Abstract

[In this study, the main aspects of the economical, technological, political, and cultural process called "globalization", which has been affecting our world during the past few years, as well as its possible effects on mental health, and organization of mental health services are discussed.]

We Really Live In A Different World Right Now!

Sociologist Anhony Giddens, who answers the question "Is this world we live on during the end of the twentieth century different than the previous ages?" with "Yes, it is", considers globalization as a political, technological, and cultural process, rather than just economical. According to him, the gigantic changes, which occurred in the field of communication form the basis for the globalization process, and has a major affect on all related aspects. For the first time in the history, we have the chance to communicate with other parts of the world, instantly. Instant electronic communication is not just a way to transmit news or data faster and more efficient. The presence of instant communication leads to changes in the basic structure of our lives, no matter if we are poor or rich. (Giddens 2000, p. 24).

Not Only The World, Our Lives Change Completely!

Together with the fundamental changes in the infrastructure of information technologies, the main focus of the economy shifted from industry towards service sector, which lead to major changes in our lives. When services in the fields of information, entertainment, electronics, and finance became the vital essence of the economy, our lives begin to be shaped accordingly.

Except those changes, which originate from the business life, our new life-style which result form information technologies makes it necessary for us to think of globalization as a "local" process in our immediate vicinity, which deeply affects the private and personal aspects of our lives (sex, marriage, family), rather than something "remote". During the recent years, terms such as "here" and "there", "inside" and "outside", "far" and "close" don't mean anything especially to the elite section, but progressively also to everybody who make use of information technologies. Any event, which happens in one part of the world concerns anybody in any other part of the planet.

The advances in transportation means also contribute to our global movements, erasing geographic borders from our lives (Baumann 1999a, p.20). As a result, global changes occur in the way we think of ourselves, and how we establish relationships with others. The most important aspect of globalization that affects our mental health is changes in cultural life, i.e. the human side of it.

When Traditions Get Lost, Our Ego-Identities Become Restored!

Due to changes in information technologies, traditions began to lose their importance world-wide, and the fundamentals of our "self" perception and feeling started to shake. In traditional populations, the self-feeling and the ego-identity is preserved mainly by stability of roles and status of individuals within the society. With the loss of traditions, the "self-feeling" and the "ego-identity" has to be reconstructed. According to Giddens (2000, p.61), the main task of psychotherapy and psychoanalysis nowadays is to answer this need for reconstruction of this "self".

This sociological analysis of psychotherapy and psychoanalysis by Giddens offers us the opportunity to reveal how this kind of approaches, such as "object relationships" and self-psychology come about, as well as indicates, although "cross-cultural psychiatry" and "culture-specific psychotherapy" desires (Göka, 1997) became popular recently, they will never be able to hit the target. Together with globalization, it becomes more and more evident that the main development behind the discussions about multi-culturalism (Gutman, 1996) is a single-culturalism, i.e. a kind of homogenization. Our life-styles become standardized. Together with globalization, the Western-type of economical behavior becomes assimilated by the rest of the world (Yıldırım 2000, p.74). There are critics that the Internet has been designed to make whole world think like Northern Americans do (De Benoist 1996, p.120).

The family structure becomes dissolved, and privacy, love, and erotism acquire a new shape!

Traditional family was an economical unit. In the medieval Europe, marriage was not related to sexual love, and family home, was not considered to be a place where sexual love would grow; usually women and children were devoid of any rights. Today, on the other hand, we talk about the "death of the family", like about the death of many other things. Marriage may still be popular, but this comes together with increases in divorces, and marriage is not a definitive factor of being a couple. Due to high rate of marriage and divorces in countries, such as the UK and the USA, they are referred to as "high divorce, high marriage" societies. In some other countries, more than one third of all birth cases are extra-marital, with the rate of single living people increasing, and birth-rates decreasing in Western world.

