Western Psychiatry and Traditional Healing:
Postcolonial Perspectives Dr. Tony B. Benning,
MSc PGDIP MRCPsych (UK) FRCP (C)
Maple Ridge Mental Health Centre
22470 Dewdney Trunk Road
Maple Ridge, BC,
Western Psychiatry and Traditional Healing: Postcolonial Perspectives.
International Journal of Psychosocial Rehabilitation. Vol 19(2) 3-11
review takes as its starting point the chasm separating Western
psychiatry from the indigenous healing traditions−especially in the
North American context. The principle arguments of this paper are
twofold: that this state of affairs is unlikely to change unless there
is a greater understanding of the sorts of factors that are
underpinning and perpetuating this chasm and secondly, that
indispensable to this understanding, is a perspective that takes into
consideration the way in which Western psychiatry has historically
related to and continues to relate to the indigenous world in a manner
that reproduces and reinforces colonial values. A greater awareness of
the enduring impact of colonialism and its legacies promises to
illuminate the problematic nature of the relationship between Western
psychiatry and indigenous or traditional systems of healing.
Key Words: Western
psychiatry, traditional healing, Psychiatry and traditional healing, Psychiatry
share with several authors (Belmaker, 2010; Grof, 2011; Harner, 1980),
a critical attitude towards the materialistic biases and commitments
that dominate psychiatry. Such biases are arguably, reflected in
psychiatry’s seeming reluctance to accommodate or honor spiritual or
indigenous ways of knowing as well as by an apparent chasm that
separates Western psychiatry from indigenous or traditional systems of
Harner (1980), who has arguably spearheaded the
contemporary Western renaissance of shamanism and shamanic studies
claimed that Western psychiatry is biased in two ways: it is
ethnocentric (that is, it posits its own view of the human psyche as
innately superior to the views of the human psyche in non-Western
cultures) and it is cognicentric (it only considers as valid and
legitimate those experiences that have occurred in ordinary
consciousness). These two biases and features of Western thought
articulated by Harner may well assist in beginning to understand why it
is, at least in so far as psychiatry in the Western world goes, that
there would appear not to have been any sort of serious dialogue with
indigenous healing traditions. One might also reasonably speculate that
were such a dialogue to become possible, new therapeutic horizons could
emerge, supporting integrated approaches to the treatment of
individuals suffering from mental illness.
My aim is to
understand better the sorts of factors that might be contributing to
and maintaining the present chasm between Western psychiatry and the
indigenous world−including indigenous healing. I contend that this
chasm is a reflection of Western psychiatry’s narrow conceptual
commitments and ultimately, it is my hope that such an
understanding will potentially facilitate some sort of
rapproachment and that psychiatry’s “ontological matrix” (Wautischer,
2008) will undergo a long overdue expansion that would bring it
in line with the recent paradigm shifts seen in such disciplines
as consciousness studies (Penrose, 1994; Stapp, 2006) and anthropology
(Turner, 2008;Young & Goulet, 1994). As valuable and as profitable
a greater understanding of the relationship between Western psychiatry
and indigenous healing systems might be, there has been, perhaps
surprisingly, a lack of scholarly attention to understanding this
important interface. The relationship between mainstream psychiatry and
indigenous peoples in North America remains problematic. This statement
is supported by several observations including the fact that psychiatry
has been unable to imbibe those elements of indigenous healing that may
have the potential to be of therapeutic benefit for patients as well as
by the fact that there are significant problems with
under-utilization of mainstream mental health services by North
American First Peoples (Sue, 1977).
(1976) schema for conceptualizing the relationship between Western
medicine and traditional healing systems, it can be seen that the
relationship between Western psychiatry and North American indigenous
healing systems can only be characterized as one of “competitive
co-existence.” Similar observations by Ruiz and Langrod (1976) led them
to characterize the relationship as a “dichotomy” (p. 95). Ruiz
and Langrod’s call for greater dialogue and integration between
mainstream psychiatry and indigenous healing practices have not been
realized. The central arguments of this paper are twofold; that
this relationship of competitive co-existence is unlikely to change
unless there is a greater understanding of the sorts of factors that
have led to it and that are perpetuating it−and secondly, that a
perspective that is aware of the enduring impact of colonialism on
present psychiatric thought and practice, especially to the way in
which psychiatry relates to indigenous world, is indispensable if we
are to move towards a greater understanding.
