DecoloDecolonisation - current approach

Decolonising systems that have grown up in Western cultures of Europe, and its extension to America, Australia New Zealand and other ex-colonial settler dominated regions of the world, whether of academic university-based disciplines (like psychiatry or psychology) and / or systems providing services for human beings (like mental health systems), appertains to both theoretical and practical matters. The notion ‘decolonisation’ however can be traced to discussions at the Bandung Conference in 1955 and the Conference of the Non-Aligned Countries in Belgrade in 1961 forming the Non-Aligned Movement (NAM) of former colonised countries, initially led by Tito of Yugoslavia, Nasser of Egypt, Nehru of India, Nkrumah of Ghana, and Sukarno of Indonesia. That was when the term Third World was born ─ a term now seen as outdated and derogatory but to many people living in the colonised world between the two world wars (1914-1918 and 1939-1945), representing a vision of a different sort of world from what had been the world of colonialism, imperialism, and Eurocentric domination of what we now call the Global South (former colonised countries except the settler-states such as Australia and New Zealand). This Third World was envisaged at the time of the cold war between USA-dominated ‘First World’ and the Soviet Union dominated ‘Second World’ as different from both, not just politically but ideologically, ethically, spiritually and a lot else. Since the 1960s, ‘postcolonial’ and ‘decolonial traditions’ of thought and discourse have emerged in sociology and philosophy, summarised by Gurminder Bhambra (2014); and a there is a large literature now on the association between racism, the chattel slavery of Africans transported across the Atlantic, different to all other forms of slavery that the world has known (see Patterson, 1982, Black, 2011, Walwin;1996)

Clearly, turning the clock back to a time before colonialism is not an option and there are other practical considerations to bear in mind in trying to unravel and rectify the damage done by the many years of colonisation (for example the ethnic and other enmities resulting from the ‘divide and rule’ policies described by Morrock, 1973). Essentially, decolonisation today amounts to completion of political decolonisation when (as in most instances) political power was handed over by the colonising (European or Europeanised power) to a limited group of people who claimed to be residents of the colony concerned but without any ‘decolonisation’ in terms of coloniality or antiracism. The sort of decolonisation envisaged at Bandung has not resulted in anything like a Third World envisaged at the Bandung conference (see earlier). The current wave of decolonisation appears to be basically aimed at structural changes to take political change further but more importantly, at coloniality although there seem to be various views on what needs to be covered and what left out in the course of ‘decolonising’ a body of knowledge or curricula.

Concomitant Movements accompanying decolonisation

It should be noted that, although decolonisation of Clinical Psychology at an academic level is important, it should be accompanied by other action (not considered in this book) implicit in movements such as:

Reparations for slavery and genocides of African and indigenous peoples of America which was the basis for the vast wealth of European countries and the current international disparities of wealth and under-development across the world

Restorative justice (including epistemic injustice (Fricker, 207) at an individual level focused on families and communities still suffering from long-term effects of colonisation. These should include both long term psychological and social effects of colonisation as well as loss of property; like the reparations offered after the end of WW2 by Germany to Jewish and other minority groups across the world.

Decolonising the Mind

As decolonisation was talked about in recent times, it seems to have turned towards getting rid of colonial ways of thinking ─ ‘a process that inevitably leads to more fundamental questions … how did people’s minds get “colonized” in the first place? … A “colonial mentality”, or the “colonized mind”, shows a preference or desirability for whiteness and cultural values, behaviors, physical appearances and objects from or derivative of  “The “West” (i.e. Western Europe and North America), with disdain or undesirability for anything coming from the non-“West”; and Europeans wrote about indigenous people in the Americas, Africa, the Middle East and Asia, using the terms “savage”, “wild” and uncivilized”’ (Heinrichs 2010). Clearly, this dimension of decolonisation, decolonising the mind, is of particular importance in talking about psychiatry and psychology; in other words, coloniality is tied up with language and power in complicated ways: ‘The perspective of knowledge “Eurocentrism” naturalizes the experiences of people within this model of power … [T]urning the colonized into non-human or less-than-human beings’ (Veronelli 2015, pp. 111-112).  Racism, power, colonialism, imperialism, a variety of oppressions and capitalism were all involved in the imposition of European language-supremacy which became increasingly English, the dominant language in the USA resulting from the language supremacy established during colonialism and now influencing (for example) reviews of literature (as in this document) and current writing all over the world. Importantly, most of the current literature, especially that published in academic publications and books fail to draw on wisdom and experience of the Global South; and the way knowledge is developed in (culturally) non-Western circles (for example in Asia and Africa) may be very different to what is generally accepted as the ‘scientific’ (and hence ‘best’) approach. Storytelling, parables, and paradoxes play a much greater part in cultures adhering to Asian and African languages −a point made in the work of Ngūgi Wa Thiong’o 1986):

‘As a writer who believes in the utilization of African ideas, African philosophy and African folklore and imagery to the fullest extent possible, I am of the opinion the only way to use them effectively is to translate them almost literally from the African language native to the writer into whatever European language [s] he is using a\s medium of expression. … For, from a word, a group of words, a sentence and even a name in any African language, one can glean the social norms, attitudes and values of a people’ (p.8).

Catherine Walsh (2018) describes decoloniality vis-à-vis the mind thus:

‘Decoloniality denotes [points to] ways of thinking, knowing, being, and doing that began with, but also precede, the colonial enterprise and invasion. It implies the recognition and undoing of the hierarchical structures of race, gender, heteropatriarchy, and class that continue to control life, knowledge, spirituality, and thought, structures that are clearly intertwined and constitutive of global capitalism and Western modernity. Moreover, it is indicative of the ongoing nature of struggles, constructions, and creations that continue to work within coloniality’s margins and fissures to affirm that which coloniality has attempted’ (p.17).

Decolonisation of mental health systems

A study of the literature reveals no clear models available for decolonisation (meaning decoloniality and antiracism) in relation to mental health systems, in particular the disciplines of psychiatry and clinical psychology. As distinct disciplines they are peculiar to Western culture; and many of the ways of the ideologies in then as ‘psychological’ or ‘psychiatric’ are pursued in other cultures in other domains, for instance in medicine, spirituality, religion, and a host of other systems pf thought and actions. Some writers see decolonisation as a praxis, an activity (Ghaddar and Caswell, 2019), something to be pursed in action rather than academic theorising alone by changing, for instance, what Kuhn (2012) calls the paradigms ─ the ways practitioners and academics go about their business in psychiatry, clinical psychology, and mental health. Yet, theorising may well be the start for changing ways of working.

Psychiatry and psychology as disciplines developed in tandem in Europe during the time of the (European) Enlightenment when racism was rife in European culture (Eze, 1997; Morrison,1997).  The rationalism (of Enlightenment thinking) led to ‘espousal by the sciences [including later the social and human sciences] of what are termed positivist methods, which make a very rigid distinction between fact and value’ (Hamilton, 1996, p. 41), italics in original).  But this very separation (of fact and value) impeded the use of (some) scientific methods for addressing societal and cultural values (Hamilton, 1996). Mainstream academic psychology (Western psychology) is severely critiqued in the book Toward Psychologies of Liberation (Watkins and Shulman, 2008) that discusses ways of liberating psychology quoting work in Latin America. Indeed, such work was part of decoloniality which took root in Latin America in several fields after political decolonisation took place. Much of the thinking that underpinned this work in the field of psychology resonates with the writings of Frantz Fanon (1952, 1961 / 1967); and Fanon seemed near to a fully decolonised mental health system in action when he developed ‘social therapy’ for Algerian patients at Blida-Joinville Hospital in Algeria ─ setting the ground work for what may have become a system of  psychiatrie de secteur (community psychiatry) if Fanon had lived long enough to achieve it (Khalfa and Young, 2015, p. 202).

