Decolonizing Global Mental Health through Jamaican Psychiatry

Jamaican psychiatry has made considerable contributions to the decolonization of Global Mental Health in the Caribbean.

Ashley Bobak, MS
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The primary mental health care program of Jamaica has critiqued and taken leaps toward decolonizing Global Mental Health (GMH) care in the service of attempting to address the impact that centuries of European racism and colonialism have had on the descendants of enslaved African peoples.

Significant changes made to the system include the downsizing and deconstruction of colonial mental institutions, implementation of community mental health services, treating acute psychosis in open medical wards in general hospitals, and developing a diversion program for those struggling with mental health issues involved with the legal system. These improvements have led to several positive developments, including an uncovering of social psychopathology attributed to 500 years of oppression, racism, and colonization, which in turn has resulted in the development of primary prevention therapeutic programs.

“The soul murder of abuse and deprivation, linked to the history of slavery and colonialism, is the origin of the conflict and stress, tension, anger, anxiety, sadness, and despair that characterize the postcolonial experience. My experience as a third-generation African Caribbean psychiatrist has given me insight into this intergenerational process and led to the conviction that we all have to own our madness,” writes Frederick W. Hickling, Executive Director of the Caribbean Institute of Mental Health and Substance Abuse (CARIMENSA) at the University of West Indies.

Frederick W. Hickling ais a Professor Emeritus of Psychiatry at the University of the West Indies, and is the Executive Director of the Caribbean Institute of Mental Health and Substance Abuse (CARIMENSA) UWI, Mona.

European colonization and slavery in the Caribbean influenced mental health treatment in the region. Traditional, Indigenous methods of communal care were thrown out and replaced with cruel and dehumanizing European approaches to mental health care, which included, and continue to include, tactics such as involuntary commitment and detention of those diagnosed with acute psychiatric issues. Hickling recounts the history of British colonial imposition of institutionalized care in the Caribbean, and reflects how, from the perspective of descendants of African slaves, the institutionalization of the mentally ill is merely an “extension of slavery.”

In the early 20th century, the tides began to shift as black psychiatrists trained in North America and the United Kingdom began replacing white colonial administrators, and introduced treatment approaches such as social work, psychotropic medications, and outpatient care. Following Jamaican Independence in 1962, the Jamaican Government began the process of deinstitutionalizing the only asylum in the nation, Bellevue Mental Hospital.

The Jamaican Government created the National Mental Health Program in 1964, and a psychiatry training program was developed in 1965. The influx of mental health practitioners as a result of this program paved the way for new and innovative postcolonial approaches to understanding and addressing Caribbean mental health. Hickling writes:

“The mental health challenge for descendants of African people enslaved in Jamaica in this time has been to negate the psychology of 500 years of racism and colonial oppression, and to create psychosocial decolonization for GMH, which has involved several key steps. . .”

Hickling begins by pointing to the deinstitutionalization of the Bellevue Mental Hospital as the first step. The hospital has been downsized significantly over 50 years, with a population reduction of 87% between 1960 and 2015. The plan is to ultimately close the hospital entirely.

In addition, a new treatment approach, psycho-historiographic cultural therapy, established at the hospital, combines historiography with oral tradition and has provided patients with the opportunity to share their stories in such a way that allows for an exploration of collective experience, as well as moves to identify social forces and group dynamics that can allow for change.

For example, a cultural therapy program initiated at the hospital led to the creation of sociodramas acted out by patients and staff, which depict the history of psychiatry and mental health in Jamaica. These plays were performed for the local community, and led to new community perceptions and understandings of mental health, reducing the stigma associated with mental illness.

According to Hickling, “Psychohistoriographic analysis proposed the concept of the European-American psychosis, which refers to the 500-year collective delusion of European world ownership and white supremacy based on Divine Right.”

He highlights modern-day, “American Psychosis,” best exemplified in the election and presidency of Donald Trump. He also discusses how the concept of collective neurosis can enable recognition of these delusions, which have perpetuated violence upon those deemed “different.” This, in turn, opens the possibility for the development and application of postcolonial strategies to refute these delusions.

Further, a Community Mental Health Service was put in place into primary and secondary health care services in Jamaica as a result of new mental health care legislation passed in 1974 and 1998. Community mental health care provides an alternative to institutionalization, and the initiative is grounded in the anti-psychiatry movement, in that it critiques institutionalization, the coercive and hierarchical relationship between psychiatrist and patient, and the pathologizing of social issues.

Individuals called Mental Health Officers (MHOs) provided in-home and community treatment in a cost-efficient and culturally congruent manner. This advancement in the mental health care system had positive results – within the first two years of implementation, there was a 52% reduction in admissions at the Bellevue Mental Hospital.

Other developments include the treatment of acute psychosis on open wards in general hospitals, and the implementation of the Diversion at the Point of Arrest Programme (DAPA), which provides an alternative to prison for those struggling with mental illness involved with law enforcement.

The overhaul of mental health care has brought along with it a significant number of benefits, including the reduction of stigma in Jamaica. Additionally, mental health care has become more integrated with general medicine, and there has been a significant rise in the number of mental health practitioners, as well as general practitioners trained in mental health care.

Further, postcolonial approaches to addressing mental health issues have resulted in the uncovering of social psychopathologies, such as violence, child abuse, and family fragmentation. Importantly, this social psychopathology has been understood as being grounded in 500 years of slavery and colonialism in Jamaica. This, of course, points to the desperate need for postcolonial approaches to address these issues.

Changes in the Jamaican mental health care system have also led to the development of primary prevention programs. For example, the Caribbean Institute of Mental Health and Substance Abuse (CARIMENSA) was developed by the University of the West Indies in 2005 as a preventative approach to mental health issues in Jamaica and the Caribbean. CARIMENSA created the Dream-A-World Cultural Therapy and Cultural Resilience therapy programs to address behavioral and overachievement issues in children residing in at-risk Jamaican communities. Both programs use “group and play therapy, social skills training, remedial assistance, and nutritional enhancement,” in addition to using creative arts techniques to improve “academic performance and pro-social skills.”

Jamaican psychiatry’s contributions to the decolonization of GMH have resulted in a move toward treatment that is humanizing and grounded in the cultural context. These contributions have also allowed for a more in-depth exploration of both individual and social psychopathology.

They offer an alternative to Western biomedical psychiatric models and provide a way of understanding that negates the predominant narrative of white supremacy. They allow for understandings and treatment of mental health that this grounded in empowering marginalized voices and moving towards undoing centuries of colonialist racism and oppression.

 

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Hickling, F. W. (2019) Owning our madness: Contributions of Jamaican psychiatry to decolonizing Global Mental Health. Transcultural Psychiatry, 0(0), 1-13. (Link)

14 COMMENTS

  1. “the institutionalization of the mentally ill is merely an ‘extension of slavery.’” I’m pretty certain this is how most psychiatric survivors feel, not just the “descendants of African slaves.” I’m pretty certain the head of the APA is also having difficulty garnering insight into the fact that most psych survivors equate forced psychiatric treatment as a form of slavery, not just black people.

    “Further, postcolonial approaches to addressing mental health issues have resulted in the uncovering of social psychopathologies, such as violence, child abuse, and family fragmentation.” Does this mean that profiteering off of covering up child abuse, and destroying families, is NOT the number one actual societal function of the psychiatrists in Jamaica, as it is in the US mainland?

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

    “CARIMENSA created the Dream-A-World Cultural Therapy and Cultural Resilience therapy programs to address behavioral and overachievement issues in children residing in at-risk Jamaican communities.” Why do the “mental health” workers believe that “overachievement” is a problem? It should be considered a good thing.

    Definitely, alternatives to Western biomedical psychiatric models are needed. But since the psychiatrists and psychologists are attacking both white and black people, not just black people. I’m not sure it’s appropriate to claim psychiatry and psychology are inherently ‘white supremacist.’ Although, I do concede, when drapetomania was a DSM disorder, the psychologists and psychiatrists were “white supremacists.”

    I think, given the huge percentages of child abuse and rape survivors mislabeled with the DSM disorders, and this is by DSM design.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1
    https://www.theguardian.com/lifeandstyle/2019/mar/27/are-sexual-abuse-victims-being-diagnosed-with-a-mental-disorder-they-dont-have

    It’s more appropriate to label the psychologists and psychiatrists as child abuse and rape cover uppers, haters of child abuse and rape survivors (since they can’t bill to help them), or pedophile aiders, abetters, and empowerers, than the larger, overused term, “white supremacist.”

  2. “He highlights modern-day, “American Psychosis,” best exemplified in the election and presidency of Donald Trump. He also discusses how the concept of collective neurosis can enable recognition of these delusions, which have perpetuated violence upon those deemed “different.” This, in turn, opens the possibility for the development and application of postcolonial strategies to refute these delusions.”

    You guys like my new red cap? “Make America Psychotic Again” lol.

    “Community mental health care provides an alternative to institutionalization, and the initiative is grounded in the anti-psychiatry movement, in that it critiques institutionalization, the coercive and hierarchical relationship between psychiatrist and patient, and the pathologizing of social issues.”

    I’d question this statement also. Community Mental Health care is prison without bars, an abuse of human rights, and if anyone cares to go through it with me is resulting in some of the most vile conduct i’ve ever witnessed. The home delivery of drugs with police, and the constant threat of being incarcerated (in a place where your highly likely to be subjected to further abuses) because you haven’t done your dishes like the nice Community Nurse wants. And the authorities charged with protecting the community ignoring the very laws put in place to protect because Pappa (Community Nurse) knows best. I don’t believe that ‘anti psychiatrists’ would claim a victory for this metamorphosis of abuse from psychiatry. Perhaps the reformists/apologists may claim it a victory?

