Rethinking Culture and Colonialism in the History of Global Mental Health

Researchers argue that understanding the historical context of global mental health can offer fresh insights, challenge colonial biases, and promote a more inclusive and holistic approach to mental well-being.

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In the ever-evolving landscape of global mental health (GMH), researchers at the University of Copenhagen, Denmark, and Universidad Diego Portales, Chile, urge us to pause and look back.

In a new article, “Toward a new relationship between history and global mental health,” published July 2023 in SSM-Mental Health, a group of historians, anthropologists, and practitioners argue that a “thick historical analyses” can help the field radically re-imagine itself and go beyond its current colonizing psychiatric norms. 

 

The authors, Ana Antic, Gabriel Abarca-Brown, Lamia Moghnieh, and Shilpi Rajpal, emphasize the significance of understanding mental health through a historical lens:

 

“History can offer much more than just a critique of power relations, nor is it only about interrogating practitioners’ values and ethics. Most importantly, it does not aim to paralyze practitioners who engage in valuable mental healthcare by reminding them of historical examples of psychiatric abuse or the colonial pasts of global mental health. Quite the opposite, our historical perspective invites us to re-imagine a new future for health and healing by drawing attention to alternative practices of illness and recovery in many sites worldwide. A source for alternative ideas and initiatives in mental health and madness, history can foster new imagination for global mental health that goes beyond existing psychiatric frames of representations and towards truly radical and egalitarian projects and relations.”

Globe and old books on the desk.The recently published paper emphasizes the vital link between historical context and current challenges in Global Mental Health (GMH). It sheds light on the often ignored but deeply intertwined history of psychiatry and its implications in modern practices. The authors suggest that a comprehensive understanding of history is crucial to tackling the existing dilemmas in global mental health.

This nuanced perspective can not only broaden the discussions surrounding fundamental concepts like illness, suffering, care, and culture but also help address the inherent power imbalances rooted in colonial and post-colonial dynamics. The short communication briefly touches on four topics.

‘Historicizing global mental health: recentering the history of patients, actors and expertise beyond the global north.’

The authors contend that global mental health, despite grappling with its history frequently, fails to conduct a deep and comprehensive historical analysis to be truly meaningful. Instead, GMH only refers to its past as a ‘cautionary tale,’ something to be avoided, rather than something to learn from and build upon, which should remain present in the day-to-day practice of GMH professionals.

“A deeper historical perspective has the capacity to broaden the conversation on the making of GMH. It sketches out new relationships between social institutions, practices of care, and actors, developing new analytical constellations that have the potential to dislocate classical psychiatric, clinical, and public health frames.”

Historical analysis of global mental health often presents a linear narrative, sidelining deeper historical nuances and the implications of colonial-era psychiatry. Traditional GMH research has been criticized for its oversimplified historical backdrop, drawing concerning parallels to colonial oppression. A comprehensive historical approach can reveal the intricate interplay between institutions, care practices, and stakeholders, thereby challenging conventional views. Emphasizing patient experiences has become increasingly important, promoting their roles as integral contributors to understanding and shaping psychiatric care. Moreover, contributions from mental health professionals outside the Global North are gaining recognition, debunking the one-way knowledge transfer myth. Adopting this broader historical perspective can foster a richer, more diversified global understanding of mental health.

‘De-colonial histories: politics and power in global mental health’

A thicker historical approach to Global Mental Health (GMH) can help the field identify the colonizing foundations and move away from them by reframing the field. The authors suggest that instead of attempting to remain apolitical, those involved in GMH need to understand how their global political viewpoints have been shaped by a history that has harmed mentally ill and psychosocially disabled individuals in the majority world (Global South). Hence, they ask GMH practitioners and scholars who aim to close the ‘treatment gap’ to consider this question.

“By reducing ‘the gap,’ does it also reproduce problematic political (colonial) legacies through Western notions of personhood, culture, mind, and suffering?”

Colonial histories significantly influence global mental health (GMH), particularly in relationships between the global north, south, east, and west. Despite its efforts to address inequality, the Movement for GMH often mirrors colonial-era ideas. Historical insights, such as the post-WWII shift in psychiatry, underscore the lingering impact of colonial perspectives in current GMH discourse. It’s crucial for GMH to recognize its political roots and critically assess if it unintentionally perpetuates colonial biases.

‘Rethinking cultural difference in mental health’

In this section, the authors explore how the legacies of colonialism exist in all cultures and how some cultures and researchers have attempted to resist these legacies in the past.

For example, “…lesser-known East European psychiatrist Vladimir Jakovljevic attempted in the 1960s to counter the colonial legacy of psychiatry and medicine in Guinea by bringing Marxist psychiatric and psychoanalytic concepts to Guinean mental health trainees.”

A deep dive into the role of ‘culture’ in global mental health unveils its complex implications, from access barriers to symptom expression. Some efforts to incorporate cultural perspectives risk oversimplifying or echoing colonial biases. Historical examples, like blending Western psychiatry with local traditions, offer insights. For a holistic view, researchers should probe the colonial undertones in ‘culture’ and understand its historical power dynamics in health. This approach can pave the way for patient-centric healing.

