S1E11 – Decolonising mental health, with Dr Arya Thampuran

E: Before we go any further, I wanted to let you know that today's episode explores sensitive topics, including colonialism, slavery, medical abuse, the experience of hearing voices, the pandemic, and shared or collective trauma.


Signposting to support is available at our website, anyamedia.net/LiveyMinds 


W: also just to let you know that today's guest, Aria, makes a few references to the DSM, which is the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.


W: Hello, my name is Will.


E: My name is Ellie.


W: You're listening to Lively Minds, the podcast about mental health challenges that go beyond
the ebb and flow of the everyday.


E: The podcast that is less about how we deal with our mental health and more about how
we understand it in the first place.


[Music]


W: In today's episode we are talking to Dr. Arya Thampiran, a researcher from Durham University in the UK about her work focusing on how creative practitioners in African diasporic contexts express distress and healing in ways that challenge traditional western views of mental health.


E: Dr. Thampiran's work aims to go beyond the idea of distress as a disorder and explores alternative perspectives. She analyses various forms of creative expression such as books, art and films by contemporary African artists to understand how these representations can reshape our understanding of mental well-being.


Hello Arya! I wondered if to start with you could just tell us a bit more about your research and
what you've been focusing on at the moment. 


A: Thanks for having me Will and Ellie, I'm really excited to be here and thank you for that introduction as well. So I actually came from a literary studies background, um, I started by looking at trauma narratives in afrodiasporic fiction, largely Nigerian fiction about bi-afro war. So I looked at Jima Manda Adichie's novels, Tinoachi-based novels, texts that have become quite canonical in university post-colonial literary studies - module reading lists really. And what really struck me was how much these texts had an autobiographical or semi-autobiographical element to it. 


So then I moved into life writing and I started looking at other forms in which authors, artists and activists was sort of expressing mental health and the after effects of structural violence like war, um, colonial trauma, sexual violence, racialised and gender-based violence and how that was affecting the everyday and how there was this persistence um, of the past and past violence and how it sort of influences the present as well and how healing then has to be thought about as a continuous process, um in very non-linear ways too, and what fundamentally struck me as well was that these Western models of understanding or rather the DSM, which was, I suppose, the psychiatric text that I was most familiar with, speaking from lived experience as well, or like Western psychiatric systems and practices, just didn't capture that sort of, the structural conditions that were really underlying a lot of these experiences. 


So a lot of the time in Western models, we looked at the individual as being, you know, especially in a biomedical model, we think about pathology as being individually contained and healing as being something that's an issue of self management, so either through medication or therapeutic intervention. But in a lot of these texts from literary analysis, and from like theatre, performance studies, visual art, there was a sense of the collective being involved, of um, trauma being something that's collectively shared, and hence a collective communal responsibility to repair not just on an individual and communal level, but on a wider macro structural level and really stage that sort of institutional critique as well. So that's what really got me interested, looking at different forms. It was just that sheer range of thinking about mental health and healing that just was not captured in something like the DSM or Western psychiatric practice, at least in my personal experience. 


W: Am I understanding correctly in that it's about looking at how African diaspora or, or in fact people in African, in Africa will use a more communal approach and a more structural approach to understanding mental health than in the Western context, which is a much more individualised approach, would that be fair?


