Navigating Whiteness: Decolonizing Finnish Ethnopsychiatry Mental Health Caring Services

She opened the door to her apartment after two to three persistent knocks. As we entered, we were welcomed by the tantalizing aroma of food. In her tentative English, she apologized for the small apartment that she was in and asked us to sit down. My colleague and I, from an ethnopsychiatric outpatient clinic, were paying her a home visit. the colleague, a white Finnish woman, started speaking to her in English. She had bought an assortment of fruits which she put on the kitchen counter and asked the racialized client to prepare a fruit salad. She rapidly fired instructions on what fruits to start with. All this while, there was no interpreter who would have translated these instructions for the racialized patient. But most importantly, who would have told her that my colleague was about to make a report that could significantly change the course of her life in Finland. The patient did not have utensils for preparing a fruit salad. Moreover, she’d come from a culture where fruit salads were not the norm. However, she tentatively started by cutting a fruit but would stop midway to narrate her personal problems and fears. The patient was clearly distressed and not in the right frame of mind to do anything else other than to talk about her suffering. Suffice to say, after an hour, the racialized patient had only managed to partially cut two fruits. The colleague would go back and report that the racialized client was unable to follow instructions and prepare a fruit salad. As such, the natural progression would be that the Finnish doctor would then make a diagnosis that the racialized patient was “developmentally challenged”. 

I watched this discourse where power dynamics were in display between the dominant culture and the dominated culture. This would become one of the many similar discourses between racialized patients navigating whiteness in Finnish mental health services and white Finnish service providers interacting from a place of power and at times racial supremacy.

As a racialized professional, I tried to question the disempowering discourses I was observing, and the subsequent diagnosis made that were detrimental to the wellbeing and agency of the racialized patients. The main issue of contention was the essentialization of the “other” as being prone to mental illness due to their cultural practices or ethnicity. There was too much focus on ethnic and cultural differences as a reason for mental illness instead of the prevailing socioeconomic challenges facing the racialized patients in the form of racism, exclusion, and marginalization.

The team felt uneasy whenever these matters were raised. My questions were seen as going against the institutional norm, an institution which was clearly white and that carried outdated services rooted on colonialism. The prevailing response was paternalistic. The team felt it was helping the racialized patients because the diagnosis given would entitle them to receive certain benefits from the government. “We are doing good. These patients tell us that they are happy with our services”. What else would these racialized patients say in a discourse where power dynamics are completely eschewed? What can they say when some of them have a fear of authorities and what going against such authorities could lead to? It must be noted that the Finnish medical professionals providing ethnopsychiatry care were not from the racialized communities they were encountering. They did not speak the language(s) of their clients. They were not from those cultures they were encountering. Yet, they had the power to diagnose racialized clients based on their cultural practices or ethnicity using Eurocentric methods and tools. This is problematic as ethnopsychiatry is deeply rooted in colonialism. It essentializes its subjects by focusing on other cultures other than western cultures. Yet, western cultures are historically known for engaging in morally objectionable actions such as slavery, colonialism, imperialism, racism and wars. Those subjected to these atrocities question whether a civilization known for these atrocities should have the right to research and project itself on civilizations that it subjugated?

My time at the Ethnopsychiatry outpatient clinic and encounters with the staff left me with a lot of questions. As a result, I decided to do my doctoral research on decolonizing ethnopsychiatry services and the whiteness that I had to navigate as a racialized professional.

My research departs from the proposition that ideologies of colonialism infused the development of the Finnish welfare state thus embedding structures of whiteness. It seeks to analyze how racialized patients navigate and negotiate whiteness in Finnish ethnopsychiatry mental health services. Building on the argument that social and health work is a locus of white dominance in Finnish society, the study explores the following overarching question: How do ethnopsychiatry mental health services racialize patients and how does it affect the quality of care?

A plethora of studies indicate that racialized individuals are more likely than others to encounter discriminatory behavior in mental health settings. As a result, their treatments tend to be more subjective or prescriptive than those of their white counterparts, which makes them less likely to receive appropriate care. However, fewer studies have tested how prevailing values and social norms become embedded in and shape the provision of Finnish mental health care, even though empirical evidence supports the claim that structural and systemic issues affect clients’ lives and clinical interactions.

Ethnopsychiatry is a highly contentious field because it is founded on colonial psychiatry. It propagates ethnic and cultural differences as a reason for mental illness instead of the prevailing socioeconomic challenges facing the racialized patients in the form of racism, exclusion, and marginalization. Ample research indicate that racism is a determinant of health and causes mental illness (Paradies et al., 2015), and inequalities in diagnosis as detrimental to racialized patients (Nazroo et al., 2020).

There is a dearth of research on whiteness in Finnish mental health services or on the experiences of racialized patients accessing Ethnopsychiatry Mental Health Services. Therefore, this study is very significant and timely as it fills gaps in the literature using observational and storytelling methods and may have important implications for the future development of Finnish health and social care systems.

Fadumo Dayib

Doctoral researcher, University of Helsinki

References:

Nazroo, J. Y., Bhui, K. S., & Rhodes, J. (2020). Where next for understanding race/ethnic inequalities in severe mental ill- ness? Structural, interpersonal and institutional racism. Sociology of Health & Illness, 42(2), 262–276.

Paradies, Y., Ben, J., Denson, N., et al. (2015). Racism as a determinant of health: A systematic review and meta-analysis. PLoS One, 10(9), e0138511.