The introduction in the book Global Psychologies; Mental Health and the Global South refers to ‘liberation psychologies’ as innovative psychologies, [that] unlike ‘traditional Western psychology which attributes distress and psychopathology to individual and intrapsychic processes … contextualise the subject [of psychology] within an anti-oppressive environment; consider power structures as templates of distress rather than unconscious motivation of psychopathologies’ (Fernando and Moodley, 2018, pp. 9-10); and the book describes versions of the work by Frantz Fanon, Mohandas Gandhi and Steve Biko as examples of ‘inspirational and constructive psychologies associated with liberation movements that opposed European oppression of black and brown-skinned peoples during the colonial era’ (p. 10), while referring to other liberation psychologies not covered in the book, such as those of Martin-Baró (1994), social psychologist, philosopher and Jesuit priest, and Paolo Friere (1972), Brazilian educator and philosopher who was a leading advocate of critical pedagogy that ‘draws attention to the ways in which knowledge, power, desire, and experience are produced under specific conditions of learning, and in doing so rejects the notion that teaching is just a method or is removed from matters of values, norms, and  power  –  or, for that matter, the struggle over agency itself and the future it suggests for young people’(Giroux 2019).  Decoloniality is clearly the underlying feature of many liberation psychologies.

In decolonising psychiatry and psychology, we need to be cognisant of the fact that problems conceptualised as ‘mental health problems’ and even ‘mental illness’ or something very much like it, are now accepted in many parts of the world in order to provide help (through mental health systems) for real human being with real problems mostly admittedly, problems that may be better called problems of living with medical and spiritual / psychic dimensions (although the original notions of ‘mental’ problems came about during colonialism). While words similar to ‘mental health’ and ‘mental illness’ are now used in most countries, their meanings are still understood very differently in many ways, despite suppression of indigenous systems for mental health care during colonial times and the aggressive imposition of Western psychiatry since the mid-1970s in what is called the ‘Movement for Global Mental Health (MGMH); and what exists now in many countries of the Global South are either plural systems of mental health (Western and non-Western systems side-by-side) or hybrid systems, mixtures of Western and non-Western systems (see Fernando, 2014; Mills, 2014).

Neo-colonial / postcolonial) issues

It should be noted too that (a) forces of colonisation / neo-colonialism are being pursued actively even as we talk about decolonisation, for example in the way ‘evidence-based’ therapies are being introduced in developing mental health services (see Fernando, 2014; Mills, 2014), under the umbrella of development and / or modernisation;  (b) racialised minorities are being excluded, oppressed and even subject to worse indignities (such as police brutality, compulsory psychiatric treatments, and so on ─ see Fernando, 2010, 2017), and that people identified as Muslims are subjected to coercive racist pressures (Younis, 2020; Younis and Jhadav, 2021) in the field of mental health.

An issue that complicates the process of decoloniality (colonial thinking) is that group / national cultures themselves are changing and have changed since the time when political colonisation took place, as a result of which both the notion of individual culture (the culture of an individual) and that of different cultures (rather than numerous hybrid cultures) appear at times to be re-fashioning what culture means in terms of specificity in a world of human beings communicating and interacting with each other in complex ways and forming groups that may well cut across the older ‘cultures’ and even ‘races’. In the international arena, some countries such as Israel appear to be following policies reminiscent of old-fashioned colonisation by occupying and supporting by military means illegal settlers in occupied territories set out as a future state of Palestine─ a situation ironically resulting from the UK (a former coloniser) having acquired the responsibility to manage the disputed land of Palestine.

Urgent antiracist and anticolonial action to counteract these current racist activities that could be dangerous to health and even the lives of racialised citizens of the UK and Palestine may well be necessary even before considering decolonisation. 

Carrying out decolonisation

We should start by assuming that most human beings need some form of socio-cultural system that people identifying as ‘having mental health problems can call upon for support and (if necessary) help; and all this is happening in a world beset with forms of racism. Further, we should assume that the system for mental health includes a care system that includes medical, spiritual, and psychological dimensions and has integrated into its ways of work the preventing of all forms of racism and discriminatory forces that tend to be divisive in terms of gender, sexual orientation social class and other similar ways that intersect with ‘race’.  A team of professionals to work on decolonisation of current systems of psychiatry and clinical psychology should include professionals of diverse backgrounds of ‘race’ cultural background, ethnicity, age, gender, and sexuality ─ all well versed in criticality and compassion (see later) because these concepts may not be commonly known in European cultural circles and some in-depth study may be helpful. The inclusion in the group of people with experience of various systems of mental health care is likely to be helpful.  Once, a team (work group / working partly) is assembled there must be an honest engagement with the realities of the history of European Empires from the 14th Century onwards and the neo-colonialism since their fall.  A reading list as essential reading should be agreed including all the publications suggested later. The team should then agree a procedure including (for example) six sessions of brain storming, talks by specialists in the field and perhaps two one-day meetings.

It should be noted that there is no quick-fix or one single easy pathway to follow; there are many pathways for decolonisation to take and what is followed may depend to some extent on the experience of participants in the group considering decolonisation and their basic knowledge, and the criticality they may be able to summon up in the discussions. Discussions are likely to take some time since they need to be based on counteracting not just racism but also coloniality (colonial thinking controlling knowledge creation and social systems ─ Quijano, 2000). Since curricula for training are usually formulated in terms of competencies it may be best to retain these terms but adding the need for criticality so that professionals maintain the decolonised attitudes, rather that slip back into the racist approaches that tend to be seen as the ‘norm’, the default position when there is difficulty in being (for example) self-critical.  Finally, a time limit should be set for agreeing the basics, perhaps of between six months and one year. It is possible that ways of counteracting and diminishing racism in the mental health system (especially if this is limited to one country) can be identified quickly and changes encompassing antiracist practice with guidelines, changes in legislation and administrative changes based on advice from service users and others who may have experience of the system.

Fields of study and reading lists.

Essential reading necessary before embarking on discussions on decolonisation are listed under ‘Bibliography: Essential Reading’. Additional bibliographies are provided that may be useful for later sessions.  The recently published How To Be An Antiracist by Ibram Kendi (2019) presents a transformative approach to racism and antiracism relevant to the 21st Century. Examples of useful works that provide guidance on the variety of issues that need to be addressed in the process of decolonisation include a critical analysis of existing histories of liberalism (Losurdo, 2014). On order to learn about the distortion of non-Western cultures, Africa’s Tarnished Name by Chinua Achibe (2009) during the colonial period and the reviling of colonised people (as in les damnés in Fanon’s seminal The Wretched of the Earth (Fanon, 1961 / 1967) are very readable works. Psychological effects of personal interactions between the colonisers and the colonised (for example, matters discussed by Memmi, 2016) should provide topics for discussion. The psycho-political concomitants of colonisation, especially its Eurocentricity and failure to confront racism − the leaders of the European Enlightenment voiced extreme racist views (Eze, 1997; Habib,2017) − and how these may be seen from critical philosophical viewpoints are brilliantly discussed in the books by African philosopher Emmanuel Eze (2001, 2008). Eze’s book On Reason, rationality in a world of Cultural Conflict and Racism published posthumously explores models of rationality in the thought of philosophers from Aristotle, René Descartes, Francis Bacon, and Thomas Hobbes to Noam Chomsky, Richard Rorty, Hilary Putnam, and Jacques Derrida; portrays contemporary work of the African thinkers and novelists Chinua Achebe, Ngugi wa Thiong’o, and Wole Soyinka; and reflects on contemporary thought about genetics, race, and postcolonial historiography as well as on the interplay between reason and unreason in the hearings of South Africa’s Truth and Reconciliation Commission. Eze contends that while rationality may have a foundational formality, any understanding of its foundation and form is dynamic, always based in historical and cultural circumstances.  The varieties of colonisation and ways in which they can be explored for decolonisation are covered by Mignolo and Walshe (2018); and issues around the virtual continuation of colonialism in the ongoing ‘Westernisation’ and ‘globalisation’, in the context of neoliberal policies and Western power, such as in the movement for global mental health are introduced by Fernando (2014) and Mills (2014). A good example of decolonisation in the field of history is Black Athena; the Afroasiatic Roots of Classical Civilization by historian Martin Bernal (1987, 1991, 2020) (not necessarily to be read fully─ it is a three-volume tome!), where the author decolonises written history of ‘classical [Greek] civilization’.

