Scene: It is early evening, and a World Health Organization Mental Health Provider (WHOMHP) steps out of a United Nations helicopter just outside an indigenous community quite far from here. Community members look on as an elder steps forward, a woman highly familiar with their traditions and medicines pertaining to health and wellness, an indigenous scientist.
WHOMHP (unfurling a scroll and reading very loudly): “Mental health has been hidden behind a curtain of stigma and discrimination for too long. It is time to bring it out into the open . . . We need to enhance our investment in mental health substantially and we need to do it now.”1
“Vulnerable Group: Certain groups have an elevated risk of developing mental disorders. This vulnerability is brought about by societal factors and the environments in which they live … including:
- Stigma and discrimination
- Violence and abuse
- Restrictions in exercising civil and political rights
- Exclusion from participating fully in society
- Reduced access to health and social services
- Reduced access to emergency relief services
- Lack of educational opportunities
- Exclusion from income generation and employment opportunities
- Increased disability and premature death.”2
Indigenous Scientist [stepping forward]: Pardon me . . . I’m glad I understand your language quite well. I’ve met with people from your august body before as have my ancestors. You must be new. Would you please explain why we are now being labeled as ‘vulnerable’ people who may be ‘mentally disordered’ because of these political factors? They sound very similar to what you call in your language ‘oppression, genocide, and cultural destruction.’
WHOMP [searching his scroll]: ‘Oppression, genocide, and cultural destruction’ are not in my list nor is the word ‘political.’ Please allow me to continue …
Indigenous Scientist: I’m sorry. Please do.
WHOMP: “[An] essential requirement is for services to be responsive to the needs of vulnerable and marginalized groups in society, including … indigenous people.”3
Indigenous Scientist: Excuse me again, I’m so sorry. What are these ‘services’ you wish to offer?
WHOMP: Services to combat the depressive, bipolar, and schizophrenic disorders you indigenous community members suffer from, of course.
Indigenous Scientist: Oppression or depression? I’m uncertain which is which.
WHOMP (searching the scroll): Nothing in here about oppression, so they must mean depression. This was put together by an Expert Work Group, and they’d know. [reading again] “Depression is currently one of the leading causes of disability in the world. The key interventions are treatment with (generic) antidepressant drugs and brief psychotherapy.”4
Indigenous Scientist: Hmm, if it weren’t for oppression, genocide, and cultural destruction, I wonder if they’d see us as vulnerable, depressed, and prone to disability.
WHOMP: Well, I see nothing at all in my notes on oppression, genocide, and cultural destruction, only depressive, bipolar, and schizophrenic disorder. And what’s recommended is that we provide you with drugs and brief psychotherapy.
Indigenous Scientist: That’s the recommendation?
WHOMP: Yes. “The availability of basic medicines for mental disorders in primary health care is notably low . . . and their use restricted because of the lack of qualified health workers with the appropriate authority to prescribe medications.”5
Indigenous Scientist: I suppose you’ll be providing these drugs through expansion of our community health clinic.
WHOMP [smiling]: Absolutely! That’s the good news. [looks at scroll again] “It is surprising to find that less than 40% of countries have rehabilitation facilities and anesthetist support as a pre-requisite, given that psychiatric conditions are chronic in nature and require long-term management and rehabilitation.”6
Indigenous Scientist: When was it you spoke to us about all this? And why is an anesthetist necessary?
WHOMP: “Anesthetist support is generally considered essential for administering electroconvulsive therapies.”7
Indigenous Scientist: That doesn’t sound particularly friendly . . .
WHOMP: Our intentions are entirely benign and benevolent. “Low income countries need to increase their training resources in definite even though small steps to reach the standards generally prevalent in higher income countries.”8
Indigenous Scientist: Well, how do the standards of high income countries work out for the people living there? I’m sorry to tell you, but the resources you offer conflict with our cultural ways regarding what it means to be healthy and happy.
WHOMP [pleading somewhat]: We would be very culturally sensitive in promoting them.
Indigenous Scientist: Well, are these new ideas valid and reliable?
WHOMP: They are evidence-based and empirical.
Indigenous Scientist: We also use our senses to investigate and understand our world. But that’s not really an answer, is it? Our people value truthfulness greatly. Again, as a caretaker for my people I ask, are these new ideas you wish to bring to us from your science valid and reliable?
WHOMP [blushing and searching the scroll again]: I guess I don’t see much regarding what’s valid and reliable about all this in here.
Indigenous Scientist [looking up at the fading light]: Maybe your expert scientists don’t feel all that confident in their own ways. [pointing to an early star] Do you at least see that?
WHOMP [a little put off and puffing up slightly]: Of course. Our scientists can actually measure the distance from here to that star. They go to school for many years.
Indigenous Scientist: Hmm. Very impressive. Our fishermen use that star to find their way home when bringing in food for our families. Several of them would like their children to be able to learn to read.
WHOMP [flustered]: I don’t quite get your point . . .
Indigenous Scientist: We both agree that there’s a star there, but we view its purpose very differently.
WHOMP [still flustered]: I still don’t understand . . .
Indigenous Scientist: I’ve pointed out the star, and we both see it. Now please point out this bipolar disorder you say we have.
WHOMP: It’s in your head, in your brain. We have brain-scanning machines and chemical studies to show your brain is diseased with it.
Indigenous scientist: And are those methods valid and reliable?
WHOMP [blushing and searching the scroll again]: There’s nothing written in here about that question but I’m sure . . .
Indigenous Scientist: Perhaps there is an idea of bipolar disorder stuck in your own head, and you believe it’s also stuck in ours. Your ancestors took our brains from our heads and looked at them before. Did they see this disorder inside our heads back then?
WHOMP [mildly defensive]: I wasn’t even alive! We don’t do things like that anymore. You must have people here who suffer from hearing voices in their heads.
Indigenous Scientist: Yes, we do. There are disturbances of the spirit and also visions that our healing traditions describe.
WHOMP: Well, there’s nothing spiritual about schizophrenia. It’s a brain disease.
Indigenous Scientist: I see. Another interesting idea you have. And you have located this schizophrenia reliably and validly in your peoples’ brains?
WHOMP: Uh, not exactly.
Indigenous Scientist [confused]: Well, how can you say for certain if it’s in ours? Say, in your science, do you have a division between your brain and your spirit?
WHOMP (impatient now): Yes, yes, of course, we’ve had a division between physical and metaphysical since our Enlightenment—that is, for nearly the last 500 years!
Indigenous Scientist: Hmm, well, that’s not something we have ever had in the science in our community. I think our sciences don’t agree. But ‘500 years’ sounds very familiar.
WHOMP: How so?
Indigenous Scientist: That was about the same time we first began to experience oppression, genocide, and cultural destruction around here.
WHOMP: As I mentioned, our intentions are completely benign and benevolent . . .
Indigenous Scientist [pointing to the sky]: Let’s take a look at that star again.
* * * * *
1World Health Organization, Mental Health Action Plan, 2013- 2020, p. 40
2 World Health Organization, Mental Health Action Plan, 2013- 2020, p. 14
3 World Health Organization, Investing in Mental Health Care, p. 31
4World Health Organization, Mental Health Action Plan, 2013- 2020, p. 9
5 World Health Organization, Mental Health Action Plan, 2013- 2020, p. 9
6,7,8 World Health Organization, Psychiatric Education and Training Across the World, p. 14