24

Dwornik

Critical Social Work

School of Social Work
University of Windsor
167 Ferry Street
Windsor, Ontario N9A 0C5
Email: cswedit@uwindsor.ca

Publication details, including instructions for authors and subscription information can be found
at: https://ojs.scholarsportal.info/windsor/index.php/csw

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The Interface of Mad Studies and

Indigenous Ways of Knowing:
Innovation, Co-Creation, and
Decolonization
Critical Social Work 22(2)
Ania Dwornik
Social Dimensions of Health Program, University of Victoria, British Columbia, Canada

Correspondence concerning this article should be addressed to Ania Dwornik, e-mail:

a.m.dwornik@gmail.com

Abstract
This paper explores the interface between Mad Studies and Indigenous ways of knowing, and
argues that the dialogical expanse that exists between these two fields could be a site for
innovation, co-creation, and decolonization. Mad Studies is a radical approach to studying the
ways we organize and respond to mental health experiences. The field questions and unsettles
biomedical understandings of mental illness, and frames psychiatric experiences as diverse forms
of human emotional or spiritual expression. Indigenous perspectives on disability describe
mental health using a holistic, wellness-based lens, with many scholars highlighting the link to
colonial violence and oppression. The interface of Mad Studies and Indigenous ways of knowing
could provide a unique platform for gaining a broader understanding of Indigenous mental health
while resisting Western, psy explanations of emotional distress. Different interpretations and
understandings can be discussed and debated, and through ethical spaces (Ermine, 2007) new
understandings or ideas may emerge. These, in turn, may help decolonize some of the dominant
biomedical biases that underpin many contemporary psychiatric treatment approaches.

Social workers have a particularly important role to play in these conversations. Our professional
commitment to anti-oppression and social justice implores us to take an active role in these
debates. Through our workplaces we can problematize dominant discourses from within
dominant systems, and make our contribution to decolonization.

Keywords: Mad Studies, decolonization, survivor research, Indigenous health

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This paper begins with the premise that the dominant Canadian approach to psychiatry has biases
and ideological underpinnings that prevent the adequate addressing of issues related to
Indigenous mental health. This is due to deeply rooted Western, biomedical and Eurocentric
understandings of mental illness, which hinder the authentication of any alternative approaches
to mental health. The term “Western” is used to acknowledge the European origins of modern
psychiatry, which have infiltrated and influenced the development of psychiatric ideas and
practices on a global scale (Ingleby, 2014; Nelson, 2013). These ideas and practices in turn have
upheld a positivist way of thinking, which aims to standardize and universalise psychiatric
conditions across cultures. Several scholars, including Joseph (2015) and Mills and Fernando
(2014), argue that this reductionist approach is closely aligned with European Enlightenment-era
thinking, and the pursuit of a single, observable, universal truth. Joseph (2015) explains “any
pre-capitalist, pre-modern, pre-enlightenment … ideas … are seen as naïve or archaic. Within the
Eurocentric view, the ‘maturity’ to use reason represents a type of evolution of society” (p.
1026). Mills and Fernando (2014) write “there is widespread critique that psychiatry, and the
psy-disciplines in general, construct distress as symptomatic of ‘neuropsychiatric disorders’
rather than as responses to socio-political-economic conditions of conflict, entrenched social
inequality, and chronic poverty” (p. 189). These neuropsychiatric disorders, Ingleby (2014)
argues, are closely linked to pharmacological treatment, and a biomedical assumption that
psychiatric symptoms are most effectively treated through the use of pharmaceuticals.

The implications of these claims for Indigenous resurgence and decolonisation of mental
health treatment services in Canada are, I believe, apparent. At a minimum, traditional healing
methods may be thwarted in favour of biomedical approaches that have little in common with
traditional healing practises, while treatment strategies may fail to acknowledge the impact of
colonization or the current socio-political realities that shape the lives of many Indigenous
peoples in Canada. These include homelessness, criminal justice involvement, involvement with
the child welfare system as well as high rates of suicide, addiction and poverty (Linklater, 2014,
p. 20). As social workers committed to the pursuit of social justice and anti-oppressive practice,
it behooves us to engage actively in decolonization and resist remaining passively committed to
the status quo. I work clinically in this field and can attest to seeing Indigenous clients treated
using assessments designed by Western practitioners with Euro-Canadian patients in mind; a
one-size-fits-all approach. Such an approach not only hinders Indigenous resurgence and
decolonization, but challenges our professional commitments.

