There has been a lot of talk about current negotiations with the International Monetary Fund (IMF). A return to the IMF is a major decision and will impact all of us. I decided to address this topic in a health column because it impacts the economic health of the nation. The country's economic health affects our state of well-being and that of the health sector.

Economics is not only about crunching figures and balancing books, it influences attitudes and behaviour. That is why we need to engage the country in any decision to re-engage with the IMF.

Is Jamaica a failed state?

In preparing this article, I asked an attendant at the service station what he thought of a possible return to the IMF. He responded: "God almighty, we a go dead." For those of us who are old enough and have lived through the decades of the '70s and '80s, the thought of returning to the IMF already is generating fear and trepidation.

The fact is Jamaica is being viewed as a failed state. This was long echoed by a former chief executive officer of a well-established bank. It generated a lot of discussions. Many economists have long stated that Jamaica has been teetering on the brink of disaster. The current recession has tipped us over. We have no other option but to borrow from the IMF.

It is painful for any government and its people to accept this. No one likes failure. Admitting to the truth is important. We have borrowed and borrowed and borrowed to the extent that we are among the most indebted country in the world. This country is in crisis. As a country, we need to get out of this perpetual state of denial, accept that our corner is dark, unite and mobilise our collective will to tackle the problems.

The return to 'backra massa' days

'Backra massa' was the master on the plantation. He ruled supreme. His methods were harsh and ruthless. Our experience with the IMF is one where it dictated economic policies. It dictated how much and when we spent; the value of our currency, the size of the public sector and the extent of salary increases. This is a slap in the face of any sovereign state.

It means we are no longer masters of our destiny and we become subject to the whims of a few people who hop on a plane, review the state of our economy and call the shots. Many therefore see the return to the IMF as a return to backra massa, hence the fear, ambivalence and deep concerns. We are told that that the new IMF has become sensitive to these issues and it now insists that countries take ownership of their economic policies and decisions. The reality is that only a fool lends money on the borrower's terms.

This is our greatest fear. For the past 30 years, we have been on a downward economic trend. What lies ahead? Will it be pain and more pain? The IMF policies have always been characterised by unpopular spending cuts, wage freeze, public-sector cut and a reduction in social services. Will we break the vicious cycle of poverty this time around or will it be pain and more pain?

Dr Wendel Abel is a consultant psychiatrist and head, Section of Psychiatry, Dept of Community Health and Psychiatry, University of the West Indies; email: yourhealth@gleanerjm.com.