Decolonising psychiatry and global mental health – a historical perspective
Ana Antic
In their recent article on decolonising the psychiatric curriculum, a group of authors from the Critical Psychiatry Network argued that ‘any effort to decolonise our discipline must start from an acknowledgment of the role psychiatry played in the colonial characterisation of non-Western societies, their cultures and indigenous healing systems, as inferior.’ Starting from this premise, they rightly draw parallels between psychiatry’s colonial engagements and its current Eurocentric biomedical framework, emphasising the imperialist roots of the discipline’s tendency to marginalise non-Western traditions of healing and concepts of mental illness. According to China Mills, such a failure of mainstream global psychiatry to recognise the relevance and validity of non-Western systems of knowledge amounts to epistemicide, ‘psychiatry’s assault on indigenous healing systems’.[1] In order to begin the difficult process of decolonisation, therefore, it is vital to integrate a critical history of colonial psychiatry in present-day medical curriculum: without this deeper historical understanding, claim the authors, it will be impossible to see how contemporary psychiatry’s Eurocentric universalism is rooted in the same assumptions which underpinned and perpetuated colonialism. Most importantly, it was the colonial belief in the superiority of Western reason and science that determined the discipline’s lack of cross-cultural sensitivity and inclusivity. The authors of this important article convincingly argue that this difficult colonial legacy hinders the development and effectiveness of global psychiatry, prioritising Western and European notions, classifications and experiences over the voices, needs and emotional worlds of non-Western populations.
One of the most important conclusions of the article is its recommendation to psychiatrists and psychiatry students to engage substantially both with the history of psychiatry and with postcolonial scholarship. Very significantly, the article demonstrates that the challenges psychiatry faces in its attempts to decolonise and address racial discrimination and remnants of colonial thinking are formidable, primarily because the colonial framework runs so deep and was built into the discipline’s foundations. The current call for decolonisation is, of course, part of a broader social and political movement, which has initiated important and thought-provoking discussions in humanities, social and medical sciences. But this is not the first time there have been efforts to decolonise the psychiatric profession – even though the term was not used in this way, the aftermath of the Second World War saw significant efforts by psychiatrists and other mental health experts to distance themselves from their discipline’s colonial associations and value systems. Thus began the history of transcultural psychiatry – a relatively new field premised on the idea of inclusivity and cross-cultural exchange and dialogue. This attempt was largely initiated by Western psychiatrists – some of whom were directly involved in colonial psychiatric projects – but it was soon supported by a diverse group of experts from different parts of the world, including the decolonising territories. As historians have noted, these early attempts at decolonisation of conceptual frameworks and practices were fairly limited, and many ideas and paradigms associated with the colonial period continued to influence post-colonial developments to a significant extent – remnants of evolutionary thinking, cultural reductionism and beliefs in the superiority of Western science shaped transcultural psychiatry throughout the post-war decades.[2] On the other hand, the increasing diversification of the psychiatric profession itself certainly helped the process of widening cross-cultural consciousness and sensitivity – early transcultural psychiatrists defined their goals in explicitly inclusive terms, aiming to prove that there were no fundamental psychological differences between different cultures and ‘civilizations.’
Most present-day critiques of global mental health focus in particular on the movement’s problematic assumptions of universality of both mental distress and treatment, and see those as signs of quasi-imperialist and Eurocentric attitudes towards the Global South.[3] What is particularly interesting in the context of the current debate is that universalism also played an important political role in these early psychiatric discussions, but it was often associated with progressive and anti-colonial thinking or activities. While colonial psychiatry tended to insist on fundamental differences between racial and ethnic groups in order to strengthen a global regime of inequality, post-war transcultural psychiatry embarked on a search for ‘universal’, common psychological traits and mechanisms shared among different cultures. This search for a new definition of humanity could, therefore, be revolutionary in the early years of decolonisation, precisely because it confirmed that all partook in a common humanity regardless of their cultural background.
