Can you decolonize mental health though?
I mean, it’s a reasonable question, right?
There has been a great deal written on this subject, by people far more eloquent and well informed than me. I have not read every book, listened to every podcast, or reviewed every paper, but I do my best to stay informed. This post is not here to argue with any of my fellow clinicians and thinkers, but to explore an idea. I don’t claim to know all the answers. I invite you to sit in the ambiguity with me here for a little while. I’ll add more posts on this subject over time.
When we talk about therapy, mental health, or even just health, as concepts, we are tapping into colonial concepts. All of these ideas are rooted in norms of white supremacy: what acceptable “health” looks like, what acceptable experiences of self or reality are, what acceptable ways to heal or treat can be. Part of this is a function of language. English is a colonial creole, built on the bones of every society it has invaded, looting words it finds useful while expunging terms that do not fit into its worldview from written and oral records. It has retained its strict implicit binaries while leaving us at a loss to describe the thousand shades of nuance between.
When I say I offer mental health treatment in the USA, I am also implicitly saying that what I offer is bound by laws, ethical guidelines, professional codes of conduct, and standards of care developed from European cultural concepts. All medicine is cultural medicine. Western medicine, including what we call “evidence-based,” is the cultural medicine of colonialism.
Before anyone gets the wrong idea, I am not opposed to evidence-based medicine. What concerns me is that for most of its history, in order for something to be considered “evidence” under western medicine culture, it had to be:
Observed by a white cisgender man of sufficiently high social class and education level
Interesting to a white cisgender man with sufficient financial and educational privilege
Useful to wealthy people and organizations (mostly or wholly white cisgender men)
We got penicillin this way, and the Untreated Syphilis Study at Tuskegee. We got the Pill, and we got the medicalized torture of Black, Indigenous, and Latine AFAB people in the USA its development involved. And we got the whole gamut of medically-approved psychological treatment techniques, from humanistic talk therapy to lobotomy.
It’s complicated.
And it’s not.
So when we return to the original question, it begins to sound like I am asking if we can take the flour out of a loaf of bread. Can you do that, and still have bread? Can you decolonize a colonial institution, and if you do, what is the thing that is left?
(yes, I am aware of “flourless” breads. Let “flour” here mean the main ingredient of the bread)
So far, the best I’ve got is that the decolonization of colonial institutions will always be a constant struggle towards harm reduction. There is no perfect here. No true and complete decoupling from the systems and norms of empire, when living within empire is the only option we have (here in the USA, and in all colonized areas). I cannot fully decolonize colonial medicine—that would mean replacing it (which isn’t a bad idea long term). But I can apply the concepts of decolonial theory within it, to the fullest permissible extent, and make room for non-western ideas.
There will be shade some day from the trees we plant now. But we have to keep planting them.
