“You know, we had a lot of trouble with Western mental health workers who came to Rwanda immediately after the genocide, and we had to ask some of them to leave…They came and their practice did not involve being outside in the sun like what you’re describing – which is, after all, where you begin to feel better.
There was no music or drumming to get your blood flowing again when you’re depressed and you’re low and you need to have your blood flowing. There was no sense that everyone had taken the day off so that the entire community could come together to try to lift you up and bring you back to joy.
There was no acknowledgement of the depression as something invasive and external that could actually be cast out of you again. Instead, they would take people one at a time into these dingy little rooms and have them sit around for an hour or so and talk about bad things that had happened to them. We had to get them to leave the country.”
Over 500 years ago a profound change happened globally. Countries from modern day Europe began to explore and then colonize much of the Western Hemisphere, parts of Africa and Asia. Within just a few hundred years much of the world was divided up amongst a few countries such as Spain, Portugal, Great Britain and the Netherlands. Vast territories inhabited by indigenous peoples were turned into conquered lands. Wealth in terms of minerals, timber, beaver pelts, tea, sugar and other commodities were extracted and sent to conquering countries that grew rich. Indigenous people were decimated by war and disease and most were forced into impoverished fragmentary settlements that represented only a fraction of their previous territories.
This period of colonization continues and though some of the brute force of conquest has diminished, the lasting effects for indigenous peoples continue in the form of breaking treaties, institutional poverty and racism. In the U.S., one third of Native Americans live in poverty, 22 percent have post traumatic stress and suicide is 2.5 times more prevalent amongst native youth.
Though at times there has been concerted effort to right some of the wrongs of our predecessors one of the main areas that we continue to fall short is in the mental health system. We continue to perpetrate some of the worst facets of colonization by funneling people into a system of medicine that is outside of traditional healing practices for many indigenous people. In essence, we have asserted that only very specific “evidence based” forms of treatment are valid such as psychiatric labels, medication and cognitive behavioral therapy. Insurance is likely to only pay for these Westernized ways of approaching mental health.
Much of the problem lies with how the mental health system is structured. Those who come for treatment are promptly given a label and then tend to receive a medication. Someone who has dealt with their recent ancestors losing their lands, being forced on a reservation and often forced to assimilate into Western culture is likely to experience emotional distress. But simply labeling this person as depressed, offering an antidepressant or trying to talk them through it with cognitive behavioral therapy is a further form of colonization…requiring them to be treated by a mental health system that ignores underlying wounds.
This is further exacerbated if the rationale for diagnosis and medication is based on the idea that one has a chemical imbalance such as serotonin deficiency that a medication can resolve. Not only is this untrue, mental health professionals ignore the deep roots of trauma and racism that are really the underlying causes of distress.
When we couch our language in the cloak of science, we also imply that traditional methods of healing are not valid, not “evidence based”. And in that way we marginalize time honored traditional ways of healing such as ritual, drumming and herbalism and denigrate ancient folk ways of recovering. Can scientific researchers measure the importance of tribal ceremonies via double blind studies? Or gauge the importance of shared meals and community gatherings, a conversation with an elder, the virtue of connection to land and geography?
Our reductionist take on mental health that centers around cognition and neurotransmitters avoids the much more complex conversation about deep cultural and environmental wounds that continue to underlie depression, anxiety and other forms of distress for many people.
The scientific process can be enormously enlightening and productive when exploring complex subjects such as geology, astronomy and climate. But for the past 60 years mental health research has focused ever more intently on neurotransmitter theories and underlying genetic markers for mental illness. But in this ever narrowing search for underlying biochemical etiology, we have lost sight of the larger picture of why we are depressed and anxious. And those reasons are often very easy to see. Poverty. Racism. Homelessness. Stress. The modern diet. Oppression. Colonization. Trauma.
And through the lens of these issues it’s important to note that when we talk about mental illness simplistically in terms of labels and treatment, we perpetuate a continuation of colonization and avoid the hard work of exploring the issues and trying to address the root causes of distress.
Decolonization of the mental health system encourages ways of healing that honor the wounds of colonization, unique cultural experience, traditional healing, and ways of perceiving distress in complex ways outside of simplistic labeling. But it also requires us to look at the mental health system as a whole and acknowledge its strong deficiencies not only for indigenous communities but for all of us. When we are forced into a one size fits all system with a very structured language that emphasizes defective biology, we can lose sight of how our depression and anxiety are often culture bound by a language and system that promotes productivity, objectivity, competition, domination and individualism.
When we don’t fit into that model, because we are poor, have been marginalized, are queer, oppressed or fall far out of the norm, then we are further damaged by a system that sees us as broken and as a set of symptoms to suppress so that we can fit in to “normal” society. Forcing order onto the complexities of nature is one of the core attributes of colonization. When applied to people who are “mentally ill”, this can look like forcing someone to be calm with a tranquilizer, making them happy with an antidepressant or changing “thinking errors” via cognitive therapy. Deep grieving, extreme emotions, dark thought patterns, confusion and disassociation are seen as aberrant instead of natural reactions to trauma.
Decolonization of the mental health system is a process of seeing how we continue to try and confine, box and label people while erasing traditional cultural ways of healing distress. But further, it is a way of trying to box the forest of the heart and mind itself, which is far more complex and wild to be ever reduced to neurotransmitters and faulty thought patterns.