Should Global Mental Health Decolonize?

A field debates how to best confront the legacies of colonialism.

Posted Jan 01, 2021

Some of us at our university have joined the conversation on decolonization in global mental health and global health. We want to learn from history, understand the concept, and try to translate it into helpful actions.

In September, Dr. Lynette Jackson, associate professor of Gender and Women's Studies and African American Studies at the University of Illinois at Chicago was invited to give a lecture. She focused on the history of psychiatry and colonialism in the former British Colony of Southern Rhodesia, which in 1980 became Zimbabwe. Based upon her book, Surfacing Up, she told the story of the Ingutsheni Lunatic Asylum. She argued how the asylum played a significant role in maintaining the colonial social order, for those who did not fit "the social background of the colonial type." After gaining independence, major changes in psychiatry offered more humane community mental health practice.

As global mental health has grown over the past decade, some critics have said that expanding Western models of mental health in poor countries remains too rooted in colonial attitudes and relationships. They too called for more intentionally eradicating structural violence and its consequences and supporting local cultural practices.    

Dr. Frederick Hickling, professor emeritus of psychiatry from the University of West Indies, documented how Jamaica deinstitutionalized their large psychiatric hospital and incorporated multiple mental health policy innovations. They developed therapeutic and collective interventions to “reverse the psychological impact of 500 years of European racism and colonial oppression.” According to Dr. Hickling, they succeeded in incorporating Western biomedical psychiatric models and in developing “postcolonial strategies that counter the historical legacy of structural violence.”

In November, we hosted a lecture by Vanderbilt’s Dr. Quentin Eichbaum, a humanist and pathologist, born and raised in Namibia and South Africa. His lecture drew upon his April 2020 paper on “Decolonizing Global Health Education.”

Eichbaum focused on a "decolonization of the mind that made the colonizer feel superior and the colonized inferior by enforcing structural drivers of discrimination and barriers to self-determination.”  His perspective on decolonization reaches beyond removal of a colonial power and dismantling of colonial structures. He sets his sight on improving education in global health.

To counter the colonialist paradigm in global health, Eichbaum called for critical reflection, transformative learning, and suggested five decolonizing strategies. One of which calls for applying fair trade principles to educational programs while another calls for bidirectional exchange programs. These strategies are aimed at ending one-way extractive practices that have dominated the field — a critique that could also be applied to global mental health.

Others have called for more far-reaching decolonization in global health. Dr. Seye Abimbola (University of Sydney) and Dr. Madhukar Pai (McGill University) recently declared: “an equal, inclusive, just, and diverse global health architecture without a hint of supremacy is not global health as we know it today.” To realize their dream, they call for a radical transformation in which global health as we know it may not survive.

Over the past month, we spoke with several of our partners in low- and middle-income countries about decolonization. Overall, they were not all that focused on the term decolonization, but they were very focused on the need for an equitable balance between high income and low- and middle-income countries and for approaches not based predominantly on the priorities of Western countries. 

From what I hear on our campus and among colleagues in the U.S., many agree that we in global mental health and health can do much better to come to terms with the histories and legacies of colonialism. But there is not yet a clear enough sense of what strategies or practical actions are needed and there are several areas of disagreement.

Some like Abimbola and Pai call for radical change, whereas others, like Dr. Roger Glass, Director of the Fogarty International Center, call for a more incremental approach. Dr. Glass recently called for “democratizing and decolonizing global health” which is a paradigm shift but with progress measured over decades.

Some don’t explicitly focus on the role of race and racism in decolonization, whereas others say it is necessary given the link between colonization and racism. Go back to Franz Fanon, the Martinique psychiatrist and thought leader who wrote in Black Skin, White Masks: “It is the racist who creates the inferiorized.”

Some in global mental health are in favor of working with the police and government security services to achieve reform on police practices whereas others are against any such collaboration which confers legitimacy to the “carceral state” as one young scholar said.

These are each important points of policy and philosophical differences that call for further debate.

Yes, global mental health should decolonize, if that means working towards more equity, diversity, and inclusivity. But to do so, we need more than a catchy slogan. We need a theory of change and an action plan through which many different stakeholders can work together and make social change. 

References

Jackson L. Surfacing up: psychiatry and social order in colonial Zimbabwe, 1908–1968. Cornell Studies in the History of Psychiatry. 2005.

Lovell AM, Read UM & Lang C. Genealogies and anthropologies of global mental health. Cult Med Psychiatry. 2019 43: 519–547.

Hickling FW. Owning our madness: Contributions of Jamaican psychiatry to decolonizing Global Mental Health. Transcult Psychiatry. 2020 Feb;57(1):19-31.

Eichbaum QG, Adams LV, Evert J, Ho MJ, Semali IA, van Schalkwyk SC. Decolonizing Global Health Education: Rethinking Institutional Partnerships and Approaches. Acad Med. 2020.

Abimbola S, Pai M. Will global health survive its decolonisation? Lancet. 2020 Nov 21;396(10263):1627-1628.

Glass R. Decolonizing and democratizing global health are difficult, but vital goals.  Global Health Matters newsletter, July / August 2020,  Volume 19, Number 4.

Fanon, Frantz, and Charles L. Markmann. Black skin, white masks. Grove Press, 1967.