Medicalizing the Different: Culture, Colonialism, and Mental Wellness

Introduction

The idea of disability as an issue is not universal, but has been created and perpetrated by Western ideology and colonialization. Colonialism has been described as ‘a phenomenon with political, social, geographical, cultural and economic dimensions’ (Chakraborty, 1991). Colonialism brought in various forced policies such as education, religion, westernized medicine and institutionalization. As a result of colonialism, Indigenous people have been inappropriately pathologized by being erroneously diagnosed with mental illness based upon a psychiatrist’s lack of understanding of the situations and contexts that they have lived (Fernando, 2010). In the construction of psychological tests, since the beginning of psychiatry, Indigenous people have been excluded, under-represented, or not matched with those in Western cultures on relevant demographic variables (Fernando, 2010).

Western culture has developed psychiatry by suppressing and policing the identity and knowledge of Indigenous peoples. Psychiatry is experienced differently by Indigenous peoples because of the forced repression of different societal and cultural views. Psychiatrists in the developing world, who are far away from any contact with research centres, have accepted a diagnostic framework developed by western medicine. This framework does not consider the diversity of behavioural patterns Indigenous people encounter (citation). Psychiatry is built on the assumptions of colonialism, and too often erases the different traditions and values of other cultures in order to diagnose, treat, and medicalize mental health and well-being.

The idea that the only correct way to live is by the standards of Western culture perpetuates colonialism. The policies of forced assimilation have had profound effects on Indigenous peoples at every level of experience from individual identity and mental health and to the structure and integrity of families and communities (citation). Specifically, psychiatry as a forced policy is a harmful and erasing component of colonialism that points to the loss of individual and collective self-esteem, to cultural disempowerment, and to the destruction of communities. In order to grow as a community that encourages mental wellness, society needs to look at alternative interventions to treat, prevent, and heal in a way that accepts both western and Indigenous traditions and values. 

Validity of Psychiatry

With the rise of mental health diagnoses comes a rise in treatment and intervention plans (citation).  Psychiatry is often dismissed as being biomedical, narrow, and irrelevant. People often state the ‘medical model’ of mental health and disability does not belong within public mental health and a ‘well-being’ focus would instead allow a focus on what ‘actually matters’ yet does so often without the any supporting evidence (citation).

Modern psychiatry is based on and shaped by scientific evidence, allowing it to prove the effectiveness of therapeutic measures by using evidence-based practices (citation). As a result of this, enormous gains have been made in patients experience, and psychiatric treatments can vastly improve the lives of people with mental illness. Psychiatrists evaluate evidence, consider the impact of a mental illness on overall health and provide some form of treatment plan to make the lives of individuals who seek out treatment better (citation).

Psychiatry is a diverse discipline. Psychiatrists play a vital leadership role within multidisciplinary teams. Many people who have mental disorders also need treatment for other medical issues. This can involve input from a range of other health professionals, such as GPs, nurses, psychologists, occupational therapists, or social workers (citation). Psychiatrists’ holistic understanding of the physical, mental, social, and behavioural aspects of mental health problems allows them to recognise and treat both the physical and emotional effects of mental disorders (citation). Effective mental health care requires collaboration between patients and a variety of health professionals. Teamwork provides continuity of care, an overview of the consumer’s networks and problems, a broad range of skills, mutual support and education.

Mental Illness and Indigenous Peoples

Colonial conceptions of mental illness frequently involve the medicalization of difference, or the creation of diagnoses based on departure from a norm. It can then be argued that Western society has no basis for defining mental illnesses other than departures from the norm. This way of defining mental illness is not inherently problematic, but it can lead to problems when different groups of people have different norms or standards, or different ways of defining illness. For example, in western society, Schizophrenia is seen as a major mental illness that needs to be treated with medication, cognitive behavioral therapy, and perhaps even group living environments that separate schizophrenics from “normal” people. In Indigenous communities, schizophrenics are seen as spiritual beings – individuals who live two separate but distinct lives, one in the real world, and one in the spiritual world (citation). Forcing medicine on Indigenous communities experiencing mental health in this way prevents them from exploring their cultural belief systems and explaining their mental illness in ways that contribute both the identity and the community, thus preventing the acceptance of tradition and values of Indigenous peoples in a Canadian medical model. 

