Decolonizing Community Mental Healthcare
Through understanding the colonial origins and underpinnings of coercive treatment practices, this post will begin to unravel the systemic condition of forced treatment and dissociative care that permeates the field of mental health care, today.
It is time that we reimagine depths of care
A System Comprised of Trauma
It is the sworn duty of the mental health care professional to offer the best care, given the conditions laid before them. Although much of the therapeutic work is focused within the consulting room, there are many external factors that can impede, inhibit, and fracture the therapeutic work that is attempted with clients. It must be understood that the field of community healthcare is built within a complex system with a traumatic history. It is not just clients that need healing. The operating system needs healing as well. Psychiatrist Dr. Sandra Bloom and psychotherapist Brian Farragher (2013) noted:
Regardless of whether we are talking about families, organizations, or entire systems, there are parallel similarities. Just as the encroachment of trauma into the life of an individual client is an insidious process that turns the past into a nightmare, the present into a repetitive cycle of reenactment, and the future into a terminal illness, the impact of chronic strain on an organization is insidious. As seemingly logical reactions to difficult situations pile upon each other, no one is able to truly perceive the fundamentally skewed and post-traumatic basic assumptions upon which that logic is built. (p. 18)
Much of the modern industrialized world is and was built on top of the blood of indigenous peoples. Black slaves built this country and now slave workers are held captive by poor resources and income inequality. Mental and physical illness is growing exponentially while resources for affordable healthcare for those that need it the most cannot meet demands. The system is ill. It is ill because its origins are built upon traumatic events. The modern colonized world is a system plagued by its own wounds, unable to step outside itself long enough to invoke transformation. It is a system that is strangled by its lack of capacity. It is a system that is unable to feel.
Clinical psychologist Dr. Donald Kalsched (2022) described trauma as reducing the capacity to feel. Wherein, unconscious dissociation from undesirable emotions leaves the individual in a cycle of conflict with themselves. Therefore, disempowered, depressed, repressed, and engulfed by their own fragmented psyche. He described living hell as the symptom of being held captive by the dissociative effect of trauma. Wherein, symptoms of dysfunction can be found. Healing increases the capacity to feel, and in part, this is the duty of the therapist; to help a client access parts of themselves that cannot be accessed without an outer influence (Stewart, Marchiano, & Lee, 2022). While Dr. Kalsched’s remarks are based on individual trauma, these concepts can be applied to the collective psyche just as well. However, recalibrating the collective operating system is too large a task for any individual. Through community engagement, honoring future generations, and most importantly, healing oneself, leaves an imprint on the world that sets an example of resilience, compassion, and empowerment. The change we wish to see in the world, truly, begins with ourselves. This place of empowerment leaves the individual in a unique position to see beyond the vail of a community trapped by its own fragmentation.
Coercion and Tending to the Soul
In 1830, United States president Andrew Jackson signed the Indian Removal Act into law. This piece of legislation forced five tribal nations, in the eastern United States, from their home land and onto a very long and deadly journey to what is now the state of Oklahoma. Known as the Trail of Tears, this forced removal killed more than 3,000 Native Americans and disregarded the very soul of nations of people. This decision by the United States government was one of the greatest acts of coercion against indigenous peoples. The United States is righteous and believes at its core that everything it does is for the betterment of the world. The merciless Indian savage does not know what is best for them. They must be ripped from their profane spirituality and their children must be boarded, assimilated, and educated on how the world really works. Colonialist rule committed one of the greatest acts of violence that still permeates our world, today. Ripping the sovereignty away from a community of people who are different and coercing them into believing something that was not true to them; ruptured and fragmented the collective and individual psyche of hundreds of thousands of indigenous peoples. This fragmentation is still seen today, generations later.
Coercive behavior still permeates the zeitgeist of the 21st century in overt and subtle ways. Think for a moment how a suicidal teenager may feel if they are ripped from their home, against their will, and forced to spend to two weeks in a psych ward. This overt level of coercion can have traumatizing effects. There are many patients who are still struggling from symptoms related to post-traumatic stress years after they are forced into a psych wards for suicidal ideation. They are often taken against their will, placed on pharmaceuticals, underfed, neglected, and with no one to offer emotional or spiritual support throughout their entire experience. They find themselves living in fear and with anger towards a system that destroyed their sovereignty. It is through psychotherapy that they have the opportunity to process and tend to what their experience of overt coercive treatment completely disregarded; a spacious loving container for which he is held safe and supported in depth.
