Part Three of Three
Across the first two parts of this series, I have focused on the idea that behavior means something. In Part One, we considered what changes when we stop reading behavior as defiance and begin reading it as communication. In Part Two, Internal Family Systems took us further inside the person, where we asked which part was speaking and what that part might be trying to protect.
There is a third question, which may be the most uncomfortable of the three, because it is not about the person in front of us at all. Who decided what this person is supposed to look like when they are well? Who defined normal, and who determined what counts as appropriate behavior, a healthy family, insight, motivation, cooperation, or successful treatment? Whose values are we using when we make those judgments? Those questions bring us to the decolonization lens.
Looking at the Lens Itself
Most of us in behavioral healthcare were trained to assess people. We observe symptoms, identify dysfunction, evaluate risk, assign diagnoses, recommend interventions, and establish treatment goals. Those skills matter, and there are days when they save lives. Decolonization asks something different of us, which is to examine the person doing the observing and the system those observations come from, which means looking at the lens rather than only through it.
Every clinical system carries assumptions inside it about independence, productivity, emotional expression, family roles, authority, communication, spirituality, gender, sexuality, parenting, and what makes a life meaningful. Those assumptions developed within particular historical, political, and institutional contexts, and they arrived with the people who built the field. When we forget where they came from, we begin to mistake cultural norms for clinical truths.
Jennifer Mullan makes this argument forcefully in Decolonizing Therapy, where she describes therapy as inherently political and asks clinicians to reckon with the colonial and historical roots of the systems we practice inside. A reader does not have to agree with every conclusion she draws to find the underlying challenge worth sitting with, because a field that cannot examine its own history will go on repeating it.
When Difference Becomes Pathology
One of the persistent dangers in behavioral healthcare is our tendency to pathologize what we do not understand. Direct communication is considered healthy in one culture and deeply disrespectful in another. Independence reads as a developmental achievement in one family, while in the next family interdependence and obligation to the extended family are the organizing values and separation would be the symptom. Eye contact may be interpreted as engagement by the clinician and experienced as intrusive or threatening by the person sitting across from them. Spiritual experience can be a source of profound meaning in one cultural context and get interpreted exclusively through a psychiatric framework in another. Our expectations about privacy, parenting, adulthood, marriage, work, and family obligation are all culturally situated, though we rarely name them as such.
None of this reduces everything to cultural difference. Psychosis, addiction, trauma, eating disorders, abuse, and danger are all real, and I have spent four decades in rooms where the stakes were exactly that concrete. What is also true is that our interpretation of a person’s behavior is never fully separable from the assumptions we carry into the room with us, and that is the argument for clinical humility.
From “What Is Wrong with You?” to “Who Told Us This Was Wrong?”
In Part One, I suggested changing the question from what is wrong with this person to what this person has adapted to. In Part Two, Internal Family Systems allowed us to ask what this part is trying to protect. A decolonization lens adds a third question. Who decided that this behavior, identity, relationship, or way of being is inherently wrong?
Sometimes the answer arrives immediately, because the behavior is dangerous and requires intervention. Other times the answer is far less comfortable. What we are working to change may not be pathology at all. It may be difference or a reasonable response to an environment that does not fit, or the accumulated weight of discrimination, exclusion, poverty, racism, sexism, homophobia, ableism, and generations of marginalization.
We may be asking a neurodivergent person to perform neurotypicality when the better intervention would be to change the environment so that they can function within it. We may be asking someone from a collectivist culture to adopt an individualistic model of recovery and then reading their discomfort with that model as denial. We may be calling a family enmeshed without understanding what closeness means inside that family’s culture. We may be interpreting distrust of healthcare as resistance without ever asking whether that distrust was earned, specifically and honestly, in earlier encounters with institutions. The decolonization lens asks us to become curious about those possibilities before we decide what needs fixing.
Behavioral Healthcare Has a History
This conversation matters because behavioral healthcare does not exist outside of history. Psychiatry, psychology, social work, medicine, and addiction treatment have all evolved dramatically over time, and all of them have also participated in systems that harmed people. Homosexuality remained a psychiatric diagnosis until 1973. Women’s distress was medicalized for generations in ways inseparable from the era’s expectations of women. People with disabilities were institutionalized and stripped of autonomy. Indigenous healing practices were dismissed as primitive during the same period in which boarding schools were severing children from the cultures those practices belonged to.
