"No group of patients in the world is as stigmatized and bereft as the untreated mentally ill," Kleinman said, with quiet emphasis. He chastized the field of psychiatry for its lack of action on behalf of people with mental illness in low- and middle-income countries. Among the obstacles to action, he listed the "absence of a sufficient number of professionals who actually commit their careers to global mental health or can find the resources to commit their careers to global mental health" and the absence of funding to support research and training needs.

Kleinman encouraged the "robust evaluation of demonstration projects" and bemoaned the lack of commitment to scaling up existing demonstration projects. He alluded to the work of Jim Kim, Paul Farmer and others, whose actions on behalf of people with AIDS in poor countries contributed to the introduction and scaling up of AIDS treatment in sub-Saharan Africa and other settings.

Despite the difficulties of pursuing a global mental health career, Kleinman called for "antiheroic" action.  He explained that these were "people who are willing to step out of the ordinary and do the non-conventional, recognizing that there's a small chance they'll have a game changing effect."  Kleinman noted that these people provide something else, "they become a moral exemplar, taking the road less traveled."  He reminded the social workers, psychology interns, psychiatric residents, anthropologists and psychiatrists that the field needed people "who recognized that their contribution would be small, that their involvement does not yet capture the spirit of the times."  He warned that career advancement was not the reason to pursue this field; rather, a moral commentment to change the world.