International Journal of
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Review Article Volume 10 Issue 3
Relational healing, diagnostic limits, and the misalignment of western psychiatry in indigenous communities: implications for family practice
Marcello Maviglia
Received: May 30, 2026 | Published: June 16, 2026
Citation: Maviglia M. Relational healing, diagnostic limits, and the misalignment of western psychiatry in indigenous communities: implications for family practice. Int J Fam Commun Med. 2026;10(3):99-106. DOI: 10.15406/ijfcm.2026.10.00422
Abstract
Primary care is the setting where most psychiatric diagnoses are made and where the majority of psychotropic medications are prescribed. This gives family physicians enormous interpretive power: the frameworks they use to understand distress shape diagnostic outcomes, treatment trajectories, and long‑term patient identity. For Indigenous patients, this interpretive power carries even greater weight because Western diagnostic systems were not designed to perceive Indigenous relational worlds, historical contexts, or land‑based forms of meaning. When applied uncritically, these systems can misclassify relational, communal, or historical suffering as internal pathology and promote pharmacological interventions that are difficult to reverse. This manuscript examines how biological reductionism and diagnostic expansion shape clinical practice in primary care—and how these frameworks fail to perceive Indigenous forms of distress. It argues that Indigenous healing systems provide a more accurate interpretive frame because they reflect the relational, contextual, and historical realities in which suffering and healing occur. The paper also outlines the physiology of psychiatric‑medication withdrawal, emphasizing the relational and neuroadaptive processes that clinicians must understand to support safe tapering when appropriate. Medication practices in primary care often obscure meaning, reinforce diagnostic colonialism, and create long‑term dependence through neuroadaptive changes that are frequently misinterpreted as relapse. Healing in Indigenous communities arises from relational accountability, land‑based coherence, and intergenerational continuity, while Western psychiatry fragments these dimensions into individualized symptoms. Psychotherapy research further demonstrates that relational factors—not techniques—drive therapeutic change, aligning more closely with Indigenous healing than with manualized Western interventions. The manuscript concludes that primary care clinicians must cultivate contextual knowledge of Indigenous history, culture, and healing practices; adopt reflective and intentional prescribing; recognize withdrawal as a legitimate phase of treatment; and integrate peer support as a core component of care.
Keywords: indigenous relational healing, diagnostic colonialism, psychiatric medication withdrawal, primary care prescribing
©2026 Maviglia. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.