 Indigenous people have, historically, not initiated or been involved in a large proportion of the mental health research involving their communities (citation). In addition, much of this research has been based on assumptions on the part of the researchers rather than on empirical evidence (citation). Many health problems in Indigenous communities may not be best understood as expressions of psychopathology or severe mental illness, but rather in terms of relatively high levels of social, mental, and emotional distress caused by colonialization and the suppression of Indigenous traditions. It is important to note that much of the research done on Indigenous mental health is rooted in the stereotypical views that western culture has of Indigenous peoples. Thus, psychiatry is rooted in the assimilation and discrimination of Indigenous peoples, setting up their values, traditions, and culture as deviating from the norm, putting the whole community into the category of ‘mentally ill’.

 Western culture has a major problem with labelling other societies as wrong, but not truly allowing them to integrate into Western culture when they want to. When Europeans colonized Indigenous peoples, they forced their beliefs on them, simply because there was an assumption that non-Europeans lacked a culture to learn about and integrate into western life (Fernando, 2010). Canadian colonialism introduced the term ‘mental health’, as a government with European origins imposed its ways of thinking on Indigenous peoples (citation). Today in Canada, the language and worldview that predominate in mental health still have foundations in colonial thought – thought which involves inequitable assumptions about colonized peoples, which inherently disadvantages Indigenous peoples who access mental health care. The idea of mental health makes social problems into medical problems, which diverts the blame for sickness and responsibility for healing to those who are suffering. In the case of Canada’s Indigenous peoples, this amounts to placing the burden of responsibility for health and social problems on people who are simultaneously denied the resources with which to adequately combat these problems.

Race and Psychiatry

Racism not only justified historic colonialization but compounds its contemporary effects, contributing to the obstruction of Indigenous self-determination and failure to recognize treaty lands, the lack of access to services and resources, and the over-surveillance by criminal justice and child welfare systems. The continued marginalization and criminalization experienced by Indigenous peoples and people of colour occurs in direct relationship to the continued societal and systematic privileging of white people in Canadian society. White-ness, then, refers to a set of assumptions, beliefs, and practices that place the interests and perspectives of white people at the centre of what is considered normal and every day.

Another critical way that race has been used in colonialism is that it is understood as biological categories. Psychiatry is in the business of finding deviations from the norm and pathologizing that. When you have people that deviate from the white norm, they run the risk of being pathologized by psychiatry from their “biological differences”. Western society has put people into different categories and has decided that there are biological differences between “us”, the colonizers, and them, Indigenous people, based on these characteristics that colonialism has decided to signify race. Race is socially constructed and racial difference is invented, perpetuated, and reinforced by society (citation) Western colonizers have taken and controlled whole populations with this need to dominate and treat people with biological differences as inferior. The fact that these biological categories have been chosen to demarcate people, categories that are socially constructed by colonizers that have chosen to take power, shows that there is a major disconnect between what people in Western cultures deem as correct, and what other cultures may do.

 Psychiatry sees these “biological differences” as something to be pathologized. People rush to the scientific model to justify the use of psychiatry in creating racial hierarchies. Fernando (2010) discusses this idea that people believed that Indigenous people that tried to escape residential schools were labelled as mentally ill. These people took real psychiatric diagnoses and used them to legitimize the destruction and erasure of Indigenous traditions, and yet North America still follows the psychiatric diagnoses of colonialism to label people today.

Alternative Interpretations of Mental Wellness

Indigenous communities do not believe that Western cultures hold a superior hierarchical position than Indigenous knowledge. Negative positioning is indicated by terms such as developing, underdeveloped, uncivilized, and savage, which are often used to describe Indigenous communities (citation).  For example, if the definition of the term developed is limited to technological development, then Indigenous communities may be disadvantaged; however, if the term is defined by natural democracy and diversity inclusion, Western cultures would be considered underdeveloped, placing Indigenous cultures in the hierarchical superior developed position.