To carry out decolonisation, participants in the process need:

(1) To get a grasp of the history of (what is understood as) mental health today in many parts of the world and some understanding of traditional cultures of non-European cultures. This means careful analyses of various culture-specific terms used traditionally, taking on board the variety of meanings of terms used, many connecting with variations of wellbeing, (in English), getting round the problems of translation, and adjusting for loss of meaning that may have occurred during translation. Participants need to draw on the literature in transcultural psychiatry and cultural psychiatry, taking account of the histories of the variety of systems used all over the world to improve mental / psychological wellbeing and support.

The section ‘Essential history of mental health worldwide’ as an additional bibliography attached to this document provides examples in the literature of non-Western mental health systems, especially those that predate the Western variety. One of the most important mental health systems for discussions on decolonisation may be that in Medieval Islamic society (Atiyeh, 1982; Dols,1987, 1992; Gorini,2002) partly because (like the system that developed in Western Europe) the mental health system was influenced by general medical knowledge to an extent that one could envisage it as a medicalised system, not that dissimilar in overall social structure to the Western bio-medical system.

(2) Accept that decolonisation is not an attempt to resurrect older systems of psychiatry and psychology but rather to unravel the effects of colonisation (with its racism); envisage what this unravelling may look like when incorporated into psychiatry / psychology that suits the present day in all parts of the world; and finally put into words the training and educational curricula that may best suit that. In doing this, it is important that the universal nature of the task is foremost, with the cultural and other differences (the diversity) around the world. Therefore, it may help if the writings and teaching of relevant people from many different cultures are drawn on, and in doing so, allowance is made for possible institutionalised racism (which needs to be corrected). 

Preparing a body of decolonised basic knowledge

This should be in a form that academic tutors can use for structuring training schemes for practitioners undergoing training to become psychiatrists and psychologists who work in mental health. This should include:

1.History of mental health from perspectives in both the global South and global North from the early fourteen century onwards, focusing particularly on methods of care in the community, medical systems in Asia, Africa and Europe; relations between mental health systems and religion in all the major civilisations; the first medicalised hospital systems in the medieval Islamic Empire; and the development of secular (Western) ‘clinical psychology’ and ‘psychiatry’ in the post-(European) Enlightenment period. It should cover (a) the development of eugenics in the nineteenth and twentieth centuries including the part played by clinical psychologists and universities such as University College London,; (b) the  opposition to eugenics and complicity of psychiatrists in racist work, such as the antisemitism leading to the Jewish holocaust, the struggles against racism in  psychiatry and psychology in UK and the USA; (c) the imposition of asylum psychiatry and the treatment of indigenous people in psychiatric institutions in colonised countries; and (d) the history of the Islamic mental hospital where there was a mixture of religious and medical systems constituting a ‘psychiatry’.

2. A variety of forms of psychology (Global Psychologies), Ethnopsychiatries, and neurological topics including research should be covered, including work done in social anthropology and religious studies and in neuroscience departments.  This should include the main systems of psychology embedded in religion and philosophy, especially Buddhism (sometimes seen as a form of medical psychology) and Chinese medicine (viewed sometimes as a form of psychological treatment), the systems embedded in Maori culture and various African and medical systems in indigenous nations of Pre-Columbian) America. The neurological work to be covered would obviously have to be presented by neurologists and scientists working in neuroscience.

3. A series of sessions where various aspects of psychiatry, psychology and neurology / neuroscience are discussed in conjunction with each other. It is important that teachers should be drawn from philosophy, religious studies and neuroscience, as well and clinical psychiatrists. Trainees should be given assignments and carry out collaborative work with service users from a variety of cultural backgrounds, if possible, from a variety of locations.

Writing the curriculum in terms of what is expected from training.

The team preparing the decolonised curriculum should either agree on (say 4 or 5) broad headings under which specific topics are listed or use the following two sets which are of relevance to decolonisation in addition to others as the Four C’s, relevant to decolonisation:   Capabilities & Competences, Criticality & Compassion

Capabilities and Competencies

These should be based on a knowledge base derived from both the Global North and Global South (for definitions see earlier) and consist of information on:

(a) Mental health care in a variety of medical and social systems worldwide.

(b) History of systems of mental health worldwide in a variety of cultural and social contexts ─ the variety of (ethno)psychiatry which was created in Europe post (European) Enlightenment is only one; and many systems of Global psychology (‘indigenous psychologies’) are still functioning. It should be noted that one of the earliest medicalised systems based on mental hospitals developed between the 9th to 13th Centuries in the Islamic Empire, while descriptions of Tibetan psychiatry, varieties of healing systems in African, Asian, Pre-Columbian American, and those of South Pacific / South-East Asian, Maori, Polynesian and Australian communities; and varieties of culturally hybrid systems worldwide are well known. Today too there are several culturally hybrid psychologies and hybrid systems of care that resemble forms of (medicalised) Western bio-medical system.

(c) Nature of discriminatory and racist attitudes prevalent in various parts of the world during the colonial era (roughly between end of the 15th Century when the invasions of the American continents began after Columbus’ 1492 voyage across the Atlantic and the early 1970s when the European Empires fell.; and the nature of various forms of neo-colonialism that have thrived in several parts of the world in the ‘post-colonial’ period. 

(d) Diverse philosophical (including religious) understanding of the human condition and its relevance to mental health care.

(e) How culture shapes notions of self that stress social and moral connectedness to family, community, and spirituality (commoner in non-Western cultures) contrasting with the rationality and interiorised individuality stressed in the post-Enlightenment Western self.

(f) Limitations of cross-cultural research because of category fallacy, observer bias, loss of meaning in translation and help-seeking practices.

(g) The problems arising from imposition of colonial (asylum) psychiatry in the European Empires; in much of Europe and the American continent; and settler colonies in Australasia and post-Columbian America

(h) Various types of racist and other discriminatory practices prevalent in various parts of the world, especially in the former settler colonies.

(i) How the history of European colonialism since the sixteenth century, particularly (but not exclusively) slavery was justified by Christianity and scientific thought.

(j) Understand the legacy of slavery and colonialism for contemporary life in multicultural Britain, with reference to different forms of racism.

Examples (by no means a final list) of capabilities and competencies

[Some of these are drawn from and adapted from Generic Professional Capabilities Framework of the (British) General Medical Council (2021)]

Ability to identify, analyse and address institutional threats, including those from institutional racism to patient safety quality of care and diagnoses made.

Awareness of recent and historic collective experiences of ill health that continue to impact social groups today.

Awareness of how cultural beliefs and lived experience of what happens in the interactions between professionals and users of mental health systems may impinge on behaviour and attitudes of service users.

Awareness of the impact of coloniality (colonial thinking) and neocolonialism on

historical and contemporary attitudes towards service users and make determined efforts to make sufficient allowances in practice.