The relationship between race and diagnosis has been documented as well. Jonathan Metzl’s research at Michigan’s Ionia State Hospital traced how schizophrenia shifted across the middle of the twentieth century from a diagnosis associated largely with white women to one applied disproportionately to Black men, with the diagnostic language itself moving toward hostility and aggression over the same decades. That history is directly relevant to anyone working with psychosis today, because diagnostic categories do not reach us from somewhere outside of culture.
Addiction treatment carries its own version of this. In Alcohol Problems in Native America, Don Coyhis and William White document the firewater myths, a set of long-standing beliefs about Native people and alcohol that shaped policy and treatment for generations and that the historical and scientific evidence does not support. What eventually worked came from Native communities themselves. Coyhis founded the Wellbriety Movement in 1994 and built a recovery framework grounded in the Medicine Wheel and the Red Road, and our field spent a long time treating culturally rooted approaches of that kind as supplements to real treatment rather than as treatment.
We cannot undo that history by pretending it has no bearing on contemporary practice, and acknowledging it does not require us to reject modern behavioral healthcare. Our clinical knowledge is worth preserving. What we owe alongside it, however, is enough humility to recognize that our field, like every field, has blind spots, and that some of those blind spots have been very expensive for the people in our care.
Power is Always in the Room
Power is another dimension of decolonization that matters a great deal in intervention work. Behavioral health professionals hold power. So do treatment programs, hospitals, and courts, and in family systems where money moves, families hold considerable power of their own. In many of the cases I am called into, several of those systems intersect at once. A person may be sitting in a room with family members, clinicians, attorneys, physicians, and treatment professionals who have already reached agreement about what should happen next.
Sometimes that is precisely what the situation requires. Someone may be psychotic, suicidal, medically compromised, intoxicated, cognitively impaired, or dangerous to others, and genuinely unable, in that moment, to protect themselves. There are circumstances in which we have an ethical obligation to act, and I have never been reluctant to act in them. However, necessity does not erase the power differential. If anything, it makes naming that differential that much more important, because having the authority to do something has never answered the question of how it should be done.
That distinction is the reason I built the Trauma Responsive Model of Intervention and the Respectful Adolescent Transport Protocol the way I did. Whether a young person arrives at treatment with their dignity intact is not a courtesy that sits outside the clinical work. It shapes everything that follows.
The Difference Between Safety and Control
This may be the most difficult distinction in all of behavioral healthcare. When are we protecting someone, and when are we controlling them? Occasionally that line is obvious. More often, it is not, particularly when everyone in the room is frightened.
Families want certainty, and they want their loved one safe. They want the drinking to stop, the psychosis treated, the eating disorder interrupted, and the dangerous behavior contained, and every one of those wishes is legitimate. Clinicians want safety, too. Fear, though, has a reliable way of converting treatment into a contest for control, and once that conversion happens it is very hard to see from the inside.
The decolonization lens asks us to keep examining our own interventions. Is this restriction necessary for safety, or does it mainly make the system more comfortable? Is this rule clinically indicated, or is it institutional tradition that no one has questioned in twenty years? Are we asking for collaboration or for obedience? Does this person actually lack capacity in this moment, or do we simply disagree with the decision they are making? Are we creating the least restrictive environment that still maintains safety? I ask these questions in order to intervene better, and in forty years I have never found that asking them made me slower to act when action was genuinely required.
Resistance May Contain Information
We constantly describe people as resistant. We might say a person is resistant to treatment, to the family, to medication, to our recommendations. Part Two asked what a protective part might be defending when someone refuses help. This lens entails a similar inquiry, which is whether the resistance is carrying information about us.
A person may resist because they are frightened, because a previous treatment experience humiliated or harmed them, or because no one has explained what is happening in language that makes sense to them. They may resist because decisions are being made about them rather than with them, and sometimes they resist because what we are asking genuinely does not fit who they are or where they come from.
None of this gives resistance the final word. however. There are moments when illness has substantially compromised judgment and safety requires us to act regardless. Even in those moments we can stay curious about what the resistance is telling us, and we can carry that information into the conversation that comes after.
