Compassionate solidarity: Drawing links between the work of David Smail and Cuban psychology

Brief history of Cuba

For all but the last 56 years, Cuba has been a colony, or neocolony, first under Spanish rule and then US domination (except for a few months under the British). This history of colonisation and domination by European powers and North America is key to understanding Cuba and the origins of its ‘compassionate solidarity’.

For writers such as Enrique Dussel, European colonisation of the Americas led to an entirely new set of relationships between people in Europe and the rest of the world (Alcoff & Medieta, 2000). This colonisation provided the wealth on which European capitalism was built and at the same time created a new way of looking at the ‘other’ as inferior or subhuman. In many ways, the cultures of the Americas were destroyed or subordinated by colonialism and within these subaltern areas, new hierarchies were constructed. The Cuban revolution can be understood as part of an ongoing struggle against this colonial history, as was evident in the earliest speeches of the Cuban leaders after the revolution in 1959.

The Cuban revolution identified itself in compassionate solidarity with those people who had suffered colonisation; and with subaltern populations across the globe. The revolution can therefore be viewed as a struggle for both independence and decolonisation.

Colonialism has been inextricably linked with the development of capitalism and in its process of decolonisation Cuba developed a non-capitalist/socialist economic model that is based in the absence of exploitation, a high degree of social fairness and the widest possibilities for access to culture and education (Martinez, 2007).

The Cuban revolution can be seen as a striving to shape a new social consciousness and set of relationships founded on humanistic values. Che Guevara spoke of a ‘new human’ (Guevara, 1971) where people valued social relations and these were given priority over productive or economic forces. This social consciousness is the foundation of compassionate solidarity and was at the heart of the process of decolonisation. For the leaders of the Cuban revolution, this was not seen as something to be limited to Cuba and the Cuban people, but rather something to be extended to all disempowered people across the globe.

Internationalism

Following the revolution, compassionate solidarity became central to Cuba’s relationship with the wider world, and Cuban medical internationalism was a key part of its support for anti-colonial struggles. In 1963, the first Cuban medical brigade was sent to Algeria during its war of independence. Since then, Cuban medical missions have involved ‘135,000 Cuban health workers working in 37 Latin American countries, 33 African countries, and 24 Asian countries’ (De Vos et al., 2007, 772). Most recently, Cuban medical teams have worked in Haiti after the earthquake (Castro et al., 2015) and in West Africa during the Ebola crisis.

A key aspect of Cuban internationalism is that local problems are seen as global; as problems for all. In other words, peoples’ suffering (regardless of their governments’ politics and policies) is something the Cuban people have an ethical obligation to respond to. This ethical approach is at the core of the training of health professionals offered by the Latin American Medical School (Escuela Latino Americana de Medicina, ELAM). ELAM in Havana is the world’s largest medical school and has trained doctors from 29 countries (including the US), mostly selected from impoverished backgrounds, mostly from countries across Latin America and lower- and middle-income countries (LMIC), as it is considered that they will have a better understanding of working in poorer communities (Huish & Kirk, 2007). The Cuban State covers tuition costs, accommodation, sustenance and a small stipend over the six-year training period but students are required to make a commitment to return to their countries and work with the underprivileged and those most in need.

Cuba’s medical internationalism has provided significant support to many countries and has been widely acknowledged, for example by President Rouseff in Brazil:

Nelson Mandela’s first port of call on being released was Havana in 1991, where he paid homage to the Cuban people. He stated:

Cuban psychology

We have seen how compassionate solidarity is evident in Cuban internationalism, but what of psychology? What would psychology look like under the Cuban system? We may even wonder whether psychology would exist at all. In Power, Interest and Psychology, David Smail hints at his disillusionment with the discipline, seeing it as a central tool of ideological power that diverts people from criticising the material conditions of their lives (Smail, 2005, p.ii). However, in a system that acknowledges such materiality, what role would psychology play?

Before the revolution, psychology in Cuba was just an academic subject among many others in the university, while in practice, there were a few psychologists trained in the US, Europe or Mexico who were working but reproducing the main theoretical trends of US psychology. These psychologists had little contact with one another and did not see their role as addressing the social needs of poorer Cuban communities (Lacerda, 2015).

The Cuban revolution created a new context. Many of the existing Cuban psychologists left the country, leaving a vacuum. Perhaps surprisingly, after the revolution it was Che Guevara who was keen to develop psychology. Che dispatched Cuban psychologists and health professionals to visit various countries such as the US, Mexico, the Soviet Union, Hungary and the UK to research how psychology was organised (Yaffe, 2009).

The revolution saw psychology as having a key social role: firstly, in developing an understanding of the social conditions of the Cuban people; secondly, in helping to develop literacy campaigns in poor communities; and thirdly, in working to promote health. Psychology was to be a public service, free of charges and available in public spaces. Psychology was seen as having an important role in building the conditions in which a socialist society could flourish, and in creating a new social consciousness, a compassionate solidarity (Corral, 2011).

Psychologists were employed to develop an understanding of the social conditions by undertaking surveys and research to shed light on Cuban society and provide grounds for making political and economic plans (Rodriguez, 1990). These surveys examined factors such as housing conditions, women’s roles and religious practices, as well as working conditions in sugar mills.