A: Absolutely. There's also this tension because in a lot of the texts that I look at, because of colonialism and past and globalisation patterns of migration, there is this cross-cultural context. A lot of these creative practitioners are situated in the West, either in the US or the UK. A lot of the authors whose work I look at or a lot of the visual artists and performance artists that I've been in conversation with have immigrated. So they've got these two frames of reference that they're toggling indigenous um, ways of knowing, knowledges that they've grown up seeing, indigenous practices that they might have seen in their families. Not always clashing with, but sitting alongside sometimes uncomfortably with these Western frames of reference that they've been exposed to. So it's not so much a either or situation, which again is I, I think largely this compulsion to sort of categorise in black and white binaries is again a very Western mode of thinking and something that I have to catch myself doing also.  Whenever I look at these texts I'm like oh yes they're always in in contradistinction, they're always counter they're always a counter narrative but sometimes they're just co-narratives they co-produce they all mingle in the same space and there's no sense of resolution as to either or it's more like let's, this cobbled together way of being, that can accommodate this. So it's quite interesting really because I think that either or binary, um, binary sort of mode of thinking is one of the deep dissonances between that Western model of understanding the mind and perhaps ground level reality for a lot of marginalised communities or minoritised communities as well with thinking about that mind-body dualism especially in healing and thinking about pathology as being concentrated in the brain for example in these like neuropsychiatric and understandings of the self, that's something that really fits at odds with thinking about health as being something that's a lot more holistic so it's the environment, it's the relationship with the land, with labour, with the body and like a communal body. 


E: That's amazing. I was just wondering do you think, say I'm just thinking of the UK as an example just because that's where we are and that's this health system that I understand the structure of even if I don't agree with it, but with that different kind of understanding and approach to mental health, what do you then do if all of the routes to treatment are very much based on a very specific Western idea of like binary view of mental health? Because even if you've, you’ve got your community and your own kind of ways of understanding, it's not kind of built into the fabric of how you can receive treatment.


A: Absolutely, I think one thing that we've seen recently are grassroots level community-based organisations like the Healing Justice Network, or there are therapists, psychotherapists who are trained in culturally adapted or culturally sensitive therapy, which is, I mean, it has its own, it has had its own pushback, but these are modes and forms of therapy where the people who are accessing the therapy feel seen and represented by the therapists and the communities of practice. And it's also a model of therapy that sort of meshes Western psychodynamic approaches, say, or like CBT and familiar frames, with also an understanding and appreciation of communal modes of healing. So for example, the oral tradition is something that's very rooted and steeped in afro diasporic culture. So one thing that's sort of come into that, come into healing practices from oral tradition, has been the power of storytelling. And I think storytelling is a really interesting thing. And it's also my interest in narrative because I think with the Western psychiatric system, sometimes we can get stuck in a single story, which is the single story of the brain. Um, oftentimes, so things like OCD or depression being a neurochemical imbalance, for example, or cognitive um impairment in many ways, and your neurodivergent sort of conditions.


But with these models, then you're thinking about it beyond the brain, I suppose, and you're thinking about multiple stories. So you could relate to your distress through that sort of neuropsychiatric paradigm, but equally you could relate to your distress through a spiritual paradigm, which is often the case. And it's less a case of which paradigm you're using to explain things away or to rationalise things, 'cause I think there is always this impulsive in the West as well to explain, to put a, to put a label on something to diagnose. It's not so much about where we can root that pathology, but how we understand it and how we experience it that's at the heart of it, um yeah.


E: Yeah, yeah, that makes sense.


W: And I guess moving into sort of the colonial aspect a little more, I guess that what you're also talking about here is a pervasive approach to approaching mental health, i.e. the Western approach, which of course exists within Western countries. But then there's also this kind of colonial aspect which presumably includes the sort of, a more historical context of this as well.  It's not just about the present day, but also about the past. And you, you started off by talking about historic events that you've read about and how that kind of was a formative part of , ofyou understanding. Can you talk to that a little bit more? 


A: A lot of Western medicine is rooted in colonial practices and we have to sort of, we can't separate it from sort of structural metrics that exist because science doesn't exist as the body of knowledge apart from the sort of environments that it is produced and constructed and in dialogue with. So if we think about this model of the healthy body or the healthy mind, it very much is a white male body and mind. And we see a lot of colonial interventions in Africa as well that sit at the root of a lot of medical mistrust and mistrust towards the medical system in the West by minoritised and marginalised communities. So if we just think about COVID and, you know, vaccine hesitancy or the hesitancy towards allowing personal data to be mined by healthcare institutions, that's very much steeped in the sort of legacies of colonial medical violence.


