Elisa Lacerda-Vandenborn is a professor at Werklund School of Education at the University of Calgary, Canada. As a non-Indigenous scholar, she is currently part of several national and international research projects examining education in indigenous communities and the decolonization of mental health. Her writings explore alternate ways of understanding human suffering, challenge the dominant psychiatric worldview, and critique the Euro-American understandings of distress and disease.

Her interests include understanding different ideas of self, especially in indigenous communities, and how our ignorance about these differences harms people we say we are healing.

Lacerda-Vandenborn notes that “Psychology is not a very reflective discipline.” This is a conversation about lost indigenous children, psychology’s blind spots, and how we can address these concerns with epistemic humility.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Ayurdhi Dhar: Dr. Vandenborn, welcome. Could you tell us about your work on the decolonization of mental health? How did you become interested in it? Did you find something missing in the way Psychology was being practiced?

Elisa Lacerda-Vandenborn: I would like to start with a territorial acknowledgment of where I am. I am currently in Calgary; the indigenous name is Mohkínstsis. I am working in the traditional territories of the people of Treaty 7 region in Southern Alberta, which includes the Blackfoot Confederacy of the Siksika, Kainai, and Pikani first nations, also the Tsuutʼina first nations and the Stoney Nakoda, which includes the Chiniki, Bearspaw, Chiniki, and Wesley first nations. Mohkínstsis is also the homeland of the Métis Nation of Alberta region three.

Decolonization is a process of correcting the oppressions that have been imposed on indigenous peoples — dismantling the structural, ideological, historical, and cultural beliefs, practices, and values that have cost indigenous lives, wellbeing, resources, culture, land, families, and communities. In terms of mental health, it is about rethinking how our Euro-centric practices have contributed to indigenous peoples’ suffering and continuous colonization.

We can challenge the single view that permeates our practices in mainstream psychology, such as the over-reliance on a biomedical model — defining health and mental health as the absence of illness or disorder. Rather we think of individuals as holistic beings where mental health is only one aspect of emotional, spiritual, and physical health. These are not in isolation, but they are intertwined to a sense of place, to land, to the teachings of the land, to ancestral teachings, and to a sense of the history of that particular community.

About how I got into this. These things have a way of finding us. I became attuned to it after being a newcomer to Canada 18 years ago when I felt that I lost a lot. I remember being in my undergraduate years with 35,000 students and feeling the most alone I could feel. There was a profound sense of loss of community, loss of not being myself through language, and being in the space where I was the odd one out.

When I sought counseling, all of this got located in my inability to cope and low self-esteem. I thought it was quite interesting because I was really mourning the sense of having a big family, my cultural references, ways of being, and it was being located within me. I thought that there was much more to the story that wasn’t making it into the office. I thought there had to be another way of thinking about this, and I’m glad that I resisted that approach and assessment. That misalignment made me research concepts of selfhood.

 

Dhar: We often portray indigenous communities as deficient and suggest that they do not access mental health services because of stigma, but we don’t look at how the services offered can harm. People can get caught up in the narrative of “it’s a self-esteem problem within me.” You talk about these Euro-American values in Psy-disciplines, and when we export them to non-Euro-American populations, there is this disconnect. Have you seen cases where there was an effort to put these one-size-fits-all services on people?

Lacerda-Vandenborn: Unfortunately, there are plenty of examples of that. For example, the child welfare system has a very individualistic lens. We take these intricate family systems and intervene in a way that really detaches them from themselves and their context.

It’s not uncommon to take families going through complex situations and treat them individually and ignore the larger context. For example, a family experiencing domestic violence — if the mom seeks any support, she is then analyzed as being someone that either has the strength to cope or not. We look at children separately. When families access social services, they are literally placed in different branches. We often end up with children in care. Psychology is intertwined in this process because the intake, the assessments of the mental health of children and of the mom, are provided from a psychological apparatus.

We treat individuals separately and create this big problem where children are placed in care, and the chances of mom actually getting children back, drop by 85%. So, you instantly create more harm when you don’t look at families as systems and their context such as poverty, lack of access, social support, afterschool care. We take something with so many social references and simply attribute the problem to the coping mechanisms of the mom. We are intervening and separating mom from a child over the perceived notion of risk attributed from a Euro-centric perspective.