Linda Bishop never had that opportunity. Rachel Aviv (2011), a staff writer with The New Yorker, told the tragic story of Ms. Bishop, a women who rejected her diagnosis of bipolar disorder with psychotic features. Her rejection of this diagnosis and treatment posed upon her by a psychiatric facility eventually led to her death in an abandoned home in the darkness of mid-winter (p. 2-17). This begs the question of what could have prevented Ms. Bishop’s death. An organization posed a belief about her and threatened her sovereignty through coercive treatment. She ran from that threat with no one to support her in her identity. The system failed Ms. Bishop. In essence, she died just as the native American people died in the height of winter on the Trail of Tears; cold and without resources to tend to what they needed the most. Respect and dignity of their sovereignty, a loving hand to support them in their humanity.
Decolonizing Psychoanalysis
An empowered therapist whose intention it to help others connect with themselves, the world, and foster empowerment in others does not reach this space of capacity with their clients by claiming to know what is best. A good helper picks someone up off the ground when they have fallen so they may stand, together, in a place of wonderment and awe of the life before them. For the psychotherapist, this a tricky process when the system in which they operate says they must brand, tag, and coerce their clients into believing that the man in a white coat knows what is best. Although, clinical psychologist Dr. Nancy McWilliams (2011) offered perspectives on this intrinsically coercive model of empiricism that can enrich an individual’s healing process. She stated:
There are at least five interrelated advantages of the diagnostic enterprise when pursued sensitively and with adequate training: (1) usefulness for treatment planning, (2) its implications for prognosis, (3) its contribution to protecting of mental health services, (4) its value in enabling the therapist to convey empathy, and (5) its role in reducing the probability that certain easily frightened people will run from treatment. (pg. 8).
Research and the medical model has given the field of mental health care many wonderful perspectives on treatment processes that have helped people around the world heal and better understand their illness. However, as clinical psychologist Dr. Irwin Hoffman (2009) stated, “systematic empirical studies simply do not control for the consequential uniqueness of the analyst, of the patient, of their relationship, and of the moment” (p. 1050). Decolonizing psychoanalysis is to walk between two worlds. It is to proceed with the heart forward in deep reverence for the unique healing order of each individual’s process while honoring any explanatory model that may be helpful in a client’s process towards living a beautiful life.
What is Medicine?
A path between two worlds is also a path between two truths. A therapist’s role is to neither confirm nor deny what a client believes as true. Their role is to simply offer an empathetic hand in support and discovery of a client’s world. The therapist may not always know what truth really is and, in that regard, should refrain from leading a client down a path that may not be of benefit to the client’s healing order. The roots of a compassionate therapist in mental health care is grounded empathy, genuineness, and unconditional positive regard. This foundation provides a decolonized approach where acceptance, love, and wonderment resides. This is the well of life force that will keep a therapist in their chair for life.
Subtle forms of coercion such as advice or pressure has its place. It is okay for a therapist to offer concern for their client. The question a therapist must ask themselves is whether that intervention is therapeutically relevant. It is okay to restrain a young women who is beating her head against the wall until she bleeds. The question a therapist must ask themselves is what comes after the restraint. Medicine is found all around. A therapist should continue to ask themselves, what is the moment calling for and where am I rooted?
If you suffer from symptoms related to traumatic events laid upon you by the hands of a system that was suppose to help you, please feel free to reach out to me, Derrick Radford, Depth Psychotherapist in Oregon State.
Paining by Simone Mcleod, Cree-Ojibway, “Celebrating New Life”
References
Bloom, S., & Farragher, B. (2013). Restoring sanctuary: A new operating system for trauma informed systems of care. Oxford University Press
Aviv, R. (2011). God knows where I am. What should happen when patients reject their diagnosis. The New Yorker.
Hoffman, I. Z. (2009). Doublethinking our way to "scientific" legitimacy: the desiccation of human experience. Journal of the American Psychoanalytic
McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). Guilford Press.
Stewart, D. & Marchiano, L. & Lee, J. (Hosts). (2022, August 24). Donald Kalsched: trauma and the informed heart (No. 228) [Audio podcast episode]. In This Jungian Life. https://open.spotify.com/episode/6I4liOyVFezvrROuqqaLwd?si=725996ecdbd84907
