A recent article, published in the Archives of Scientific Psychology, describes how racial, ethnic, cultural, and national disparities in counseling and psychotherapy outcomes are inevitable, but eliminating global mental health disparities with indigenous healing is not. After describing the incongruence of exporting psychotherapy to other countries, Robinder Bedi, a psychologist and researcher from the University of British Columbia, suggests an integration of local indigenous practices with culturally competent psychotherapy practices to address mental health disparities.
“Although this [exporting psychotherapy cross-culturally] is generally done with good intentions to promote global mental health and to address differences in mental health across the world, these practices can be inconsistent with the societal values and collective beliefs of individuals in non-Western countries and can sometimes lead to more harm than good,” writes Bedi, “Instead, promoting traditional healers and indigenous healing practices and integrating them with culturally adapted counseling and psychotherapy is recommended to reduce international mental health disparities.”
The Lancet Commission on Global Mental Health and Sustainable Development recently published a report detailing plans to “scale up” mental health care across the globe. Simultaneously, the UK government hosted a Global Mental Health Ministerial Summit proposing to globally implement mental health policies. In contrast, Bedi argues that the notion of utilizing western psychotherapy with racial and ethnic minority individuals within Western countries as well as promoting its use to non-Western countries “has not received the careful deliberation that it deserves.” Bedi, among other mental health professionals, activists, and service users, challenges the cross-cultural applicability of Western mental health healing practices and calls for a more intentional approach to addressing global mental health disparities.
Psychotherapy is a cultural byproduct. In fact, Bedi suggests that psychotherapy might correctly be considered an indigenous mental healing practice of the West, “originally developed by and for Western individuals to address mental health concerns endemic in the Western world.”
“In light of the dominance of the medical (diagnose-and-treat) model of mental health disorders, there is burgeoning but oft-neglected research that has concluded that (a) counseling and psychotherapy are forms of healing indigenous to the West rather than universally valid practices, and (b) counseling and psychotherapy share important therapeutic systems and structures with all well-established indigenous healing approaches across the world.”
These universal structures share the following factors: a culturally approved healing setting (counseling office), a trusting and confiding relationship with the healer (a therapeutic alliance), a therapeutic rationale and conceptual framework (psychotherapeutic theory), and rituals and procedures that logically flow from the therapeutic rationale.
While others have critiqued the action of and intentions behind disseminating Western psychotherapies cross-culturally, Bedi’s article is unique in its proposal to integrate indigenous healing practices with culturally adapted counseling and psychotherapy.
Culturally adapted counseling and psychotherapy aims to “ensure all individuals, regardless of race, ethnicity, culture, or country, experience equal benefits from counseling and psychotherapy” and is ostensibly “backed by an abundance of North American and European research.” Yet, many studies, indicate just modest improvements and high dropout rates, albeit better outcomes than non-culturally adapted approaches.
Bedi raises concerns about the often unquestioned propagation of Western psychotherapeutic techniques such as the potential marginalization of indigenous systems of mental healing, a loss of local skills by ignoring traditional healing methods historically implemented to address mental well-being, and the insensitivity of reifying “colonial mentality as a hegemonic imposition of Western cultural and political interests.”
Bedi offers a format in which culturally adapted counseling and psychotherapy could be applied abroad, particularly when Western understandings have to some degree “permeated non-Western countries,” which could be measured by considering ethnic identity development and acculturation to the West prior to treatment. Alternative solutions to integrating traditional healing practices and psychotherapy are also outlined:
Alternative 1: Focusing on the preexisting cultural congruence of current Western methods. Rather than exporting psychological interventions based on Western evidence, identify what interventions are already most consistent with local cultural beliefs, avoiding the need to “convince” the culture of intervention efficacy. This approach should only be applied if locals determine indigenous healing methods as lacking.
Alternative 2: Collaboration with traditional healers as equals. This approach follows that “individuals will likely be best served by the integration of Western and indigenous methods in either a “common factors” or technical eclecticism manner…a fully cooperative model…blended into a well-integrated hybrid service.”
Alternative 3: Using traditional healers to provide culturally congruent psychological interventions. Traditional local healers incorporate and employ culturally appropriate psychotherapeutic interventions into indigenous healing practices, an approach that would require “scanning hundreds of bona fide counseling and psychotherapy approaches to see which ones are already most consistent with a particular culture and extrapolating its explanations and interventions to supplement not supplant local indigenous healing practices.”
