Inter-American Development Bank. Youth Mental Health in Latin America and the Caribbean: A Call to Action. Inter-American Development Bank, 2016.
Kral, Tammi R A et al. “Impact of short- and long-term mindfulness meditation training on amygdala reactivity to emotional stimuli.” NeuroImage vol. 181 (2018): 301-313. doi:10.1016/j.neuroimage.2018.07.013
Laplanche E, Jean, y Jean Pontalis. Diccionario de psicoanálisis. Barcelona: Labor, 1993.
National Center for Health Statistics. Anxiety and Depression – 2024
https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm
Oliveira e Souza, Renato. Salud Mental en la región de las Américas. Organización Panamericana de la Salud. Organismo Andino de Salud. 2022 https://orasconhu.org/sites/default/files/Renato%20Oliveira_Salud%20Mental.pdf
Organización Mundial de la Salud- Organización Panamericana de la Salud. La carga de los trastornos mentales en la Región de las Américas, Washington, 2018.
Organización Mundial de la Salud. La salud mental en el trabajo. World Health Organization, 2022.
Petersen, Anne. Sarigiani, P.A. & Kennedy, R.E. “Adolescent depression: Why more girls?” Journal of Youth Adolescence 20, 247–271 (1991). https://doi.org/10.1007/BF01537611
United Nations Office on Drugs and Crime. World Drug Report 2023. United Nations Office on Drugs and Crime, 2023.