Ezra Susser, MD, DrPH

Dr. Ezra Susser is an expert in epidemiology and psychiatric science whose research focuses on the developmental origins of health and disease throughout the life course. 

Why do you do this work?

I think this work comes from deep within me. One part of it is my interest in mental illness, my interest in public health and epidemiology, and my interest in low income contexts across the world.

They all were part of my upbringing because my parents were a part of the anti-Apartheid movement with Nelson Mandela and then they were refugees. We moved so much that I never really belonged to any particular country. I met a lot of refugees from Chile and lived in India for a while—I had a lot of experience in other settings and in low- and middle-income countries to understand how different it is. The interest in mental illness came partly from my own experience; I feel some kind of commonality with people who are socially excluded. When I was working with homeless people, many of the people I was working with were migrants from other countries and therefore we had a shared identity. I liked working with people with schizophrenia or children with autism. A lot of people think this is difficult but I found it liberating, because there is room to be very creative, and every small step forward brings some joy. Outside of the formal office setting you can be really creative and really learn about people.

So what’s my motivation? I guess at the bottom of it, the notion that we are all equal and that every life is valuable. I have empathy for people whose lives aren’t valued and people with severe mental illness are among those whose lives are most unvalued.

What is your proudest moment working within Global Mental Health?

It’s hard to just choose one, but I think it would be the meeting that we had in Argentina where we reconvened everybody in the RedeAmericas. RedeAmericas was a NIMH hub in Latin America and we trained a lot of the younger generation who’ve gone on to do great things- including Franco! We wanted to turn it over to younger people who were living and/or grew up in Latin America to keep it going in the long run. That meeting represented a point of transition to leaders by such investigators. Ultimately, the initiatives have to come from the countries themselves and not just as a derivative of things done in high-income countries. And that’s really my dream- to build local capacity and acknowledge local developments in different locales in the world. This program has been sustained for more than 30 years now.

How do you envision the future of Global Mental Health as a field? What contributions would you hope to have?

The way that I envision it is…well, it hasn’t changed that much. Jose Lumerman and I went to Bahia, Brazil together and we dreamed up this idea of self-led regional initiatives. Latin America was a particular focus. That was the idea that ultimately led to the RedeAmericas initiative. What’s unusual about Jose Lumerman’s program in the Patagonia region of Argentina is that he built it all from local resources. He put it together with what they had—they didn’t have psychiatrists but they had primary care doctors and nurses and other health workers. So they trained primary care doctors to lead mental health teams, and trained community mental health workers who did home visits, and so forth. They constructed a building that felt warm in a place where people liked to be, near the center of the city, with a kitchen in the very middle of the main room where delicious food was made. He brought in artists from the community to teach art and writers to teach writing. When you talk about Structural and Social Determinants of Health, place is a part of it. Where you see people matters. It matters whether it’s a cold and sterile clinic or a warm, inviting place where you are treated as a person with many parts to them, not just a person with schizophrenia.

I envision the future of Global Mental Health as having places that are built in a local context that use resources based in that community. And by doing that, they can reduce the stigma surrounding mental illness and help people be socially included. At a higher level I envision the enforcement of the UN Convention of the Rights of Persons with Disabilities, for people with mental disorders. My broader vision, which won’t be achieved in my lifetime, is that people will be valued for whatever they are and equally valued. The philosopher John Rawls puts it well: a society where if you chose a random place to be born in that society, any place is equal to the other. However you were born, you have the same rights and ability to enjoy whatever you can.

Milli Wijenaike-Bogle, an MPH Candidate in the Department of Sociomedical Sciences, interviewed Dr. Susser for this Q&A.