Jacqueline Leckie

Unsettled Minds: Gender and Settling Madness in Fiji

Postcolonial studies have presented new perspectives to established narratives that emphasised the tangible material dimensions of colonial settlement.1 Instead of narratives of guns and trade, more attention has been paid to what Edward Li Puma describes as ‘power in the passive voice, the gradual Western saturation of medical knowledge and justice, the aesthetics of dress and the sociality of food, the conception of thinking and the representation of the body. Thus the everyday, the routines, the “givens” of everyday life.’2 Colonial psychiatry encompassed both the coercive and more passive aspects of colonial settlement.

Mental Health in the Smaller Pacific States

This chapter traces changing patterns of mental health and its provision within the smaller Pacific Islands. Although small and distant from Europe, some people living within precolonial Pacific cultures suffered from stress and mental illness. This chapter emphasizes indigenous conceptions of Pacific minds and mental health and the entanglement with Western biomedicine, psychiatry and global mental health structures. The smaller nations in the Pacific are covered—American Samoa, Cook Islands, Federated States of Micronesia, French Polynesia, Kiribati, Marshall Islands, Nauru, NewHawai Caledonia, Niue, Northern Mariana Islands, Palau, Tokelau, Tonga Tuvalu, Samoa, Solomon Islands, Vanuatu, Wallis and Futuna—but not Fiji, Papua New Guinea and Hawai‘i. This chapter begins with the discussion of indigenous conceptions and treatment of mental illness within the Pacific Islands. We then examine the introduction of mental health infrastructure and biomedicine into the region. The Islands also attracted researchers who offered divergent interpretations of mental health epidemiology among Pacific cultures. The second half of this chapter focuses on contemporary health provision in the Pacific. Global mental health structures have been directed through the Pacific Islands Mental Health Network (PIMHnet), launched in 2007. Despite this, mental health within the small islands of the Pacific region continues to receive low priority, competes for scarce resources, faces problems of isolation and struggles to be recognized at all levels of government and society. Indigenous communities still rely heavily upon traditional treatments and support—offering some resilience but also presenting challenges for contemporary health initiatives.

The History of Mental Health in Fiji

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 ‘drua 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 heath 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 (1877–1953) and the major regional provider of health practitioner training. The 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 training 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.

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pressure on them, the conflicting demands of home and work life, was not thoroughly examined. This is disappointing and surprising considering that the connection between work and domestic relations is a prime analytic focus. Scase and Goffee argue that ’[Plarenthood rather than marriage ... would seem to be more significant in generating home-work conflicts’ (page 111). Marriage, argue Scase and Goffee, is not an obstacle for women pursuing