Colonialism is a Social Determinant of Health and Should Inform Our Thinking About “Aboriginal” Mental Health
Sarah Nelson argues that ‘mental health service research and discourse reflect… colonial ideas and, as such, constitute a social determinant of mental health for Aboriginal peoples in Canada” (1).Colonialism has resulted in the “displacement and marginalization of Aboriginal communities and individuals, and the perpetuation of discriminatory or stereotyped ideas about what it means to be Aboriginal” (1). Colonialism, “limits available resources and opportunities,” and more directly, “has impacted Aboriginal peoples’ mental health through the experiences of residential schools, as well as government restrictions on ceremonies and movement in and out of reserves” (9).
Social Determinants of Health, or, “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness… (which) are in turn shaped by… economics, social policy, and politics (9),” influence a person’s health and wellness. These social determinants can be divided into three layers: proximal, factors that immediately affect a person such as the physical environment or unemployment; intermediate, factors such as the health care system or community infrastructure; and distal, factors that are “overarching systemic, institutional, economic, or political,” (10). Colonialism can be thought of as a distal social determinant of health that affects the intermediate and proximal levels.
Nelson argues that “research in the area of Aboriginal mental health is too often built upon or influenced by assumptions rooted in stereotypical views of Aboriginal peoples” (3). Past mental health research in Aboriginal communities has not been initiated or carried out by communities members. Furthermore, “mental health research involving Aboriginal peoples has historically been undertaken from a Western point of view… they involve certain assumptions about what constitutes mental health.., and about the nature of knowledge itself” (2).
Mental illness is diagnosed as being different from normal. While Nelson admits that this is not necessarily a bad way to define illness, it does become problematic when “normal” is defined by one group and then applied to another (6). It is also problematic that certain mental health issues described in DSM-IV and that certain methods of healing are described as culturally specific, and that biomedical definitions are considered devoid of culture and unbiased (7-8, 11).
Nelson further argues that in discourses around mental health, when we talk about healing mental illness, Aboriginal healing is generally historicized and placed in juxtaposition to biomedicine that is constantly developing and testing its conclusions. According to Nelson, this, “overlooks considerations that the development of new knowledge in Aboriginal communities has been interrupted in a profound way by the past century of residential schooling” (6). Furthermore, by valuing “cutting-edge, rapidly changing knowledge of biomedicine,” Aboriginal healing that focuses on the knowledge of ancestors is “implicit(ly) devalue(d)” (6).
When effects of social determinants of health are thought of as simply medical differences between populations, “the blame for sickness and responsibility for healing,” is shifted “to those who are suffering” (7). Nelson argues, “the oppression of Aboriginal peoples within Canadian society had resulted in social inequalities that are at the heart of many mental health issues. The resolution to such issues requires attention to the effects of colonialism on the individual and community health, and the promotion of self-determination and community control within mental health care” (3-4).
Nelson suggests that the way forward must go beyond cultural competence training for healthcare workers, which can be helpful but can also attribute the same, unchanging characteristics to a large group of people (10). Certain groups must not be considered devoid of culture, while others are defined by their culture (11). She suggests encouraging the practice of cultural humility: “a lifelong commitment to self-evaluation and self-critique in order to redress power imbalances and to develop and maintain mutually respectful dynamic partnerships based on mutual trust” (11).
This is a summary article authored by Chenoa Sly. For further information, please see the original published research: