Defining Decolonization
“Decolonization” is a term I only recently came to know, but since discovering, has become a beacon on my journey of being a clinician, treating primarily OCD and related diagnoses. So often I hear stories from friends, colleagues, and clients who have had healthcare experiences that left them feeling objectified—treated as a diagnosis, a problem to be solved, or a collection of symptoms to be managed. In the world of OCD treatment, this often shows up through rigid, protocol-driven approaches that focus so heavily on symptom reduction that they leave little space to understand the person beneath the compulsions. Decolonized healthcare asks us to slow down and see more: to ask who this person is, what they carry, what has happened to them, and what they need beyond just relief. It calls us to make room for relationship, for dignity, and for the fullness of someone's story—not just the parts we’ve been trained to treat.
The Merriam-Webster dictionary defines the term “decolonization” as “to free from the dominating influence of a colonizing power”[1], which in our modern world, was not something I initially associated with healthcare.
It wasn’t until one night, engaged in researching healthcare, that I learned about J. Marion Sims, or the man who is often referred to as the Father of Gynecology.
I remember the article I read included an artistic interpretation of Sims in a sparse cabin where the studs of the wall are exposed, and a white sheet is haphazardly hung across the length of a room. Sims stands in his jacket and bowtie, arms crossed, as two other men stand casually with their sleeves rolled up, ready to work. In front of the sheet is a table, on which a black woman in a headscarf and denim dress kneels as she gingerly unbuttons the top of her dress. Two other black women peer from behind the curtain, shoeless and clutching each other as they watch[2].
I learned that her name was Anarcha, an enslaved woman who revolutionized the field of gynecology by becoming the victim of Sims’ trails that included being operated on for fistulas without the use of anesthesia. She was not the only one, nor was Sims the only “father of” to build his name off the work conducted on non-consenting parties.
When I talk to clients about the early discoveries of psychology, I often begin by reminding them of the lineage of the knowledge we have today. A lineage that did not begin at colonialism, but that was professionalized and popularized by it. In so much of our learning about what healthcare is and isn’t we are so often confined to a narrow box of data, such as the data Sims brought us. Yet I can’t help but wonder, who was Anarcha’s real doctor? Who was her trusted elder, friend, spiritual healer, or medicine woman who was first doing this thing called “healthcare” before an educated man from the Western world came with his stethoscope and doctorate? Who was treating her first, and how? To me, decolonizing healthcare means widening our scope of data; exploring the world of healthcare before someone defined it. To me, it means honoring what Sims studied, but also what Anarcha knew, and didn’t get to ask for. To me, it means not showing up to my barefooted clients in leather loafers and a copy of the DSM. Instead, it means showing up to my barefooted clients, barefooted myself, and armed with their voice and knowledge at the center of my remedy for healing.
A Brief History of Psychological Care
One of the things I admire most about this field, is being a witness to it’s youth. Psychology as a field only emerged about 150 years ago with the publication of Wilhelm Wundt[3], a German psychologist who developed the first lab capable of studying matters of the human psyche, and published his work in “Principles of Physiological Psychology” for the public.
From there, psychology burst onto the scientific scene and other educated Westerners like G. Stanley Hall, Sigmund Freud, John B. Watson, and B.F. Skinner began searching for their explanations for the mechanisms involved in psychological distress. Like much of our healthcare and scientific history, these fathers of psychology also based their understanding of psychology on the disease-based model of medicine[4], or the idea that pathology can be isolated from a person, and managed through actions taken against that singular factor alone. In other words, psychological distress is a result of something invading the self, and not a natural part of the self.
I will caveat that I, myself do not claim any declarative knowledge about where mental dis-ease comes from. Afterall, the field of psychology, in my opinion, is still only just emerging. What I will say, is that I have had the honoring of being a witness to so much knowledge through studying storytelling, and what I’ve come to know is that we’ve been studying the psyche for far longer than the “fathers” have. From even our first record of human ponderings, the Epic of Gilgamesh, a Mesopotamian story that grapples with curiosities about our existence, we have been engaging in getting to know the psyche.
With the thousands of years of data recorded in stories alight with existential dis-ease and symptoms related to dread and fear, it is a wonder that our primary understanding of Psychology comes from what was identified only 150 years ago. In fact, if we speak exclusively in terms of OCD conceptualization and treatment, we are only just celebrating the 65th birthday of when Aaron Beck established Cognitive Behavioral Therapy (CBT)[5], the leading treatment for OCD which includes Exposure and Response Prevention (ERP) methods[6].
Exclusive Use of CBT and ERP as Colonized Care
When I mention that CBT and ERP are colonized approaches to OCD treatment, I want to clarify that I do not mean that they are ineffective, bad, or that I do not use them. In fact, time and time again our evidence suggests that, generally, CBT and ERP are the most effective types of therapy to manage OCD symptoms[7], and I do use them in my practice when they are wanted and needed.
When I mentioned that they are colonized approaches to OCD, I mean that when used alone, they are only effective under the terms and conditions of the disease-based model of medicine that they were founded on, or in other words, they alleviate symptoms in the same way that Sims alleviated Anarcha’s fistula. Her fistulas were closed, but only after 30 experimental and non-consensual procedures, exposure to opium, and the loss of her family and identity[8].