So for example, one way of understanding the brain was through colonial psychosurgery or leucotomy. So often what they do, um particularly, so JC Carathas was a very influential figure in the 1940s. So in Kenya, in the Matari hospital, that was a colonial um medical facility, and they would um perform these leucotomies, which are what we know as the one flew over the cuckoos nest, sort of lobotomy, that's that sort of the cultural reference there. But they were called leucotomies and they would remove some white matter from the brain and what they do then is compare the state of the leucosomised, not just Africans but also European men who had been, who were in the colonies, and they would compare them and they would then hypothesis that was that the leucosomised European man was had the same emotional bandwidth or the same emotional capacity as the average African. So there were those sorts of stereotypes that were, and yeah, and also this, this idea that Africans have a non-rational mode of being, but a magical or superstitious mode of being. And I think that that whole framing of a particular orientation, a particular body of knowledge or understanding of the self and relationship with the world, that is non-rational is immediately, that is magical, is immediately categorised as non-rational. So these ways of understanding experiences that are considered to be spiritual, immediately designated as mythological, the counterpoint to reality. So it's all steeped in this Western idea of what rationality is, and psychiatry is rooted in that as well. There's one psychiatric reality, pretty much, um rather than it being, you know, ontologically oriented. So in relation to the people you're around, in relation to the communities of practice that you're around. So I think one really interesting um example of this really, is a quick, one very foundational text I think for me in my own research and coming to terms with these, with these things was Akwaeke Emezi’s Freshwater. So that's the semi autobiographical text where Emezi attests to the experience of being an Ogbanje and an Ogbanje in Nigerian Ebo ontology bodies of knowledge is a born to die child. So it's a malevolent spirit that comes back repeatedly and dies a premature death in order to torment the human mother. And they've got ties with the spirit world, that's how it's understood. And the body that they inhabit in the human world, the body of the child, the child that's experienced this like fracture, voices in the head and hears these multiple voices. So Emezi was diagnosed with dissociative identity disorder, would have been diagnosed with dissociative identity disorder. Their experiences of hearing the voice were also diagnosed as being a post-traumatic sort of break, which is sort of the PTSD frames of reference that we have, but they've spoken so much about how that was fundamentally dissonant with the way they understood it growing up. And it's not that this experience is not pathologized, it's not celebrated in evil communities, but it's understood completely differently, but yet it's had especially media and publishing circles and reviews, it's been designated as a mental health text or, you know, a way of reading psychiatry into someone's experience when that also performs a certain violence towards the experience because it's foreclosing any other way of engaging with it, right? 


E: Yeah, it's taking over the narrative and remove, because like what you said about storytelling, it requires the system or the person who is perhaps making decisions about treatment or whatever to make themself believe another way of thinking about things in order to be able to respond appropriately.


W: Yeah, absolutely. 


E: I'm not sure that sentence made any sense. 


A: No, no, no, it made complete sense, because it actually speaks to a lot of my research. So when I initially started looking at this, I was looking at it quite passively in terms of me reading and engaging with the text. And then I realised me coming from it, so I was born and raised in Singapore, but it is very much a colonial education system, it's,  English is our medium of instruction, and I was educated. I did my university here. My frames of reference are largely British as well or the Euro-American. And coming into this, I had this impulse or like knee-jerk reaction to diagnose everything. As soon as I saw that I was like, "Ah, that's dissociative identity disorder right there. That's depression. I see it." You know, I'm like, I mentioned DSM, I'm checkboxing it. But I think what was interesting for me then was as this research developed, I was looking more at ways of ethically engaging with these texts. So how do you encounter a text um, when it has a frame of reference that's completely,  or someone else's experience really that that might be so far out of the realm of your own experience but engage with it ethically and sensitively and I think sometimes the term empathy gets thrown around a lot but I don't think empathy is the be all and end all and sometimes you wonder as well in the clinical encounter how do you make that a bit more ethical when it's a cross-cultural clinical encounter right? Um and I think that, yeah, the heart of a lot of these problems. 