 

Dhar: A big relational and systemic problem is reduced to “the mother is narcissistic” or “co-dependent” — these psychological terms that individualize problems?

Lacerda-Vandenborn: Codependency is used a lot, and major depression, or a mother being too anxious or that the child’s socio-emotional needs are not being met. These things serve as a justification for cases where the custody can be removed, but little attention is paid to the fact that mom is deeply in need of support. Our system has this built-in adversarial approach, particularly in family relations where we need someone who stands as the perpetrator and someone as the victim. There is very little room for the family’s needs in the context of the community.

 

Dhar: If you had to pick one thing that the current mainstream mental health system completely ignores or lacks, what would it be?

Lacerda-Vandenborn: Folks are very comfortable continuing their practices as they have been, even though there is a sense that those looking for mental health support are not getting everything they need. People may feel hopeless about “what I can offer it’s not enough.” There is a sense of exhaustion about engaging in deep work to find where our approach, assumptions, and concepts are coming from. Do you think you really addressed the needs of those who are non-white, from lower socio-economic status? We are still quite comfortable refraining from problematizing where we stand, even though we know it’s not quite working out.

We may lack the entry points for this discussion. Universities have a very large role to play here because I believe it’s lacking in our educational system. I was lucky enough to be in theoretical psychology, questioning how we conceptualize things. What are the tools, where did those tools come from? What are the ethics of these approaches? We fast forward to diagnosis, assessment, naming. What’s missing is the relational piece.

That’s where social justice really comes in because we need to attend to our positionality and our intersectionality every time we enter a particular office. We like to think we are all humans, and that’s one aspect of it, but there is power; the analysis of that power is missing.

We keep spinning our wheels because we’re desperately trying to change the practical end of things, but if we don’t revisit our philosophical traditions and theoretical assumptions, it will be an exercise of frustration. That’s why those on the frontline feel the exhaustion because they see practice being changed over and over.

 

Dhar: The cultural competence idea can be a Band-Aid solution. You have done your research with community-led family group conferencing. Could you say more about this?

Lacerda-Vandenborn: Family Group Conferencing (FGC) is an approach that came from the Māori in New Zealand. This is an intervention with a much larger understanding of family, the concept of whānau. We understand that our uncles, aunties, and grandparents are part of the clan. They have a role and a responsibility in childbirth, child development, and rearing. Everybody has a responsibility to this child. I paid attention to its use in child welfare with an organization in Winnipeg, Manitoba, called Ma Mawi Wi Chi Itata. This is a grandmother organization that has been working with FGC since 2000.

In this program, once a child has been flagged in the child welfare systems, where a family is identified as at risk, instead of blaming mom and dad for their difficulties, the practice is to bring everybody important in that child’s life together. With indigenous communities, the main category of involvement in child welfare is neglect, which is intimately connected with poverty. So, we bring all of the important people in this child’s life and ask, “What is the support that you need to be the best parent that you can be? How can we be a support?” Because we all have a responsibility to this child and family, we are all part of this.

In the mainstream system, families are seen as the focus of deficit. In this program, you give agency back to the family to say, “You will create the plan. These are some of the concerns, but it’s up to you to create a plan that is sustainable, that addresses your needs.” These are relational needs, mental health needs, housing needs, employment needs, support with nutrition, etc. We say, “if these are your needs, this is what we can offer.”

Instead of a family going from place to place to find the services they need, everybody is in the room, and everybody commits to the well-being of this child. In this program, unlike the national average in Canada’s child welfare assistance, where the reunification rate is 15%, this program unifies 80% of the families without reentries into the system. We put the well-being of the families on the families; they are the experts of their lives, their relationships — they know their needs. So, instead of the child welfare system imposing rules that ignore the context of the family, we listen and then we intervene.

The mentors are actually part of the community, so they’re not psychologists. They have experience of what it feels like to be in a place where discrimination is part of your daily life. People lack support and often move away from their communities to access services in a bigger center such as Winnipeg. When they do, they lose a lot of their community and support.

So, it’s about placing agency and loving, and I know this is a very unpopular word in psychology, but how do you love families back to life? But with accountability — holding people accountable to the child, but in the process healing everybody. So, elders are involved as knowledge keepers — our reconnection to traditional teachings, ceremonies, and language. It was stripped away with colonization.