In recent years, this wave starting from the West spreads to whole world; with sexuality completely becomes separated from reproduction, sexual life undergoes a fundamental change. Equality between two sexes, as well as sexual freedom, which does not confirm to traditional family concept, starts its way. Together with mother-father-child relationship, sexual relationships and love relations also change (Giddens 1996).

When we combine all these changes in privacy the revolution in information technologies, we can easily say that the shape and content of mental disorders, and consequently of psychological treatments, psychotherapies in the first place, will undergo serious changes (Göka 1999).

Translocations in globalization are really tragic sometimes; and longer life-expectancy may also lead to several problems!

Even though not related to globalization directly, another important field of change of our lives is reflected in increases in population, migrations, and aging of the world's population (Thurow 1997, p.74-97). Higher population rates in poor countries indicate that in addition to general health problems, mental health problems will also increase in these countries. Although together with globalization, tourism from Western countries to other places of the world reaches a level to deserve the term "migration", the real problem from the point of view of mental health is mass-migrations to developed Western countries. We shall better be prepared to cruel measures to stop mass-migrations, and to poor migrating populations, whose mental integrities are lost, with severe symptoms during the next years.

The increase in the population of elderly has lead to a completely new social class, first time in the history of mankind. This group of people, who are economically not active, who vote, and whose number is steadily increasing, is one of the most important powers to reshape the world. Elderly people are those who require expensive social services, such as health, and whose main source of income is normally the government. Depending on the level of development and social policy of the countries, the services offered to elderly also vary. In the US, which is governed by information and money, we can easily predict that major investments are going to be made on the biology, psychology, and rehabilitation of elderly, thus more pages about senility problems will be added to psychiatry textbooks, whereas due to limited resources of mental health professionals in other parts of the world (including Europe), they will not be able to apply these information to the elder population in their own country.

Fanaticism Booms While Traditions Collapse!

Another result of the collapse of traditions during the globalization process, is the danger of fundamentalism (Giddens 2000, p.61-63; Thurow 1997, p.195-202). Fundamentalism means in its broadest sense the desire for the past; a tradition under siege. Fundamentalism is the reaction for globalization; the state of closing your eyes and retreating to your inner-self; thus, it can not stand polyphonicy, and refuses dialogues. We should bear in mind, however, that fundamentalism should be considered not only in the religious sense, but also from any kind of ethnical, nationalistic, and political aspects; fundamentalist reactions may occur in any part of the world (e.g. capitulations in the Western countries, conservative reaction against female emancipation, etc.) The importance of fundamentalism from the mental health point of view is that it forms a social tool for violence and fanaticism. It sometimes reaches the level of a "paranoid endemic", and the mental health professional who becomes stuck between individual-culture and psychopathology is devoid of any means to interfere, and only can observe the events.

Global Individual Is Someone Who Lives In The Risk Society!

Anybody who seeks to understand globulazation under the term "risk" (Beck 1992), displays a psychosocial reality, to which mental health professionals have to react. In traditional societies, there might have been more real dangers from the nature, or other people, but still they were not "risk societies". Because risk refers to dangers which are efficiently evaluated by considering future possibilities; thus, it is true only for modern societies which are future-oriented, and which attempt to break free from the past. Our modern society has a certain level of control over external dangers from the nature or from traditions, but self-manufactured risks, which result from the effect of our knowledge on the world, environmental problems, arming, nuclear hazards, and labile finance markets may lead to greater disasters, instantly (Giddens 2000, p.35-48).

Globalization may mean that progressively increasing ecological problems becoming global, an unsolved ecological problem to bear the risk of destroying the whole planet. Self-manufactured risks are not limited to this; previously certain predetermined patterns of marriage and child-raising limited mainly by traditions did not cause any problems related to uncertainty. Nowadays, however, there is tremendous level of uncertainty in these fields, and the individual has to determine which way to choose. If we add the problem with deadly venereal diseases, such as AIDS, to the risk areas of globalizing world, we can easily understand why we are living in the "anxiety age". The best way to deal with risks is to get insured; these are the reasons for the insurance system to be developed in the risk society. But what kind of mental health insurance can we find for the anxiety-inducing atmosphere of globalization? Will this be primarily a preventive effort, or should we expect some kind of advances in the field of anxiolytic medications; unfortunately, this also remains uncertain.

