Literature DB >> 23162203

Indianizing psychiatry - has the case been made enough?

Anindya Das1, Urvashi Rautela.   

Abstract

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Year:  2012        PMID: 23162203      PMCID: PMC3498790          DOI: 10.4103/0253-7176.101789

Source DB:  PubMed          Journal:  Indian J Psychol Med        ISSN: 0253-7176


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Sir, We congratulate Professor Avasthi (2011)[1] on his award paper published in the Indian Journal of Psychiatry (Vol.53, pp.111-120) for a fresh look on the importance of culture in psychiatry and its practice in India. He has pointed out the uniqueness of the discipline; the distinctiveness of Indian psyche; the ill-fitted-ness of Western described clinical syndromes in India; cites certain biological differences implicating mental health of Indians; and discusses various other issues related to service provision and treatment. To us, the paper brings out the importance of culture in psychiatry but its arguments are weak. Such as the case for uniqueness of the discipline, Avasthi argue that similar chronic incurable physical conditions (such as diabetes) have vast differences in terms of diagnostic uniformity and treatment. Yet, we know the assumed diagnostic uniformity in chronic physical disorders often do not reflect as uniformity of practice (in diagnosis and more often in treatment) in widely different cultures, social settings, over different time periods, and in different health systems. On the other hand, expert-driven diagnostic (and management) uniformity is also a truth for psychiatric problems. Similarly, Avasthi constructs the Indian psyche as “fragmented, multifaceted …” due to compartmentalization and contextualization[2] brought about by the onslaught of British colonialism. But the discipline of discursive psychology shows these processes to be universal. In fact, it particularly focuses on how identity, subjectivity, and agency are constructed within available personal, familial, social, and cultural discourse, opening up various “interpretive repertoires” making way for a socially emergent self.[3] Thus, we see compartmentalized and often mutually contradictory ways of dealing with various social and personal situations that define self and identity. Moreover, the distinctive “Indian” influence on “compartmentalization and contextualization” is not just colonialism, traditional values, and modern ways of life but institutional structures, networks, and social movements.[4] Thus, issues of social position/hierarchy, class relations, caste dimensions, religious affiliation, and the political trends of the time needs to be considered to understand the influence of culture on Indian psyche and collective identity. On the other hand, Avasthi rightly points out the incongruence in Western diagnostic systems and Indian ways of manifesting psychological distress, described as “category fallacy.”[5] But it confuses us who does the author imply to wield the power to characterize problems. Kirmayer (2006)[6] warns that the ways, by which psychological decompensation is defined, needs evaluation within the context of global systems of knowledge generation and power. Thus, psychiatrists talk about validating (Western) diagnostic systems. Avasthi also notes people's preference for folk medicine to be partly traditionally inspired and partly due to the lack of availability/affordability of health services. We would in addition like to impress on the cultural incongruence of mental health services as a vital reason for this.[78] In addition, the consideration of Indianization of psychotherapeutic practice lacks consideration for the need to understand how the Indian culture perpetuates certain power differentials between the client and the healer (of biomedical kind or otherwise). Culturally appropriate forms of healing (e.g., faith healing, shrine healing, etc.), and their dynamics in terms of power differentials, meaning generation, family role, and manipulation of Indian psyche need consideration for the above task. At a philosophical level, professor Avasthi's assumptions on culture and mental health sciences is that the body has a universal biological base upon which culture acts in multiple ways. Anthropological account have questioned this notion and unfolded the critical interaction of the biological and the social body.[9] The root of such assumptions can be found in the methods of research and knowledge generation (the theory of knowledge/epistemology) in scientific practice. Western science is grounded on the Western Enlightenment. Psychiatry, a child of Enlightenment, is based on a medical model and positivistic approach. It aims to seek (an elusive) “objective” knowledge, assuming mental and psychological phenomenon to be a rational system, wholly accessible to human reason.[10] For this task, it assumes knowledge to be unraveled by reducing complexity of elements holding them as separate. It construes elements as self-contained/self-determining, each combining arithmetically to form groups. This leads to “epistemological dualism,” i.e., the separation of the inner world of mind from the outer world, implying that the psychological states can be examined in isolation from the world around them.[11] Such “objectification” eliminates the person's subjective influences in the process and alienates the produced objects from the producer, conveying value neutrality. As per Foucault, this objectification transforms human beings into subjects;[12] hence, in this case constraining individual qualities/capabilities to emulate the Western norms. Concluding from psychological, sociological, anthropological, and philosophical account, what is considered to be a simple transparent task of “validation” (as per Avasthi) is actually a more complex and obscure endeavor. Thus, borrowing from Kirmayer (2006),[6] the task of “Indianization” should be advanced only if one has a broad perspective that (i) is interdisciplinary breaking down the mind/body, nature/culture dualism, (ii) understands the discursive proceedings of psychological processes molded by social forces, and (iii) “critically examines the interaction of both local and global systems of knowledge and power.”
  5 in total

1.  Beyond the 'new cross-cultural psychiatry': cultural biology, discursive psychology and the ironies of globalization.

Authors:  Laurence J Kirmayer
Journal:  Transcult Psychiatry       Date:  2006-03

2.  A cultural critique of community psychiatry in India.

Authors:  Sumeet Jain; Sushrut Jadhav
Journal:  Int J Health Serv       Date:  2008       Impact factor: 1.663

3.  Pills that swallow policy: clinical ethnography of a Community Mental Health Program in northern India.

Authors:  Sumeet Jain; Sushrut Jadhav
Journal:  Transcult Psychiatry       Date:  2009-03

4.  Depression, somatization and the "new cross-cultural psychiatry".

Authors:  A M Kleinman
Journal:  Soc Sci Med       Date:  1977-01       Impact factor: 4.634

5.  Indianizing psychiatry - Is there a case enough?

Authors:  Ajit Avasthi
Journal:  Indian J Psychiatry       Date:  2011-04       Impact factor: 1.759

  5 in total
  1 in total

1.  Indianizing psychiatry - A critique.

Authors:  Anindya Das; Urvashi Rautela
Journal:  Indian J Psychiatry       Date:  2018 Apr-Jun       Impact factor: 1.759

  1 in total

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