Owning Our Madness: Contributions of Caribbean psychiatry to decolonizing Global Mental Health
Frederick W. Hickling, CARIMENSA, University of the West Indies
For the past five centuries Europeans have been fighting over possession and control of the Caribbean. Indigenous Taino populations practiced a form of communal psychiatry prior to the arrival of Europeans. Mental illness in African people was unrecognised in the initial period of African slavery by the European colonizers. In the nineteenth century the paradigm of involuntary commitment and custodialization were the principal tenets of British colonial public policy for the management of the violent, disturbed mentally ill, that led to the establishment of the Lunatic Asylum. Twentieth century political independence ushered in the pioneers of modern Caribbean mental health care by the establishment of training programs for psychiatry. Indigenous models of mental health legislation catalyzed the establishment of innovative community mental health services resulting in the negation of involuntary certification, incarceration and custodialization. This led to innovative ecosocial systemic approaches to mental health care, including: the promotion of family therapy; short-stay treatment in conventional primary and secondary care health facilities; systems for Diversion at Point of Arrest (DAPA) and the reduction of stigma through popular media and the arts. A gradual mental hospital deinstitutionalization process has been supported by novel psychotherapy models and development of primary prevention mental health institutions that have catalyzed the assimilation of psychiatry in medicine, stigma reduction and community engagement. However, these successes have unmasked high levels of violence, personality disorder, family fragmentation, migration, and dysfunctional children that have mandated the development of primary prevention programs, which have taken psychiatry to schools. These innovations point toward the need for continued decolonization of the architecture of Global Mental Health policy in the Caribbean.
Frederick W. Hickling was educated at the University of the West Indies, University of London, and University of Edinburgh. He is Professor Emeritus of Psychiatry at the University of the West Indies, and is the Executive Director of the Caribbean Institute of Mental Health and Substance Abuse (CARIMENSA) UWI, Mona. Author of more than 100 scholarly articles and six books, he was elected a Distinguished Life Fellow of the American Psychiatric Association in 2009, and a Fellow of the Royal College of Psychiatrists UK in 2011. He received the Order of Distinction (Commander) by the Government of Jamaica in August 2012.