Any approach to mental health promotion with Indigenous people must consider ongoing uses of tradition to assert cultural identity. Indigenous communities have a wide range of methods of healing are embedded in religious, spiritual and subsistence activities and that served to integrate the community and provide individuals with systems of meaning to make sense of suffering. These traditions were displaced and actively suppressed by successive generation of Euro-Canadian missionaries, governments and professionals (citation). More broadly, Kirmayer et al. (date) states that the recovery of tradition itself may be viewed as healing, both at individual and collective levels. Hence, efforts to restore language, religious and communal practices have been understood by contemporary Indigenous people as a fundamental act of healing.

Moving Forward

There exists no benefit in giving a diagnosis if it means nothing to the person being diagnosed (citation). As previously mentioned, Indigenous communities often do not view mental illnesses in the same light that the western world does, as a result of this, diagnosing those communities with labels that have no definition in the community does nothing to benefit either the medical model nor the Indigenous communities. It is a waste of resources on the part of the mental health system, and a waste of time on the part of Indigenous people seeking help in a western world. In order to fully benefit both parties, adopting Indigenous healing traditions and being familiar with more than one way of medicalizing and labelling behaviors will grow not only the population seeking help, but also the medical model’s understanding of mental health and behaviors. If we begin to use terms that did not originate in colonialism, we begin to view the world in a more open and intersectional manner.

In order to incorporate Indigenous healing in western medicine, understanding the consequences of Indigenous peoples’ history for mental health and wellbeing requires a model of the transgenerational impact of culture change, oppression, and structural violence. The social origins of prevailing mental health problems require social solutions. Although conventional psychiatric practice tends to focus on the isolated individual, the treatment of mental health problems as well as prevention and health promotion among not only Indigenous peoples, but western culture as well, must focus on the family and community as the primary locus of injury and the source of restoration and renewal.

Mental health promotion with Indigenous peoples must go beyond the focus on individuals to engage and empower communities. Indigenous identity itself can be a unique resource for mental health promotion and intervention. Knowledge of living on the land, community, connectedness, and historical consciousness all provide sources of resilience. At the same time, the knowledge and values held by Indigenous peoples can contribute an essential strand to the efforts of other peoples to find their way in the world.

No matter how open and unbiased practitioners try to be, they work against a backdrop of structural violence, racism, and marginalization. Only collaborative approaches that focus on the transfer of knowledge, skills, power, and authority can hope to transcend these limitations.

Conclusion

A crucial beginning in understanding colonialism and its current effect on Indigenous peoples’ health is acknowledging that there are gaps in our understanding and that Eurocentric dominance is a reality in the field of mental health and disability studies and this must be problematized. The ways in which mental health services are offered – and researched – in Canada have a foundation in one particular view of the world; that of the colonial powers who imposed their beliefs on Indigenous lands.

 A significant component in addressing global issues of disability discrimination requires the decolonization of concepts involving body and mind differences. Instead of attempting to eliminate disability issues within Indigenous cultures using Western tactics, traditional Indigenous knowledges and practices should be employed within these communities to regain the equality that existed prior to settlement. Additionally, by reasserting Indigenous knowledge, non-Indigenous cultures may be able to reorient the understanding of the discrimination within their own paradigms.

Indigenous peoples have not been silent or still on this issue. Researchers, psychiatrists, and policy makers should reflect on what is perceived as ‘real’ knowledge, and why such knowledge is perceived to be culture-free. All theories are ‘ethnotheories’; all human beings have culture. In fact, we all belong to several cultures simultaneously. Humility, respect, a willingness to question the status quo, and an openness to learning have the potential to create better well-being for everyone.

REFERENCES

• Allan, B., & Smylie, J. (2015). First Peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. The Wellesley Institute .
• Czyzewski, K. (2011). Colonialism as a Broader Social Determinant of Health. The International Indigenous Policy Journal.
• Kirmayer, L., Simpson, C., & Cargo, M. (2003). Healing traditions: culture, community, and mental health promotion with Candian Aboriginal peoples. Australasian Psychiatry.
• Nelson, S. (2012). Challenging Hidden Assumptions: Colonial Norms as Determinants of Aborignal Mental Health. National Collaborating Centre for Aboriginal Health.
• Schiffer, J. J. (2016). Why Aboriginal Peoples can’t just “get over it”: understanding and addressing intergenerational trauma. Vision: BC Mental Health and Addictions Journal.