This chapter contributes examples to explain how people experience, respond, and seek help for their distress in Malawi and Sri Lanka based on the research and lived experiences of the authors. These include task-shifting projects in primary health care in Malawi and approaches to responding to the impact of the Tsunami in Sri Lanka. Findings highlight a pluralism of non-biomedical ways of both understanding and responding to distress within disasters, conflicts, and uneven development situations and an analysis is presented of both formal medicalised and informal community approaches that establish the significance of negotiated beliefs of distress, and the language used to express distress. Formal and informal help-seeking is described and the role of traditional and religious support structures in providing locally responsive and effective support is explored. Within the discussion, the authors describe a ‘resistance’ of health workers under the ‘gaze’ of the dominance of biomedical global mental health. For what is hidden in this contested space between formal and informal care systems are the expression of normative philosophies and value systems that inform all aspects of a person’s life, experience, health, and distress. The chapter argues that the silencing of such local indigenous and culturally negotiated meaning of distress represents a social and epistemic injustice that mirrors colonialism. Again, the biomedical approach—and mental health market—is sustained by investing in local ‘interpreter’ health workers trained to maintain dominance and authority, even where wider structural, cultural, and socio-economic impacts are implicated in people’s distress and their resolve. The chapter concludes by summarising these challenges collectively, reminding the reader of the rich normative philosophies and value systems described in Chap. 3 . Such an analysis exposes the way that a coloniality may be seen as impacting the two case contexts—where there is an othering of people, and an exertion of power involving the exclusion and silencing of populations.