Decolonization Does Not Mean Abandoning Expertise
Clinical humility and clinical passivity are different things. Decolonizing behavioral healthcare does not require us to pretend that expertise is irrelevant, that every interpretation of a situation is equally accurate, that evidence does not matter, or that we should stand still while someone’s life is in danger. It asks us to hold our expertise differently.
We can say to a person, honestly, that we have knowledge that may help them and that they have knowledge about themselves which we do not possess. Both of those statements are true at the same time. A psychiatrist may understand psychosis. A physician may understand medical instability, and a clinician may recognize the shape of an addiction from across the room. A family carries decades of history that no assessment will ever fully capture. The person receiving treatment remains the only one who knows what it is like to live inside their own experience, and the treatment that works usually finds a way to use all of it.
Families Have Cultures Too
Decolonization is not only a matter of large cultural and societal systems, because every family is a culture of its own. Families develop rules about what may be discussed, who holds authority, how emotion is expressed, what success looks like, what brings shame, who takes care of whom, and what happens when someone violates the arrangement. A few of those rules are spoken aloud. Most of them are simply absorbed.
One family values achievement above emotional wellbeing. Another values loyalty above individual autonomy. One avoids conflict entirely, while another communicates almost exclusively through it. Behind all of it there may be generations of migration, wealth or poverty, addiction, secrecy, religion, loss, or plain survival, shaping the family long before the person now identified as the problem ever arrived.
So, when I walk into a family system, I cannot assume that my job is to teach them the correct way to be a family. My first responsibility is to understand the family I have entered.
Cultural Humility Is a Practice, Not a Credential
We talk about cultural competence as though culture were a subject a clinician could master and then be finished with. I prefer the idea of cultural humility, because humility acknowledges that we will never completely understand another person’s lived experience. We can learn, we can study, and we can ask better questions, and we should remain willing to discover that something we were certain of was wrong.
That requires a different posture in the room. Rather than entering as the person who already holds the answer, we enter with our expertise and our curiosity both intact. We listen for what we do not understand. We notice our assumptions as they form. We pay attention to who holds the most power in the room and whose voice is least represented in the conversation. And when the situation calls for it, we change course.
Natalie Gutiérrez’s work offers a useful model here that connects directly to Part Two of this series. She is a certified Internal Family Systems therapist working with survivors of complex trauma in communities of color, and her writing in The Pain We Carry treats racial and intergenerational trauma as part of the clinical picture rather than as background context sitting outside it. The parts framework and the cultural frame are not competing lenses. They are describing the same person.
Expanding the Lens
A decolonization lens ultimately asks us to widen the questions we bring into clinical work. Rather than asking only what diagnosis fits, we can ask what happened around this person. Rather than asking only why they will not comply, we can ask what compliance means in this particular situation and who benefits from it. Rather than asking only what the family is doing wrong, we can ask what this family learned it had to do in order to survive. Rather than asking only how we stop the behavior, we can ask what the behavior is communicating, protecting, resisting, or attempting to change. And rather than asking only what successful treatment looks like to us, we can ask what a meaningful life would look like to the person whose life is actually under discussion.
The Lens We Choose
Decolonization does not ask us to discard what we know. Rather, it asks us to become more conscious of how we came to know it, to recognize that clinical expertise carries power and that power carries responsibility, and to keep distinguishing safety from control, treatment from conformity, and difference from pathology. Most of all it asks us to remain curious about the person whose life is being discussed, because the most dangerous lens is the one we have forgotten we are wearing.
When we become willing to examine that lens, to question it, to widen it, and occasionally to set it down in favor of another, we make room for more humanity without surrendering any clinical rigor. We make room for greater dignity inside our boundaries rather than for fewer boundaries. We make room for intervention that preserves as much voice, autonomy, culture, and personhood as the circumstances safely allow.
The focus shifts from how we can get this person to change to how we can help without requiring someone to become more like us to be considered well. That is a much harder question, and I believe it is one our field has to keep asking.
References:
Coyhis, D. L., & White, W. L. (2006). Alcohol problems in Native America: The untold story of resistance and recovery. White Bison, Inc.
Gutiérrez, N. Y. (2022). The pain we carry: Healing from complex PTSD for people of color. New Harbinger Publications.
Metzl, J. M. (2009). The protest psychosis: How schizophrenia became a Black disease. Beacon Press.
Mullan, J. (2023). Decolonizing therapy: Oppression, historical trauma, and politicizing your practice. W. W. Norton & Company.