W: I'm interested, that you said before that the difference in approach may not necessarily be that one approach is always pathological and one approach is always non-pathological. You described before two approaches, very different approaches, that were both pathological, one Western and one non-Western. And I guess what kind of, what strikes me is that therefore, is it right for me to say that it's not so much simply just saying Western approaches are bad, non-Western approaches are good. It's actually just about saying that they're different and that the Western approach has always been the dominant approach and actually it's not always appropriate. 


A: The problem isn't the approach, the problem is with that dominant, hegemoniale imposition of the approach as the only way.  I think what really sits at the heart of this is you meet people where they are, where they're at. There is, there’s no detracting from the fact that there is comfort in diagnosis for a lot of us. Um, if that's the frame of reference you're surrounded by. And also I mean on a really basic level, sometimes you need diagnosis in order to access the medication that you need to function. 


E: Yeah


A: And I think it's fundamentally unethical also to sit in an ivory tower and sort of critique, you know, because ideologically and principally your post-world, principally, I've got tons of critiques of Western psychiatry, but does that take away from the fact that myself and others have benefited hugely from things like, you know, therapeutic access, medication? Absolutely not. But like two things can be true at the same time and I think that goes back to that storytelling thing right we're all plural in many ways that we can live with those sorts of contradictions and just sort of let that sit you know rather than trying to resolve it in this very binary way and I think it, it really speaks to this idea of recovery as well, it's something that, what really sort of, um, what the basis of this critique really is, is that singularity or that singular model of what health looks like, that singular model of what well-being looks like. And I think structurally the problem there as well is that if you locate distress and then the responsibility for well-being on the individual, you're really then not considering the structural factors that are causing that distress to begin with.  So then you're passing the buck from the, from institutions and infrastructures that are causing that violence, like what are the racist institutions or environments that are causing distress. So you know, things like environmental racism, marginalised communities being largely located in areas where there is tons of toxic, polluted, chemical debris and that affecting health, these kinds of metrics, but then immediately it goes into the sole discourses, let's, let’s manage ourselves with meditation and mindfulness. And again, not to detract from the fact that meditation and mindfulness helps a lot of us, but again it's just casting that critical glance on, really unpacking the root of all these, of these, these practices that have become so mainstream, I think, and like, who is it actually serving?


W: And it chimes very much with stuff we've talked about on the podcast before, which is fundamentally, at its heart, it's about agency, and people having control over the way that they interpret their own mental wellbeing and I think that what you're saying really chimes with, with that, in that it's about people having the power, having the control over what lens they use to be able to understand their mental health problems in the first place.


A: And also the power and the agency to determine what wellness looks like to them. Because I think in Western society in particular, there is this stronghold of what wellbeing should look like, you know, if you wake up, have your green juice, yoga, meditate, take your medications, that's the key to being well, but it's also, so if you're in recovery, what are you trying to recover? There are systems in place that are still there structurally. What does recovery then look, what does recovery actually mean? 


E: And the Western model really isn't recovery oriented. It's more, it prioritises the elimination of symptomatology and pathologises every aspect of the experience. So the, you know, psychiatrists idea of your recovery is, is quite likely to be like the elimination of the voices rather than understanding more about the voice, you know, working, working with them.


A: I think it's putting a bandaid over the wound, isn't it? Or glossing things over in many ways. And I think especially with your voices, it's such a, it's such a complex thing, such a nuanced thing, because for a lot of people, there is security and comfort in the voices, on the experiences of the voices. 


E: Yeah


A: So, in which case, then there is that 


E: You're doing damage by removing them. It's an, thats an act of violence in itself.


A: Absolutely. Absolutely. So it's about considering how do you make that experience of understanding distress and then what recovery or what being okay looks like on a baseline is to an individual person rather um, rather than what's comfortable for society I suppose or what's palatable for society. And I think in the text as well, what's really interesting is that space to sort of think about recovery as something that's not linear and that can go through cycles. A lot of these works look at recovery as an ongoing, either an ongoing process or something that's cyclical. So violence is cyclical and it's endemic, then how do we think about it beyond the, oh, diagnosis is sort of the high point in my narrative. And then it's the event, it's the big event. And then we sort of walk through this whole narrative arc of recovery and then wellness and wholeness and closure. But oftentimes there is no closure.


