This paper will consider the assumptions which underline the notion of global mental health, and the proposition that this is a straightforward unitary category. The paper will examine if this is the most useful way forward and the disadvantages and advantages of this position. There is no doubt that people all around the world suffer distress, but whether this is best labelled as an individual mental health disorder and individual psychiatric help offered appears open to question. The way distress is labelled has a range of consequences. The importance of politics, context and the wealth and power differentials which exist cannot be ignored in the way that the global health debate is constructed. DSM and ICD are not neutral documents but carry a range of assumptions and represent a range of interest groups, many of which are located in the West. Reification appears to have taken place on occasions, and different cultural constructions, explanatory health beliefs or idioms of distress, ignored or seen as additional layers of meaning rather than as the central organising concepts they appear to be for many people. The generalization and transfer of western psychiatric and psychological ideas, uncritically to the wider world, can unwittingly undermine the rich traditions and cultural heritage of low- and middle-income countries. It could be viewed as a form of neocolonialism. There are many angles to this debate including the use of language and the fact that some languages have concepts and long traditions around mental health which are different from those used in European languages, and which may not contain words which translate to much of the psychiatric lexicon. This in itself may tell us something.