Awareness of social constructivism in relation to ways of seeing, knowing and being of both users and providers of mental health services, and make allowance for these.

Awareness of unconscious biases held by professionals and their duty to address them.

Understanding that theories, descriptions, and explanations, including diagnoses and formulations are not value free.

Ability to analyse, confront and work with societal, political, and economic histories, especially those appertaining to race.

Ability to understand variety of both traditional and contemporary ways of conceptualising, exploring, and analysing mental health and wellbeing and make a choice that is best suited for users of services.

Criticality and Compassion

These notions may seem unusual, even inappropriate, for training curricula. But if we consider what qualities, rather than capabilities and competencies, are necessary for a clinical psychiatrist or psychologist o be able to work effectively anywhere in a post-colonial world, criticality and compassion are essential. It should be noted that the notion criticality is not being used here in the way it may be used or implied in what is called ‘Critical thinking’  an  intellectually disciplined process of actively (https://www.criticalthinking.org/pages/defining-critical-thinking/766) or ‘Critical pedagogy’ (see earlier). Unlike other notions that seem to appear frequently in curricula for training (such as competencies and capabilities), criticality addressed here together with compassion are not about objectives nor about being objective. They draw on subjectivity of being human; the clinician as a human being trying to establish a (therapeutic) relationship with another human being or a group of human beings. They are qualities that did not characterise the world of colonialism with its coloniality of power and racism, nor the psychiatry and psychology that emerged in Western cultures and thence in Eurocentric mental health systems. In a colonial context, indigenous people, often seen in such systems as culturally primitive and referred to as ‘natives’ used in a pejorative sense,  were (and still are where the social structures have not been decolonised) at best seen as ‘objects of concern, but not as equal self-defining subjects entitled to choose their way of life themselves’ (Parekh, 1997, p. 184, quoted by Gasper, 2004, p.195); ruled by colonisers, the owners, the boss-men and boss-women together perhaps with the occasional native imitating  (or mimicking) the rulers, the ‘brown sahibs’ as they were called in some parts of Asia (Vittachi, 1962). The colonial period was characterised by exercise of top-down power and inequalities: the power of the gaze that Franz Fanon (1952 / 1967) (‘Look! A Negro!” (p. 89) spoke about in Black Skin, White Masks; and feminist writer Donna Haraway (1988) refers to as signifying ‘unmarked positions of Man and White … in racist and male-dominated societies (p. 581). Doctors and other professionals providing a decolonised system of psychiatry must step away from the pretence of a disengaged stance placing their emotional responses (a key element of subjectivity) in the centre of the frame in their interactions with users of the services. In writing on what a postracial future should be like, Nigerian philosopher Emmanuel Eze (2001) did not ‘dream about the future when everyone should look alike.’ He envisaged a future when ‘race no longer matters … [and] requires that disabling racial labels may no longer be forced upon individuals or groups … operating to thwart opportunities for some and enhance opportunities for others’ (p. 223). The qualities promoted by criticality and compassion are meant to enable psychiatrists to make that happen. Criticality and compassion are subjective states of being rather than objectified abilities; they have no ethnics or ethics (both divisive in their own ways); they have a uniting feel about them.

Jiddu Krishnamurti is a thinker and religious leaders of modern times, who crossed international boundaries ─ born in Andra Pradesh (India)─and adopted by Annie Besant of the Theosophy Society. He was trained by Annie Besant and theosophist Charles Leadbeater in the teachings of theosophy but later broke away from theosophy to bear no allegiance to any one kind of religion, or philosophy (or indeed caste, nationality or religion) and travelling the rest of his life talking with small and large groups, somewhat in the style of the teacher / gurus of India and the Western Asia did ─ and a few still do (for information on Krishnamurti’s background see Wikipedia at: https://en.wikipedia.org/wiki/Jiddu_Krishnamurti; for information on Krishnamurti’s teachings see Rodrigues 2001)  His work has been collected by four foundations on the website ‘J. Krishnamurti Online’(https://jkrishnamurti.org). Among other outstanding works often given as talks, Krishnamurti debated and explored the brain vs the mind, significance of death, and the individual’s relationship to society with the physicist David Bohm (1917-1992) written up in a classic book (Krishnamurti and Bohm 1985 / 2014). The two qualities criticality and compassion are considered here in the light of what Krishnamurti (1895-1986) said in the latter part of the twentieth century. On the matter of being critical, Krishnamurti wrote:

‘… I criticise you and through that very act of criticising, I am criticising myself. In that, there is partial learning. I see I must learn to function in the technological field. There, I must have experience. That is absolute law – otherwise I cannot do anything. Then I ask myself: do I learn anything through experience, psychologically? Or do I only learn when I am aware, watching, watching that I am acting from an idea, which is already the old, and conforming to that pattern? So, I watch that. I am afraid, and my conditioning says resist it, run away from it, suppress it, control it, develop courage. When I act that way, I am strengthening my conditioning, therefore I am not learning. I can only learn about fear when I watch it in myself. Can I watch it without the conditioning, neither suppressing it, running away from it, or controlling it? Then what takes place? There is a learning in the very watching. There I am very critical, saying: who is watching? Is the watcher different from fear? I see they are both the same. So, is there a watching without the watcher? If the watcher is there, he is conditioned. Is there a watching without the watcher, without being conditioned, without wanting to escape, suppress or control?’ (Krishnamurti, 1969).

The first talk ‘On compassion and action’ was delivered by Krishnamurti on 31 August 1982, and the second, ‘Does compassion spring from observation or thought’ on 4 September 1980, at question-and-answer meetings at Brockwood Park, UK. They are available as You Tube videos at:  https://www.youtube.com/watch?v=B-1zIfV2aB0 and https://www.youtube.com/watch?v=o3QJ7DCfBn4.

After studying and discussing the previous paragraph on the subjective nature of criticality and compassion, consider the following:

In the chapter ‘Ethnopsychiatry’: the cultural construction of Psychiatries’ in Ethnopsychiatry, The Cultural Construction of Professional and Folk Psychiatries, Atwood Gaines (1992, pp. 3-49) states:

‘Psychiatric systems, like religions, kingship systems, or political system, are culturally constructed. Each mirrors a culturally constructed reality…. But each sees itself as a reflection of an ultimate one’ (p. 3, italics added)

In the chapter ‘Varieties of Global Psychology: Cultural Diversity and the Construction of the Self’, in Global Psychologies, Mental Health and the Global South Laurence Kirmayer et al. 2018, pp. 21-37) state:

Psychologies are stories of the self in time, ways of narrating our experience and behavior that explain the basis of our actions. As such, they mirror local concepts of the person. The sense of self is the interior experience of personhood, which may be reified as mind or ‘the psyche’ in everyday explanations, academic psychology, or therapeutic discourse.’ (p. 23).

Considering (a) that much knowledge in the disciplines of psychiatry and clinical psychology has been constructed on assumptions of: ‘white superiority’ in knowledge production and the point of view of European ways of thinking during the post (European) Enlightenment when racism was the cultural norm; and (b) taking these universalist, rather than the Eurocentric meanings, of the psychology, critical thinking for a decolonised model of mental health may be analysed in terms of viewing all aspects of psychiatry and psychology from certain perspective(s), such as:

•           an antiracist perspective

•           a global psychology / indigenous psychology perspective

•           a post-colonial perspective

•           a humanistic perspective

•           the perspective of cultural diversity of understanding

•           a historical perspective

•           the perspective of social justice

‘Socratic questioning’ may be used so that critical thinking consists of:

Clarifying concepts.

Probing assumptions.

Probing rationale, reasons, and evidence.

viewpoints and perspectives.

implications and consequences.

