Psychiatry and Mental Health Care in Africa

Summary In African contexts, medical pluralism has significantly shaped approaches to mental health care historically. Indigenous healing systems serve as the historical baseline for understanding mental health care on the continent. Western psychiatry was introduced alongside the establishment of European colonial rule in the late 19th century ce. Colonial psychiatry did little to move the needle on epistemologies of care in Africa, with the medical and institutional footprint being relatively localized around colonial urban centers and severely underresourced even in those spaces. Perhaps more significant was the knowledge–power nexus of European colonialism, whereby Europeans created highly racialized knowledge about the nature of African psyches that reinforced colonial narratives of African inferiority and the necessity of European stewardship. Both institutional underdevelopment and colonial knowledge bias were challenged significantly in the context of decolonization, when colonial subjects began to infiltrate the ranks of Western psychiatric personnel and argue for more egalitarian, universalistic, anti-racist, and anti-colonial approaches to psychiatric care. Underdevelopment of psychiatric infrastructure continues to be the norm in most places, and the medically plural marketplace rooted in Indigenous therapeutics continues to adapt to the needs of ever-changing societies throughout the African continent. This pluralistic narrative has become mainstream over time, but in ways that probably still overemphasize the relative role of Western psychiatric interventions within the larger health-seeking landscape. Sources, methods, and theoretical approaches shape the field, imposing limitations on what and how historians have been able to engage with Africa’s psychological past, although innovations and creative approaches continue to move the field in new and exciting directions.