Future research would be necessary to implement these alternatives. Bedi recommends research that assesses the discrepancy between those who strongly ethnically identify as un-Western with more Western-acculturated individuals to test treatment outcomes. Furthermore, conducting outcomes studies of various psychotherapeutic approaches throughout multiple countries is relevant to determine if outcomes shift when a country’s popular beliefs are disparate with the conceptual underpinnings of the approach.
Finally, Bedi encourages research that would test whether Western groups do better with counseling/psychotherapy and non-Western groups do better with their culturally congruent indigenous healing practice for the same issue under examination. However, this research is complicated by the issue of “how to decide a particular issue is commensurate if it is conceptualized differently by the two groups; that is the ‘issue’ should not be wholly defined in Western terms and through Western ideology necessarily.”
Bedi concludes clarifying that he is not suggesting one approach as inferior or superior to another in some universal capacity, but rather that “context matters considerably.” Further, his article is not meant as “blanket denouncement of the humble sharing of Western psychological knowledge,” but supports careful deliberation and consideration of appropriate healing approaches. Ultimately, Bedi, whose research largely focuses on cross-cultural and multi-cultural counseling, brings a focus to the intricacy of understanding mental distress, especially across cultures:
“As complicated as the question is when considering the disparate epistemologies, ontologies of mental distress (e.g. biomedical, spiritual supernatural, magical), and goals of intervention (transformative/growth vs. restorative/symptom removal) adopted in various cultures in various parts of the world, indigenous healing methods for overcoming impairing mental distress (what we would usually term “mental disorders” in the West) have been repeatedly found to be effective. An obstacle lies in who has the highest authority to determine the rules for establishing effectiveness.”
Bedi, R. P. (2018). Racial, ethnic, cultural, and national disparities in counseling and psychotherapy outcome are inevitable but eliminating global mental health disparities with indigenous healing is not. Archives of Scientific Psychology, 6(1), 96-104. http://dx.doi.org/10.1037/arc0000047 (Link)
To understand the cultural issues of the export of psychiatry abroad, you can read Georges Devereux, or more simply, see the movie: “Jimmy P.” which traces the history of a Psychotherapy of a Plains Indian by Georges Devereux.
A lot of the people in the West that do Recover seem to borrow the means of Recovery from Non Western parts of the Globe. So maybe the West should only try to Learn from the Non Western Parts of the Globe.
And how do you suppose our psychiatric mavens will react to the ritual use of hallucinogens in tribal healing ceremonies?
In the MK-Ultra manner.
They are going to get rid of all that tribal stuff.
“To achieve world government, it is necessary to remove from the minds of men their individualism, loyalty to family tradition, national patriotism, and religious dogmas.” “We have swallowed all manner of poisonous certainties fed us by our parents, our Sunday and day school teachers, our politicians, our priests….The reinterpretation and eventual eradication of the concept of right and wrong which has been the basis of child training, the substitution of intelligent and rational thinking for faith in the certainties of old people, these are the belated objectives …for charting the changes in human behavior.” Brock Chisholm, 1959 Humanist of the Year and former head of World Health Organization, in the February 1946 issue of Psychiatry http://www.spingola.com/new_world_order5.htm ”
“World mental health” Psychiatry is a behavior control system, they have been working to make it global for a long time now.
Brock Chishom’s goals are a description of how to destroy humanity. And destroying lives is exactly what psychiatrists have been doing in Western civilization for decades, and have done in country after country throughout history. Remember the Nazi psychiatric holocaust?
Drug up everyone who believes in God and is “insightful” enough to know never ending wars waged by our government (political abuse of psychiatry) are a bad idea. Defame the patients to their spouses with your “invalid” disorders, so you may destroy their marriages and families. That’s Western civilization’s psychiatric MO today, so absolutely this psychiatric destruction of humanity should NOT be exported to other countries.
This article is overtly about psychology, however, not psychiatry. But since today’s psychologists believe in the psychiatric DSM, they just railroad people off to be drugged up by the psychiatrists, rather than providing any of the benefits claimed to exist by psychotherapists. Thus, today’s psychological paradigm is just an extension of, as opposed to being something different from, today’s mass poisoning psychiatric paradigm.
And given this takeover of today’s psychological theology, by the bio-bio-bio believing DSM psychiatric theology, I don’t think that “culturally competent psychotherapy practices to address mental health disparities” actually exist.
And, let’s be real, both historically and today the number one actual function of both the psychological and psychiatric industries is misdiagnosing people to cover up rape and abuse of children.