I approach this topic as a White Settler and raise these issues with an interest in learning
and becoming an ally. I also feel that the term “decolonization” itself warrants examination here.
Tuck and Yang (2012) encourage Indigenous and Settler scholars to really consider the meaning
of the word and resist using it as a metaphor for other forms of oppression. To decolonize, they
clarify, means to repatriate Indigenous land and rights. It means to reject state authority and
governance over Indigenous peoples, and demand Indigenous self-governance. To decolonize
means to recognize Indigenous nations as autonomous in their own right and Indigenous
knowledges as legitimate and valid. Decolonization goes beyond social justice. Tuck and Yang
(2012) argue that to include it among other forms of oppression is to diminish its purpose and
perpetuate the appropriation of Indigenous acts of resistance by Western colonial powers. In the
context of mental health treatment, decolonization would almost certainly mean rejecting
Western understandings of mental health, wellness, and identity, and replacing them with an
entirely different lens.

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Current Approaches and Differing Perspectives

Despite recent efforts to enhance cross-cultural practice within psychiatry through therapeutic
frameworks such as cultural competence, cultural humility and trauma-informed care, these
efforts continue to frame mental health as an individual problem rather than a collective or
societal one. Cultural competence, for example, has been particularly critiqued as a Eurocentric
approach that normalizes Whiteness and perpetuates “othering” of those from non-White cultural
backgrounds (Yeager & Bauer-Wu, 2013). Betancourt et al. (2005) define the term cultural
competence as a “strategy to improve quality and eliminate racial/ethnic disparities in health
care” (p. 499), with a goal of “creating a health care system and workforce that are capable of
delivering the highest quality care to every patient regardless of race, ethnicity, culture, or
language proficiency” (p. 499). Such an approach implies that health care should be colour-blind
and upholds the pursuit of the one-size-fits all approach.

Trauma-informed care is a principle-driven technique for working with clients who have
a history of trauma (Mihelicova et al., 2018). The goal is to significantly mitigate any risk of re-
traumatization by identifying triggers and maintaining awareness of how certain actions may
have traumatizing implications. Trauma-informed care pushes clinicians to explore an
individual’s situation holistically, thereby paying greater attention to factors such as
demographics, cultural background, personal history, and family situation, as well as socio-
political factors. It is believed that having this information provides a better understanding of a
client’s “ability to cope with trauma” (Mihelicova et al., 2018, p. 142) and allows clinicians to
choose a more suitable and tailored treatment program. However, while cognizant of
psychosocial factors, such analysis continues to place the locus of the illness and treatment
within the individual.

In studying Indigenous suicide, Chrisjohn et al. (2017) found that such individualization
is consistent with most contemporary, Western understandings of emotional distress. They note
that suicidologists ultimately attribute the act of suicide to individual factors such as feelings of
hopelessness, helplessness, negative view of self or the future. The authors argue that such
reasoning is akin to victim blaming, as the analysis fails to recognize the impact of living within
a deeply oppressive, colonial state. This state has systematically tried to eradicate Indigenous
ways of being and is ultimately responsible for the high rates of Indigenous suicide within
colonized territories. Such a perspective, they argue, is entirely supressed within contemporary
mental health discourses.

It can also be argued that with the emphasis on individual pathology, practices including
cultural competence and trauma-informed care are ideologically at odds with the relational
ontology that often underpins Indigenous understandings of health and healing. This perspective
is shared by Nelson (2013), who explains that mental health services “are based in colonial ideas
and therefore may not adequately address mental health problems for Aboriginal peoples” (p.
12). She argues that for Indigenous peoples, healing must occur at the community level, and that
individualized, biomedical treatment approaches may not be appropriate. Decolonization, the
process of rejecting Western state authority over Indigenous peoples and reclaiming the
legitimacy of Indigenous knowledges (Tuck & Yang, 2012), may be severely restricted as
Indigenous peoples continue to be treated within a Eurocentric paradigm. Nelson (2013)
recommends stepping outside of the Western, psychiatric paradigm and allowing Indigenous

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peoples to access treatment services that are more closely aligned with Indigenous ways of
being, rather than those rooted in Western ideology. Examples include having traditional healers
available at mental health treatment centres, or providing services using Indigenous languages
and concepts.

An important consideration when applying treatment services based on Indigenous

knowledges is mitigating risk of appropriation. There is evidence to suggest that recently, in the
era of self-proclaimed reconciliation between the Canadian government and Indigenous nations,
new initiatives to make mental health treatment services more culturally appropriate have often
only served to perpetuate colonial dominance, as Indigenous healing traditions have been
extracted and appropriated by Western institutions (Corntassel & Gaudry, 2014; Geniusz, 2009;
Smith, 2012). Examples include Western-based restorative justice healing circles, group
conferencing initiatives, the use of Indigenous plant-based medicines by Western pharmaceutical
companies, and the almost mandatory inclusion of Indigenous healers in prisons and hospitals.
While seemingly well-intended, many feel these initiatives have done little to support Indigenous
self-governance and in fact have robbed Indigenous peoples of their intellectual property, forcing
them to continue seeking treatment through Western institutions rather than relying on their own
knowledges (Corntassel & Gaudry, 2014; Smith, 2012). This is especially true in the context of
mental health, as many Indigenous behaviours and experiences are routinely pathologized and
treated, often ineffectively, within a Western, psychiatric mental health treatment system (Mehl-
Madrona, 2007; Nelson, 2013).

Scholars Leanne Simpson (2008, 2011), Glen Coulthard (2014), and Taiaike Alfred
(2009) describe Indigenous resurgence as a reclaiming of Indigenous knowledges, laws,
traditions, values, ethics, and processes from colonial control and dominance. It is a way of re-
storying history (Cortassel, 2009), rejecting Euro-Western knowledge systems, and transforming
a “colonial outside into a flourishment of the Indigenous inside” (p. 17). It is a turn away from
the state, rejecting assimilation attempts, and drawing on Indigenous philosophies to direct
governance, education, health care, and economy, and to ensure the methods are immersed in
Indigenous ways of being, knowing, and doing. Simpson (2011) explains that “we need to not
just figure out who we are; we need to re-establish the process by which we live who we are
within the current context we find ourselves” (p. 17). Through resurgence, Simpson (2008, 2011)
argues, Indigenous nations can alter their relationship with the colonial state; reclaim their
authority, their health, and their governance; and move toward mino bimaadiziwin, living the
good life. Resurgence also highlights and validates diversity between nations. There is no such
thing as an “Indigenous culture,” but rather there are many Indigenous cultures. Furthermore,
Wilson (2009) writes that relationality provides the foundation for Indigenous ontology and
epistemology, while Indigenous axiology and methodology are governed through accountability
to relationships. A relational ontology, by its very definition, maintains that the relationships
between entities (people, plants, land, spirit) are fundamentally more important than the
individual entities themselves. This doesn’t mean individuality is unimportant, but that agency is
always understood in relation to others. Conducive to these discussions is the Indigenous framing
of reality as dependent on “… the relationship one has with the truth” (Wilson, 2009, p. 73). As
such, knowledge is experiential. Meyer (2008) explains, “How I experience the world is different
from how you experience the world, and both our interpretations matter” (p. 2).

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The Trouble with Trauma

Linklater (2014) and Million (2014) have established that Indigenous peoples have been
particularly impacted by the oppressive, authoritarian nature of the psychiatric treatment system,
which often pathologizes experiences of emotional pain experienced at the hands of colonizers.
Diagnostic labels such as post-traumatic stress disorder are commonly used to reduce, perhaps
even normalize, the harm suffered as a result of colonialism and assimilation policies, and many
culturally appropriate behaviours are often conceptualized as psychopathological (Linklater,
2014). In Therapeutic Nations, Million (2014) points to the authority of the Indian Act and
neoliberal practices, which she argues shape and influence the way expressions of emotional
distress are conceptualized, individualized, and understood by contemporary society. Poverty,
drug addiction, alcoholism, and social dissolution have become “medicalized and portrayed as
colonial trauma” (p. 19), and any financial support given to treating Indigenous peoples closely
tied to very particular and prescriptive treatment methods.

