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Historical Consciousness

Such changes in the expert discourses of cultural psychiatry correlate with an increasingly self-critical historical understanding of colonial and postcolonial psychiatry, through which clinical professionals have become aware that psychiatric diagnostic and explanatory systems are only semi-autonomous of wider political agendas. It is partly because of critical historiography that theories of indigenous inferiority and exoticism have gradually ceded to more sophisticated, dynamic and affirmative models of non-Western cultural resources. A brief survey of contemporary history of colonial and postcolonial psychiatry reveals the political analyses with which the clinical professions are confronted.

In his study of colonial-era ethnopsychiatry in Africa, Jock McCulloch argues that “European colonialism [...] provided the social setting for ethnopsychiatry and it is impossible to separate the story of the profession from the colonial enterprise” (McCulloch 1995, p. 1). The ethnopsychiatric project, which lasted from around 1900 to 1960 (McCulloch 1995, pp. 1-2), was an effort to “describe the study of the psychology and behaviour of African peoples” (McCulloch 1995, p. 1). It was epitomized, for McCulloch, by authorities such as the English-born J.C. Carothers (1903-1989), a Kenyan ethnopsychiatrist and author of the WHO-commissioned The African Mind in Health and Disease (Carothers, 1953). As McCulloch convincingly demonstrates, this text was little more than a UN-sponsored “theory of African inferiority” (McCulloch 1995, p. 63) that legitimated the interests of African colonizers: Carothers “expanded his explanation of the Africans’ deficiency to include culture, race, brain morphology, morality and intellectual endowment. [.] The African Mind was not a study of mental health but a politics of possibilities—a theory of citizenship, economic behaviour and moral failing” (McCulloch 1995, p. 61).

An African response to the brazenly colonial ideology of ethnopsychia- try was developed by the celebrated Yoruban psychiatrist Thomas Adeoye Lambo (1923-2004), whose work in Nigeria came to prominence in the 1950s, just as the authority of McCulloch’s ethnopsychiatry was beginning to be eroded by decolonization. Lambo is perhaps best remembered for the challenge to Western expertise in the success of his Aro village system, whereby schizophrenics were given care in the local community, rather than in a hospital setting. As Matthew M. Heaton explains, “Lambo credited the cultural emphasis on community care in African healing systems, and his own reformulation of it at Aro Village, as the most apparent contribution to the recovery and reintegration of African schizophrenics into their societies” (Heaton 2013, p. 112). Such experiments, though, should not be misinterpreted as a defence of culturally specific therapeutics—the Aro model was conceived as potentially universalizable. In the work of Lambo and others, belief in uni- versals of progress was intimately linked with belief in universals of psychopathology: “Nigerian psychiatrists’ political and professional agenda meshed in ways that led them to repudiate racist conceptions of the inferiority of African psyches [...] and to replace them with a theory of the universal similarities of human psychological processes that transcended perceived boundaries between races and cultures” (Heaton 2013, pp. 4-5). Tolani Asuni, for instance, proposed that the apparently low rate of depression in Nigeria (as indicated by low suicide rates) was only because “depressive illness in this country does not manifest itself by feelings of guilt, unworthiness, and selfreproach” (Asuni 1962, p. 1096). Nigerian cultural factors, in Asuni’s view, moulded the underlying (putatively universal) psychopathology in a way that made familiar indices unreliable. In the context of such work, Lambo thus “began to produce research arguing for the basic universal similarity of human psychology, irrespective of race, religion, ethnicity, or geography” (Heaton 2013, p. 52)—a thesis that would later be fundamental to the Movement for Global Mental Health.

Historiography shows that while Carrother’s ethnopsychiatry was an unconscious medical legitimation of colonial paternalism, Lambo’s psychiatry was more self-consciously an expression of the modernizing ambitions of postcolonial Nigeria. Nor were such universalistic programmes of research confined to Africa: as Sumeet Jain and Sushrut Jadhav explain, postcolonial India saw “attempts to develop an ‘Indian psychology and psychiatry’ by uncovering mental health concepts within indigenous texts and traditions” (Jain and Jadhav 2008, p. 567). The aim was not an autonomous ethnopsychiatry but rather a developmentalist validation of “indigenous Hindu traditions” via a “linking of ‘modern’ psychiatry to ‘traditional’ Indian knowledge systems” (Jain and Jadhav 2008, p. 567). However, as faith in postcolonial development along Western lines has waned, so there has emerged an increasingly historically self-aware strand of psychological and psychiatric thought and practice. As Richard Peet and

Elaine Hartwick explain, the postcolonial era was one in which “the economies of Third World societies had already been captured, in structure and orientation, by the capitalist world market” (Peet and Hartwick 2009, p. 165), so that formal independence really ushered in an era of “neocolonialism” or “neo-imperialism” in which direct “hard” power was replaced by indirect social, political and cultural hegemony. Peet and Hartwick argue that the USA has emerged as the dominant neo-i mperialist after the collapse of the Soviet Union: “Contemporary U.S. neoimperialism has the confidence to control others in the long term by setting ideals that people strive for rather than controlling bodies through violent intimidation” (Peet and Hartwick 2009, pp. 165-166).

The social psychologist Ignacio Martin-Baro (1942-1989), who was active in El Salvador until his assassination during the civil war (Portillo 2012, pp. 77-82), proposed a “liberation psychology” for the neocolonial age. He criticized dominant psychologies “imported from the United States” (Martin- Baro 1996, p. 20) for their “positivism, individualism, hedonism, [...] homeostatic vision, and ahistoricism” (Martin-Baro 1996, p. 21). Such psychologies were an ideology and instrument which “served [...] to strengthen the oppressive structures, by drawing attention away from them and toward individual and subjective factors” (Martin-Baro 1996, p. 19). He trenchantly criticized the intellectual vices of a positivist discipline that, “[r]ecognizing nothing beyond the given, [.] ignores everything prohibited by the existing reality” (Martin-Baro 1996, p. 21): a “positivist analysis of the Salvadoran campesino would lead one to the conclusion that this is a machista and fatalistic person”, just as “the study of the intelligence of blacks in the United States leads to the conclusion that the IQ of blacks is on average a standard deviation below that of whites” (Martin-Baro 1996, p. 21). The supposed fatalism of the Salvadoran people was for Martin-Baro exemplary of a positivist conclusion—this contingent reality was due to a lack of social and political autonomy which forced the Salvadorans “to learn submission and expect nothing from life” (Martin-Baro 1996, p. 27).

The preceding brief survey indicates that the expert discourses of mental health in non-Western settings have been strongly inflected by contemporaneous ideologies and institutions. Carother’s theory of the African mind was an apology for colonialism; Lambo’s work in Nigeria responded to racism within a context of modernization and development; Martm-Baro’s liberation psychology was a consciously politicized resistance to US neocolonialism in Central America. What then underpins contemporary professional anxieties regarding the global medicalization of distress? What are the political meanings of a more affirmative response to non-Western cultures of mental health?

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