ASU Future Security Fellow on the colonial origins of psychiatry

Global health physician Khameer Kidia speaks at Center on the Future of War event

March 17, 2023

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. Portrait of Khameer Kidia. Khameer Kidia. Download Full Image

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.

Grace Peserik

Communications Assistant, School of Politics and Global Studies

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Spring break trip to Alaska provides ASU students with firsthand look at Indigenous law

March 17, 2023

It was not your typical spring break. There were no trips to a beautiful beach or movie-watching marathons.

Instead, a group of 29 Arizona State University law students packed their parkas and took off to Alaska for a course in Indigenous law as part of ASU’s Indian Legal Program.

“The trip proved to be a once-in-a-lifetime experience for some of our students,” said Stacy Leeds, Willard H. Pedrick Dean and Regents Professor of Law at the ASU Sandra Day O’Connor College of Law.

The course, titled Alaska Native Legal Issues and Solutions, was created by Leeds and Alex Cleghorn, senior legal and policy director at the Alaska Native Justice Center. It took place from March 6–10 in Anchorage, Alaska. 

ASU’s Indian Legal Program, one of the most respected in the country, has conducted traveling classrooms since 2010.

Past spring break trips have been to Nebraska and taught by Professor Lance Morgan at HoChunk Inc., the business enterprise of the Winnebago Tribe. This was the first to Alaska. 

According to Leeds, most of the literature in federal Indian law minimizes or entirely fails to address the Alaska Native experience.

The trip offered law students insights into some of the most complex legal and political issues of our time, she said.

Students learned about everything from criminal and civil jurisdiction to the area’s world-class intertribal health system. The class tapped into the expertise of local attorneys, business leaders and government officials.

Cleghorn helped co-teach the course and secured local experts as guest speakers. The Cook Inlet Tribal Council and Southeastern Foundation tribal nonprofits provided classroom space and technical assistance. Cook Inlet Region Inc., an Alaska Native regional corporation, hosted a reception for students to meet attorneys and business leaders. 

“For many, the course was both intellectually and emotionally challenging because it unpacked so many conflicts, injustices and tensions,” Leeds said. “Every single participant grew in their understanding of Indian law and in their exposure to the diverse perspectives and unique lived experiences of Alaska Native communities and individuals.”

Exploring legal land rights

Land is a consistent legal issue for most Native American tribes, and central to the course were discussions about the complex legal issues that flow from Congress’ 1971 Alaska Native Claims Settlement Act, which extinguished Native Alaska land claims and abolished tribes’ legal claims to the land in Alaska, and instead conveyed 45.5 million acres to newly created regional Alaska Native corporations. This differs from land ownership patterns in the lower 48 states under the reservation model and other tribal land tenure systems.

“It was very eye-opening for our students to learn about Alaska’s rich history and see how the Alaska Native Claims Settlement Act changed the landscape for tribes in Alaska,” said Kathlene Rosier, assistant dean for community engagement and executive director of ASU Law’s Indian Legal Program, who took part in the trip. “The students were able to compare the differences between tribal structures and land claims in the lower 48 states.” 

Second-year law student Clayton Kinsey said he appreciates the opportunity to go on ASU Law trips. 

“This was basically a semester's worth of Alaska Native issues and solutions packed into one week,” said Kinsey, who plans to get an Indian Law Certificate at ASU along with a law degree. 

Kinsey was surprised to learn that for the 229 federally recognized tribes in Alaska, there are limited rights to hunt and fish. 

“Many of these people survived on hunting caribou, whaling and fishing for salmon, trout and other fish,” Kinsey said. “So, in a way, there was no established right for many of these people to continue their way of life.”

Ravynn Nothstine, a third-year student who grew up in Alaska, was able to stay with family and participate in traditional Alaska Native dancing while she was there. She knew about the settlement act most of her life but the trip, combined with her studies at ASU Law, gave her a new perspective. 

“My understanding was deepened,” Nothstine said. “I learned a lot more about the nuances of the law. And since I am a bit more legally trained, I now have a better understanding of how it works.” 

Maryam Salazar, a second-year law student, described the trip as amazing.

“What mostly resonated with me was applying a forward-looking approach to changing legislation instead of relying on legislative history to advocate for Native peoples,” Salazar said. 

“We were exposed to many different perspectives on the Alaska Native Claims Settlement Act that allowed me to see the creativity of self-determination and how tribes and the corporations can use different approaches to reach their needs.

“I don't think there is a perfect way to go about things, but I've been digesting these new approaches and thinking about possibilities for Indian policy.”

Leeds said that without the support of the local community, her students wouldn’t have had this rare opportunity.

“We are so grateful for the extended legal and business community in Alaska — especially for Alex Cleghorn, who leads the Alaska Native Justice Center, and Gloria O’Neill, CEO of Cook Inlet Tribal Council Inc. — who came to together to make this possible,” she said.

Photos courtesy Ravynn Nothstine, Maryam Salazar and Clayton Kinsey

Dolores Tropiano

Reporter , ASU News