Western notions of health and illness have been forced, often in contradiction to
Indigenous traditions and understandings, and the Western concept of trauma frequently used
with little regard for the socio-structural forces that contributed to its creation (Linklater, 2014, p.
22). Linklater (2014) notes that dominant discursive practices regarding trauma serve to alleviate
responsibility and blame on the part of the Canadian government and society, and instead assign
individual responsibility for the recovery from this pain. Meanwhile, Indigenous understandings
of trauma reject the diagnostic label and define trauma as “a person’s reaction or response to an
injury” (Linkater, 2014, p. 22). They also draw connection to intergenerational and
multigenerational experiences of trauma, using language such as “blood memory” to describe the
process by which emotional injury can be passed down through generations (Younging, 2009, p.
327).

Chrisjohn and Young (2016) and Chrisjohn et al. (2017) argue that contemporary,
Canadian mental health treatment practices only serve to perpetuate assimilation policies and
eradicate Indigenous ways of being. Labels such as residential school syndrome assign blame for
emotional distress onto Indigenous peoples themselves, promoting the narrative of the “Broken
Indian” who is lost, helpless and disconnected (Chrisjohn et al., 2017). Psy explanations and
treatment practices are presented as the only solution, treating Indigenous peoples within
Western, Eurocentric conceptualizations of normalcy. Locating this discussion within a broader
critique of capitalism in North America, Chrisjohn et al. (2017) argue that contemporary mental
health practices purposely force Indigenous peoples into surrendering their own identities and
assimilating into a Western way of life. They claim that “defining the issue of Indigenous suicide
as a personal problem immediately depoliticise and decontextualizes it” (p. 119), which is
convenient for the Canadian government.

The notion that diagnostic labels and treatment practices can be used as a form of social
control have been established elsewhere. Past examples include homophobia, drapetomania and
hysteria, all of which served to oppress and control individuals whose behaviour did not fit with
contemporary conceptions of normalcy (Joseph, 2013). The feminist critique of Borderline
Personality Disorder (BPD) has also been well documented and claims that the contemporary
diagnosis of BPD only serves to pathologize women’s emotional responses to abuse while failing
to address structural systems of gender-based violence (Shaw & Proctor, 2005).

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Western psychiatry separates the mind and the body and upholds a biomedical model
based on illness rather than wellness, while an Indigenous worldview takes a holistic approach
which considers spiritual, emotional, mental, and physical aspects of a person (Linklater, 2014,
p. 21). Linklater (2014) writes “we must maintain relations with our land, language, people,
ancestors, animals, stories, knowledge, medicine, culture and spiritual environment” (p. 27).
Many scholars also note that Western approaches routinely neglect the impact of
intergenerational or multigenerational trauma: trauma that is based on current, ancestral,
historical, individual, and collective experiences within Indigenous communities (Linklater,
2014, p. 23). In so doing, they further individualize experiences of emotional distress and limit
acknowledgment of the collective harm experienced as a result of residential schools, forced
relocation from land and communities, and violent dispossession of land, language, and culture.

Analysing this situation using a critical lens, one can hardly accept that these practices
developed in isolation of the broader colonial agenda. Nelson (2013) and Joseph (2019) align
with Chrisjohn and Young (2016) and Chrisjohn et al. (2017) in highlighting the linkage between
Western understandings of mental illness and imperial or colonial ways of thinking. Joseph
(2019) writes “colonial conceptions of mental illness have always been closely interrelated with
the goals of colonialism itself.” (p. 4) and that “psy knowledge, expertise, and its positioning as
superior is imbricated with historical colonial projects of white supremacy and has become an
overwhelming mode of domination” (p. 15). Evidence of such domination can be seen in the way
that Indigenous health service providers, such as the First Nations Health Authority (FNHA),
continue to be dependent on State oversight rather than maintain autonomy in their own right.
Despite its best efforts to regain authority over the health of Indigenous peoples in British
Columbia (BC) and to offer holistic services that are rooted in Indigenous ways of knowing and
being, the FNHA continues to exist as a branch of the broader Canadian health care system. It
does not “replace the role or services of the Ministry of Health and National Health Authorities”
(FNHA, 2020), and subsequently, is dependent on the state’s definitions of what constitutes
wellness, health, and treatment.

The Promise of Mad Studies

The growing field of Mad Studies may present a unique platform for Indigenous resurgence,
allowing Indigenous and Mad advocates to unite in their resistance against Western, psy
explanations of emotional distress. Rooted in the social model of disability, Mad Studies is a
radical movement within the mental health community that rejects biomedical understandings of
mental illness and instead “demand[s] … an end to the way of thinking which calls our anger
‘psychosis,’ our joy ‘mania,’ our fear ‘paranoia’ and our grief ‘depression’” (Annual
International Conference on Human Rights and Psychiatric Oppression, 1981, p. 3A, as cited by
Starkman, 2013, para. 9). Instead, Mad scholars conceptualize madness as an expression of
“emotional, spiritual, and neuro-diversity” (Menzies et al., 2013, “For Mad Studies” section,
para. 1), which validates the spectrum of human emotional and spiritual experience. Mad Studies
is interested in highlighting the positive aspects of a “mad identity,” and celebrating diversity of
experience (Diamond, 2013).

Mad Studies materialized as a form of resistance against what was seen as an oppressive
mental health system, calling on those living with mental health conditions, known as survivors,
to critically challenge the authority of the biomedical model rather than perpetuate and support it.

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Mad advocates feel that conventional, biomedical studies uphold a blind “centrality of
biomedical psychiatry” (Faulkner, 2017, p. 514), and fail to deliver a comprehensive
understanding of mental health. Advocates consequently support the growth of survivor research
across a multitude of disciplines including but not limited to cultural studies, history, sociology,
gender studies, and philosophy. In this way, psychiatric survivor-led research can “strengthen the
ideas and thinking emerging from other routes and roots” (Faulkner, 2017, p. 514), and as with
disability studies, foster further development of a social model of madness and distress
(Beresford, 2009). Mad researchers and advocates are committed to reclaiming language
previously used to oppress them, such as the words “mad” and “lunatic,” and try to remain
connected with the mental health community at-large. This ensures that studies stay grounded in
real-world experiences and needs rather than academic or clinical agendas (Faulkner, 2017;
Sweeney, 2016). Mad people enter academic circles, either as graduate students, teachers,
professors, participants, or collaborators, in order to grow a Mad presence and empower those
with psychiatric conditions to conduct research within a variety of settings and fields.

One such example can be found in Poole et al. (2012), who used community-based
research to engage a group of social work students with lived experience of madness in analysing
systemic and structural barriers to their education. The study identified several areas of
discrimination at the hands of social work educators, including resistance by faculty to allow for
assignment extensions, the frequent usage of offensive language such as “crazy” within
classroom settings, and the normalization of beliefs that students with mental health conditions
could be deemed dangerous to the school or their peers. Mad scholars are also committed to
unsettling and deconstructing notions of normalcy. In a study by Liegghio (2016), a photo voice
activity was conducted with youth aged 14–17 that challenged conventional attitudes about
normalcy, which the youth felt often pathologized their emotional expressions of distress. The
youth felt diagnostic labels such as “schizophrenia,” “autism,” and “anxiety” contributed to “the
unmaking of a person, and the making of a disorder” (Liegghio, 2016, p. 111). The study aspired
to answer the question of “What is normal mental health for children and youth,” and questioned
diagnostic labels as defined by categorization systems.

Poole et al. (2012) suggest using intersectionality and anti-oppressive practice (AOP) to
understand Mad Studies, and support efforts to reframe madness through a social rather than a
medical lens. AOP is a person-centered approach that frames oppression as a product of multiple
sources of power imbalance (Poole et al., 2012). An individual can be simultaneously subject to
several forms of oppression, such as sexism, racism, and ageism, and together these impact the
individual’s experience and sense of identity. In the context of Mad Studies, the term sanism is
frequently used to describe “the systematic subjugation of people who have received mental
health diagnosis or treatment” (Poole et al., 2012, p. 20). AOP interventions focus on
empowering individual voice and promoting individual strategies of combatting personal
oppression. Viewing Mad Studies through the lens of intersectionality deepens the analysis
further and facilitates a broader discourse on how individual and structural experiences are
interconnected. Intersectionality studies “how aspects of social identity intersect with
oppressions … to produce and exacerbate suffering” (Poole et al., 2012, p. 23). It therefore
studies the ways in which individual identity is impacted by institutional and structural forms of
oppression (racism, ableism, homophobia, sexism, etc.), and how these are in turn reproduced or
resisted depending on that experience.

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The Interface of Mad Studies and Indigenous Ways of Knowing

There is significant value in placing Mad Studies and Indigenous knowledges in conversation
with one another. Despite their distinct ontologies, these traditions share much common ground.
Through partnership and collaboration, they can strengthen the resistance against psy
explanations of emotional distress and widen the discourse on Indigenous mental health. Both
widely reject a biomedical, illness-based approach in favour of a wellness-based model. Both are
committed to combating structural and institutional systems of oppression. Like Mad Studies,
many Indigenous perspectives on disability take a holistic lens, acknowledging the impact of a
wide range of factors such as colonialism, poverty, and lack of community resources (British
Columbia Aboriginal Network on Disability Society, 2019–2020; Nelson, 2013). Through
Indigenous epistemologies, there is a belief in healing the whole person rather than eradicating
an illness within them, and trying to understanding the root cause of a person’s experience rather
than simply reacting to it. Discourse regarding social determinants of health is increasingly seen
in Indigenous scholarship (McGibbon, 2018; Nelson, 2013), and mental health experiences are
framed by both traditions as expressions of the range of human emotion, rather than a
pathological condition requiring treatment. These expressions are closely linked to a person’s
overall sense of health and wellness, which is understood as complex and interlaced with the
individual’s personal and intergenerational history.

These commonalities create space for exploring different perspectives on mental health,
including those related to spirituality. For example, Mad Studies would likely welcome debate
regarding the root cause of “psychosis” as discussed in Linklater (2014). Linklater suggests that
clinicians can search for meaning and value in people’s experiences of psychosis rather than
dismiss them as simply pathological. She (2014) claims that the terms “parallel realities” and
“multiple realities” could be used instead of “psychosis” and “psychotic episode” in order to
“recognize the value and legitimacy of these experiences” (p. 24). Different explanations for
these experiences ought to be considered, including the possibility that they are indicative of
connection to a past life or spirit, a conduit for intergenerational communication. One could
argue that a Western, biomedical paradigm is ontologically at odds with such explanations, while
the field of Mad Studies presents an important opportunity. Both Mad and Indigenous traditions
stress the need for a broader and more complex understanding of what mental health experiences
are, and viewing them within the wider context of institutional and structural system of
oppression. This requires a shift away from individualized labelling and treatment systems in
favour of a more nuanced and comprehensive approach.

As a cross-disciplinary field, Mad Studies is well positioned to amplify Indigenous

perspectives and pursue the decolonization of psychiatry. Though often identified as a radical
form of scholarship, it is also a growing field that is still establishing itself. As Faulkner (2017)
writes, “The lunatics are gradually infiltrating, if not taking over, the academy” (p. 515). She
refers to a growing number of researchers with lived experience of madness who are engaging in
mental health research.

According to Faulkner (2017), Mad Studies and survivor research have generated a
growing confidence among individuals with lived experience of madness to participate in, if not
lead, research projects into their own psychiatric and social conditions. The inclusion of
Indigenous voices and a decolonizing praxis seems a natural and appropriate fit. Residential

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school, child welfare or criminal justice survivors could lead projects into their own experiences,
thus retaining ownership over their own stories while providing a unique and invaluable
perspective on Indigenous health and wellness. The platform of Mad Studies could be used by
Indigenous communities to challenge or deconstruct Eurocentric definitions of mental health and
wellness while formally incorporating their own traditions and healing methods. The voices of
Elders, healers and knowledge keepers could be further integrated into the mental health
discourse and through research, inform policy and practice. Importantly, Indigenous
communities must retain the authority to decide which knowledges they wish to share or keep
private, recognizing that not all knowledges are for public distribution. These studies should
therefore remain collaborative and survivor-led, which aligns with Indigenous research
methodologies. Such studies could then enhance our understanding of what it means to be mad
an Indigenous in Canada, and help resist the constraints of psy definitions.

By aligning these conversations with Mad Studies, Indigenous scholarship can use the
framework of intersectionality to further develop the kind of thinking seen in Linklater (2014),
Million (2013), Chrisjohn et al., (2017) and continue exploring the interplay between Indigenous
mental health, Indigenous ways of knowing and structural systems of oppression. This is not to
say that such levels of analysis do not already exist. We have seen that they do. However, the
interface of Mad Studies and Indigenous ways of knowing may provide an opportunity to enrich
these conversations, to enrich our understanding of Indigenous mental health, to unite in
combating sanist practices and to enhance our understanding of how colonialism continues to
impact Indigenous peoples on an emotional level. Simply put, it places sanism and colonialism in
conversation. These conversations can in turn inform how mental health support should be
delivered to Indigenous peoples, and pave the way for a more anti-colonial approach.

Ermine’s concept of ethical spaces may provide a useful platform for understanding this
dialogical relationship. Ermine (2007) uses the language of “ethical space” to pinpoint the
theoretical expanse that exists between two people, from two different societies and worldviews,
who engage in conversation. While their conversation may be rooted in a distinct topic or
subject, Ermine (2007) argues that the unspoken, theoretical space that exists between them is
governed by a unique set of assumptions and beliefs that each person has about the world. These
are constructed by the person’s history, knowledge tradition, philosophy, and social and political
reality, and covertly influence the flow of conversation as well as mutual constructions of self
and other (p. 194). These assumptions and beliefs impact the type of relationship the two people
can have. For Ermine (2007), when Western and Indigenous worldviews collide, as in the case of
Indigenous ways of knowing and Mad Studies, an ethical space is created. This presents an
opportunity for development and growth. It is within this ethical space that ontologies,
epistemologies, values, and ethics can be discussed and debated, and new ideas can emerge. It is
the tensions that create opportunity for meaningful dialogue and learning.

In using the framework of ethical spaces, it is important to consider how decolonization

can be upheld since the process involves collaboration between Western and Indigenous peoples.
Maintaining commitment to anti-oppressive practice can be one way of doing so. Anti-
oppressive practice acknowledges power dynamics and attends to the ways systems of
oppression impact the relationship. This level of reflexivity is important for mitigating risk of
appropriation and resisting systems of extraction and domination. One must accept that risk of
appropriation can remain despite the best of intentions, particularly within the context of a

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powerful, dominant, Western mental health system. Respecting Indigenous authority over
research projects and knowledge dissemination is one way of combating such extractive research
practices.

Implications for Practice

Social workers have an important role to play in decolonization and anti-sanism. More often than
not we are employed by the very social structures and systems that perpetuate oppressive and
colonial practices. Mental health is no exception. We are routinely asked by our superiors to
conduct standardized mental health assessments and use illness-based terminology. In British
Columbia, the British Columbia College of Social Workers (BCCSW) offers a clinical social
worker designation, which among other things, allows one to diagnose mental illness in
accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 (BCCSW,
2021). Yet as Joseph (2013) writes, “the professed values of the social work profession are
actually more compatible with the psychiatric-survivor movements than with allegiances to the
biomedical model of psychiatry” (p. 267). Many of us work in psychiatric hospitals, child
protection agencies, emergency departments or community mental health programs. Despite
inherent tensions, it also places us in an ideal position to problematize dominant discourses from
within dominant systems. Remaining actively engaged in a process of decolonization and anti-
sanism is one important way we can make our contribution.