Questioning the question.

 nisation - current approach

Decolonising systems that have grown up in Western cultures of Europe, and its extension to America, Australia New Zealand and other ex-colonial settler dominated regions of the world, whether of academic university-based disciplines (like psychiatry or psychology) and / or systems providing services for human beings (like mental health systems), appertains to both theoretical and practical matters. The notion ‘decolonisation’ however can be traced to discussions at the Bandung Conference in 1955 and the Conference of the Non-Aligned Countries in Belgrade in 1961 forming the Non-Aligned Movement (NAM) of former colonised countries, initially led by Tito of Yugoslavia, Nasser of Egypt, Nehru of India, Nkrumah of Ghana, and Sukarno of Indonesia. That was when the term Third World was born ─ a term now seen as outdated and derogatory but to many people living in the colonised world between the two world wars (1914-1918 and 1939-1945), representing a vision of a different sort of world from what had been the world of colonialism, imperialism, and Eurocentric domination of what we now call the Global South (former colonised countries except the settler-states such as Australia and New Zealand). This Third World was envisaged at the time of the cold war between USA-dominated ‘First World’ and the Soviet Union dominated ‘Second World’ as different from both, not just politically but ideologically, ethically, spiritually and a lot else. Since the 1960s, ‘postcolonial’ and ‘decolonial traditions’ of thought and discourse have emerged in sociology and philosophy, summarised by Gurminder Bhambra (2014); and a there is a large literature now on the association between racism, the chattel slavery of Africans transported across the Atlantic, different to all other forms of slavery that the world has known (see Patterson, 1982, Black, 2011, Walwin;1996)

Clearly, turning the clock back to a time before colonialism is not an option and there are other practical considerations to bear in mind in trying to unravel and rectify the damage done by the many years of colonisation (for example the ethnic and other enmities resulting from the ‘divide and rule’ policies described by Morrock, 1973). Essentially, decolonisation today amounts to completion of political decolonisation when (as in most instances) political power was handed over by the colonising (European or Europeanised power) to a limited group of people who claimed to be residents of the colony concerned but without any ‘decolonisation’ in terms of coloniality or antiracism. The sort of decolonisation envisaged at Bandung has not resulted in anything like a Third World envisaged at the Bandung conference (see earlier). The current wave of decolonisation appears to be basically aimed at structural changes to take political change further but more importantly, at coloniality although there seem to be various views on what needs to be covered and what left out in the course of ‘decolonising’ a body of knowledge or curricula.

Concomitant Movements accompanying decolonisation

It should be noted that, although decolonisation of Clinical Psychology at an academic level is important, it should be accompanied by other action (not considered in this book) implicit in movements such as:

Reparations for slavery and genocides of African and indigenous peoples of America which was the basis for the vast wealth of European countries and the current international disparities of wealth and under-development across the world

Restorative justice (including epistemic injustice (Fricker, 207) at an individual level focused on families and communities still suffering from long-term effects of colonisation. These should include both long term psychological and social effects of colonisation as well as loss of property; like the reparations offered after the end of WW2 by Germany to Jewish and other minority groups across the world.

Decolonising the Mind

As decolonisation was talked about in recent times, it seems to have turned towards getting rid of colonial ways of thinking ─ ‘a process that inevitably leads to more fundamental questions … how did people’s minds get “colonized” in the first place? … A “colonial mentality”, or the “colonized mind”, shows a preference or desirability for whiteness and cultural values, behaviors, physical appearances and objects from or derivative of  “The “West” (i.e. Western Europe and North America), with disdain or undesirability for anything coming from the non-“West”; and Europeans wrote about indigenous people in the Americas, Africa, the Middle East and Asia, using the terms “savage”, “wild” and uncivilized”’ (Heinrichs 2010). Clearly, this dimension of decolonisation, decolonising the mind, is of particular importance in talking about psychiatry and psychology; in other words, coloniality is tied up with language and power in complicated ways: ‘The perspective of knowledge “Eurocentrism” naturalizes the experiences of people within this model of power … [T]urning the colonized into non-human or less-than-human beings’ (Veronelli 2015, pp. 111-112).  Racism, power, colonialism, imperialism, a variety of oppressions and capitalism were all involved in the imposition of European language-supremacy which became increasingly English, the dominant language in the USA resulting from the language supremacy established during colonialism and now influencing (for example) reviews of literature (as in this document) and current writing all over the world. Importantly, most of the current literature, especially that published in academic publications and books fail to draw on wisdom and experience of the Global South; and the way knowledge is developed in (culturally) non-Western circles (for example in Asia and Africa) may be very different to what is generally accepted as the ‘scientific’ (and hence ‘best’) approach. Storytelling, parables, and paradoxes play a much greater part in cultures adhering to Asian and African languages −a point made in the work of Ngūgi Wa Thiong’o 1986):

‘As a writer who believes in the utilization of African ideas, African philosophy and African folklore and imagery to the fullest extent possible, I am of the opinion the only way to use them effectively is to translate them almost literally from the African language native to the writer into whatever European language [s] he is using a\s medium of expression. … For, from a word, a group of words, a sentence and even a name in any African language, one can glean the social norms, attitudes and values of a people’ (p.8).

Catherine Walsh (2018) describes decoloniality vis-à-vis the mind thus:

‘Decoloniality denotes [points to] ways of thinking, knowing, being, and doing that began with, but also precede, the colonial enterprise and invasion. It implies the recognition and undoing of the hierarchical structures of race, gender, heteropatriarchy, and class that continue to control life, knowledge, spirituality, and thought, structures that are clearly intertwined and constitutive of global capitalism and Western modernity. Moreover, it is indicative of the ongoing nature of struggles, constructions, and creations that continue to work within coloniality’s margins and fissures to affirm that which coloniality has attempted’ (p.17).

Decolonisation of mental health systems

A study of the literature reveals no clear models available for decolonisation (meaning decoloniality and antiracism) in relation to mental health systems, in particular the disciplines of psychiatry and clinical psychology. As distinct disciplines they are peculiar to Western culture; and many of the ways of the ideologies in then as ‘psychological’ or ‘psychiatric’ are pursued in other cultures in other domains, for instance in medicine, spirituality, religion, and a host of other systems pf thought and actions. Some writers see decolonisation as a praxis, an activity (Ghaddar and Caswell, 2019), something to be pursed in action rather than academic theorising alone by changing, for instance, what Kuhn (2012) calls the paradigms ─ the ways practitioners and academics go about their business in psychiatry, clinical psychology, and mental health. Yet, theorising may well be the start for changing ways of working.

Psychiatry and psychology as disciplines developed in tandem in Europe during the time of the (European) Enlightenment when racism was rife in European culture (Eze, 1997; Morrison,1997).  The rationalism (of Enlightenment thinking) led to ‘espousal by the sciences [including later the social and human sciences] of what are termed positivist methods, which make a very rigid distinction between fact and value’ (Hamilton, 1996, p. 41), italics in original).  But this very separation (of fact and value) impeded the use of (some) scientific methods for addressing societal and cultural values (Hamilton, 1996). Mainstream academic psychology (Western psychology) is severely critiqued in the book Toward Psychologies of Liberation (Watkins and Shulman, 2008) that discusses ways of liberating psychology quoting work in Latin America. Indeed, such work was part of decoloniality which took root in Latin America in several fields after political decolonisation took place. Much of the thinking that underpinned this work in the field of psychology resonates with the writings of Frantz Fanon (1952, 1961 / 1967); and Fanon seemed near to a fully decolonised mental health system in action when he developed ‘social therapy’ for Algerian patients at Blida-Joinville Hospital in Algeria ─ setting the ground work for what may have become a system of  psychiatrie de secteur (community psychiatry) if Fanon had lived long enough to achieve it (Khalfa and Young, 2015, p. 202).