Colonialism and Psychiatry
burgeoning recent literature (Diouff & Mbodj, 1997; Ernst, 2010;
Jackson, 2005; Keller, 2007; Mahone & Vaughan 2007; Sadowsky, 1999)
has examined colonial psychiatry in Senegal, India, Zimbabwe, Nigeria,
and North Africa as well as in other colonial contexts. Much of it
brings to the study of this aspect of history a distinctly new form of
historicity and self-conscious reflexivity that was rare before the
1970s/1980s. In this respect, referring to the new history of colonial
medicine, Ernst (2004) wrote that it “distanced itself in no uncertain
terms from previous, traditional accounts that portrayed the history of
colonial medicine as the successful and relentless unfolding of Western
progress and rationality and the eventual triumph of Western science ”
The review will begin by providing an overview of
some of the literature on psychiatry in the colonial period that has
emerged in recent decades highlighting major themes and conceptual
orientations. This will be followed by an overview of some recent
literature which, in interpreting contemporary psychiatry in the light
of colonialism, holds that the biases, values and commitments which
characterized and infused colonial psychiatry are also seen in
contemporary Western psychiatry− suggesting continuity between the two.
Psychiatry as colonial discourse
wrote that “the objective of colonial discourse is to construe
the colonized as a population of degenerate types on the basis of
racial origin, in order to justify conquest and to establish systems of
administration and instruction” (p. 70) and Colonial psychiatry did, as
Kirmayer (2007) noted, serve to justify and maintain the social order
of colonial regimes. There are few better examples of this than the
concept of drapetomania, a psycho-pathological term coined by an
American physician Samuel Cartwright in 1857, referring to a slave who
desired to flee captivity (Littlewood & Lipsedge, 1989).
very notions of primitivity and psychopathology as legitimate objects
and subjects of discourse, contributed to the colonial articulation of
what Waldenfels (2007) referred to as doubled otherness and the
colonial project was very much served by the Europeans’ hypertrophied
valuation of reason and rationality, and the juxtaposition of this with
the view that reason and rationality are lacking in the so called
“primitive”. An influential publication by the French Anthropologist
Levy-Bruhl (1926) Primitive Mentality supported and reflected this
dualistic conceptualization, positioning the mentality of the civilized
European as superior, and as representing a more advanced state, in
teleological and evolutionary terms, compared to the mentality of the
primitive. Influential intellectuals such as Levy-Bruhl then,
contributed to a primitivist discourse, and Lucas and Barrett (1995),
in explicating the notion of psychiatric primitivism showed how
psychiatry also contributed to this. Undergirding the argument of Lucas
and Barrett, and Ingleby (2006) is that the colonial relationship
between colonizer and colonized was predicated on a notion of
fundamental difference, indeed hierarchized difference, and that
psychiatric discourse reproduced and reinforced this. Kraepelin, often
dubbed the Father of comparative psychiatry, also understood
psychopathology in terms of a developmental hierarchy: Kraepelin (1904)
explained his observation of the relative absence of delusions and
hallucinations among the Javanese, for example, on the basis of their
presumed lower stage of intellectual development.
Colonial Psychiatry’s Stance Towards Traditional Healing
medical systems were not only ignored by colonial administrators as
Unschuld (1976) suggested, but they were actively subjugated as Diouff
and Mbodj (1997) suggested in writing about Senegal under the French
empire and as Ernst (2010) described with regard to the Indian context.
The motif of folk medicine, applied by the British such indigenous
medical practices such as Ayurveda in India, according to Ernst (2010),
displayed an attitude of denigration on the part of the
colonizers. One sees throughout the colonial period, the
widespread deployment of psychiatric and psychoanalytic rhetoric to
denigrate indigenous worldviews. The late nineteenth century saw a
decline in the influence and authority of the church in the Western
world and the authority of positivistic science and psychiatry stepped
in to replace the resulting explanatory void (Jilek, 2005) and against
the background of this new “episteme”, to borrow Foucault’s (1972, p.
191) term, the shaman was increasingly constructed as a case of
psychopathology. Read (1920) and Hambly (1926) considered the shaman’s
voluntary movements to be suggestive of epilepsy and anxiety
respectively. The psychoanalytically oriented anthropologist Devereux
(1961) was a particularly strong proponent of the prevailing
pathological hypothesis, stating that “the shaman is psychiatrically a
genuinely ill person” (p. 262) and that “the Mohave shaman is a
fundamentally neurotic person” (Devereux, 1957, p. 1044). An important
influence on Westerners’ assumptions (starting in the late nineteenth
century) about the pathological nature of shamans, according to
Znamenski (2007), was a body of accounts from ethnographers and
explorers, linking arctic hysteria to shamanism, to imply a
connection between native spirituality and insanity.