Numerous scholars including Corntassel and Gaundry (2014) have cautioned Settlers
against taking a leading role in decolonization, stating that only Indigenous peoples can know
how to best pursue their own decolonization. Instead, they encourage Settler allies to challenge
dominant discourses, undermine colonial practices and de-privilege colonial institutions. This is
precisely where our professional role and potential lies. While I do not know what a decolonized
mental health system looks like, I accept that working unquestionably within the status quo does
little to promote it. Practical ways of maintaining an anti-colonial and anti-sanist praxis may
include 1) rejecting the usage of standardized mental health assessments; 2) promoting the
inclusion of Elders on healthcare teams; 3) facilitating the usage of Indigenous healing practices
and medicines; 4) offering services using Indigenous languages; 5) challenging the usage of
oppressive language, such as “crazy,” within our workplaces; 6) encouraging clients,
communities and families to share their own belief systems regarding their mental health
experiences; 7) openly discussing colonial violence and challenging colonial practices within our
workplaces; and 8) resisting participation in an illness-based discourse while highlighting links
to colonialism and social determinants of health. As a social worker engaged in clinical practice,
I am aware of the practical difficulties these suggestions present. Diagnostic labels, for example,
create opportunities for accessing services and funding. Confidentiality policies pose barriers to
incorporating Elders or community leaders into healthcare teams. None-the-less, it is our
professional responsibility to ask difficult questions, to make suggestions, to challenge dominant
discourses and to remain active in promoting decolonization and social justice.

Conclusion

Contemporary psychiatric practices are deeply embedded within a Western, biomedical

paradigm that individualizes emotional distress and fails to recognize structural and institutional
systems of oppression. The solution is often framed as psycho-pharmacological, with little

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attention given to the ways in which power dynamics and systems of oppression contribute to
these experiences. Many have argued that a Western, biomedical approach is ontologically at
odds with Indigenous ways of being and knowing, and subsequently, ill-equipped to serve
Indigenous peoples. Scholars including Million (2013) and Linklater (2014) point to the ways in
which Western, psy explanations of emotional distress engage in victim blaming, promoting the
narrative of the “Broken Indian” (Chrisjohn et al. 2017) who is dependent on Western, treatment
practices. This narrative frames counselling and self-help treatment programs as the primary
solution, while broader discussions regarding oppression and colonial violence take a backseat
role. While seemingly helpful on an individual level, such an approach offers little in terms of
systemic and structural change.

It has been suggested here that engaging Indigenous ways of knowing in conversation
with Mad Studies may provide a unique opportunity for deepening the discourse on Indigenous
mental health. Such collaboration could strengthen the resistance against psy explanations of
emotional distress, and ultimately, support the decolonization of psychiatry. Through its rejection
of biomedical understandings of mental illness and its celebration of personal experience, Mad
Studies creates a platform for deconstructing and decolonizing contemporary psychiatric
practices. Rooted in anti-sanist advocacy and a social rather than biomedical model of disability,
Mad Studies celebrates madness as an expression of human emotional experience, and calls for
the recognition of a mad identity that is free of discrimination and definition. Mad scholars and
advocates deconstruct biomedical understandings of mental illness and challenge dominant
discourses that categorize, generalize, and pathologize those with psychiatric symptoms.
Through the lens of intersectionality, Mad Studies critically examines the ways in which mental
health experiences are connected to a person’s relationship with systemic violence and
oppression. A decolonizing praxis seems a natural fit for these conversations.

Social works have an especially important role to play in these conversations. The nature
of our work often locates us within the very institutions and systems that perpetuate colonial
aggression and authority, including psychiatry. This provides us with a unique opportunity to
deconstruct dominant discourses from within dominant systems. Our professional identity and
commitments implore us to ask difficult questions and challenge oppressive treatment practices
within our daily work. Corntassel and Gaudry (2014) caution Settler advocates and scholars
against taking a leading role in decolonization, noting that only Indigenous nations can be
responsible for their own decolonization. However, allies, they say, can show their support by
challenging dominant discourses, undermining colonial practices and de-privileging colonial
institutions. As social workers, we are perfectly positioned to contribute in this way.

Indigenous mental health is a complex subject that must be viewed within the broader
context of colonialism and structural oppression. The dominant, biomedical approach is
epistemologically at odds with such a level of analysis, and subsequently, severely restricted in
its ability to pursue its own decolonization. After all, how can one decolonize one’s own actions,
when one fails to acknowledge the ways in which these actions are in fact, colonial. Mad Studies
may present a platform in which power dynamics are acknowledged and dominant assumptions
about normalcy challenged. Indigenous knowledges regarding mental health and wellness would
contribute greatly to these discussions, and further inform our understanding of the human
emotional experience. Through collaboration, the two traditions can unite in their resistance

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against Western, psy explanations of emotional distress, and in-so-doing, contribute greatly to
the complex yet essential process of decolonizing psychiatry in Canada.

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