{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:18:10Z","timestamp":1787941090860,"version":"build-2784847793"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmentalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Ment Health"],"abstract":"<jats:p>Psychiatrists are trained to evaluate biological, psychological, and social dimensions of illness simultaneously, yet the dominant frameworks governing psychiatric practice remain oriented toward individual symptom management rather than the structural conditions that produce these symptoms. This essay argues that psychiatrists working in global mental health contexts carry an ethical obligation that extends beyond diagnosis and treatment: to practice what Paul Farmer termed pragmatic solidarity, the practice of standing alongside communities to address the upstream drivers of mental distress through structural advocacy, community-led care, and institutional accountability. This essay draws on evidence from three intersecting domains. First, it examines the well-documented global mental health burden, including treatment gaps and the disproportionate impact of conflict, displacement, and structural inequity on psychological wellbeing. Second, it argues that effective global mental health work requires horizontal partnerships, epistemic justice, and the centering of community-defined priorities over externally imposed frameworks. Third, it illustrates what pragmatic solidarity looks like in individual, institutional and policy contexts. Importantly, this essay is a call to action, identifying concrete entry points through which psychiatrists can move from recognition of structural drivers to active participation in dismantling them, including through material redistribution, community partnership, participatory research, and policy engagement. Pragmatic solidarity offers psychiatrists not just a theoretical framework, but a tangible, enactable way of improving global mental health.<\/jats:p>","DOI":"10.1371\/journal.pmen.0000705","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:30:39Z","timestamp":1787938239000},"page":"e0000705","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmen.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the clinic: The role of the psychiatrist in practicing pragmatic solidarity"],"prefix":"10.1371","volume":"3","author":[{"given":"Anne","family":"Berhe","sequence":"first","affiliation":[{"name":"Columbia University","place":["New York, New York, United States of America"],"department":["Department of Psychiatry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7967-1859","authenticated-orcid":true,"given":"Abishek","family":"Bala","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Eastern Ontario, University of Ottawa","place":["Ottawa, Ontario, Canada"],"department":["Department of Child & Adolescent Psychiatry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobi","family":"Okopie","sequence":"additional","affiliation":[{"name":"Boston Children\u2019s Hospital","place":["Boston, Massachusetts, United States of America"],"department":["Department of Psychiatry"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4447-796X","authenticated-orcid":true,"given":"Jennifer","family":"Agwagom","sequence":"additional","affiliation":[{"name":"Geisinger Commonwealth School of Medicine","place":["Scranton, Pennsylvania, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manal","family":"Khan","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine, University of California Los Angeles","place":["Los Angeles, California, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1553-5676","authenticated-orcid":true,"given":"Suzan J.","family":"Song","sequence":"additional","affiliation":[{"name":"George Washington University School of Medicine and Health Sciences","place":["Washington, District of Columbia, United States of America"],"department":["Department of Psychiatry and Behavioral Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"issue":"3","key":"pmen.0000705.ref001","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-005604","article-title":"Decolonising global health in 2021: a roadmap to move from rhetoric to reform","volume":"6","author":"M Khan","year":"2021","journal-title":"BMJ Glob Health"},{"issue":"7","key":"pmen.0000705.ref002","article-title":"Decolonising global health: where are the Southern voices?","volume":"6","author":"SO Oti","year":"2021","journal-title":"BMJ Glob Health"},{"key":"pmen.0000705.ref003","doi-asserted-by":"crossref","first-page":"24731242261435337","DOI":"10.1177\/24731242261435337","article-title":"Decolonization and Health Systems: A Scoping Review","volume":"10","author":"K Wright","year":"2026","journal-title":"Health Equity"},{"issue":"12","key":"pmen.0000705.ref004","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2022-011564","article-title":"Is decolonisation sufficient?","volume":"7","author":"SQ Contractor","year":"2022","journal-title":"BMJ Global Health"},{"key":"pmen.0000705.ref005","volume-title":"Writings for a Liberation Psychology","author":"I Mart\u00edn-Bar\u00f3","year":"1994"},{"issue":"1","key":"pmen.0000705.ref006","doi-asserted-by":"crossref","first-page":"2092183","DOI":"10.1080\/17441692.2022.2092183","article-title":"Reimagining global health: From decolonisation to indigenization","volume":"18","author":"S Hindmarch","year":"2023","journal-title":"Glob Public Health"},{"key":"pmen.0000705.ref007","volume-title":"Pathologies of Power: Health, Human Rights, and the New War on the Poor","author":"P Farmer","year":"2003"},{"key":"pmen.0000705.ref008","unstructured":"Farmer P. 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