For instance, in order to counter racist colonial psychiatry's notions of hierarchical fundamental difference between Europeans and the 'African mind', Nigeria’s most important psychiatrist Thomas A. Lambo aimed to 'produce research arguing for the basic universal similarity of human psychology, irrespective of race, religion, ethnicity or geography.'[4] Starting with his dissertation research at the University of Birmingham, Lambo identified Carothers’ arguments about the biologically determined inferiority of the ‘African mind’ as particularly harmful for the development of cross-cultural psychiatry, and ‘dangerous to scientific thinking’ in general. Lambo endeavoured to prove unfounded psychiatrist John Collin Carothers’ infamous claims that ‘African backwardness and the occurrence of “primitive psychosis” can well be linked to frontal idleness’[5], and used his schizophrenia research on the Yoruba people in Nigeria to demonstrate that ‘the nature of men is the same, what divides them is their custom.’ While Lambo was everything but ignorant or dismissive of the myriad cultural nuances relevant to psychiatric research in Africa, his argument in favour of universality hinged on the idea that mental distress in Africa and in the Western world shared fundamental mechanisms which could be explained ‘in terms of common psychodynamic formulations.’[6] The political implications of Lambo’s work underscored the liberal and progressive origins of such psychiatric universalism in the decolonizing territories. In that sense, and especially in the hands of experts from the decolonising territories, the psychiatric universalism of the 1950s and 1960s was an explicitly anti-colonial intellectual and political platform, aiming to broaden the definition and extend the boundaries of humanity
However, while universalism played a more complex political role in the aftermath of the war, post-colonial definitions of mental health 'universals' often resembled European concepts of the human mind/interiority/psychological life. In the context of universalist transcultural psychiatry, practitioners and activists struggled with similarly hierarchical conceptualisations of non-Western communities and their relationship to the global North, and often continued to see the world in racialized terms of primitivism and backwardness. Even though transcultural psychiatrists from the Western world regularly assumed a universal core of illnesses and argued that cultural differences simply formed a veneer which shaped external expressions but not the fundamental nature of psychological disorders, they still tended to formulate overly culturalist explanations of mental disorders in the decolonising world, disregarding a variety of social, economic and political factors, and exoticising and reifying the very idea of cultural difference in the process. At the same time, as is the case today, the transcultural psychiatric profession largely assumed that Western psychiatric diagnostic categories were universal, i.e. culture-free, and (unlike non-Western psychological concepts and categories) not rooted in specific cultural trends and influences. Post-war universalist transcultural psychiatry was, furthermore, marred by evolutionary thinking, which ascribed to non-Western peoples the simplicity of the mind and less sophisticated forms of psychological experiences and expressions.
Therefore, even though quite different from current biomedically informed psychiatric universalism, the post-war version of it did not overall succeed in providing a global platform for genuine cultural inclusivity. A number of important critical voices, inspired by the ‘new cross-cultural psychiatry’, started appearing since the 1970s, and this discussion exposed the extent to which leading Western psychiatrists still viewed their own system of classifications and diagnoses as both culturally neutral and superior to other ‘ethnopsychiatries’ around the world.[7] In that sense, the early desire of transcultural psychiatrists – to lay the foundation for a more inclusive, egalitarian communication between Western and non-Western concepts of mental illness and healing – remained only partly fulfilled. It was primarily this anthropologically minded critique of transcultural psychiatry that made it possible to further advance the discipline’s global framework for cross-cultural conversation between different systems of healing – mainly because these critics rejected the idea that clinical research in non-European territories should begin with Western categories and focus on exploring to what extent indigenous concepts fit with or depart from them. They also argued against any attempts to order different cultures’ interpretations of illness and healing in a hierarchical order, warning researchers away from assuming a ‘necessary progression’ from Third World categories to supposedly ‘more advanced “scientific” models.’[8]
The recent article on decolonising the psychiatric curriculum builds on this legacy, adding an important interpretive layer by insisting on the important and unacknowledged legacies of colonial psychiatry for the current theoretical and intellectual frameworks. This is a supremely important argument, because it explicitly draws attention to, among other things, complex continuities between colonial psychiatric frameworks and post-colonial transcultural/global psychiatry. In addition to integrating the colonial history of the discipline in the curriculum, it is also important to understand the history of the post-colonial period, and grasp the multiple and complex transformations which the psychiatric profession underwent in its search for both common/universal humanity and cultural sensitivity. In the decades following the decolonisation process, many of the debates the discipline is currently facing – about the relationship between mental illness and socio-cultural contexts, and about the role of Western medicine in cross-cultural settings – were extremely topical, and having a deeper understanding of these earlier conversations, conclusions and controversies can help us have a better grasp of what is at stake in present-day discussions about psychiatry and global mental health.
[1] China Mills, Decolonizing Global Mental Health: The Psychiatrization of the Majority World,
London: Routledge, 2014
[2] Matthew Heaton, Black skin, white coats: Nigerian psychiatrists, decolonization and the globalization of psychiatry, Athens: Ohio University Press, 2013; Erik Linstrum, Ruling minds: Psychology in the British Empire, Harvard University Press, 2016
[3] Mills and Fernando, 'Globalising mental health or pathologising the Global South?’, 188–202.
[4] Heaton, Black skin, white coats, 52.
[5] John Collin Carothers, ‘A Study of Mental Derangement in Africans, and an Attempt to Explain Its Peculiarities, More Especially in Relation to the African Attitude to Life’, East African Medical Journal, 1948:25, 197–219
[6] Thomas A. Lambo, ‘The role of cultural factors in paranoid psychosis among the Yoruba tribe’, The journal of mental science, 1955, 423:101, 239-266.
[7] See, for instance, Julian Leff’s response to Roland Littlewood’s critique: Julian Leff, ‘The “new cross-cultural psychiatry”: A case of the baby and the bathwater’, British Journal of Psychiatry, 1990, 156:3, 305-307.
[8] Roland Littlewood, ‘From categories to contexts: A decade of the “new cross-cultural psychiatry”’, British Journal of Psychiatry, 1990, 156:3, 308-327.