The introduction in the book Global Psychologies; Mental Health and the Global South refers to ‘liberation psychologies’ as innovative psychologies, [that] unlike ‘traditional Western psychology which attributes distress and psychopathology to individual and intrapsychic processes … contextualise the subject [of psychology] within an anti-oppressive environment; consider power structures as templates of distress rather than unconscious motivation of psychopathologies’ (Fernando and Moodley, 2018, pp. 9-10); and the book describes versions of the work by Frantz Fanon, Mohandas Gandhi and Steve Biko as examples of ‘inspirational and constructive psychologies associated with liberation movements that opposed European oppression of black and brown-skinned peoples during the colonial era’ (p. 10), while referring to other liberation psychologies not covered in the book, such as those of Martin-Baró (1994), social psychologist, philosopher and Jesuit priest, and Paolo Friere (1972), Brazilian educator and philosopher who was a leading advocate of critical pedagogy that ‘draws attention to the ways in which knowledge, power, desire, and experience are produced under specific conditions of learning, and in doing so rejects the notion that teaching is just a method or is removed from matters of values, norms, and  power  –  or, for that matter, the struggle over agency itself and the future it suggests for young people’(Giroux 2019).  Decoloniality is clearly the underlying feature of many liberation psychologies.

In decolonising psychiatry and psychology, we need to be cognisant of the fact that problems conceptualised as ‘mental health problems’ and even ‘mental illness’ or something very much like it, are now accepted in many parts of the world in order to provide help (through mental health systems) for real human being with real problems mostly admittedly, problems that may be better called problems of living with medical and spiritual / psychic dimensions (although the original notions of ‘mental’ problems came about during colonialism). While words similar to ‘mental health’ and ‘mental illness’ are now used in most countries, their meanings are still understood very differently in many ways, despite suppression of indigenous systems for mental health care during colonial times and the aggressive imposition of Western psychiatry since the mid-1970s in what is called the ‘Movement for Global Mental Health (MGMH); and what exists now in many countries of the Global South are either plural systems of mental health (Western and non-Western systems side-by-side) or hybrid systems, mixtures of Western and non-Western systems (see Fernando, 2014; Mills, 2014).

Neo-colonial / postcolonial) issues

It should be noted too that (a) forces of colonisation / neo-colonialism are being pursued actively even as we talk about decolonisation, for example in the way ‘evidence-based’ therapies are being introduced in developing mental health services (see Fernando, 2014; Mills, 2014), under the umbrella of development and / or modernisation;  (b) racialised minorities are being excluded, oppressed and even subject to worse indignities (such as police brutality, compulsory psychiatric treatments, and so on ─ see Fernando, 2010, 2017), and that people identified as Muslims are subjected to coercive racist pressures (Younis, 2020; Younis and Jhadav, 2021) in the field of mental health.

An issue that complicates the process of decoloniality (colonial thinking) is that group / national cultures themselves are changing and have changed since the time when political colonisation took place, as a result of which both the notion of individual culture (the culture of an individual) and that of different cultures (rather than numerous hybrid cultures) appear at times to be re-fashioning what culture means in terms of specificity in a world of human beings communicating and interacting with each other in complex ways and forming groups that may well cut across the older ‘cultures’ and even ‘races’. In the international arena, some countries such as Israel appear to be following policies reminiscent of old-fashioned colonisation by occupying and supporting by military means illegal settlers in occupied territories set out as a future state of Palestine─ a situation ironically resulting from the UK (a former coloniser) having acquired the responsibility to manage the disputed land of Palestine.

Urgent antiracist and anticolonial action to counteract these current racist activities that could be dangerous to health and even the lives of racialised citizens of the UK and Palestine may well be necessary even before considering decolonisation. 

Carrying out decolonisation

We should start by assuming that most human beings need some form of socio-cultural system that people identifying as ‘having mental health problems can call upon for support and (if necessary) help; and all this is happening in a world beset with forms of racism. Further, we should assume that the system for mental health includes a care system that includes medical, spiritual, and psychological dimensions and has integrated into its ways of work the preventing of all forms of racism and discriminatory forces that tend to be divisive in terms of gender, sexual orientation social class and other similar ways that intersect with ‘race’.  A team of professionals to work on decolonisation of current systems of psychiatry and clinical psychology should include professionals of diverse backgrounds of ‘race’ cultural background, ethnicity, age, gender, and sexuality ─ all well versed in criticality and compassion (see later) because these concepts may not be commonly known in European cultural circles and some in-depth study may be helpful. The inclusion in the group of people with experience of various systems of mental health care is likely to be helpful.  Once, a team (work group / working partly) is assembled there must be an honest engagement with the realities of the history of European Empires from the 14th Century onwards and the neo-colonialism since their fall.  A reading list as essential reading should be agreed including all the publications suggested later. The team should then agree a procedure including (for example) six sessions of brain storming, talks by specialists in the field and perhaps two one-day meetings.

It should be noted that there is no quick-fix or one single easy pathway to follow; there are many pathways for decolonisation to take and what is followed may depend to some extent on the experience of participants in the group considering decolonisation and their basic knowledge, and the criticality they may be able to summon up in the discussions. Discussions are likely to take some time since they need to be based on counteracting not just racism but also coloniality (colonial thinking controlling knowledge creation and social systems ─ Quijano, 2000). Since curricula for training are usually formulated in terms of competencies it may be best to retain these terms but adding the need for criticality so that professionals maintain the decolonised attitudes, rather that slip back into the racist approaches that tend to be seen as the ‘norm’, the default position when there is difficulty in being (for example) self-critical.  Finally, a time limit should be set for agreeing the basics, perhaps of between six months and one year. It is possible that ways of counteracting and diminishing racism in the mental health system (especially if this is limited to one country) can be identified quickly and changes encompassing antiracist practice with guidelines, changes in legislation and administrative changes based on advice from service users and others who may have experience of the system.

Fields of study and reading lists.

Essential reading necessary before embarking on discussions on decolonisation are listed under ‘Bibliography: Essential Reading’. Additional bibliographies are provided that may be useful for later sessions.  The recently published How To Be An Antiracist by Ibram Kendi (2019) presents a transformative approach to racism and antiracism relevant to the 21st Century. Examples of useful works that provide guidance on the variety of issues that need to be addressed in the process of decolonisation include a critical analysis of existing histories of liberalism (Losurdo, 2014). On order to learn about the distortion of non-Western cultures, Africa’s Tarnished Name by Chinua Achibe (2009) during the colonial period and the reviling of colonised people (as in les damnés in Fanon’s seminal The Wretched of the Earth (Fanon, 1961 / 1967) are very readable works. Psychological effects of personal interactions between the colonisers and the colonised (for example, matters discussed by Memmi, 2016) should provide topics for discussion. The psycho-political concomitants of colonisation, especially its Eurocentricity and failure to confront racism − the leaders of the European Enlightenment voiced extreme racist views (Eze, 1997; Habib,2017) − and how these may be seen from critical philosophical viewpoints are brilliantly discussed in the books by African philosopher Emmanuel Eze (2001, 2008). Eze’s book On Reason, rationality in a world of Cultural Conflict and Racism published posthumously explores models of rationality in the thought of philosophers from Aristotle, René Descartes, Francis Bacon, and Thomas Hobbes to Noam Chomsky, Richard Rorty, Hilary Putnam, and Jacques Derrida; portrays contemporary work of the African thinkers and novelists Chinua Achebe, Ngugi wa Thiong’o, and Wole Soyinka; and reflects on contemporary thought about genetics, race, and postcolonial historiography as well as on the interplay between reason and unreason in the hearings of South Africa’s Truth and Reconciliation Commission. Eze contends that while rationality may have a foundational formality, any understanding of its foundation and form is dynamic, always based in historical and cultural circumstances.  The varieties of colonisation and ways in which they can be explored for decolonisation are covered by Mignolo and Walshe (2018); and issues around the virtual continuation of colonialism in the ongoing ‘Westernisation’ and ‘globalisation’, in the context of neoliberal policies and Western power, such as in the movement for global mental health are introduced by Fernando (2014) and Mills (2014). A good example of decolonisation in the field of history is Black Athena; the Afroasiatic Roots of Classical Civilization by historian Martin Bernal (1987, 1991, 2020) (not necessarily to be read fully─ it is a three-volume tome!), where the author decolonises written history of ‘classical [Greek] civilization’.

To carry out decolonisation, participants in the process need:

(1) To get a grasp of the history of (what is understood as) mental health today in many parts of the world and some understanding of traditional cultures of non-European cultures. This means careful analyses of various culture-specific terms used traditionally, taking on board the variety of meanings of terms used, many connecting with variations of wellbeing, (in English), getting round the problems of translation, and adjusting for loss of meaning that may have occurred during translation. Participants need to draw on the literature in transcultural psychiatry and cultural psychiatry, taking account of the histories of the variety of systems used all over the world to improve mental / psychological wellbeing and support.

The section ‘Essential history of mental health worldwide’ as an additional bibliography attached to this document provides examples in the literature of non-Western mental health systems, especially those that predate the Western variety. One of the most important mental health systems for discussions on decolonisation may be that in Medieval Islamic society (Atiyeh, 1982; Dols,1987, 1992; Gorini,2002) partly because (like the system that developed in Western Europe) the mental health system was influenced by general medical knowledge to an extent that one could envisage it as a medicalised system, not that dissimilar in overall social structure to the Western bio-medical system.

(2) Accept that decolonisation is not an attempt to resurrect older systems of psychiatry and psychology but rather to unravel the effects of colonisation (with its racism); envisage what this unravelling may look like when incorporated into psychiatry / psychology that suits the present day in all parts of the world; and finally put into words the training and educational curricula that may best suit that. In doing this, it is important that the universal nature of the task is foremost, with the cultural and other differences (the diversity) around the world. Therefore, it may help if the writings and teaching of relevant people from many different cultures are drawn on, and in doing so, allowance is made for possible institutionalised racism (which needs to be corrected). 

Preparing a body of decolonised basic knowledge

This should be in a form that academic tutors can use for structuring training schemes for practitioners undergoing training to become psychiatrists and psychologists who work in mental health. This should include:

1.History of mental health from perspectives in both the global South and global North from the early fourteen century onwards, focusing particularly on methods of care in the community, medical systems in Asia, Africa and Europe; relations between mental health systems and religion in all the major civilisations; the first medicalised hospital systems in the medieval Islamic Empire; and the development of secular (Western) ‘clinical psychology’ and ‘psychiatry’ in the post-(European) Enlightenment period. It should cover (a) the development of eugenics in the nineteenth and twentieth centuries including the part played by clinical psychologists and universities such as University College London,; (b) the  opposition to eugenics and complicity of psychiatrists in racist work, such as the antisemitism leading to the Jewish holocaust, the struggles against racism in  psychiatry and psychology in UK and the USA; (c) the imposition of asylum psychiatry and the treatment of indigenous people in psychiatric institutions in colonised countries; and (d) the history of the Islamic mental hospital where there was a mixture of religious and medical systems constituting a ‘psychiatry’.

2. A variety of forms of psychology (Global Psychologies), Ethnopsychiatries, and neurological topics including research should be covered, including work done in social anthropology and religious studies and in neuroscience departments.  This should include the main systems of psychology embedded in religion and philosophy, especially Buddhism (sometimes seen as a form of medical psychology) and Chinese medicine (viewed sometimes as a form of psychological treatment), the systems embedded in Maori culture and various African and medical systems in indigenous nations of Pre-Columbian) America. The neurological work to be covered would obviously have to be presented by neurologists and scientists working in neuroscience.

3. A series of sessions where various aspects of psychiatry, psychology and neurology / neuroscience are discussed in conjunction with each other. It is important that teachers should be drawn from philosophy, religious studies and neuroscience, as well and clinical psychiatrists. Trainees should be given assignments and carry out collaborative work with service users from a variety of cultural backgrounds, if possible, from a variety of locations.

Writing the curriculum in terms of what is expected from training.

The team preparing the decolonised curriculum should either agree on (say 4 or 5) broad headings under which specific topics are listed or use the following two sets which are of relevance to decolonisation in addition to others as the Four C’s, relevant to decolonisation:   Capabilities & Competences, Criticality & Compassion

Capabilities and Competencies

These should be based on a knowledge base derived from both the Global North and Global South (for definitions see earlier) and consist of information on:

(a) Mental health care in a variety of medical and social systems worldwide.

(b) History of systems of mental health worldwide in a variety of cultural and social contexts ─ the variety of (ethno)psychiatry which was created in Europe post (European) Enlightenment is only one; and many systems of Global psychology (‘indigenous psychologies’) are still functioning. It should be noted that one of the earliest medicalised systems based on mental hospitals developed between the 9th to 13th Centuries in the Islamic Empire, while descriptions of Tibetan psychiatry, varieties of healing systems in African, Asian, Pre-Columbian American, and those of South Pacific / South-East Asian, Maori, Polynesian and Australian communities; and varieties of culturally hybrid systems worldwide are well known. Today too there are several culturally hybrid psychologies and hybrid systems of care that resemble forms of (medicalised) Western bio-medical system.

(c) Nature of discriminatory and racist attitudes prevalent in various parts of the world during the colonial era (roughly between end of the 15th Century when the invasions of the American continents began after Columbus’ 1492 voyage across the Atlantic and the early 1970s when the European Empires fell.; and the nature of various forms of neo-colonialism that have thrived in several parts of the world in the ‘post-colonial’ period. 

(d) Diverse philosophical (including religious) understanding of the human condition and its relevance to mental health care.

(e) How culture shapes notions of self that stress social and moral connectedness to family, community, and spirituality (commoner in non-Western cultures) contrasting with the rationality and interiorised individuality stressed in the post-Enlightenment Western self.

(f) Limitations of cross-cultural research because of category fallacy, observer bias, loss of meaning in translation and help-seeking practices.

(g) The problems arising from imposition of colonial (asylum) psychiatry in the European Empires; in much of Europe and the American continent; and settler colonies in Australasia and post-Columbian America

(h) Various types of racist and other discriminatory practices prevalent in various parts of the world, especially in the former settler colonies.

(i) How the history of European colonialism since the sixteenth century, particularly (but not exclusively) slavery was justified by Christianity and scientific thought.

(j) Understand the legacy of slavery and colonialism for contemporary life in multicultural Britain, with reference to different forms of racism.

Examples (by no means a final list) of capabilities and competencies

[Some of these are drawn from and adapted from Generic Professional Capabilities Framework of the (British) General Medical Council (2021)]

Ability to identify, analyse and address institutional threats, including those from institutional racism to patient safety quality of care and diagnoses made.

Awareness of recent and historic collective experiences of ill health that continue to impact social groups today.

Awareness of how cultural beliefs and lived experience of what happens in the interactions between professionals and users of mental health systems may impinge on behaviour and attitudes of service users.

Awareness of the impact of coloniality (colonial thinking) and neocolonialism on

historical and contemporary attitudes towards service users and make determined efforts to make sufficient allowances in practice.