‘History as a source for alternative reconfigurations of illness and recovery’

The fourth and final topic emphasizes the importance of history in driving innovation and radical thinking in GMH. The authors note that a historical analysis need not hinder GMH’s progress but can help it move forward and avoid repeating past mistakes. Moreover, history can do even more than this, as it can assist GMH in becoming:

 “…an inspiring, creative exercise that highlights alternative (and forgotten) solutions, geographies, and ways of thinking – which enable the field to engage with actors, ideas, and structures outside the borders of psychiatry. It opens new horizons for understanding mental illness, healing, and its relationship to culture, social/political equality, justice, and well-being.”

Diving into history can provide fresh insights into today’s global mental health challenges. By studying diverse past treatments, like Frantz Fanon’s experiments or Chile’s community health projects, we can discover new tools and perspectives. Instead of repeating old mistakes, a historical lens reveals alternative solutions, promoting a holistic approach to mental health that considers cultural, social, and political dimensions.

 

Global Mental Health is in dire need of radical change. To move beyond medication and psychiatric interventions, we need to incorporate perspectives from the Global South. This change cannot come soon enough, as GMH still faces challenges in addressing social and structural determinants of distress and effectively scaling its efforts.

 

 

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Antic, A., Abarca-Brown, G., Moghnieh, L., & Rajpal, S. (2023). Toward a new relationship between history and global mental health. SSM-Mental Health, 100265 (Link)

 

3 COMMENTS

  1. Hi Samantha

    A little light on examples but a little heavy on generalisations. Many of us agree that much can be learned from history and cross-cultural studies – but the article needs some more examples. eg. Tuke at the York Quaker retreat used a form of therapy similar to Haley’s strategic therapy (successfully – see the cowman) compared with Pinel who used coercion and fear (the rattling of chains before he entered the locked cells) – Tuke was not a doctor and a Quaker to boot – but Pinel was a doctor – we would have been better following Tuke. Or take NZ Māori who told a story of “depression” as our moods arising with the seasons, and even the harshest winter has its spring.

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  2. Hi Samantha,
    I am a well educated mental health reform activist based in Australia. I read many research papers on mental health and related subjects. Only a few of them have any substance. I read your article and to be perfectly honest I didn’t have a clue about what you are trying to say.
    I know the old academic cliche ‘Publish or Perish” but there is another cliche that many academics should pay attention to . It is “Content is King” which could also have a positive affect on their careers.

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  3. I tend to mirror the first two comments, except I can see the contradictory goals of the authors in writing about:

    The interest in using the histoy of MH, and the interest in perpetuating the seudoscientific goal of “treating” unexistant mental disorders.

    I also have trouble understanding how anyone would know about it’s history and at the same time believe it’s a pursuit keep doing. Self serving interests aside.

    I am not denying the suffering, I only think the evidence has speaked for itself: there are no bases for calling suffering a mental one.

    Maybe that explains the comments: There is no way to square that circle with the tools available, or available in the distant future…

    But I agree with myself that putting in the spotlight the history of mental health is among THE best ways to understand the seudoscientific nature of it. Just the proliferation of psychological theories has parallels with divination and the paranormal…

    Using simple logic, not on mental disorder classification, but on the REAL meaning of these two authoritative paragraphs of the DSM:

    “Since a complete description of the underlying pathological processes is not possible for most mental disorders, it is important to emphasize that the current diagnostic criteria are the best available description of how mental disorders are expressed and can be recognized by trained clinicians.” (Preface to DSM-5, included on p.xxiii of DSM-5-TR)

    “In the absences of clear biological markers or clinically useful measurements of severity for many mental disorders, it has not been possible to separate normal from pathological symptom expressions contained in diagnostic criteria.” (Use of the Manual, Clinical Significance Criteria, p.23, DSM-5-TR).

    from:

    https://madincanada.org/2023/10/maid-and-mental-illness-an-interview-with-dr-jeffrey-kirby/

    “complete description … not possible” means incomplete description, incomplete description means does not describe/explain the symptoms, particularly when “absence … of meassurements of severity…” is paired with “… has been not possible to separate normal from pathological…” QED.

    And it STILL does sound colonial to address humans suffering “patients”, when there is no disease to be found, created or constructed to explain the “symptoms”.

    And no disease, no disorder, “pathological” process known “completely” enough to at least explain the symptoms, must be a TRUE authoritative statement. Obfuscated in the DSM.

    If it was not refering to the lack of EXPLANATORY power for the symptoms, it would be a vacuous statement otherwise, an empty useless TRUTH:

    Under a different light, ALL knowledge is incomplete!, why even mention it?!. Knowledge in physics is incomplete, but it is complete enough to predict accurately the results of physical experiments. No one could call knowledge in physics incomplete in the sense that does not predict accurately enough…

    And unstated, not even the pathological process explains itself…

    And calling it mental, that it is the human mind not subatomic particles, is a way to justify the pseudoscientifc!. Psudoscientific because it does not follow the rules of simple logic connecting pathology with symptoms, the causality of the whole thing. All arguments built on that are necesarily false, since it starts from false premises.

    No pathological process, therefore no symptoms. Symptoms without pathological process are “growing pains”, part of the human condition, particularly when explained by development, as in teenagers and children…

    But I have to give credit to SL, the topic tried to address is a tough one, a usefull one, just the conclusions of the authors are building Chappels of pseudoscience to avoid going to the Cathedral. Again and again…

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