(2004) perspective typified the recent turn in the humanities alluded
to above. It understood psychiatric practice during the colonial period
in India against a backdrop where European attitudes of superiority
over Indians were closely intertwined with European colonizers’
assumptions of the superiority of their rational worldview over what
was assumed to be the Indians’ backwardness and irrationality. Ernst
argued persuasively that within this frame, rationality and all that
was scientific increasingly came to be pitted against all that was
irrational and backward in a binary configuration. The practice of
mesmerism, despite promising beginnings, failed to flourish−for it fell
on the wrong side of the rationality/irrationality divide. Despite
attempts by its most ardent champions in India to emphasize its
scientific basis, mesmerism’s perceived closeness to magic and Eastern
tradition as well as the fact that many Indians themselves expressed
interest in it influenced, according to Ernst, its eventual demise.
Persisting colonial commitments in contemporary psychiatry
has recently been increasing acknowledgment of the links between
contemporary and colonial psychiatry, of the persisting, often
implicit, colonial commitments of Western psychiatry. Taylor (2003), an
anthropologist, brought attention to the assumption of universality in
Western medicine in general. It is often assumed, argued Taylor
that Western medicine does not have a culture, that it is a “culture of
no culture” (p. 555). In her thorough meta-analysis of scholarly
publications between the 1940s and 1980s, O’Nell (1989) persuasively
demonstrated that colonial forces have continued to influence research
on mental health among American Indians and Alaska natives, often
through covert universalist commitments. O'Nell showed that this has
been operant in several areas of research including pathological
categories (nosology), epidemiology and diagnostic instruments. Gaines
(1992) noted and objected to the same universalist tendencies in
psychiatry and went so far as to suggest that the term ethno be applied
as prefix to psychiatry in the West (ethnopsychiatry) to rescue it from
pretensions of its own aculturality. In their theoretical analysis of
some aspects of Western cultural psychiatric literature, Lucas and
Barrett (1995) demonstrated that Western psychiatry continues to relate
to the non-European in ways that are strongly characterised by a
primitivist orientation. That is, it conceptualizes the other by
employing one of two opposing perspectives: the barbaric and the
arcadian. The former equates primitive society with degeneration and
pathogenesis and the latter treats it as pristine and harmonius.
Whether expressed in the form of barbarism or in the form of its polar
opposite: arcadianism, Lucas and Barret persuasively showed
that what they have referred to as psychiatric primitivism, has
been a continuous theme over the course of more than a century:
apparent in the comparative psychiatry of Emil Kraepelin, in debates in
recent decades about the possibility of differing rates of
schizophrenia in different cultural groups, in Western constructions of
shamanism, as well as in contemporary psychiatric classification
Tracing the roots of the Western enterprise of
ethnopsychiatry to racist routes in colonial ethology with special
reference to the African context, Bidima (2000), writing in a polemic
style, found ongoing evidence in ethnopsychiatry’s contemporary forms,
of ongoing evidence of essentialism and culturalism. Bidima warned of
the dangers of both extreme contextualism as well as universalism in
the conceptualization of the cultural other. Contextualism runs the
risk of pathology being overlooked and universalism risks the
assumption of the universal relevance of European constructs and
concepts. One of the most compelling claims of this paper, throughout
which, the author is concerned with discourses of power and
relationships of power, is the fact of the absence of the voices of
African therapists from discussions about ethnopsychiatry and so, by
bringing a postcolonial sensibility and by persuasively linking
ethnopsychiatry and many of its contemporary tendencies with
racist colonial ideology, this paper proposed to consider the sorts of
biases that attend ethnopsychiatry to the present day. A tone of
activism permeated through this paper as did a de-centred perspective
which was committed to honoring the emic reality of what
ethnopsychiatry has only known as the cultural other. Bidima’s
commitment to honoring emic subjectivity was also expressed
through a concern about the problematic nature of translation.