Awareness of social constructivism in relation to ways of seeing, knowing and being of both users and providers of mental health services, and make allowance for these.

Awareness of unconscious biases held by professionals and their duty to address them.

Understanding that theories, descriptions, and explanations, including diagnoses and formulations are not value free.

Ability to analyse, confront and work with societal, political, and economic histories, especially those appertaining to race.

Ability to understand variety of both traditional and contemporary ways of conceptualising, exploring, and analysing mental health and wellbeing and make a choice that is best suited for users of services.

Criticality and Compassion

These notions may seem unusual, even inappropriate, for training curricula. But if we consider what qualities, rather than capabilities and competencies, are necessary for a clinical psychiatrist or psychologist o be able to work effectively anywhere in a post-colonial world, criticality and compassion are essential. It should be noted that the notion criticality is not being used here in the way it may be used or implied in what is called ‘Critical thinking’  an  intellectually disciplined process of actively (https://www.criticalthinking.org/pages/defining-critical-thinking/766) or ‘Critical pedagogy’ (see earlier). Unlike other notions that seem to appear frequently in curricula for training (such as competencies and capabilities), criticality addressed here together with compassion are not about objectives nor about being objective. They draw on subjectivity of being human; the clinician as a human being trying to establish a (therapeutic) relationship with another human being or a group of human beings. They are qualities that did not characterise the world of colonialism with its coloniality of power and racism, nor the psychiatry and psychology that emerged in Western cultures and thence in Eurocentric mental health systems. In a colonial context, indigenous people, often seen in such systems as culturally primitive and referred to as ‘natives’ used in a pejorative sense,  were (and still are where the social structures have not been decolonised) at best seen as ‘objects of concern, but not as equal self-defining subjects entitled to choose their way of life themselves’ (Parekh, 1997, p. 184, quoted by Gasper, 2004, p.195); ruled by colonisers, the owners, the boss-men and boss-women together perhaps with the occasional native imitating  (or mimicking) the rulers, the ‘brown sahibs’ as they were called in some parts of Asia (Vittachi, 1962). The colonial period was characterised by exercise of top-down power and inequalities: the power of the gaze that Franz Fanon (1952 / 1967) (‘Look! A Negro!” (p. 89) spoke about in Black Skin, White Masks; and feminist writer Donna Haraway (1988) refers to as signifying ‘unmarked positions of Man and White … in racist and male-dominated societies (p. 581). Doctors and other professionals providing a decolonised system of psychiatry must step away from the pretence of a disengaged stance placing their emotional responses (a key element of subjectivity) in the centre of the frame in their interactions with users of the services. In writing on what a postracial future should be like, Nigerian philosopher Emmanuel Eze (2001) did not ‘dream about the future when everyone should look alike.’ He envisaged a future when ‘race no longer matters … [and] requires that disabling racial labels may no longer be forced upon individuals or groups … operating to thwart opportunities for some and enhance opportunities for others’ (p. 223). The qualities promoted by criticality and compassion are meant to enable psychiatrists to make that happen. Criticality and compassion are subjective states of being rather than objectified abilities; they have no ethnics or ethics (both divisive in their own ways); they have a uniting feel about them.

Jiddu Krishnamurti is a thinker and religious leaders of modern times, who crossed international boundaries ─ born in Andra Pradesh (India)─and adopted by Annie Besant of the Theosophy Society. He was trained by Annie Besant and theosophist Charles Leadbeater in the teachings of theosophy but later broke away from theosophy to bear no allegiance to any one kind of religion, or philosophy (or indeed caste, nationality or religion) and travelling the rest of his life talking with small and large groups, somewhat in the style of the teacher / gurus of India and the Western Asia did ─ and a few still do (for information on Krishnamurti’s background see Wikipedia at: https://en.wikipedia.org/wiki/Jiddu_Krishnamurti; for information on Krishnamurti’s teachings see Rodrigues 2001)  His work has been collected by four foundations on the website ‘J. Krishnamurti Online’(https://jkrishnamurti.org). Among other outstanding works often given as talks, Krishnamurti debated and explored the brain vs the mind, significance of death, and the individual’s relationship to society with the physicist David Bohm (1917-1992) written up in a classic book (Krishnamurti and Bohm 1985 / 2014). The two qualities criticality and compassion are considered here in the light of what Krishnamurti (1895-1986) said in the latter part of the twentieth century. On the matter of being critical, Krishnamurti wrote:

‘… I criticise you and through that very act of criticising, I am criticising myself. In that, there is partial learning. I see I must learn to function in the technological field. There, I must have experience. That is absolute law – otherwise I cannot do anything. Then I ask myself: do I learn anything through experience, psychologically? Or do I only learn when I am aware, watching, watching that I am acting from an idea, which is already the old, and conforming to that pattern? So, I watch that. I am afraid, and my conditioning says resist it, run away from it, suppress it, control it, develop courage. When I act that way, I am strengthening my conditioning, therefore I am not learning. I can only learn about fear when I watch it in myself. Can I watch it without the conditioning, neither suppressing it, running away from it, or controlling it? Then what takes place? There is a learning in the very watching. There I am very critical, saying: who is watching? Is the watcher different from fear? I see they are both the same. So, is there a watching without the watcher? If the watcher is there, he is conditioned. Is there a watching without the watcher, without being conditioned, without wanting to escape, suppress or control?’ (Krishnamurti, 1969).

The first talk ‘On compassion and action’ was delivered by Krishnamurti on 31 August 1982, and the second, ‘Does compassion spring from observation or thought’ on 4 September 1980, at question-and-answer meetings at Brockwood Park, UK. They are available as You Tube videos at:  https://www.youtube.com/watch?v=B-1zIfV2aB0 and https://www.youtube.com/watch?v=o3QJ7DCfBn4.

After studying and discussing the previous paragraph on the subjective nature of criticality and compassion, consider the following:

In the chapter ‘Ethnopsychiatry’: the cultural construction of Psychiatries’ in Ethnopsychiatry, The Cultural Construction of Professional and Folk Psychiatries, Atwood Gaines (1992, pp. 3-49) states:

‘Psychiatric systems, like religions, kingship systems, or political system, are culturally constructed. Each mirrors a culturally constructed reality…. But each sees itself as a reflection of an ultimate one’ (p. 3, italics added)

In the chapter ‘Varieties of Global Psychology: Cultural Diversity and the Construction of the Self’, in Global Psychologies, Mental Health and the Global South Laurence Kirmayer et al. 2018, pp. 21-37) state:

Psychologies are stories of the self in time, ways of narrating our experience and behavior that explain the basis of our actions. As such, they mirror local concepts of the person. The sense of self is the interior experience of personhood, which may be reified as mind or ‘the psyche’ in everyday explanations, academic psychology, or therapeutic discourse.’ (p. 23).

Considering (a) that much knowledge in the disciplines of psychiatry and clinical psychology has been constructed on assumptions of: ‘white superiority’ in knowledge production and the point of view of European ways of thinking during the post (European) Enlightenment when racism was the cultural norm; and (b) taking these universalist, rather than the Eurocentric meanings, of the psychology, critical thinking for a decolonised model of mental health may be analysed in terms of viewing all aspects of psychiatry and psychology from certain perspective(s), such as:

•           an antiracist perspective

•           a global psychology / indigenous psychology perspective

•           a post-colonial perspective

•           a humanistic perspective

•           the perspective of cultural diversity of understanding

•           a historical perspective

•           the perspective of social justice

‘Socratic questioning’ may be used so that critical thinking consists of:

Clarifying concepts.

Probing assumptions.

Probing rationale, reasons, and evidence.

viewpoints and perspectives.

implications and consequences.

Questioning the question.