W: Wow. What a fascinating conversation. Let's go to a quick break, but we'll be right back.


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Now back to the show.


W: Hi everyone and welcome back. So Arya, for the next section we were just wondering if you could tell us a little bit more about some examples of how African perspectives have challenged and provided alternatives to Western narratives of mental wellbeing.


A: One piece of work that's really stuck with me and that was really instructive in my way of thinking, rethinking healing was Selena Thompson's Salt. So this is actually, Selena Thompson is a live performance artist. She's based in Britain. And Salt was an autobiographical replaying of her own journey through the Atlantic Triangle. So she was retracing the ancestral, her ancestral enslaved roots through the middle passage in that Atlantic Triangle. She encountered a lot, she was on a cargo ship. She had a filmmaker with her. She encountered a lot of violence, sexism, racism along the way. She had this deep sense of guilt as well as sort of spectating distress from an alternate, from an outside perspective almost having, with her British passport and her British context and feeling almost privileged by that mobility. So she was grappling with a lot of things. She replayed that on stage, but the stage sort of transformed for her into a communal healing space. So what she did was reconstruct her journey on stage, but she used salt, she had a big rock, big salt rock with her and she'd smash and it would go to smithereens and that was sort of symbolic as breaking down Europe and breaking down that sort of structural violence in each member of the audience. So it was a space where this history was reconstructed and then deconstructed and it's almost, you have to tap into the trauma, you have to tap into the past in order to rebuild and think about the future. And I think that's really at the heart of what we think about with decoloniality. We bring in these frames of reference and treat them in the same space and in the same breath as the ones that we might be familiar with and not think about them as alternative or other. And each member of the audience was then given a piece of salt to carry with them and bring back with them as a memento, but also this sort of shared established sense of community. So it was that story, that oral tradition, that storytelling tradition that came together. There was that touch, that sense of that memento signifying something, that symbolism of the middle passage and water as well, and something of her body being with the rest of the communal body almost, which was really quite poetic and powerful and moving. 


But I think also what was really particularly powerful about Thompson's work was the fact that she's very candid about how much emotional and mental labour that takes, that idea of communal healing, ‘cause often when you think about, oh, let's reject certain Western models of healing and move it onto the community, there is a mass amount of labour that's being placed, not just to educate the Western model especially, we saw, we saw this happen a lot in the wake of BLM, or looking towards people to educate us. That kind of emotional labour that's being placed on, on communities. And she talked about how just reliving that experience was deeply re-traumatizing, having to access therapy herself. But what she eventually did was outsource that to a fellow theatre practitioner who had the capacity to do it. And she also started putting in place care practices in her theatre. So now she's an advisor as well. She acts in an advisory capacity to other um, filmmakers and producers in theatre spaces about how to adequately care for people who are performing things that have intimate personal experience. And this, I actually unpacked this material with the Black Health and the Humanities Network, um, which I'm currently the principal investigator on. So at the time I was a member of the network and it was run by Josie Gill, Drs Josie Gill and Amber LaSalle. It was based in Bristol and it was Wellcome Trust funded. Now it's hosted under the Institute for Medical Humanities at Durham, where I'm the PI as well. Um, and in this training, so it was a group of academics, artists and activists who are all looking at the intersection of black health within the humanities and how we can ethically en, engage with these experiences and how we can rethink health really in Britain. And that text was so powerful and poignant because it really made us think then about holding space for communities of reading.


How do we care for each other? when we are engaging with material that has intimate personal experience or personal resonance or meaning. So there's all these multi-levels of thinking about care and healing and community-building, the power of narrative as well to mobilise healing in many ways, but also what kind of labour we are putting onto text to sort of educate us and give us that sort of experience. So yeah, that, that would be one way of sort of reframing healing, I think, as a communal experience, a collective experience. Not that that's necessarily ideal or without its own complexities like Thompson's experience has to, but, or that a Western model is terrible or bad, but yeah, it's just holding two things in the space together.


