School of Psychology and Speech Pathology A causal layered analysis of movement, paralysis and liminality in the contested arena of indigenous mental health Darren Charles Garvey This thesis is presented for the Degree of Doctor of Philosophy of Curtin University December 2015 A Causal Layered Analysis of the Indigenous Mental Health Arena i Declaration This thesis contains no material which has been accepted for the award to any other degree or diploma in any other university. To the best of my knowledge and belief this thesis contains no material previously published by any other persons except where due acknowledgement has been made. Signature: ……………………………… Date: …………………………………… A Causal Layered Analysis of the Indigenous Mental Health Arena ii A Causal Layered Analysis of the Indigenous Mental Health Arena iii Acknowledgements I wish to acknowledge the Whadjuk Noongar Boodja within which the thesis was written. The realization that the answers to the questions that occupy our mind may in fact be under our feet, or in the sky above, will remain an enduring lesson beyond this investigation. I wish to acknowledge my supervisors, Associate Professor Brian Bishop and Professor Jan Piek. Brian served as an endlessly patient and often unsettling listener over the course of the investigation. His insights were thought provoking, and guidance respectful. Our yarns covered a range of topics, and the references to Remarque, Adams, and Monty Python are a nod to the various academic and other sources discussed with him. Jan was beacon- like in her presence and influence. Although our discussions were less frequent, I always knew when I spoke with her that I would receive wise counsel. For her guidance in the latter stages of the PhD, I wish to thank Dr. Peta Dzidic who proved formidable in her attention to detail and generous in her constructive critique. I also wish to thank Associate Professor Anita Lee Hong whose initial encouragement to commence the PhD was greatly appreciated. I wish to acknowledge and thank Healthways WA and the NHMRC Building Mental Wealth Capacity Building Grant for their scholarship assistance. I also wish to acknowledge The Western Australian Aboriginal Health and Information Ethics Committee for their valuable guidance. Thank you to Mark Robertson who converted my ideas into the images that illustrate the thesis. Thank you also to Joel Howell for his generous technical assistance on the home stretch. For mum and dad - Tina and Alan Garvey - who always encouraged their kids to do well at school. For Darlene and Amanda, my sisters and without doubt the most intelligent and courageous of Alan and Tina’s children. Finally, for my wife Beth, an untrained but naturally gifted researcher whose astute observation skills and tenacious inquiries deconstruct me on a daily basis. And for our boys, Oliver and Elliot, who appear to be following in her footsteps. A Causal Layered Analysis of the Indigenous Mental Health Arena iv A Causal Layered Analysis of the Indigenous Mental Health Arena v Dedication How senseless is everything that can ever be written, done, or thought, when such things are possible. It must be all lies and of no account when the culture of a thousand years could not prevent this stream of blood being poured out, these torture- chambers in their hundreds of thousands. A hospital alone shows what war is. Ericha Maria Remarque, All Quiet on the Western Front It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat. Theodore Roosevelt This thesis is dedicated with great respect to the present and emerging players in the Indigenous mental health arena who told me what it was like to be afraid and daring, unsure and certain, defeated and victorious. A Causal Layered Analysis of the Indigenous Mental Health Arena vi Abstract At the turn of the twentieth century, Indigenous mental health was considered a site of conflicting cultural perspectives (Reser, 1991), and a tensely contested arena (Hunter, 2004). My own involvement commenced during this period and I, along with many collegial and community based stakeholders, were required to navigate an often tumultuous conceptual, social and structural terrain in order to establish a viable professional involvement. Reflecting on that time, I became increasingly interested in how a site concerned with the amelioration of mental and psychological distress, could, simultaneously, be described by language more suggestive of antagonism and contestation. It was from this nexus of personal reflection and social interactions that this investigation into the arena of Indigenous mental health emerged. Aim One examined the constructions of Indigenous mental health over time in an attempt to chart the qualities of the aforementioned tensions, and to gauge the qualities of its current construction. Aim Two was interested examining how participants described their experiences and expectations of the arena. This aspect was refined around two interests, first with the accounts of real or anticipated conflict, and second, with how participants navigated those tensions in order to provide or receive service. A qualitative methodology was adopted within the tenets of a transformative research paradigm. Semi-structured interviews were utilized to obtain the perspectives of fourty-four participants comprised of Indigenous Community Members, mental health professionals, and mental health students. Researcher autoethnography provided collateral material, augmented by a historiographic literature review. Causal Layered Analysis (Inayatullah, 2004), an analytical framework that allows for the exploration of complex social issues at multiple levels of understanding, permitted intragroup elaboration and intergroup comparison, while grounded theory (Charmaz, 2008) guided theory development. This analytical process facilitated the development of a conceptual framework of the arena that identified avoidant and approach- oriented movements employed by community, professional and student players in their quest to provide and receive service. A Causal Layered Analysis of the Indigenous Mental Health Arena vii The arena was revealed as a more nuanced site than that suggested by common litanies of Indigenous/ Non-Indigenous antagonism. Expectations about conflict were formed as part of one’s professional and community socialization, reflecting long-held cultural myths about the nature of mental health, mental health service and Indigenous/ Non-Indigenous relationships. Intra-group, as well as inter-group conflict was elaborated in ways that revealed tension permeating the experience of all players in multiple areas of engagement including research, education and clinical realms. Ambivalence was described in contexts where participants encountered paradoxical scenarios raised by their burgeoning encounters with material and personnel that conflicted with their prevailing worldviews of equality, fairness and professionalism. Thresholds were discernible from accounts in which participants described being on the uneasy verge of cognitive, emotional and behavioural transformation associated with choice-making and role transition. Metaphors and myths emblematic of righteous and wronged discursive positions were identifiable amongst those seeking to attract or maintain intellectual and structural authority in order to assist them in evading scrutiny or to merely validate their presence. Speculation around the qualities of movement have important implications for those engaged in the preparation of providers and recipients of mental health service, and warrant the acknowledgement of nuanced players who engage in this unsettled context. The findings encourage reflection on the conceptualization of cultural competence, and critique those approaches that promote a naïve mimicry or oppressive systemic regeneration. This investigation suggests that a dynamic and depth-oriented conceptualisation of the movements of players towards, within and away from the Indigenous mental health arena could be developed that acknowledge the communities that formed as sites of respite and transformation amidst conflict, and the thresholds players navigate in order to step into novel roles and contexts. In this endeavor, a challenge is posed for teachers to consider how it is we construct ourselves within intercultural exchanges, and as participants within a proposed co-constructive praxis of uncertainty in order to enhance the Cultural Agility and Deep Competence of our students. A Causal Layered Analysis of the Indigenous Mental Health Arena viii Keywords: liminality, arena, players, Indigenous mental health, righteous discourse, wronged discourse, threshold concepts, myth, metaphor, ambivalence A Causal Layered Analysis of the Indigenous Mental Health Arena ix Table of Contents Declaration ..................................................................................................................