 

Dhar: In rural parts of Northern India, to cure any problem, mental or financial, people often say, “You have to get everyone together. You have to come back here to the ancestral land with your whole family and village.” That reminds me of reports from the Rwandan genocide when psychologists went in afterward to cure trauma. The people there asked, why would you want to put us in dingy rooms and make us talk about the very worst thing that happened to us? You said we often impose values on indigenous communities. Can you think of an example of this kind of imposition in the way we intervene?

Lacerda-Vandenborn: You’d be hard-pressed to find people who would speak openly about this and say this is why we are removing this particular child. There is always a way of justifying. For example, it’s not uncommon in indigenous communities for families to take care of each other and for the kids to be in the community. Maybe the parent is not in the same room or even in the home, but you always have neighbors and aunties check-in. But if a social worker would arrive at a home and the parent is not present, this is grounds for children being removed because there is no adult supervision.

That is a particular lens of what parenting looks like, that you have to be physically present, but in these smaller communities, there is a different kind of understanding. These values are imposed. If things don’t align with Western values and something happens, then all of that is used against you. We see this in interventions, for example, a social worker walking into a home and looking into the cabinets. If there is no fruit in the cabinet, they say, “you’re unable to provide the needs,” but the mom and dad are also hungry.

Or for example, in indigenous communities, we have a chronic problem of lacking proper housing, overcrowding. This is a treaty responsibility of the federal government, but the government has been failing indigenous communities for decades and has not been honoring treaties for centuries. Yet, the onus is on indigenous peoples to make it work with lack of access to potable water, housing, medical care, unemployment, and school. But if a social worker or a psychologist would walk into a community, the tools that are available to them is to individualize problems. The tools are not sensitive to the context.

Psychology is not a very reflective discipline. Nikolas Rose said in your interview that Psychology has the tendency of saying yes to solving every problem. That’s an issue because we don’t recognize that our mainstream knowledge is oblivious to context.

In the context of indigenous peoples, Psychology is not equipped or willing to admit that colonization continues in many ways — that our children and family are living in poverty, that every aspect of treaty rights are being violated, that we are dealing with the aftermath of assimilationist policy. All we are equipped to do is to describe, diagnose, and intervene with medication.

 

Dhar: With the African American communities in the US, one of the most commonly overused diagnoses is schizophrenia. Have you seen certain psychological concepts or diagnoses that are overused with indigenous communities?

Lacerda-Vandenborn: Oppositional defiance disorder is commonly used in child welfare, then ADHD and fetal alcohol syndrome disorder are used as a diagnosis, and often a misdiagnosis.

There was this young boy whose story really impacted me in looking at how Psychology is intervening. I met this boy in a brief encounter with a friend. This seven-year-old boy was in his 17th home in the system, and he would arrive in daycare absolutely drugged. My friend said, “There’s nothing I can do. The social worker requires me to give him the medication.” This child was taking five different psychotropic medications to make his behavior manageable and had a host of diagnoses. That was such a shock coming from a collective culture where I understand family and community as having a fundamental role.

I didn’t know about the absolutely devastating statistics of indigenous children in care; this situation was the norm. In Manitoba, 90% of children in care are indigenous. We are removing children from their homes and not taking into account the profound impact of disadvantage. Children bounce from placement to placement, even in the US and other countries.

We keep intervening individually, and there is very little in terms of support. So, diagnosis becomes the intervention, but it does very little to help. That’s the role that universities can play. What is being enacted in legislation is not coming out of the government, it’s coming out of expert knowledge, and we are complicit in this process.

 

Dhar: There is a global conversation around indigenous communities and the restoration of justice, but the fear is that the political issues might get co-opted by psychological ones. Dian Million, an American studies scholar, writes about people wanting land and water resources while we offer them talk therapy and point to psychological trauma. What have you seen?

Lacerda-Vandenborn: I’m glad that you brought that up because this is a concern for those of us who are not in that position of a particular community; we have the privilege to step in and out of it. It requires us to be in that place of self-analysis constantly. Are we going to keep doing the superficial things, or are we ready to engage in this deep positionality analysis and transformative work of decolonizing ourselves first? It’s a position of continuous epistemic humility. Are we doing our homework and trying to understand the experience of this particular community so that we don’t co-opt things, so we don’t appropriate wisdom or knowledge, or have a partial understanding, where we sanitize things that will fit our way of doing things?

