The History of Mental Health in Fiji

Abstract

That cultural transition entailed risks of mental illness remained a favoured theory well into the twentieth century and effected the early development of mental health services across the Pacific. Fiji has a distinct form of Melanesian culture, although ontological beliefs are based on a similar integrative physical and metaphysical model of life where spirits and ancestors play an active part according to the conduct of the people. In the early years of British Administration Fijian secret societies and cannibalism were outlawed, but many still believe in and fear the sorcery of 'dma ni kau', which means 'a leaf and refers metaphorically to personal items left behind that could be used in ritual sorcery to generate a curse to induce weakness, insanity, illness or death. The colonial administration sought to protect the indigenous population from the effects of cultural transition and brought indentured Indian labourers to Fiji's sugar farms between 1879 and 1920. The plurality of Indian deities and cultural beliefs found resonance with i-Taukei beliefs of health and illness, including the potential to incite malicious spirits. This highly exploitative labour scheme entailed profound disruption to the lives of people from disparate regions, castes and cultures. In 1890, suicide rates among indentured labourers were close to 16 times those in the Indian provinces from whence they had come. Now, after 100 years of cultural interaction, many folk beliefs are held in common. That the metaphysical world is potentially malevolent, all of the major communities of Fiji agree. During the colonial era, Fiji became a major regional hub as the headquarters of the British Western Pacific High Commission introduction of psychiatric hospitalization in 1884 shaped Fiji's mental health services during the entire colonial era and beyond. Fijian villagers had long experience of mental distress and had been unable or unwilling to cope with the severely mentally ill. Hospitalization provided a new alternative based on the authority of the administration and its legitimization of medical interventions. For the last 130 years, St. Giles Hospital has been the locus of changing psychiatric practice. There is little evidence of traditional concepts of aetiology having any influence on the application of psychiatry in Fiji; however, at the community level, 'witchcraft' is often the first-line treatment for mental disorders, while demonic possession, not fulfilling customary obligations or being cursed, is still thought to be the common causes of mental illness. Recent mental health policy favours the establishment of general hospital psychiatric units and community care, now articulated in the 2010 Fiji Mental Health Decree (MHD). Incrementally, Fiji is moving towards a more humane and integrative approach to treating the mentally ill. Recent legislative and reform developments have been supported by tinning and capacity building and active membership of international mental health advocacy groups, resulting in strengthened consumer and caregiver rights and the application of principles of international practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved)