What does it mean to decolonize mental health?

THINGS TO LEARN (AND UNLEARN) ABOUT JUSTICE-ORIENTED MENTAL HEALTH CARE

By Jackie Menjivar

(Kvnga / Unsplash)

Decolonization means different things to different people. For some, it means undoing colonialism and its historic byproducts (things like racism, environmental exploitation, economic underdevelopment). For others, it’s about re-centering Indigenous knowledge and culture. And still, some academics warn against using decolonization as a metaphor for any social justice work, and, for them, decolonization requires Indigenous land return. 

That being said, the topic of decolonizing mental health has been making waves lately. And for as much as it’s discussed, there isn’t always a clear understanding about what exactly it means to decolonize mental health. There isn’t a single answer, but there are some themes that tend to pop up. Here are a few ways that people are working towards decolonizing the mental health system. 

Honor ancestral wisdom. 

Western psychology is a relatively modern field. Around the mid-1800s, academics started to use the scientific method to try and understand human thought and behavior — and Western psychology was born. But people have been treating their minds and bodies since way before that (think several centuries, if not millennia). So it’s more than a little naive (ahem, racist) to assume that a couple of European guys born after the invention of electricity were the first to crack the code.

Traditional practices — like spirit work, meditation, shamanism, sound healing, etc. — have been used for generations to uplift and restore mental wellbeing. And there are practitioners who still use ancestral methods in their work to this day. To decolonize mental health, we have to acknowledge that these ancient cultural practices are just as valid as modern tools like talk therapy or medication. Our ancestors have a lot to teach us about survival and resilience, and we shouldn’t discredit their wisdom just because they came from a different time or place.

“I’m always asking, ‘How have Black folks historically healed in the face of oppression, in the midst of enslavement, how is it that we are still here?’ And inevitably it goes directly to...our spiritual practices, communing with the earth, utilizing herbs, connecting with our ancestors,” says Shawna Murray-Browne, LCSW-C for World Channel. “One of the huge impacts of colonialism, present-day, is the disconnect that African Americans have from even our pre-colonial experience. By illuminating some of the richness of how we survived and resisted continually, we can bring that into present-day.”

Challenge psychiatric “expertise”.

The way a lot of us understand psychology today is through a Westernized medical model of illnes, specifically a psychiatric clinical lens. Thissystem says certain people (doctors, scientists, academics) are the experts, and they have the final say when it comes to assessing and treating mental health conditions. Conducting research or using scientific methods to explore mental health is valuable — but these practices  can and should be challenged. 

At the end of the day, mental health providers like psychiatrists and psychologists are just people, no matter how much training or education they have. They’ll always have their own perceptions and biases, and, yes, they will make mistakes (because we all do!). Remember that the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) classified homosexuality as a mental illness up until the ‘70s. And in the ’60s, the DSM’s new framing for schizophrenia was used to overdiagnose Black men with the condition (especially those who were involved in civil rights activity). 

The folks we trust as experts can overdiagnose, underdiagnose, misdiagnose, and mismedicate people, causing more harm than good. It gets especially dicey when you consider that people of color (and Black people in particular) are often misdiagnosed. Sometimes, doctors even pathologize behaviors of BIPOC people (like anger or distrust) when they’re just normal reactions to racism and systemic oppression. Some might even argue that the pathologization of behavior outside of the dominant culture isn’t just an unfortunate side effect of the  biomedical model of mental health but a desired outcome of the system. 

“Psychiatry was built with a core desire to dehumanize, drug, and discard those whose behavior and ways of being diverged from the status quo,” says Stella Akua Mensah for the Disability Visibility Project. “This status quo was and is white, patriarchal, and absolutely enamored with respectability and compliance with the state’s self-serving notions of ‘normalcy.’”

Recognize cultural context and complexity. 