much similar vein, but with a much better informed understanding of the
breadth of cultural psychiatry and of the different traditions
constituting it than is conveyed by Bidima (2000), Kirmayer (2007)
considered cultural psychiatry from within an historical perspective
which reveals sensitivity to the post-colonial context. Factors
influencing the presently changing landscape of cultural psychiatry
(such as increasing numbers of mental health professionals in the West
hailing from diverse ethnocultural backgrounds) were accurately and
astutely observed and Kirmayer brought attention to the various social
forces that helped to mount a challenge to the hegemony of
Western accounts of history in the mid twentieth century. Throughout
his paper, Kirmayer showed a keen awareness of the surviving influence
contemporary psychiatric discourses, of colonial assumptions –
including assumptions of human and social progress. According to
Kirmayer, residues of this kind of thinking can be identified in some
of the writings of British psychiatrists from as recently as the 1980s.
In this respect, Kirmayer brought attention to Leff’s (1981) argument:
that there is a progressive differentiation of the emotional lexicon in
Indo-European languages – with British English being conceptualized by
Leff as the most differentiated. For all the strengths of this paper,
and for all that it achieves in providing an overview of the history of
cultural psychiatry from a laudably critical perspective by
appropriately considering relevant social and historical forces, the
paper is not propped up by anything that comes close to matching
the tone of activism or advocacy as one sees in Bidima and
Kirmayer’s concerns in this paper, though clearly striking an
unequivocal note of criticality, did not extend to any serious attempt
to champion the cause of the subaltern, those whose voices
remain excluded from Western cultural psychiatric discourse.
Western Psychiatry and Indigenous Healing
(1961) Persuasion and Healing represented an attempt by an
American psychiatrist to reflect on psychotherapy from a comparative
perspective. Frank’s concern encompassed modern Western schools of
psychotherapy and healing in non- industrialized settings including
shamanic healing and his central argument was that the superficially
diverse therapeutic traditions share a common concern with rhetoric
(persuasion) and hermeneutics (meaning). There is no evidence of the
author having phenomenologically engaged with the indigenous healing
practices he described and this contributed to this work’s “experience
far” flavor− that is, distant from direct experience. The
interpretations made and the attempts to conceptualize indigenous
healing were characterized by a strong etic bias in their over reliance
on Western psychotherapeutic concepts and categories. Nonetheless, if
one is to follow the thesis advanced by Prince (1981), Persuasion and
Healing did contribute to some rapproachment between Western psychiatry
and traditional healing because, through its espousal of common
therapeutic factors in Western and traditional therapy, it made
traditional medicine more intelligible to Westerners. Jilek’s (1982)
Indian Healing stood apart as comprehensive study of indigenous healing
by an anthropologically orientated psychiatrist. This study, of
shamanic ceremonialism in the Fraser Valley region of British Columbia,
was based on the author’s immersion in “the field” over several years
and the study benefited from a multidisciplinary perspective which drew
on existing ethnographic literature, direct ethnographic observation,
and the author’s extensive knowledge of concepts from Western
psychotherapy. The drawback of this work was the author’s uncritical
and un-reflexive use of terms from the Western psychiatric and
sociological lexicon such as anomie, depression and somatization
as well as a “one size fits all” prescriptiveness about what the author
considered to be best for all “Indians”. Jilek inadvertently then
perpetuated an essentialism in his view of the indigenous other and a
further shortcoming was the conspicuous lack of first person narrative
from indigenous people in this work. Jilek and Todd's (1974) paper,
detailing the authors' work with British Columbia's Coast Salish
community also accomplished much: Over a four year period, outcomes of
24 individuals who had gone through a “winter spirit dance initiation”
were described in qualitative as well as quantitative terms. The
sequence of events in the winter ceremonial were described: symbolic
clubbing to death of the initiate in the smokehouse followed by
relative seclusion for at least four days before a symbolic rebirth in
the presence of cheering crowd and rhythms of drums. Out of 11 cases of
anxiety or depression or somatic illness, 7 showed significant
improvement. Out of 13 cases of behavioral disturbance or aggressive
tendencies, 13 were rehabilitated and 4 were described as having
improved remarkably. The authors claimed then that collaborations
between Western psychiatrists and traditional healers were associated
with empirically demonstrable favorable outcomes. This quantitative
information was complemented by five detailed case reports and
ethnographic descriptions of indigenous healing (including the spirit
dance initiation) and this made for what was a methodologically
eclectic paper. The case reports suggested that indigenous healing lead
to clinical improvements in many cases where the efforts of Western
psychiatrists had failed. Unfortunately, there were some methodological
shortcomings in the study’s design that precluded general conclusions
to be drawn about the efficacy of spirit dance initiation as a
treatment for psychiatric disorder: The overall sample size was small.
