The History of Mental Health in Papua New Guinea

Abstract

Papua New Guinea, with over 840 languages, presents the most complex of situations for transcultural understandings of what it means to be mentally ill. The earliest comments on a Papuan population suggest the possibility of a Rousseauian ideal of the natural human condition devoid of mental pathology, where psychoses occurred as a result of the stresses set up by white influence. The theme that the stresses associated with cultural transition were causative of acute psychosis recurs throughout the early PNG literature. The first government-initiated investigation into mental illness in 1957 produced a report that initiated much of the subsequent development in mental health in PNG. Soon after, an admission facility was established at Laloki 10 miles north of Port Moresby near the Bomana Correctional Facility, where psychiatric patients had previously been held in indefinite detention in an annex. Laloki continues to provide an inpatient service today. Subsequent policy has supported the development of general hospital psychiatry units in provincial hospitals, although staffing them with qualified mental health staff has not been achieved and several units have closed in recent years. In forecasting culturally relativist approaches, the report stated that ‘the mental health of an individual can be assessed only in relation to his culture and environment’. Dr. Burton-Bradley, appointed as the territory’s only psychiatrist, struggled with this concept over the next three decades. While modern anthropology argues for culturally relevant understanding of behaviour based on the social structures in which it occurs and the suspension of the explanations of an observer’s own culture, psychiatry found this difficult to achieve in Papua New Guinea. Burton-Bradley’s view of clinical psychiatry, his training of clinicians and his prolific writing and teaching shaped the development of psychiatry in PNG and established the medical model as the dominant explanatory paradigm. In 1975, PNG gained independence and many positions were nationalized. Dr. W. Moi was appointed as medical superintendent of the Laloki psychiatric centre and head of mental health services and stated that ‘culture and language represent a way of thinking and of understanding …and there are real advantages of being able to choose your frame of reference’ forecasting the accommodation of the culturally relevant diagnoses now in use in PNG. The 2010 mental health policy recognizes PNG’s cultural diversity and refers to a ‘home-grown policy’ to address the ‘complex cultural circumstances and other related factors which contribute to the origin of mental and neurological disorder unique to Papua New Guinea’, which confirms that European theories of aetiology and psychiatry’s medical nosology have not achieved complete acceptance, even at the policy level. Current traditional beliefs concerning both mental and physical illness are still widely centred on sorcery, witchcraft, spirit possession/supernatural agents and violations of social norms and taboos. But the inclusion into psychiatry of metaphysical conceptions, and beliefs and actions based on factors that are not empirically verifiable, calls into question psychiatry’s place within science. This perennial issue for psychiatry is brought into sharp focus in PNG.