The work of psychologists in literacy campaigns was part of an attempt to empower the Cuban people and to construct a new culture and identity. Surveys after the revolution showed that the subjective representations Cubans had about themselves as a consequence of colonialism were characterised by inferiority and insecurity (Corral, 2011; De la Torre, 1997). Interestingly, in subsequent decades, studies of Cuban people using questionnaires, action research and analysis of dreams showed the emergence of a new identity, qualitatively different from other countries in Latin America. While for many people in Latin America identity was associated with feelings of inferiority, Cubans showed confidence, a sense of solidarity and co-operation (De la Torre, 1995, 1997; Diaz Bravo, 1993).

Psychologists were also employed to promote health through the development of ‘health psychology’. Health psychology was defined as a field that spans the health–disease continuum, pursuing both health promotion and disease prevention (Lacerda, 2015, p.310). The aims were: to understand health as a process instead of a state; to focus on the social determinants of health; to give attention to educational processes and promote social research; to have a commitment to poorer communities, and to encourage active participation (Morales, 2011).

Thus, Cuban psychology was initially employed as a device in the service of social and political needs, and was very much part of the Cuban ‘national project’. Cuban psychology was seen as a tool for developing a social consciousness and as part of tackling social injustices. It was characterised by pragmatic eclecticism with diverse roots that reflected Cuba’s history, with an appropriation of ideas and techniques from North American psychology and European models.

A significant part of Cuba’s history that I have not discussed so far, is the Soviet influence from 1962 up until the euphemistically termed ‘special period’ in 1989 when the Soviet bloc collapsed. Over this period, Cuba’s economic isolation as a result of the US blockade led to economic dependence on the Soviet bloc. As the Soviet economy influenced the Cuban economy, so too was culture and science influenced. While the Soviet influence facilitated the diffusion of Marxist ideas and a critique of capitalism and imperialism, it also meant external domination by another country and a further form of colonisation. Some Cuban psychologists such as De la Torre (2009), as reported by Lacerda, acknowledged this cultural impact:

With the fall of the Soviet bloc in 1989, Cuban psychologists began questioning the Soviet influence. None the less, Marxist ideas were retained along with the idea that psychology could be used as a tool to eliminate unjust social conditions. De la Torre (2009) refers to ‘critical assimilation’ as a device to overcome coloniality in psychology.

In practice, this ‘critical assimilation’ is evident in the influential legacy of Vygotsky’s cultural historic focus (CHF) approach which underpins much of the Cuban approach to psychology today. The CHF approach is not a direct imitation of Soviet psychology, but has been adapted to fit within a Cuban context and acts as an umbrella or frame within which many models are incorporated, such as CBT, and psychodynamic and humanistic approaches. It is important to note that while there may appear to be resemblances with psychology in the West, the CHF approach means that these models are used in a different way in practice.

Within the CHF approach, symptoms are understood as disruptions in the network of social relationships within an individual’s life. The work of the psychologist is seen as an ethical intervention that facilitates a person to think about why and how the symptom has occurred and how it relates to their social history, as well as how it is related to the wider cultural and political context. Symptoms are, therefore, not seen as simply happening, but are understood through the person questioning the social structure and the place they have as part of that system. As the Cuban psychologists Otto Vasquez and Ana Gutierrez explain:

The critical assimilation of De la Torre meant that elements from the ideas and writings of indigenous thinker-activists such as José Martí were also incorporated into Cuban psychology. José Marti is the Cuban national hero who led Cuba’s independence from Spain in 1900. The Cuban psychologist González Serra draws links between the thinking of Marti and Vygotsky stating that:

Since the beginning of the new millennium, Cuban psychology has started to develop closer ties with critical psychologists in Latin America. There was a renewed interest in rebuilding a psychology from indigenous sources and in developing an understanding of psychology as part of a wider theoretical decolonisation and transformation process within Latin America (Quintana, 2013). The pragmatic eclecticism of Cuban psychology, where practice has tended to dictate theory rather than the other way round, has been likened by Mark Burton to the approach of Martín Baró, the founder of liberation psychology (Burton, 2011).

Today, Cuban psychology is very much integrated into Cuba’s national health strategy and inextricably linked to working towards the goals of prevention of illness and promotion of health. Cuban psychology is also very much part of the social context of Cuban society.

For psychologists in Cuba, their context has been shaped by the cultural and political discourse about revolutionary change and by the revolutionary project to build a more equitable and just world. This context has in turn clearly shaped their practice and their theoretical perspective. While Cuban psychology has been very much part of the revolutionary project, and some may argue it has been a ‘tool of ideological power’, it has also played a critical role in making visible some of the contradictions and hidden aspects of Cuban society such as domestic violence, machismo and gender issues.

In thinking about Cuba today, my sense is that while the revolution seems a distant event and the imagery and slogans associated with it seem somewhat stale and outdated, there remains a revolutionary legacy among many Cuban people that is manifest in a social consciousness and a spirit of compassionate solidarity. While many Cuban people are understandably desperate to overcome the many economic problems they face, it seems many also want to make ‘an ethical choice… to reject the ruthless world… based on the globalised neoliberal market’ (Smail, 1993, p.v). For many, ethics continues to be at the heart of the Cuban psyche as well as the Cuban model of healthcare, its internationalism and its psychology.

In conclusion, Cuban psychology does demonstrate that a different psychology can and would exist in a different social political context. Furthermore, for the outsider, Cuban society and the ‘Cuban psyche’ does provide glimpses of an alternative way of being as a self in a social world. and Cuban psychological practice does indicate that another psychology is possible, just as another world is possible.