Colonialism and evolution of mental health practices in Chile
The trace of colonialism in mental health practices in Chile is undeniable. First, there is “Casa de Orates’ that inherits the moral role of charity institutions of mental health of Colonial times. On the other side, it is important to highlight that innovations in mental health practices in Casa de Orates such as, the aforementioned incorporation of psychotherapy, were not ideas born in Chile but they were brought from the outside by foreign physicians like William Benham, an Englishman financed by the Government of Chile to perform as house physician and who eventually would be in charge of Casa de Orates. Other Chilean physicians like Dr. Carlos Sazié (successor of Dr. Benham), were sent to Europe in order to study mental health practices (Carrasco 2018).
According to Jimena Carrasco (2018), a consequence of the colonial expansion of Europe is the generation of the idea that colonizer countries are in the center of the world, leading them in the thought that all the other countries are Otherized, as if Others are ‘discovered’ by colonizers.These elements make possible the existence of believing that a neutral place is where it can be observed and known, the colonizer place became that place and the colonized countries the elements that can be known.
This leads to the idea that ‘true knowledge’ emerge in the colonizers or, at least, through their methods and thinking schools. This is why current psychiatry has been influenced by the foreign thinking, to such an extent that is possible to question the problematic of whether there is a real Latin American psychiatry or not (Alarcon 1976).
The same happened with psychology, the discipline that arrived at Chile thanks to the collaboration of diverse people such as Germans Jorg Heinrich Schneider and Wilhelm Mann. Schneider, scholar of‘Instituto Pedagógico’ (currently ‘Universidad Metropolitana de Ciencias de la Educación’) during the second half of the 19th century, was the one who transferred his knowledge in Psychology from Germany to create the first laboratory in Santiago of Experimental Psychology. The first nationwide one was ‘Escuela Normal’, Copiapó. After Schneider’s retirement and death, he was replaced by Wilhelm Mann who continues in psychology and pedagogy research (Salas 2014).
Noteworth is the presence of the foreign influence even before the emergence of psychology. The first dean of the oldest university in the country, Universidad of Chile, Andrés Bello had great influences from the British psychology and philosophy. In the middle of the 19th century, French positivism had an important place between intellectuals who studied psychology in those times, outstanding authors like Comte, D’Alembert,Trugot and Saint Simon (Salas 2014).
The community approach to mental health arrived in Chile due to the influence of Italian antipsychiatry. Nowadays, many psychologists are trained in the systemic school and travel to Italy to take postgraduate degrees. That is without mentioning the general support that exists from the State of Chile towards health professionals to carry out postgraduate and specializations abroad through the Chile Scholarship system to support the study at Anglo-Saxon universities.
In this way, we can notice the strong European influence in all the development of mental health in Chile from Spanish colonialism to the full range of intellectuals influenced by German, British and French authors; the current Italian influence on community models and the continued financing of the State for professionals to specialize abroad.
Social representations of health and disease in Chile
Quoting sociologist Durkheim’s concept of cultural representations where human experiences in life are socially constructed, Moscovici (1979) points out the concept of social representation to refer to the psychological organization with which each individual categorizes the diverse knowledge about something given by everyday life, but also by science and philosophy. This set of knowledge is irreducible and is, at the same time, the way in which man captures the concrete world.
Accordingly, social representations shape all our daily lives. Through languages, gestures, encounters in every interaction, socially attributed set of ideas will arise (Moscovici 1979). It also happens with health and illness; according to Flores-Guerrero (2004), the perceptions of people of good or bad health are culturally constructed. In other words, health and disease are socially represented in a collective imaginary that will vary according to the society in which we find ourselves.
In Chile, the disease is associated with death and the doctor with the avoidance of it. With the scientific advances of modernity, the doctor becomes a counselor and an expert in improving and correcting the body, which leads people to begin to have confidence in the medical diagnosis. According to Flores-Guerrero (2004), this trust began in the 19th century at the same time that the first mental health institutions in Chile were created.
With advances and confidence in medicine, the concepts of health and disease began to distance themselves from philosophy and religion. Health began to be associated with medicine and medicine with the postponement of death (Flores-Guerrero 2004), so that health means moving away from death, it is not having a medical diagnosis that brings you closer to death.
The advance in medicine with the increase to access it has managed to postpone death, giving people control over it to the point that it has become a concept of illness that is associated with bad practices in everyday life. According to Flores-Guerrero (2004:27), “it is always a surprise, an accident, and as such it becomes a clandestine fact that must be disguised, hidden and quickly overcome, so that it appears as a failure of the technique or model of modern man who can do everything” if they do not control their own illness.
In this way, disease that is a concept associated with death, is linked to bad practices in everyday life. According to the bad practice that is carried out, a certain disease will be developed. For example, according to Susan Sontag (1996), there is a social metaphor that cancer is caused by repressed emotions, especially rage (which, if not expressed, would manifest itself in a tumor of a malignant nature). Thus, the social representation of cancer would be linked to a daily bad practice that manifests one’s capacity to manage rage, referring to one’s faculty.
Just as there are social representations for cancer and for other physical illnesses, mental illnesses also began to have social representations. A study developed in 2005 made by the Chilean author Cristiân Massad indicates that patients diagnosed with different psychiatric disorders feel excluded and stigmatized in society. According to Massad (2005), in Chile stereotypes are formed in which it is considered that any person who has a mental illness and who has been admitted to a psychiatric institution ‘must be someone who hears voices’ or also someone ‘aggressive’. In Massad’s work, many people interviewed said they were not aggressive or heard voices, however, they felt how other people treated them as if they had this symptomatology.
In the same way, in a later work on social representations and schizophrenia, Ricardo Fuentealba (2013) highlights that the patients with the diagnosis of schizophrenia in his study also had to deal with the same stereotype and that this is due to the lack of information and, even to the misinformation often circulated in the mass media. In addition, within the families of people with schizophrenia, there have been negative social representations of the disease, which makes the occurrence of the mental illness in the family to be something extremely traumatic.