  3. Unfortunately – as Boans has pointed out – neuroleptics are part of the Jamaican model of mental health care. In his article, Prof. Hickling quotes an author who writes that (compared to Britain) in Jamaica:

    “There seems to be a much greater willingness on the part of families and neighbors to cooperate with the services,locate people when they need help and make sure they take their medicine. It’s accepted as part of the community’s responsibility”. (one can download the whole article for free here: http://sci-hub.tw/http://doi.org/10.1177%2F1363461519893142).

    So making sure that patients take their “meds” is, sadly, part of this model – and Prof. Hickling clearly has no problem with it…

      • Amen!

        The “medicine” drives sane people nuts and ensures people going through a rough patch never come out of it.

        It makes me so angry how they lie to well meaning family and neighbors to cripple people and turn functional people into hopeless lunatics/village idiots. That’s what psychiatric “treatments” do after all.

        I remember Mom and Dad crying and getting upset at how my “treatments” weren’t helping me as I took them religiously. They had no positive effects except when I took 10 mg of Haldol and could no longer voice my misery though I seized every day.

        When I say the treatments don’t “work” I mean as the shrinks promised. Helping us to lead meaningful, productive lives and get along with others.

        They don’t work for any of the above. Nor do they prevent crime nor suicide.

        The only way psychiatric treatments successfully work is at making shrinks and pharmaceutical makers filthy rich and providing the former a professional status no legitimate doctors enjoy–along with unquestioned legal powers.

  4. Another quote from the article (page 10): “The Jamaican contribution to GMH incorporates the evidence-based Western biomedical psychiatric models but adds to them our decolonization experience of the 50-year post independence comprehension from colonial Britain.” So the Jamaican model does NOT reject the biopsychiatric approach…

      • If you can’t blind them with science, baffle them with bulls*it.

        By the time you have checked the claim of evidence based, the thief has been through your belongings and is heading to the pawn shop with your jewellry.

        Our politicians here make these types of false claims all the time. 85% of the community wants these Euthanasia laws (but were not going to allow the community to vote on it, or provide you with any evidence to support that claim of 85%. You will have to trust us). More people want the death penalty so I look forward to that legislation being rushed through before an election.

        I’ve also heard ‘verballing’ being called ‘noble corruption’. Tell that to the people who have served 12 years in prison for something they didn’t do, and all because some police officer knew their corrupt conduct would receive support from their superiors and the courts.

        And let me say after receiving a letter from a police superintendent who refuses to accept ‘evidence’/proof of serious criminal offences I do not put much faith in what they claim to be evidence based. Turning people away who have inconvenient truths does not make for sound decisions in our courts, in fact it is possibly the very essence of corruption. However when you have falsehoods to maintain the truth can be very inconvenient.

        And they wonder why they have the reputation they do? We had a police officer sharing a pornographic image of a woman she had photographed (revenge porn) telling the court she would not lie because she was a police officer (evidence based of course). She did not delete the image and was sharing it with other officers because she didn’t want anyone to think she was deleting ‘evidence’. Funny but they can send me away with documents proving I was spiked with benzos becuase their is “insufficient evidence” (like 5 witnesses and documents stating when and where it was done). Frauds and slanderers who are providing material support for criminals via their own criminal negligence.

  5. So Dr. Hickling is worried. HE knows what’s best for those “psychotic” Jamaicans who don’t know any better and are afraid to come to people like him for help because they associate his institution with the master/slave relationship.

    How is Dr. Hickling any different? There’s the real question.

    “Those ignorant, potentially dangerous, mentally incompetent defectives need a White Knight to take care of them.” That sums up all Western “mental health” in a nutshell.

    The symbols for psychiatry since the Industrial era have been whips and chains. Traditional treatments of all written off as hopelessly mad. A casual perusal of Victorian Gothic literature will furnish plenty of references.

    Then shrinks realized scars from lashings and and chain cuffs made their profession look brutal. So they figured out new ways to torture and harm without leaving any visible marks.

  6. Funny how these very shrinks who condemn Donald Trump and want to “diagnose” him are more than happy to curry favor and kiss up to him when it serves their purposes. Such as siphoning more tax dollars to open new AOT programs to indirectly sell more drugs and psycho surgeries or open a franchise of lunatic asylums.

    Dr. Drew, Dr. Torrey, etc. What a bunch of back-stabbing phonies! As all of us who have had dealings with this profession know.

    Biederman went on the air saying it was an insult to “bipolars” to call Donald Trump one. Before you applaud him too hard remember he called Trump worse than Hitler too.

    So definitely not a complement to anyone he labels. More like a back handed insult. I guess Biederman gave up hope of cashing in on the mass shootings like others have done.

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