There’s a lot of talk around cultural competence in psychiatry — the idea that mental health professionals should be able to understand and interact with people from different cultures. But that’s really just the first step. It’s good to understand someone’s cultural beliefs and background. But it’s also important to understand the complexity of a person influenced by cultural factors and how that plays out in their day-to-day life. Cultures aren’t monolithic, and every person will engage with and be influenced by cultural factors differently (things like language, religion, traditions, gender roles, family, geography, etc.). This work also includes recognizing the forces that oppress and may impede someone from recovery — because discrimination has such a huge impact on mental health (and your ability to find help). Mental health professionals need individualized cultural context to be able to work with people to address their mental health concerns.

“It’s important to recognize that the majority of educational institutions still lack training and education in anti-oppression,” says justice-oriented counselor Ji-Youn Kim on her blog. “Unless therapists are proactively educating themselves on anti-oppression and unpacking their own complicity as individuals, therapists will have an incomplete understanding of trauma and therapeutic practice when supporting clients who experience any form of systemic oppression.”
You can’t just take one training and become culturally competent — both because there’s so much to learn and because every person interacts with and expresses their culture differently. You risk stereotyping and stigmatizing people when you assume everyone from the same cultural background behaves the same way. That’s where cultural humility comes in. Cultural humility recognizes that you don’t know everything, and that the best source of information for a person’s cultural context is, well, that person. This is especially true when it comes to understanding how a person’s different identities (race, gender, sexuality, etc.) intersect. A provider should ask questions about their client’s experiences instead of making assumptions, while being aware of their own biases and position of power. 

Confront the mental health industrial complex.

If we’re gonna talk about oppressive forces, we have to acknowledge the elephant in the room: the mental health system can also perpetuate systemic harm and inequality. Mental health care isn’t affordable or accessible for a lot of people, which means worse mental health outcomes for folks already impacted by poverty, unemployment, housing insecurity, and lack of insurance coverage. People of color, in particular, face some of the steepest barriers in accessing treatment. 

On the other end of the spectrum, there’s the issue of forced or coerced psychiatric “treatment.” Involuntary psychiatric holds are legal in every state in some form or another. And a lot of people leave these psychiatric institutions and services more harmed than when they were first forced into them. And sometimes there’s financial incentive to institutionalize or medicate. For example, a yearlong BuzzFeed News investigation found that America’s largest psychiatric chain “turned patients into profits,” hospitalizing people unnecessarily to maximize their revenue. From 2016-2017, over half of active psychiatrists received some form of payment from pharmaceutical manufacturers — which ProPublica found makes them more likely to prescribe that company’s drugs.

When care becomes commercialized, the mental health industrial complex profits financially from suffering.

Look beyond individual healing. 

So much of our current understanding of mental health is based around the individual. It’s often framed like it’s your particular brain chemistry, behavior, or personal history that determines your mental state. But this doesn’t take into consideration the larger context that you exist in.

“It's easier to talk about diet, exercise and meditation rather than the fact that you cannot afford healthy food, you have no time to exercise because of the debt you're in and meditation doesn't help much when you're surviving the daily grind of racism,” says Dr. Rupa Marya on her Instagram @rupa.marya . “Couching systemic toxicity as something that could possibly have an individual fix is a cruel way of framing the problem and the solution. These structures must be addressed upstream, through transformation.”

While Western culture tends to be more individualistic, there are other perspectives. Indigenous culture emphasizes connectedness with other people, ancestors, and the environment. A decolonized approach to mental health acknowledges collective healing and community care models, not just individual healing. That means recognizing the role of intergenerational or historic trauma, in addition to individual trauma. You also have to look at how ancestral trauma (like displacement or enslavement) translates to present-day oppression and inequality. You can’t heal a person’s individual suffering without addressing these collective contexts. 

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If that feels like heavy stuff, it’s because it is. 

Our mental health system has centuries worth of inequities, and that isn’t something that gets fixed overnight. The most important thing is to approach the topic of mental health with curiosity, and seek out the voices you may not always hear from.

And if you’re wondering how to show someone care, solidarity, or support, the best thing you can do is ask them — and then really listen. 

BIPOC Mental HealthKristina Benoist