At this point, no one can share Anarcha’s experience; what became of her as her wounds were healed but grief was not. What I do know is that of my own care. I know the way that CBT and ERP successfully helped me perform as a healed person in public, but left me with what I used to tell my therapist felt like “a black hole” within me that never left whether I succeeded in exposures or not. I know that in trialing psychotropic medications, another frontline approach to OCD treatment[9], the way I was moved from psychiatrist to psychiatrist, like a stray dog looking for the one hand that may feed it rather than shake it’s fists at the burden. I know the way that my attempts to squash this thing everyone regarded as irritating and unrelatable succeeded, but only fed the black hole within leading to a slew of new health concerns like a game of whack-a-mole.
In so many ways being in a colonized system of care did have an effect. From all that people could see, my compulsive behaviors were less noticeable, but from the data I have from that which only I could see, I don’t think that is good enough.
Decolonized Approaches to OCD Treatment
Over the course of my own therapeutic journey, I was introduced to something greater than treatment alone; I have come to call what I experienced “healing”. Healing, to me, is not the absence of symptoms but the presence of connection, dignity, and personal agency. For me, it began with something I never would have expected, a relationship with a therapist that did not claim any particular specialty of care. A therapist that was not an OCD, CBT, or ERP therapist at all. I chose her because she offered me something beyond a treatment plan. What she offered me was my first experience at a relationship without resistance. She never batted an eye when I talked about my obsessions and the gruesome lengths I went to in order to keep myself safe. She felt my pain when I needed someone to feel it. Remained steady when I needed steadiness. She offered me permission to exist as I was, and went even further to offer me kindness and closeness. If I had been a stray dog, she would have not only fed me, but also housed me, bathed me, and cared for me in a way all loved things should be.
Often people are surprised when I talk about the intimacy of a healing therapeutic connection. People struggle to believe it’s possible to be loved and cared for without a string attached. And I understand that, because in colonized healthcare we are so often taught to provide treatment at an arms length from the patient. It’s palpable in the photo of Anarcha and Sims, the way that resistance fills the air as a man from a white, educated, professional caste steps into a foundationally intimate experience with a black, enslaved woman he cannot, and does not, want to relate to.
In decolonized care, it is not enough to treat the medical object of a broken leg, or heart disease, or OCD alone. In decolonized care, the provider and patient must enter into a real relationship. One where both parties are human, and both care about the other. One where the provider is willing to forego ego and micromanagement, and the patient is willing to honor their own expertise and needs. One where both parties feel safe to check in, consent is mutual, and no one seeks to erase any part of the other.
When a client enters my care, it is never a race to treat their symptoms. When people explain their OCD symptomology to me, I see it as merely the prologue of an anthology of literature with their name on the cover. My greatest work and honor is to read a person cover to cover, and help them read themselves cover to cover before any modality or methodology can be applied.
Yes, decolonized care is slow healthcare, and there is often grief in those of us used to efficiency-based, disease-based models of treatment. There is also immense grief in this type of care for those of us who have found it easier to see themselves and others as a disease rather than as a whole person with needs and preferences and fears worthy of connection. I have seen this grief.
Through decolonized care, I have also seen healing. I will say, “healing” is a hard thing to describe, and something I did not know could exist in absence of the extinction of my OCD symptoms. If you’re wondering, yes from the outside I do still have OCD symptoms, and I know I am healing because of something beyond just those symptoms. I see healing in my sense of safety and connectedness, in the weight I’ve gained back after years of struggling with unknown gastrointestinal issues, in the way my years of repeated nightmares have shifted, in the ease at which I engage in what I love, in the grief I feel when I am treated poorly, in the strength I have to stand up for myself, and in the way that whatever black hole I once felt was expanding within me all those years ago, no longer aches with doom.
Clinical Considerations
If there’s one truth I’ve come to trust, it’s that healing begins in the relationship something that has long been shown to impact healing in positive ways[10]. Not in tools alone, but in the presence we offer, the safety we build, and the courage it takes to sit beside another human being in their pain. As clinicians, we are not Sims. We have the power to choose differently—to honor autonomy, to center consent, to show up with humility and heart. That is not just where healing happens—it’s where justice begins.
Healing does not happen in a vacuum, or even in the perfect treatment plan. It happens in the spaces between us—in the moments when we allow our clients and ourselves to be whole, seen, and sovereign. As clinicians, our relationships are not just a backdrop to care; they are the care. And when we offer that with respect, with consent, with softness, we begin to undo the harm of what came before. We begin to build something better. We begin to build the foundation for decolonized care.
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Title image courtesy of the New York Times: https://www.nytimes.com/2023/06/09/books/review/say-anarcha-jc-hallman.html
Edited using AI
[1] https://www.merriam-webster.com/dictionary/decolonize
[2] https://www.npr.org/2016/02/16/466942135/remembering-anarcha-lucy-and-betsey-the-mothers-of-modern-gynecology
[3] https://www.britannica.com/biography/Wilhelm-Wundt
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC1071693/
[5] https://beckinstitute.org/about/understanding-cbt/
[6] https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd/treatments-for-ocd
[7] https://pmc.ncbi.nlm.nih.gov/articles/PMC6343408/
[8] Remembering Anarcha documentary by Josh Carples
[9] https://iocdf.org/about-ocd/treatment/meds/
[10] https://www.apa.org/monitor/2019/11/ce-corner-relationships