In terms of psychopathology in the subjects, the sample represented an
overly heterogenous spectrum of pathologies. Claims of efficacy were
also weakened by the lack of a control group. Details about the manner
in which subjects’ progress were rated were lacking in that there was
no mention of any independent rater or the use of rating
scales/instruments. Nor were there details about the time period over
which follow up occurred. Examples such as this and Dick’s (1971)
project in Arizona in which psychiatry and Navajo healing practices
were integrated, unfortunately, for all their merits, failed to have
sustained or wide impact on practice.
Voices of Resistance
and Wane (2005) articulated their concerns about sharing aspects of
indigenous healing practices, arguing that “scientific paradigms are
often used to deny or refute out time-tested, reliable, valuable, and
successful practices” (p. 53). Such contemporary resistance
discourse was also powerfully captured by the research methodology
deployed by Joseph Gone (2008) in his extended ethnographic interview
with an Amerindian elder from Northern Montana, for it allowed for the
articulation and expression of one individual’s views towards Western
Several themes emerged in Traveling Thunder’s discourse which Gone (2008) enunciated.
thunder very much acknowledged the epidemic rates of pathology among
native peoples, but as Gone (2008) noted, Traveling Thunder emphasized
“the spiritual and sociohistorical” (p. 376) level of analysis
over the “intra-psychic and biogenetic” (p. 376) in locating
understandings of pathology within the context of colonial trauma. He
saw Western psychiatry in oppositional terms, as an institution of
relevance only to the “white man” (p. 381) and considered indigenous
ceremony as a far more appropriate therapeutic intervention.
Specifically, space and place emerged as strong themes in Traveling
Thunder’s understanding of indigenous therapeutic intervention. This
study profited from the explicit rendering by the author of important
details about Traveling Thunder’s background so that the reader obtains
a sense of Traveling Thunder’s positionality and biases (as a
Traveling Thunder’s is one of
an emerging chorus of North American indigenous voices who consider the
apparent incompatibility between Western psychiatry and indigenous
traditions , with the latter perceived as more holistic in its
conceptualization of health and healing. (Adelson, 2007; Cohen, 1998;
Vukic, 2011). The major shortcoming of this research was that, despite
the richness and candid nature of Traveling Thunder’s narrative, no
generalizable conclusions can be made from such a single interview.
Traveling Thunder’s views against psychiatry were extreme to say the
least and they cannot be held to be typical or representative of
indigenous people. It is difficult to imagine how such views could
leave any room for meaningful dialogue between indigenous people and
psychiatry. Gone (2008) failed to address these important issues.
A growing literature
positions Western psychiatry on an historical continuum with colonial
psychiatry. An increasingly self-reflexive and self-
critical orientation among several psychiatrists towards the heritage
of their own discipline in the West has contributed to an
increased awareness of the way in which psychiatry has, and
continues to relate to indigenous peoples and to indigenous
systems of healing.
Elements within Western
cultural psychiatry have concerned themselves with indigenous healing
but their interpretive frameworks and paradigms have often precluded an
understanding of indigenous healing on its own emic terms. In the rare
instances of some sort of integration and mutual dialogue having been
achieved, lasting or tangible impact on Western psychiatry has not been
seen. This review also points to the existence of significant currents
of resistance, of anticolonial discourse, from an indigenous
perspective, against Western psychiatry and the literature hints at but
fails at this point to satisfactorily elucidate the meanings(s) carried
by the signifier indigenous healing within what can be said to be the
nexus of social and discursive power relations which constitute it and
within which it (and psychiatry) are embedded. Any contemporary attempt
to understand better the relationship between Western psychiatry and
indigenous healing systems can ill afford to ignore the full spectrum
of semiotic significance indigenous healing has in the present
postcolonial landscape. In the service of this task, it is high time
that a systematic attempt be made to gather the perspectives of those
whose voices have historically been under-represented in Western
academia. To date, little scholarly attention has been given to
ascertaining the perspectives of indigenous healers, specifically in
the North American context, on the relationship between their healing
systems and modern Western mainstream psychiatry, and this has not
certainly been done through the explicit lens of
postcolonial theory. Kirmayer (2007), in endorsing its relevance
for the understanding of alterity and identity in the
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