W: Yeah, it's interesting, yeah, because again, on the one hand, it's not about saying that Western models are bad and non-Western models are universally good. It's not necessarily about making that kind of binary distinction, but it's a bit of, at the same time for me, it's about recognising the dominant historical pervasive western influence that's happened, as a result of colonialism, I mean literally as a result of colonialism through the western countries going around and invading countries and taking them over and subjugating the people of those countries, that therefore means that as the dominant narrative and, as a dominant way of looking at mental health, it's absolutely understandable that people will be reacting against that
and will be finding their own ways of being able to reshape their experiences through a prism which is, which feels far more relevant for their cultural context. Does that make sense? Did I make sense there?


A: That makes absolute sense. But again, it's about meeting people where they're at, right?


W & E: Yeah, exactly.


A: Delivering a model that actually speaks to individual experience rather than seeing every experience as being universal in a way or seeing everyone as being or having a universalised model of what health is or what distress looks like, really being sensitive to conditions and like the wider context of illness. 


E: I wonder because this is your area of research, have you felt that because there was more of a sort of like mainstream public discourse about this idea of shared trauma in relation to the pandemic and the sort of, we, as a population collectively went through something quite traumatic. Have you found that that has, do you feel like there's been a shift generally into more in public health towards looking at things more collectively and healing collectively following the pandemic or have we just gone back to individualism? 


A: I don't know, this might be a bit cynical of me but I think there are issues with this idea that it was a shared experience 


E: Yeah, I would absolutely agree. 


A: because it might have been a shared condition but it absolutely wasn't a shared experience. Different people had differential experiences based on class, gender, race, positionality. And I think subsuming everything into a collective, my experience of the pandemic as say, someone who's universally educated and who's living in a fairly safe town, living alone, was vastly different from perhaps like, a single mother who had to raise a couple of children in the pandemic and you know, worry about putting food on the table and things like that. And people with certain health vulnerabilities and conditions.


E: Yeah, it was like shielding for like two years and it was rubbish. 


A: Absolutely, absolutely. So I think this idea of collectivising, it can be good in terms of building solidarity, but equally, I think there is this, we need to constantly check our own positionality in relation to what we're engaging with. You know, it's just the ethical thing to do, isn't it?


E: Yeah, it was like the discourse going towards a collective model but getting it really wrong. 


A: Yeah, absolutely. A collective, yeah.


E: Yeah, remember when we all went through that?  No, we didn't, we all went through something completely different. 


A: Exactly, exactly. 


E: What are you working on at the moment? 


A: So I'm currently working on a project actually to address gaps in accessing wellbeing services amongst Black and minoritised students in higher education institutions and why they they fall through the cracks essentially. It is largely because of the lack of culturally adapted or culturally sensitive sort of provision of counselling through CAMS, but equally how university wellbeing ecology is sort of failing these students. So I'm trying to formulate a space for these students to create zines as alternative narrative practices for expressing their distress and really to understand the experiences. So that's one project I have in the pipelines. And this year I'm also hugely excited to be leading the Black Health and the Humanities Network. So expanding the membership and that just means more people in the field who support it doing this kind of really important work and expanding conversations on what it really means to interrogate ideas of health and wellbeing, particularly through a racial lens.


E: It sounds fantastic. And yeah, thank you so much for coming to talk to us as well. 


A: Thank you for having me


E: I've really enjoyed it. I feel like I've got lots of food for thought.


Thanks so much everyone for listening and please do tune in again in two weeks for another episode of Lively Minds, the Mental Health Podcast. 


W: You can find us by searching Lively Minds wherever you get your podcasts.


And please remember that this show does not constitute medical advice and is not a replacement for seeking professional help. You can find signposting to support on our website,
anyamedia.net/livelyminds.


Bye-bye for now.


E: Bye-bye.


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