Are Nation-States, National Economies, And National Health Policies Collapsing?

Another result of globalization is best explained by the statement of sociologist Daniel Bell, saying that the nation is too small to solve big problems, and too big to solve small problems (Bell 1987). Together with globalization in the political and economic stage of the world, especially two powers are steadily regressing. Those are nation-states and poor Southern countries. In spite of intensive debates about globalization and the future of nation-states (Hirst and Thomson 1998; Rodrik 1999), it is quite obvious that together with the process of globalization nation-countries and especially social-welfare governments are losing steam.

This fact is clearly indicated by fifty of the worlds' greates economic powers being enterprises rather than countries, and by the assets of the richest three man of the world being higher than the income of 48 nation-countries, in other words, one third of the worlds' population (Başkaya 1999, p.21). We can not expect national economical policies being as effective as they were in the past, and the historical geopolitical concept has undergone changes. National identities need to be reformed; similar to "family", "job", "tradition", and "family" concepts, the concept of "nation" is undergoing fundamental changes during recent years. The gap, which results from erosion and regression of national identity, is filled with ethnical and cultural solutions on behalf of multi-culturalism.

The relationship of the negative aspect of globalization for national countries with mental health consists of the deep concern, suspicions, violence and conflict environment resulting from the chaos, which is a consequence of loss of national identity, and the burden on people with mental disorders and their families because of the retreat from social policies.

A negative effect of regression of nation-states on mental health comes from a totally unexpected field: In a world where world problems remain uncertain and without any rules and a control mechanism, the mafia is free to move as it wishes. In the year 1995, it was predicted that the drug business has reached a volume of 4000 Billion Dollars. This figure constitutes 8% of the total business volume in the world, and exceeds the share of iron-steel and automotive industries (Bozkurt 2000, p.109). The social aspect of a drug market with no control mechanism naturally affects the field of psychiatry!

Is Globalization Neutral?

Globalization is apparently not a neutral process, and its effects are advantageous only for "Northern" people, more specifically the US, and disturbs lots of people who are living outside of Northern countries. The poor people of South whose local cultures disappear progressively, and who feel the inequality in their lives to a higher degree with every passing day perceive globalization as "becoming Western" and "becoming American", and are in deep doubts and suspicions about their future. There are circles claiming that this is the most important feature of the feeling of "non-Western countries being continuously watched-over by Western ones, and the Western people always see and know everything", and define the process as "cybernetic exploitation" (Sid-Ahmed 1996, p.17-21). We have to keep the global psychological environment of the poor Southern people who are covered with millions of satellites and hundred thousands of cables extending from Atlantic to Pacific shore in mind.

Actually, if we consider globalization from the point of view of social inequality, statistics are frightening. It is adequate to scan through the "1999 humanistic development report" of the UN, or the reports of the World Bank (Global Economic Prospects 1998/1999). The share of the poorest one fifth of the world population on the global income has decreased to 1.4% from 2.3% during 1989 and 1999. The security and environmental arrangements of the poor Southern countries is at a very low level, or is totally missing. Some international companies sell items here that are prohibited in their own countries, such as low-quality medical equipment, harmful insecticides. The present picture of the world is a global pillage, rather than a global village (Giddens 2000, p.27).

The present picture in this world, where the total assets of 358 global billionaires is equal to total income of 45% of world's total population can be described as a new way of "robbery" (Keegan 1996). Moreover, in the past the rich people needed the poor to become rich and to preserve their fortunes; today, on the other hand, after the change in the nature of "working", rich people no longer need the poor. The poor people are left to their destinies (Bauman 1999b)...

The distribution of income during globalization process doesn't only lead to inequality between North and South; all the developmental determinants focus on the US. The USA, which is the supporting beam of the present international system, has acquired half of the increase in income during the last two years (Ulagay 1999, p.85). Looking from this point of view, globalization process is also referred as "Americanization of the world" (Gerbier 1999, p.107).

In addition, if we consider social inequality, globalization also leads to reactions even in the poorer parts of the North. While poor people are left to misery in the city centers, the elite layer lives in fancy places outside of the cities. The stress between the ones inside and outside of the walls increases in the same manner as described by Gregory Bateson in "Schismogenetic chain theory" (1973, p.41-42); according to this theory, if eternal competition is not limited and changes into enmity, the collapse of the system is inevitable. Occasional demonstrations of the poor, clashes with the police, which become a kind of ritual nowadays, attacks of soccer fanatics might be the first sign of the violence potential of the cities. The fear factor in our new postmodern cities is certainly growing, as indicated by endless news warning the citizens, as spread by the media, by cars and doors always getting locked, and widespread security systems, by the increase of "closed" and "secure" communities among all age and income groups, and by the increased level of control in public places (Elin 1997, p.13).

Not only the huge gap in the distribution of income, but also McDonaldization (Ritzer 2000), and consumption-oriented structure of the society (Featherstone 1996) causes heavy critics. There are also some serious critics about the information technologies, which form the backbone of globalization. Some sociologists (Bauman 1999a, p.60; Poster 1996, p.204) compare our bodies to networks, data bases, or beads lined along information corridors, and claim that we live in a world where we can not escape from being watched, and can't do anything but watch the information stars.

And in a world where traditions, family, nation-states, social policies are regressing, whereas the inequality of income distribution is increasing, liberal suggestions do not work in case the problems are mental disorders, especially severe and long-lasting mental disorders which are hard, even impossible to cure. "Socially responsible globalization" which is currently discussed for problems related to globalization, is especially needed for mental disorders, too (Bozkurt 2000, p.108; Ulagay 1999).

All these changes indicate the need for new ideas for the mental health concept and organization of services. We especially need to review the public supporting system concept, which has vital importance for mental health services, and properly refill the gaps caused by the loss of tradition and family effects (Göka 2001).

Globalization Of Science And Technology, And The Unpredictable Results Of The Bio-Technologic Revolution!

Another fact of the present times is that science and technology themselves have been globalized. The number of scientists all around the world today exceeds the total number of people who made efforts in this field for the whole history of mankind; just like the number of the deaths during the two World Wars, and the recent ethnical struggles exceeds the number of people who died in wars throughout the history...

Meanwhile, the concept of "science" also undergoes some changes. In the past, we were talking about social sciences imitating natural sciences, while nowadays we discuss the similarity of natural sciences to social sciences. Terms, such as "uncertainty", "probability", and "interpretation" are emphasized (Göka, Topçuoğlu, Aktay 1996; Gulbenkian Commission 1996). This situation reflected itself to psychiatric etiology and management discussions as "multiple-factor" concept.

But meanwhile the advances in genetic sciences and biotechnology, which have enlivened the claim of "precise scientific knowledge of truth" of the last centuries' positivism are close to create the most important changes of near future (Giddens 2000, p.46). In the middle of the year 2000 Clinton and Blair have announced that "Human Genome Project" (HUGO) has been completed, and this is even a greater revolution than information reform. Several states and pharmacological companies are about to take important steps in the field of biotechnology (Miller 2000). While we were talking about socio-biology in the past, we began to talk about "bio-sociality", meaning reformation of the community according to biology.

The advances in genetics and biotechnology, when combined with steps in the field of behavioral genetics (Hamer and Copeland, 2000), it is possible to state that in the following years there will be fundamental changes related to mental health, from etiology to management, and at the same time, the ongoing discussions related to ethics will quickly turn out to be real ethic problems. Psychiatry, which was influenced from inside and outside by the public criticism wave of 1968, now seems to become influenced by the wave of criticism against globalization coming from Seattle, and any other places. The critics against psychiatry will now apparently originate from patient rights, and psychiatry will be accused to be at the service of "eugenics" and international concerns.

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