Decolonization is a broad term referring to attempting to undo or rectify the consequences of colonialism. The repercussions of colonialism are widespread, influencing many, if not all, facets of life in countries of the Global South. As a result, there are numerous possible strategies to accomplish the goal of decolonization across various disciplines. In mental health disciplines, discussions about decolonization are "en vogue” in academia. Yet despite an abundance of research, translating this knowledge into settings of clinical practice remains a challenge in the Global South. The question of “where do we go now?” in the process of actualizing decolonization emerges in both primary health care and specialized psychotherapeutic settings.
While other social science disciplines have made efforts to decolonize for over five decades, clinical psychology and psychiatry lag behind on systematically raising questions about decolonization. In fact, earlier scholars calling for decolonization in psychiatry, such as psychiatrist and political philosopher Franz Fanon, were often disregarded or left out of the discipline’s mainstream discourses until the past decade or two. The works of both Fanon and more modern-day scholars who have raised similar questions have been used and celebrated in other social science disciplines, but not in ours. Although the disciplines of psychiatry and clinical psychology have not yet had their decolonization moment in which colonial and capitalist origins are acknowledged and accounted for in the mainstream narrative of their histories, there have been loud voices both from within and outside working towards change for decades.
Broad advice on decolonization for institutions and disciplines as a whole is becoming more available, yet we mostly find ourselves lost in terms of individual practice in the Global South. The main points raised in the existing literature around decolonizing psychiatry and clinical psychology include:
Psychiatry and psychology have historically been used as tools to colonize non-Western cultures by pathologizing their cultural variations and their experiences of distress. The imposition of Western theoretical frameworks in the Global South has marginalized alternative perspectives and knowledge systems. Decolonizing mental health involves recognizing and challenging the legacy of colonialism, imperialism, and systemic oppression. It requires addressing key issues such as the over-representation of Western psychiatric knowledge and the under-representation of non-Western models of local knowledge ; the need for culturally-sensitive or context-specific approaches to diagnosis and treatment; and the importance of acknowledging and addressing the socioeconomic and historical determinants of mental health. It also stresses the need to formally incorporate decolonization into psychiatric and psychological education and training to ensure more inclusive and relevant diagnostic concepts and interventions.
The issue of power dynamics and privilege has been constantly brought up in literature addressing decolonization, with authors calling for greater self-reflection and awareness of one's own positionality and biases. This includes acknowledging and challenging the ways in which privilege can shape research and clinical practice while working towards more just approaches to mental health. It also involves recognizing and challenging the underlying power structures that continue to pathologize certain communities and their experiences. This requires cultural humility: incorporating diverse cultural knowledge systems, idioms, and norms into theory and practice and approaching mental health from a more collaborative stance.
As a young clinician and researcher from North Africa, I still somehow find myself posing this question—and I know that I am not alone. What do I do inside and outside the therapy room? To answer these questions, over the initial five years of my practice, I have begun collecting and stitching together a list of actionable steps from literature and advice from senior practitioners. I share them here as an effort to reach out to colleagues to connect, discuss, and raise these questions that will bring us closer to decolonizing practice.
As I conclude and come back to my question “Where do we go now?” in mental health care, I find that there are two levels to address. At the macro-level of global and institutional efforts of decolonization, we need to stop recycling arguments and start implementing the recommendations that have already been made to enact deep decolonization on a broad scale in mental health systems of the Global South. Current efforts to step outside of “Western” frames are already promising. We need to look at how to expedite and augment them systematically in our countries.
These efforts also need to be made at the micro-level of individual clinical practice in the Global South and of those serving diverse populations. This includes acting within primary health care (when applicable), referral pathways, and specialized MHPs. We are fortunate to exist in an era where psychiatry and clinical psychology are increasingly receptive to such efforts. Subfields such as cultural clinical psychology and transcultural psychiatry have become well-established, creating ample space to pose pertinent questions and delve deeper into decolonization scholarship and programming. Our predecessors were not as fortunate, and questions pertaining to decolonization were historically limited to the realm of “critical theory.” Today, we can put forward these questions in clinical science and endeavor to find meaningful answers.
I hope that we will see more literature and actionable guidelines targeting clinicians in the Global South as well as instituting a formal body of knowledge within our training. Decolonization tools need to be given to those on the ground so that the concept ceases to be an academic debate or limited to clinical settings of minorities in well-resourced countries of the Global North to enhance access to and quality of care. The billions of people living in and originating from the Global South need us to use all available resources to enhance the quality and appropriateness of their care.
Nadine Hosny, MSc, is a psychotherapist and doctoral researcher at the Cultural Clinical Psychology Lab at the Institute of Psychology, University of Lausanne, Switzerland. She studies cultural concepts of distress, complex trauma, and the development of culturally congruent interventions. She is also an affiliate researcher in the Department of Psychology at the American University in Cairo and in the Department of Public Health at the University of California, Davis.
ChatGPT 3.5 was used to aid in the editing of this piece. All content has been reviewed and edited by the author. Prompts used:
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**Feature photo obtained with a standard license on Shutterstock.
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