Decolonising the medical curriculum: psychiatry faces particular challenges

Abstract

Colonial thinking runs deep in psychiatry. Recent anti-racist statements from the APA and RCPsych are to be welcomed. However, we argue that if it is to really tackle deep-seated racism and decolonise its curriculum, the discipline will need to critically interrogate the origins of some of its fundamental assumptions, values and priorities. This will not be an easy task. By its very nature, the quest to decolonise is fraught with contradictions and difficulties. However, we make the case that this moment presents an opportunity for psychiatry to engage positively with other forms of critical reflection on structures of power/knowledge in the field of mental health. We propose a number of paths along which progress might be made.

“Decolonizing mental health”: Exploring insights from clinicians trained in Kniffley Racial Trauma Therapy.

“…As participants noted, pretraining may be an important addition to the KRTT curriculum and further research is needed to assess how this should be integrated, what trainee baseline knowledge is needed, and how to evaluate this baseline knowledge in preparation for the training. Overall, data point to KRTT as a potentially viable way of moving toward the decolonization of mental health via clinical training that promotes critical reflection, pushes clinicians beyond cultural competence, elevates client healing narratives (i.e., racial trauma narrative), and prioritizes lived experience (see Bracken et al, 2021). Given the manualized nature of KRTT as well as the clinical consultation that accompanies the training, it may be feasibly implemented with fidelity in a number of mental health settings, including community mental health and independent practice environments.…”

“…To adequately address the depth of trauma associated with racist systems that affect BIPOC, it is crucial that the mental health field move toward training on interventions and practices that are antiracist (i.e., action-oriented practices focused on changing systems that have racist effects; Svetaz et al, 2020), equitable, and inclusive. Scholars suggest incorporating an array of education across the domains of race, privilege, and oppression to move clinical training beyond traditional, often Westernized, practices and sources of knowledge (Bracken et al, 2021). Even within our Western epistemology with the heavy reliance on evidence-based interventions, some concrete examples of decolonizing mental health training have been explicated in the literature, such as: (a) promoting critical reflection during training programs and engagement in literature that interrogates the status quo; (b) moving beyond the ideology of cultural competence to a more nuanced understanding of structural inequity and cultural humility; (c) exploration of forms of mental health care that prioritize communal or collective healing as well as alternative healing narratives; and (d) engagement with research that elevates the lived experiences of individuals along with acknowledgment of the hierarchy that has diminished the value of the voices of those with lived experience (Bracken et al, 2021).…”

“…Scholars suggest incorporating an array of education across the domains of race, privilege, and oppression to move clinical training beyond traditional, often Westernized, practices and sources of knowledge (Bracken et al, 2021). Even within our Western epistemology with the heavy reliance on evidence-based interventions, some concrete examples of decolonizing mental health training have been explicated in the literature, such as: (a) promoting critical reflection during training programs and engagement in literature that interrogates the status quo; (b) moving beyond the ideology of cultural competence to a more nuanced understanding of structural inequity and cultural humility; (c) exploration of forms of mental health care that prioritize communal or collective healing as well as alternative healing narratives; and (d) engagement with research that elevates the lived experiences of individuals along with acknowledgment of the hierarchy that has diminished the value of the voices of those with lived experience (Bracken et al, 2021). Moving toward a decolonized approach to clinical training might produce better equipped clinicians, as well as a shift in the forms of knowledge and evidence that are acknowledged to support the use of interventions.…”

Lived Experiences of Mental Health Recovery in Persons of Culturally and Linguistically Diverse (CALD) Backgrounds within the Australian Context

“…Applications of a reductionist biomedical model and the entanglement of patriarchy, psychiatry, and colonialism impacts the ways in which mental health systems are built and maintained in various parts of the world (Bracken et al, 2021;Marsella, 2010;Pu ¯ras, 2017Pu ¯ras, , 2020. Moreover, terminologies of dysfunction and disease stemming from the biomedical model may influence how people perceive themselves (Adame & Hornstein, 2006).…”

Perspective: Decolonizing postmodernist approaches to mental health discourse toward promoting epistemic justice

“…Both Foucauldian interpretations and approaches driven by epistemic in/justice perspectives suggest that knowledge and power are inseparable. Both point to social structures of deviance, and to the professions tasked with treating those who “deviate” from what is delimited as “normal” as agents of disciplining powers that rely on the distinction between the “truth” of scientific reason and all other forms of knowledge ( 10 ). In this vein, mental health services have often been cited as playing an impactful part in sustaining social hierarchies and perpetuating a status quo ( 11 ).…”