ASU Future Security Fellow on the colonial origins of psychiatry

Across the globe, the differences in how trauma and mental health are addressed are as varied as the cultures and people dealing with them.

Khameer Kidia knows this well, as the son of a man whose identity he says was built around war.

Kidia, a 2023 New America ASU Future Security Fellow, spoke recently at an event, hosted by the Center on the Future of War at Arizona State University, titled “Trauma and Empire: Uprooting Psychiatry from its Colonial Origins.”

He shared that he has often wondered why war played such a strong role in shaping his father’s identity despite him not being considered a post-traumatic stress disorder (PTSD) patient under the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) standards.

His father’s situation inspired the Zimbabwe native’s personal and professional pursuits; Kidia is a writer, anthropologist and global health physician on the faculty at Brigham and Womenʼs Hospital and Harvard Medical School who researches the colonial origins of global mental health.

During the ASU event on March 15, he spoke about the history of PTSD as a diagnosis, from the beginnings of psychiatric care for soldiers to the creation of the DSM. He covered the history of PTSD through World War II and explained that it was created to decide whether or not men were fit to fight.

Kidia explained that different cultures have different understandings, treatment modalities and terms for trauma. Given this, one culture’s response may not align with the expectations of an American psychiatrist. In other words, Western treatment philosophies and practices don’t always translate in non-Western countries.

According to Kidia, the link between colonialism and psychiatry is violence; that is, the violence of empire as well as the epistemic violence connects them. He expanded that individualizing trauma takes the blame away from a larger system of violence, and applying the word “trauma” and Western ideas about trauma to other cultures is itself a violent act of silencing.

Following his talk, Kidia answered several questions from attendees, transcribed below.

Editor’s note: The following questions and responses have been edited for length and clarity.

Question: Is there a danger in retraumatizing subjects by debriefing traumatic incidents?

Answer: Of course, there is a huge risk of re-traumatizing people. (In one situation where I was trying to help people outside of the United States who had been traumatized), I thought to myself, “Well, we do this in Boston. It's called critical incidents, stress, debriefing. It must work.” I didn't think twice about whether or not the stuff that I'd been taught at my hospital in Boston applied to people elsewhere, or if it even worked at all. … I think we get stuck in Western thought around psychology and psychiatry in terms of what helps. The Western ideal is very individualized in Western psychiatry. We're taught to turn inwards. Go internal. Figure out what happened in your childhood, or process everything that you've been through. … That's something that is prevalent in Western thought and thinking. But it may not apply elsewhere in the world, and it may not even apply in America.

Q: In thinking about structural violence, what can we do to empower people and avoid this feeling that things cannot change?

A: I think what I learned from this is just that this is a classic tension in all of the social sciences — this tension between structure and agency, and that we're always kind of oscillating between those two things. The two go hand in hand, and what it does is take away the blame from (individuals), and I think when we talk about mental distress, that's a really important thing. When you feel as though you are to blame for what's going on in your mind, you feel very guilty, and those kinds of negative emotions tend to accumulate, and having a structural reason for what's going on can be incredibly liberating for a lot of people.

Q: Do you think this continuous activation of the sympathetic nervous system with marginalized communities might be part of the reason we have such health disparities in the United States?

A: I think what (all this research in cortisol levels and biological processes) is trying to do is give us a biological reason to really think about trauma in a way that is essentialist, and it's important to keep pushing the biology of trauma as much as possible. That said, the state of biology for trauma is pretty unformed. The biology of trauma, as we know it today, is still pretty underdeveloped, and so while we're figuring that out, I think trying to combine those biological views with social constructionist views is really important since we can see clear links there, whereas biological links don't always exist in all studies.

Q: How do/should we differentiate between the conditions resulting from trauma and violence as discussed here related to war and conditions in the civilian space, resulting in situations like divorce or domestic violence?

A: Other types of traumas in our daily lives may get lost, which goes back to what Derek Summerfield said in the British Medical Journal, that in so many ways these vicissitudes of daily living get umbrellaed under this idea of trauma. For me, what's important about violence is the power dynamic, and I think domestic violence is a clear-cut thing. If you go back to the PTSD definitions in the DSM, it actually does allow for most of the things that were mentioned in that question to be defined as a type of trauma. If you'll remember, even just listening to a story of someone else who's had trauma counts as exposure.

Q: How do you navigate the risks of naturalizing definitions and boundaries of groups when addressing cultural differences in how trauma is understood and experienced when it comes to discussion with individuals?

A: What's really critical here is thinking about things through the lens that is most socially and culturally appropriate for the person that you're working with on an individual level, and there are lots of ways of doing that, but an important thing in this context is to go back to Indigenous knowledge. So, for Zimbabweans, for example, trauma is not something that actually exists, and people say, “I'm thinking too much,” or “My heart feels burdened,” which are what we call idioms of distress, ways of expressing mental anguish. (In those situations), it is really important to work with as much Indigenous knowledge as we possibly can, and, if possible, have everything done by Indigenous systems. In Zimbabwe, we have what's called a pluralistic medical system, which means we have hospitals and clinics with Western-trained doctors and we also have Indigenous healers — faith healers, traditional healers, spirit mediums — and they deal a lot with the problem of mental illness … (in ways that are) not dissimilar to Western psychiatry’s cognitive behavioral therapy. … The best thing for people is to have their version of cognitive behavioral therapy from the most appropriate Indigenous knowledge system, and what we need to do from a Western superpower standpoint in academia in medicine is to (treat) those systems of knowledge as equal.