Therapy in India Needs a Desi Touch: Moving on From Colonial Ideas of Therapy

A co-therapist, Aryan and I recently conducted a Zoom group therapy session called “Playing in the Puddle” where we used art and an eastern idea of mental health to work with emotion processing. It seems daunting to do this because emotions are messy and the world of mental health service delivery right now is full of “Instagram therapy” stuff. It’s all about instant recognition (ahem, diagnosis) of issues, quick suggestions and solutions, and on-the-spot therapy. 

One of the eight participants said, “I am finding this approach to reflecting on our lived experience and emotional states through metaphors to be very interesting.” This definitely put our minds at ease for taking this road less travelled. Another participant shared, “The discussion around suffering and discomfort being a part of life, and not something to fix/run from also felt good. Trying to accept and get comfortable with that idea means stuff like ‘why me’ or ‘did I deserve this’ or ‘did I do something wrong’ starts to fall off, I guess.”

What we are doing is part of a shift in the way cross-cultural psychology is happening, a sort of movement which is called “decolonising mental health/psychology”. This is the idea that current ways of mental health (diagnosis and treatment) consider the western life and the way people operate in it, as ideal. Thus cultural differences of the east are automatically seen as problematic, only because they are different. So, a recent shift in thought is trying to “decolonise” spaces and centre more indigenous approaches. The decolonial discourse has already entered academics and it is about time that it came onto service delivery too. 

So what would decolonial therapy in India look like? According to emerging work done by programmes like Atmiyata and Bapu Trust, it would make use of the community model of mental health care. They go into communities and use the group/community approach to tackle problems for larger groups of people rather than one person within the clinic, feeling alone with their problems on the famous couch. They (especially Bapu Trust) use an eastern understanding related to mental health issues—that suffering is in the nature of the universe and that collective suffering requires collective compassion.

They also make use of drumming, dance, drama and visual arts in order to bring up and work with emotions. “As a student, arts-based approaches opened a lot of doors, skill wise and emotionally,” says Vaidehi Chilwarwar, who experienced group arts-based therapy as part of her training to become an arts-based therapist. “Spontaneous, in the moment and flowy activities offered a sense of relief while the emphasis on being over-prepared, well planned or structured in regular therapy training was almost invisible.”

This arts-based approach also ensures that the participant experiences what is in the mind and in the heart, not just what they are aware of and can speak about. This approach is really helpful because emotional awareness can often be low in countries like ours where for generations, we have had to focus on survival and did not have the luxury to look inwards. It also helps because sometimes, despite having an emotional language, we may have subconscious experiences/psychological blind spots that our aware, cognitive self may not know of. 

These approaches also help with “task shifting”, a concept suggested by Vikram Patel, an Indian psychiatrist and researcher currently teaching at Harvard Medical School. This is the idea that in densely populated countries like ours, we need to have multiple levels of helpers: barefoot counsellors, trainee counsellors, social workers, psychologists, therapists and psychiatrists. Because what everyone is going through does not need a specialist, we need not keep people waiting for their turn. The lesser trained professionals could do broader, preventive and slightly curative work. Then, we only refer a miniscule population to specialists. This is more suited to the realities of post-colonial countries like India.

As this piece eloquently describes, “Cushman noted how the model of self put forward by psychology (in the West) has the effect of perpetuating dominant cultural values.” What this suggests is that Psychology and Psychiatry replaced religion and law when it came to describing how people “should be”. And instead of using that power well, these streams ended up saying that only certain ways of being are “acceptable/normal”, and often these ways are white/male/upper caste/class. 

Additionally, the psychology disciplines need to account for systems of oppression. In the Indian context, not only do we need to talk about colonialism, but also about caste and capitalism. Divya Kandukuri or @anticastecat on Twitter and Instagram, says in a piece, “If the only therapists we have access to belong to upper castes, there is often little talk of structural violence. The acknowledgement that well-being and mental health are affected by casteism and patriarchy is often missing; let alone the ability to speak about the intergenerational trauma that has been passed down in our communities.”

The tools to shift the conversation from internal-focused western ideas of mental health are at our fingertips. We can integrate aspects of community, eastern lens and arts based work into our existing models so that we can provide more than just specialist care. As one participant of our Zoom support group said, “Listening to others and holding space for each other helps you feel less self absorbed in some ways without dismissing what you are going through.” 

It is not surprising that so far, we have relied on the western model, because that is what ends up being in most of our textbooks: theories and insights of upper class white men, sometimes women, and hardly ever black or brown people. Right from the studies done on the university students in the west to the social priorities of the western life, everything gets copied into our treatment models. However, it would be unwise to say that everyone should embrace an arts based/community lens. It might be best to identify the unique cultural contexts and needs of each country and structure programs accordingly. Islamic countries for example, might benefit from integrated Quranic teachings that are helpful. While we go global and learn from each other, the true essence of a de-colonial future is also to embrace the local. 

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