Critical Psychiatry and Mental Health

Exploring the work of Suman Fernando in clinical practice

Roy Moodley, Martha Ocampo, Roy Moodley, Martha Ocampo

• Publisher: Routledge
• Year: 2014
• eBook ISBN:
  9781317701255
• Topic: Psicología
• Subtopic: Salud mental en psicología

Critical Psychiatry and Mental Health critically explores the current theory and practice of ethno-psychiatry and multicultural mental health practices and policies. Through an in-depth discussion of the work of Suman Fernando, one of the world's leading scholars and researchers in race, culture and mental health, an international selection of contributors discuss and debate issues affecting mental health and minority ethnic individuals and groups.

The book offers a new approach to global mental health, arguing that the use of outdated and outmoded ways in which psychiatry is researched and practiced is a thing of the past, that social justice can only be achieved through a more democratic approach to mental health care and emphasising that the inclusion of cultural and traditional healing methods and practices are vital to meeting diverse needs. Split into five parts, the book covers:

Critique of Western Psychiatry and Mental Health

Challenges and Opportunities in Mental Health Care

Training and Development in Mental Health Practice

Transnational Contexts: Engaging the work of Suman Fernando

Personal Reflections on Suman Fernando's Life and Work

Critical Psychiatry and Mental Health is ideal for researchers and practitioners in health and mental health, psychiatry, counselling and psychotherapy and anyone interested in the intersection of race, culture and mental health.

Part I

Critique of Western psychiatry and mental health

1 Transcultural psychiatry and mental health

Suman Fernando

Introduction

There are fundamental differences between, on the one hand, Western psychology and psychiatry and, on the other, non-Western approaches to ‘mind’ that were derived in non-Western cultural traditions, particularly those of Asia, Africa and Pre-Columbian America. Although there are various systems of medicine, it is only in Western medicine that a system has developed to identify a group of ‘disorders’ or ‘illnesses’ located in the ‘mind’ alone, as psychiatry does. But mind itself is both socially constructed in diverse ways depending on (social) context (Coulter, 1979) and imbued with culturally determined meaning forming the basis of a variety of ‘folk psychologies’ (Bruner, 1990).

Historically, both Western psychology and psychiatry emerged from Western thinking after the (European) Enlightenment of the 18th century reflecting a paradigm (see Kuhn, 1962, for the meaning of ‘paradigm’) characterized by: (1) positivism, the belief that reality is rooted only in what can be observed and knowledge is limited to events and to verifiable connections to events; (2) causality yielding a mechanical cause-and-effect model, implying that nothing is truly random and nothing beyond understanding (that is, supernatural); (3) objectivism, where feelings become things ‘out there’ to be studied as objects, and moral judgements are not valid; and (4) rationality, where the final arbiter of truth is reason and all assertions are verifiable by logical reasoning. The methods of study promoted by scientific thinking were (1) the mechanistic approach of Newtonian physics; (2) reducing complex systems into its parts; and (3) logical reasoning as opposed to any other type of understanding, such as intuition (for discussion, see Fernando, 2010). In the 19th century, Western psychology became biological under the influence of Darwinism (Murphy, 1938); and Morel’s theory of degeneration (Morel, 1852) built upon by Kraepelin (1899) drove psychiatry in Europe into a genetic mode, giving rise to the German-British school of bio-medical psychiatry. But it was not until this bio-medical approach was adopted in the United States in the 1970s and 1980s that it became the standard system promoted as the ‘scientific’ approach (for detailed discussion, see Fernando, 2010). However, it is noteworthy that, although Western medicine and psychiatry started in a Western setting, the development of these disciplines is no longer confined to geographical locations in the West; medical and psychiatric research and theorizing, as well as development of allied techniques and treatments, are now sometimes located in Asian countries like Japan and increasingly in China and India, as a part of the globalization of science and technology. Because of this, it is preferable to speak of bio-medicine (rather than ‘Western medicine’) and ‘bio-medical psychiatry’ – or just psychiatry – rather than ‘Western psychiatry’. Yet, it is important to note that because of fundamental conflict between, on the one hand, Western psychology and bio-medical psychiatry and, on the other hand, the psychologies that come from non-Western cultural traditions – the cultures of the majority world – very different (culturally determined) understandings prevail of what problems of the mind entail, and how they may relate to concepts of illness and health. This means that a unitary, global system of ‘mental health and illness’ is not sustainable.

