Gabriel Abarca-Brown: Rescuing Transcultural Psychiatry

The intersections of psychotechnologies, global mental health, subjectivity, and everyday life, highlighting historical, cross-cultural, intersectional, and decolonial aspects. This is the line of research of Gabriel Abarca-Brown, who works as a researcher at the University of Copenhagen, in the research project ‘Decolonizing Madness’, where a group of researchers is redefining the relationship between culture, race, and collective and individual psyche after the end of World War II.

“Mental health as a social construct where two societies meet, face each other, alchemize and bifurcate.” This was the subject of doctoral research of Dr. Gabriel Abarca-Brown who currently works as a researcher at the University of Copenhagen in the ERC-project ‘Decolonizing Madness’.

Despite his young age, Abarca-Brown has several years of experience. He has worked as a teacher and researcher in Chile, the United Kingdom and Brazil. He first studied psychology at the Universidad de Santiago de Chile, then did a master’s degree in Clinical Psychology at Universidad de Chile to finally make the transition from psychology to social sciences with the start of his doctorate in anthropology at King’s College London in England.

The seed of his doctoral research was planted in his early days as a psychologist in the Chilean public health system where he treated migrants. This exchange led him to study international evidence that stated that in migrant communities, especially in the second and third generations, the prevalence of mental illness increased compared to first generation migrants. “International research and other studies made in Chile argued that the second-generation of migrant communities had a very similar prevalence of mental disorders compared to the Chilean population. This situation opens a question of a sociological and anthropological nature,” says Abarca-Brown.

In his doctoral research titled ‘Becoming a (neuro)migrant: Culture, race, class and gender in Santiago, Chile’, he asks what it means to be a migrant and challenges the traditional concept. “Not because you get to live in another country, you become a migrant. You become one when the other excludes you, or makes you feel that you are not part of the country or society that receives you. For example: You can have a co-worker who is from abroad and they may state: ‘I am not a migrant because I am not like those people who do not have nothing to eat.’ However, there comes a time when this person understands that they may be a migrant due to a situation of exclusion, racialization or another,” Dr. Gabriel Abarca-Brown explains. “By naming my doctoral research ‘Becoming a (neuro)migrant: Culture, race, class and gender in Santiago, Chile’, I established that there are multiple ways of becoming a migrant and which allow us to understand the trajectories of migrants’ lives.”

To complete his PhD, he researched the relationship between the Chilean public health system and the communities of Haiti and the Dominican Republic. He also studied their respective health systems, such as Haitian-Creole medicine and Voodoo. His question was: What happens when certain technologies from the world of psychiatry, such as psychotherapy and modern pharmaceuticals, meet communities in Haiti or the Dominican Republic? What  happens when the practices of traditional Haitian medicine meet with the practices of the Chilean health system? And how do they meet?

It should be noted that although the culture of Haiti and the Dominican Republic have traditional health systems to treat certain afflictions, in the case of Haiti, there are few professionals available for pharmacological treatment of certain mental illnesses. Likewise, in the Dominican Republic, the first mental health reform was only carried out in 2015. They upgraded the existing mental health hospital and developed mental health services in primary health care. “In Chile, the reality is different. After the end of the dictatorship of Augusto Pinochet in 1990, three mental health plans have been implemented. Currently the Chilean health system has psychologists, psychiatrists, and neurologists at different levels. People have appropriated a psychiatric way to express their affliction ​​and know categories, diagnoses and names of psychotropic drugs. What is the social impact of this way of conceiving your own psyche? How do these technologies shape Chilean citizens and migrants?” He continues: “People started to represent themselves and think about their illness and health in a different way.”

Dr. Gabriel Abarca-Brown conducted a 14-months long ethnographic fieldwork in which he not only visited the very Chilean public health services that several migrant communities from Haiti and the Dominican Republic attend, but also visited traditional cultural spaces where this migrant community goes to heal afflictions, such as evangelical churches. Likewise, he interviewed public policy makers, health professionals, pastors, and voodoo healers.

“My objective was to learn how psychiatric technologies – psychotherapy and psychotropics, among others – and the global mental health agenda impact and shape the subjectivity and daily life of migrant communities. What I concluded is that the majority of migrants reject the efforts of Chilean public health service to treat their mental illness,” he explains.

Abarca-Brown adds: “When a person from the community in Haiti or the Dominican Republic is told that they have to go to a consultation with a psychologist, in their first consultation they tell the intercultural facilitator ‘I don’t know what a psychologist is’, or ‘I don’t know what I’m doing here’. A series of frictions and conflicts are generated in the clinical relationship, because voodoo and Haitian-Creole medicine have different ways of representing the body, health, and mental illness.”

“My research is called ‘Becoming a neuro migrant…’, because it turns out that these patients and their families start to modify the idea and way in which they talk about themselves and how they understand their afflictions as they are more exposed to the ways in which mental health is understood in Chile.”

At the end of his doctoral research, Abarca-Brown was able to identify three groups: The first one is the group of people who do not go or attend mental health sessions at all. The second is the neuro migrant, who effectively gradually modifies the way in which they represent and name their afflictions and their causes. Finally, the third group are the children of migrants who begin to integrate the Chilean mental health interventions in different spaces of their daily lives, for example in schools.

“This third group gets involved with all this psychological infrastructure and technology available in Chile as they begin to live in a social context and to study within Chilean institutions. For example, children and adolescents begin to talk about bullying, suicide, taking care of your brain, and preventing mental illness in schools,” he explains.

He also argues that this is why it is important to have a decolonizing view of mental health. “In this way, we do not neglect the practices and knowledge of different societies; what is more, we value it and question the psychiatric imperative,” Abarca-Brown says.

Chile and a Liberalizing View of Mental Health

Dr. Gabriel Abarca-Brown is currently a postdoctoral researcher at the University of Copenhagen. He joined the projectDecolonizing madnessfinanced by the European Research Council and led by academic Ana Antic. This project addresses the debate on the concept of mental health and illness, offering a transdisciplinary and transcultural psychiatry perspective as well as the concept of ‘the global psyche’ to address research topics.

Specifically, Abarca-Brown is studying the history of cross-cultural psychiatry in Chile, whose first signs date back to the middle of the 20th century. He explains that in Chile, there has been a process of liberalization in the understanding of mental health. “Thirty years ago many people did not know what a psychologist was. But now, we find a world where social life has changed. The problems and afflictions of people begin to be explained psychologically or neurologically. For example, many people come to the clinic saying: ‘I have a panic disorder and I think I need fluoxetine and alprazolam’. Patients come to the consultation with a knowledge and a language that did not exist 30 years ago.”

“When problems are individualized in a neoliberal logic, they tend to be experienced and resolved individually. We no longer solve problems collectively, at the neighborhood council, at the community club, at the bar. People’s problems are now being solved at the psychologist, psychoanalyst, or psychiatrist. There are also people who take on another type of approach to cope with their mental help, and purchase self-help books or self-medicate and buy clonazepam or alprazolam at flea markets.”

It should be noted that various studies confirm that the mental health of the Chilean population is deteriorating. The results of the third version of the Mental Health Thermometer in Chile ACHS-UC establish that during 2021, 46.7% of the people surveyed have some degree of depression, and many people attend psychological and psychiatric consultations.

This reality was very different decades ago. Abarca-Brown is researching the efforts of different people, organizations, institutions, and even social movements for mental health in the 1960s and 1970s. “Most of the time, the history of psychiatry is the history of mental health reforms. The role of multiple local actors, agents, and international institutions such as the WHO, are not considered. I believe that one can write a history of transcultural psychiatry from its limits or points of contact with other actors and knowledge. For example from anthropology, social work, or humanitarian work from different organizations,” he explains.

According to the researcher, there are studies of interculturality in Chilean mental health service founded in the 1940s, 1950s and 1960s. “During that time studies were carried out with the Mapuche and Aymara world and mental health began to be considered together with internal alterity, with those who are different in our country. In this case, not migrants, but with the indigenous world.”

Likewise, according to the researcher, in those years there were several research projects that associated economic inequality and socio-cultural aspects with alcoholism and other mental illnesses. Juan Marconi, a prominent Chilean psychiatrist, was very interested in investigating the psychosocial and cultural factors of alcoholism, for which he developed an intra-community work program in the south of Santiago, Chile’s main city.

“He is one of those who began to think about transcultural psychiatry and who was a pioneer in the world in his epidemiological studies. The first studies with direct methodologies in alcoholism, for example, were made in Chile and were a reference for the world. All this was cut short by the dictatorship. There was little investment in public health, and almost none in mental health, ”he says.

Why is a decolonial perspective important in the study of psychiatry?

“It is important because, with a decolonial perspective, we don’t neglect the practices, the knowledge or the ways of dealing with human afflictions of different societies. In the field of mental health, there are many ways of representing the world and acting to solve problems. In our ‘Decolonizing Madness’ project, we are raising a decolonial perspective while at the same time, we value the beliefs and practices that societies use to face their afflictions and problems. We reflect on these psychiatric, psychological, or psychosocial practices from specific local contexts.”

Chile 2019: There Is No Mental Health Without Social Justice

During the social, economic, and political crisis Chile experienced during October 2019, the streets of the country were filled with slogans and messages that tried to explain the strain that Chileans were experiencing. On a lot of walls you could read: “It was not depression, it was capitalism”, “There is no mental health without social justice”, among other slogans making explicit reference to the mental health crisis that Chileans navigate. Lack of time for leisure and enjoyment, territorial segregation, few spaces to build community, little social mobility, and a false promise of meritocracy are some of the circumstances that Chileans were experiencing that affect their mental health.

“There is a tendency to think that in Chile, the mental health problem of the population can be solved with more and better psychiatrists and psychologists, but this is not the case. The mental health of a country depends on economic policies, participation in society, gender, health, housing, transportation. This is because countries with a higher level of equity and with social security systems have a higher degree of well-being than countries that do not. There is no mental health without social justice. As Chileans, we need a system that is fair on different levels. One of the difficulties that we have had in Chile in the last 50 years is that there is a tendency to think that mental health problems are going to be solved with better psychologists and psychiatrists. We can design a great mental health service, inject the resources and implement it, but these efforts are in vain if we have an unequal country, which does not have gender equality and has very low quality of public transportation. In Denmark, compared to Chile, there is a universal social protection system that is tremendously equitable and transparent, with cities that are friendly in terms of architecture, construction, transportation, and green areas,” states Dr. Gabriel Abarco-Brown.

He is interested in investigating how we conceive of differences as a society. “Chile is a country that is changing fast. Globalization has made us lose our geographically isolated condition. And in addition to that, we have received foreigners mainly from Latin American and Caribbean countries in recent years. How can Chilean or Latin American multiculturalism be built? What does multiculturalism mean for Chileans? These are questions that go to the foundations of our society; that we are asking ourselves and which are worth investigating,” he concludes.

Marta Apablaza Riquelme is a freelance science journalist based in Santiago, Chile

Gabriel Abarca-Brown
Ana Antic
In Chile there are primary care health services where the community is treated and consults with doctors when they do not have urgent pathologies.