Decolonising the medical curriculum: psychiatry faces particular challenges.

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.

Mahi a Atua: A Maori approach to mental health.

Maori are the indigenous people of Aotearoa New Zealand. European colonisation had a devastating effect on their communities and their way of life. While there is some evidence of a renaissance of Maori culture in recent years, like other indigenous people across the world, they continue to be massively overrepresented in their country's figures for poor mental and physical health. In this paper, we briefly review the literature on the Movement for Global Mental Health and review the case that has been made for the use of indigenous psychologies in place of approaches based on Western psychiatry and psychology. We present two case histories where an intervention based on an indigenous Maori approach to negotiating emotional conflicts and dealing with mental health problems was used. This approach, called Mahi a Atua, was developed by two of the authors over a number of years. We conclude that indigenous approaches to mental health offer not just an adjunct to, but a real alternative to, the interventions of Western psychiatry. They provide a framework through which individuals and families can negotiate their journeys through mental health crises and difficulties. However, such approaches can also work on a socio-cultural level to promote a positive identity for indigenous communities by celebrating the power of indigenous deities, narratives, and healing practices that were marginalised and suppressed by the forces of colonisation.

Hearing voices: A phenomenological-hermeneutic approach.

The word "phenomenology" has a number of meanings. In this paper we briefly contrast the different meanings of the word in psychiatry and philosophy. We then consider the work of the philosophers Heidegger and Merleau-Ponty, as examples of what Hubert Dreyfus calls ontological phenomenology, in contrast to an epistemological approach. We present a brief outline of Merleau-Ponty's theory of embodiment, and contrast this with the dominant, epistemological (or Cartesian) view of experience. Through the example of a woman who experienced bereavement hallucinations, we try to show how this approach can open up a hermeneutic approach to the experience of hearing voices. An understanding of embodiment can help to counter reductionism, whether biological or social, and dualism (body/mind and mind/society). It is only when we consider the totality of human experience that we can understand its meaning. This has two main benefits. First, it legitimates the claims made by those who hear voices that their experiences are intrinsically meaningful. Second, it can provide a framework for those who work with voice hearers and who are interested in understanding these experiences. In this sense, phenomenology can become a valuable clinical tool.