In this chapter, I shall start with a critical analysis of Western psychology and bio-medical psychiatry. Then I shall present a précis of how the transcultural psychiatry movement developed in the West. And finally, I shall consider briefly the practical application of current Western psychology, appertaining to what is generally understood as ‘mental health’ and the way psychiatry as a practical discipline allied to (Western) medicine functions today.

Western psychology and (bio-medical) psychiatry: a critical analysis

Western psychology covers ‘the scientific study of the human mind and its functions, especially those affecting behaviour in a given context’, while psychiatry is ‘the branch of medicine concerned with the study and treatment of mental illness, emotional disturbance, and abnormal behaviour’ (Soanes and Stevenson, 2008, pp. 1158–1159). Among the important questions that go begging is one concerning the nature of ‘mind’ and another about the sociopolitical purposes fulfilled by psychiatry (as a part of a medical system). The question of whether a particular approach is ‘scientific’ or not is a moot point; and the study of the human mind, closely linked to the concept of ‘self, is recognizable in many seemingly ‘non-scientific’ (non-Western) cultural traditions (see Marsella, Devos and Hsu, 1985; Jahoda, 1992; Kirmayer, 2007). In other words, there are many psychologies in the world today, although admittedly the non-Western systems are mostly located in religion or philosophy. Examples are Indian (Hindu) psychology (Rama, 1985; Safaya, 1976) and its development in Buddhism (Rhys Davids, 1978) as a specific Buddhist psychology (Kalupahana, 1992) or the psychology of Zen (Fromm, Suzuki and de Martinai, 1960) and Tibetan Buddhism (Rinbochay and Napper, 1980); traditions in Chinese medicine that amount to a psychology (Hammer, 1990); African ways of interpreting the spirit/mind (Mbiti, 1969) and its relationship with Egyptian traditions (see Nobles, 1986); and the psychology discernible in the folklore and spiritualities of the first nations of the American continent (e.g. see Ross, 1992; Simmons, 1986).

In considering ‘psychiatry’ transculturally, the terrain is different. There are many different well-established systems of medicine as well as many others that are not yet standardized into clearly defined written forms, such as those practised in many parts of Africa and America (dating from pre-Columbian times), Ayurveda and Unani medicine (mainly practised in the Indian subcontinent and the Middle East) and Chinese medicine (predominantly used in China and neighbouring countries); but there is only one version of a medical speciality concerned with disorder of mind as distinct from body, and that is psychiatry – the system developed in the Western tradition emanating from 19th-century science. It is only in this (Western) system that feelings, beliefs and behaviours are interpreted as ‘pathological’ (abnormal), indicating the presence of ‘illnesses’ of the mind (see Fernando, 2010). Analogies between descriptions of treatment in some non-Western medical systems and those in psychiatry, such as that drawn by Clifford (1984) writing about (what she called) ‘Tibetan Psychiatry’, are in reality far-fetched when one considers their practical applications. What reigns supreme as ‘psychiatry’ is the Western variety – bio-medical psychiatry.

The major difference between Western and other traditions in relation to psychology and religion is the emphasis in the latter on a holistic perspective of health and the exclusion in the former of spirituality. As psychology developed in the West within philosophy, the stage was set by one of its early founders, Descartes, declaring that mind (seen by Descartes as an indestructible ‘soul’) and the impermanent body matter were fundamentally separate (the so-called Cartesian philosophy). Capra (1982) describes how as ‘scientific’ psychology developed, it excluded anything that smacked of ‘religion’ and produced, under the influence of Newtonian physics, a mechanistic understanding of all aspects of human nature and even of human societies. Although Descartes advocated that the mind should be studied by introspection and body by methods of natural science, both methods were used subsequently. The culmination of (Western) psychology in clinical work was that ‘structuralists studied the mind through introspection and tried to analyse consciousness into its basic elements, while behaviourists concentrated exclusively on the study of behaviour and so were led to ignore or deny the existence of mind altogether’ (Capra, 1982, p. 166). The result today is some confusion in Western thought about the role and nature of mind, as distinct from that of brain (for detailed discussion of the development of psychology from Descartes onwards, see Capra, 1982; for the relevance of all of this to mental health, see Fernando, 1991, 2002).

Psychiatry developed on the back of a power base resulting from the great confinement – the name given by Foucault (1967) to the institutionalization in asylums from around the middle of the 17th century of large numbers of people in Europe and North America considered deviant or mad. As medical jurisdiction was established over the asylums, the inmates of the asylums were deemed to suffer from various illnesses (see Porter, 1987, 1990; Scull, 1993; Castel, 1988, for interplay between custody and diagnosis of illness) and these became standardized over the years. Ultimately, ‘mental illness’ became the most popular model in the West to use in categorizing people regarded (in the West) as ‘mad’ and this model of ‘illness’ located in the mind became the model for seemingly understanding various problems that human beings had with regard to their feelings, behaviour and beliefs. A variety of therapies have emerged over the years, latterly dominated by psychotropic drugs given designations such as ‘anti-psychotics’, ‘anti-depressants’ and so on, on the premise that they antagonize specific types of illnesses.

Both Western psychology and psychiatry have had far-reaching consequences beyond the clinical mental health field. According to Capra (1982, p. 45), psychology arising from the Cartesian division between mind and body has

taught us to be aware of ourselves as isolated egos existing ‘inside’ our bodies; it has led us to set a higher value on mental than manual work; it has enabled huge industries to sell products – especially to women – that would make us owners of the ‘ideal body’; it has kept doctors from seriously considering the psychological dimensions of illness and psychotherapists from dealing with their patients’ bodies.

The influence of psychiatry (see Fernando, 2010) has resulted in a way of thinking – a ‘culture’ – that tends to reduce complex human problems attributable to a mixture of social, political and biological issues to diagnoses that assume biological causes, thereby reducing our ability to grapple with them realistically. Although its approach to human problems of living has occurred predominantly in the Western tradition, the economic, political and military power of Western nations has resulted in the spread of this ‘culture’ over many parts of the world, putting at risk the health and welfare of people in many parts of the world (for further discussion of the themes mentioned, see Fernando, 2010).

Brief history of the transcultural psychiatry movement

Although a medical approach to madness and hospitals for people deemed to suffer from illness of the mind go back to the Islamic period of European civilization between the 10th and 12th centuries (Dols, 1992; Ellenberger, 1974), the medical movement that developed into (Western) ‘psychiatry’ did not emerge until the 18th century (Shorter, 1997). As a discipline developed by (racially) white people in a Western Judeo-Christian cultural framework post-Enlightenment, problems in applying its practices became obvious as the discipline encountered people from ‘other’ cultures often identified as not being ‘white’. The encounter in Asia and Africa gave rise to ‘cultural’ studies and theorizing that was racist (see Chapter 2, this volume), while some colonial powers introduced the asylum system into their colonies.

In the 1950s an academic interest stimulated by anthropological studies (mainly outside Europe and North America) fed into developing what became known as ‘transcultural psychiatry’, centred at McGill University led by Eric Wittkower (Murphy, 1983). As the McGill group developed, the ‘Transcultural Psychiatry Section’ of the World Psychiatric Association (WPA) was formed (Murphy, 198...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Contents
• Notes on contributors
• Foreword
• Acknowledgements
• Introduction
• Part I Critique of Western psychiatry and mental health
• Part II Challenges and opportunities in mental health care
• Part III Training and development in mental health practice
• Part IV Transnational contexts: engaging the work of Suman Fernando
• Part V Personal reflections on Suman Fernando's life and work
• Index