In Canada alone, we have over 600 first nations, but we talk about indigenous peoples as though their values are similar across the board. Same in Brazil. And the position that we should adopt should also be different. Are the folks that actually have the knowledge at decision-making tables? Are they saying what they need? Our job is to listen to engage in decolonization ethically. As Dr. Cindy Blackstock has said, “indigenous children have been overrun by good intentions.”

 

Dhar: Often, indigenous treatments in mental health are still measured and evaluated using standard methodologies like randomized control trials. What would indigenous research methodology look like? How might they define knowledge and evaluate good treatment?

Lacerda-Vandenborn: In the spirit of not speaking for indigenous people, I’m going to orient our listeners to the profoundly sophisticated body of knowledge that looks at decolonizing research methodology.

One of the things that have remained consistent across many approaches is the honoring of knowledge in relation. It’s understanding that selves are in relation. How can we do research that individualizes, reduces, internalizes, and strips away the relationships? A lot of indigenous research is about that. It’s about understanding how things are happening in relation to one another.

Qualitative approaches and story-work are examples. It’s a mistake to say that indigenous research methodologies do not involve the quantitative, but that follows after we have a very robust understanding of the relationship. Understanding the research and methodology as a reciprocal process where we bring our gifts and the community shares theirs. We don’t just go with the questions; we are part of the community. Once a particular project ends, your ethical connection to that community is not over. You have a commitment.

 

Dhar: What would it look like if we moved mental health work towards a relational or communal idea of self?

Lacerda-Vandenborn: A young single mom struggled with postpartum depression and having a child, feeling that she had very little support in a condition of poverty, and substance misuse became a problem. Once this mom came into this organization to seek support, the process with a communal understanding of self is that if you’re hurting, we are here for you. It sounds very unscientific, but it’s a wrap-around intervention where this mother is not understood by the difficulties she’s having, but rather the strains she is under in raising a child on her own.

When we move from an individualistic lens to a communal lens, we broaden the horizons of the kinds of services that we can provide. Instead of locating the problem in the person and saying, “This is your inability to cope,” we say, “How can we as a community help to strengthen you in this position.” Instead of diagnosing first, offer support, and if need be, we come to a diagnosis. We shift the dynamic from deficit to strength. It’s connecting with people where they are.

 

****

MIA Reports are supported, in part, by a grant from the Open Society Foundations

2 COMMENTS

  1. Having worked with Indigenous people in Calgary, I can say that I do agree with much of what Ayurdhi has presented. Where I disagree (and she might actually agree) is that I don’t think she takes her argument far enough. Reality is, that today Indigenous Communities are in many ways healthier than the surrounding “White” communities. Appearances are deceiving.

    The Non-Indigenous in Calgary are living on borrowed time. There is no sense of community, and what is good for all of us at the leadership level. As a result we are eating our selves alive. Just try and interact with Calgary City Council to get any issue resolved. You will likely become aware that the Council is so busy playing Power Games, that what is good for Calgary’s Citizens is lost completely.

    When one tries to access Alberta Health Services for help for non-indigenous people what is obvious is that the services provided work for no-one.

    However, when one interacts with Indigenous Tribes you are aware of incredible disfunction, but you also become conscious of places of health as well. That is where I find hope for a positive future

  2. I think a lot of the new speak on culture is supposed to make the “treating teams”, the “treating persons” sound politically woke.

    It really is a popularity game and one which many indigenous peoples find insulting.
    Because no, one cannot be “aware”.

    And it keeps focusing on keeping “their” “issues” alive, despite being culturally “aware” being a well intended, albeit ignorant.

    Everyone has a culture. All those ukranians, jewish, mennonites or what have you. Every “immigrant” has a history.

    We should be much more concerned with being people aware, and not focus on “why they are the way they are”.

    Because truly, psychiatry and it’s minnions are all about colonization no matter what spin they come up with today, such as the pretense of being educated about culture. I can know and respect culture and the pretense of it all is yucky and demeaning to those receiving my generosity of kindness.

LEAVE A REPLY