And all these psychological and psychiatric misdiagnoses of child abuse survivors, which aids, abets, and empowers the child rapists and traffickers, has not boded well for Western civilization, even according to world leaders.
I’m quite certain exporting America’s multibillion dollar, iatrogenic illness creating, primarily child abuse covering up, “mental health” system to the rest of the world is a very bad idea. Since it’s proven to be a monumental, and criminal child abuse covering up, failure in Western civilization already.
The World Health Organization (WHO) sponsored major studies comparing how people recover in poor and more developed nations. The people in the poorer developing nations, on average, recovered at a far higher rate. Here is information about those studies. MindFreedom asked Professor Norman Sartorius to briefly summarize these studies, which he was directly involved in leading. The views expressed are those of Dr. Sartorius. http://www.mindfreedom.org/kb/mental-health-global/sartorius-on-who
You are better off having a “psychotic” episode in Nigeria than in the U.S. Why? Because third-world countries have better recovery rates for so-called “schizophrenia” than the United States and other industrialized nations that keep their psychiatric patients “maintained” on the drugs. In the United States, one “psychotic” episode will almost always land you in psychiatric wasteland for the rest of your life. It is psychiatry itself that created the “chronicity” in so-called “mental illness”.
In order to combat “cross-cultural mental health disparities” we have to move in and screw up the people in the rest of the world the same way we screwed ourselves with psychiatry.
Lets call it what it is, psycho-pharmaceutical colonialism.
Even though I came off psychiatric drugs very carefully I was still racked with Severe Anxiety. Learning how to deal with this, is why I never ended up back in the Psychiatric System.
The only solution I know that works for Severe Anxiety i.e. “Letting Go”, can be found in Buddhism the 12 Step and other non mainstream therapies.
WHO: I’ve known people from “3rd world countries” with family members that go mad, and they do Recover completely and get back to their Responsible lives again. But they often go mad again at a later date (and recover again).
“Lets call it what it is, psycho-pharmaceutical colonialism.”
Exactly. The Japanese culture never had a word in their language for “depression”. They did appreciate sadness and the things in life that can cause us to be sad. This is why they have an entire historical period in which there was a large emphasis for the appreciation of even the smallest things in life because life is oftentimes difficult and short. I may be wrong but I want to say it was the Edo period. This period and its philosophy was responsible for some of the greatest art and literature ever produced ty the Japanese people.
And then the Western drug companies and Western psychiatry saw a lucrative new place to, as you call it so aptly, colonize and they sent their front men into Japan. In the end they were very successful in convincing the Japanese people that depression was real and that it’s an illness that you need to be drugged for. So, psychiatry and the drug companies are not only destroying countless lives, they are responsible for the destruction of a culture, society, and philosophy. The philosophy worked very well for Japanese society until the system got its hands on everything. It’s disgusting.
Maybe Zen doesn’t work for everyone, but how many people do we read about on MIA that have recovered through this or similar methods.
Are recovery rates better in Western countries so much so that we feel the need to “save” other cultures with our ideas? Is labeling specific disorders really working so well for us? I would definitely look at the numbers before you try to “improve” the situation. How pharmaceutical companies exported the idea of depression to Japan was one of the most horrific things I ever read.
Recovery rates in industrialized countries are worse than in the developing world.
Lewis Mehl-Madrona’s work is very good on this. He is Cherokee-Lakota-European and an M.D., certified I think in psychiatry, gerontology, and family medicine. His book “Healing the Mind through the Power of Story” is especially good.
There’s lots to say about his approach, but there are two things I’ve heard him say that I especially like. “In indigenous cultures, we assume that if a person has psychic distress it means something is wrong in the community and that person should be respected and listened to carefully.” (That’s a paraphrase) And (joking): “Psychiatry is the only profession in which the customer is always wrong.” Just a lovely man with a lot to offer.
I love both quotes!
This is interesting because I believe that the Open Dialog movement in Finland works on the same principle, that when a person shows distress it indicates that there is something not right in the family/friend system.
Just how, exactly, is a Shaman who interacts with the spirit world AND a western atheistic, closed minded skeptic doctor ever going to work together and view each other as “equals”? That’s a pipe dream if you ask me. I have tried to develop and integrate my spiritual perceptions and experiences with those from the medical model and skeptics and the results are always the same — no progress. These people are not amendable, no matter how much you compromise with them. Its like describing the color red to a blind person, they have no experience with it and they just think your mentally ill. I agree with another post, keep your creepy, analytical, spiritually dead crap out of the developing world, hasn’t the west done enough damage there already?