Tag: Mental health

Mapping Mental Well-Being in India Initial Reflections on the Role of Psychiatric Spaces

By Clément Bayetti, Sushrut Jadhav and Sumeet Jain

This paper explores how two different sites—a psychiatric department and a community mental health programme embedded in a district hospital in India—construct their own peculiar understanding of mental well-being and recovery. Focusing initially on the nature of the discourse and practice emerging from a psychiatry department, this article demonstrates how members of the psychiatric profession in India are socialised into a conception of well-being narrowly defined by an absence of symptoms. It highlights how such notions emerge from the intersection existing between global paradigms such as “evidence-based medicine” and psychiatry’s “technological paradigm”. The authors argue that such conceptions of well-being can in turn be considered as both the articulation and operationalisation of a neoliberal capitalist ideology in which the hospital turns into a socially credited market where people’s “broken minds” can be fixed through the administration of psychotropic drugs, and through which recovery is narrowly conceptualised as paid employment. While such understanding may increasingly appears to fulfil the expectations of various social classes within Indian society by providing them a gateway to a form of global citizenship, this paper also shows how such notions feed into a state sponsored agenda of cost cutting public health care resources, thus impacting upon the well-being of both patients and professionals. This analysis also traces the ways in which this medicalised understanding of well-being evolves as these constructions of well-being diffuse out into wider society and become embedded into the national community mental health programme. In doing so, the paper explores ways in which such understanding may be reappropriated by people suffering from mental ill health and their communities, and the role that this plays in their personal and collective recovery.

Read the chapter here,

Dhis and Dhāt: Evidence of Semen Retention Syndrome Amongst White Britons

By Sushrut Jadhav

The uncritical application of western psychiatric concepts in non-western societies resulting in culturally invalid psychiatric syndromes, have been extensively documented. Such instances are considered ‘category errors’. In contrast, ‘reverse category errors’ although theoretically postulated, have never been empirically demonstrated. Diagnostic criteria of an established South Asian culture specific neurosis, Dhāt syndrome, were deployed by a psychiatrist of South Asian origin, amongst 47 white Britons in London, UK, presenting for the first time with a clinic diagnosis of ICD-9 Depressive Neurosis (Dysthymic Disroder, ICD-11). The proceedure yielded a new disorder, Semen Retention Syndrome. Based on narrative accounts and quantitative scores on the Hamilton Depression Rating Scale, the evidence suggests that a significant subset of white British subjects diagnosed with Dysthymic Disorder, may in fact be expressing a psychological variation of a previously unknown local White British somatisation phenomena labelled Semen Retention Syndrome. Anxiety and depressive symptoms presented by this subset of subjects were primarily attributed to a core irrational belief and a cognitive error centered around misunderstood concepts of semen physiology. Consequently, the undue focus on mood idioms by both white British patients and their health professionals, leads to a mistaken diagnosis of Mood Disorder, and results in incorrect treatment. The implications of this ethnocentric mode of reasoning raises concerns about existing concepts in psychiatric phenomenology and for official international diagnostic classificatory systems. The paper concludes by arguing that category errors in both directions are instances of cultural iatrogenesis, and underscore the importance of a culturally valid psychiatry.

Read the article here.

Psychiatric stigma across cultures: Local validation in Bangalore and London

By Mitchell G. Weiss, Sushrut Jadhav, R. Raguram, Penelope Vounatsou & Roland Littlewood

Public responses to depression have a powerful effect on patients’ personal experience of illness, the course and outcome of the illness, and their ability to obtain gainful employment. Mental illness-related stigma reduction has become a priority, and to be effective, it requires innovative and effective public mental health interventions informed by a clear understanding of what stigma means. Based on Goffman’s formulation as spoiled identity, local concepts of stigma were validated and compared in clinical cultural epidemiological studies of depression in Bangalore, India, and London, England, using the EMIC, an instrument for studying illness-related experience, its meaning, and related behaviour. Similar indicators were validated in both centres, and the internal consistency was examined to identify those that contributed to a locally coherent concept and scale for stigma. Qualitative meaning of specific features of stigma at each site was clarified from patients’ prose narrative accounts. Concerns about marriage figured prominently as a feature of illness experience in both centres, but it was consistent with other indicators of stigma only in Bangalore, not in London. Although stigma is a significant issue across societies, particular manifestations may vary, and the cultural validity of indicators should be examined locally. Analysis of cultural context in the narrative accounts of illness indicates the variation and complexity in the relationship between aspects of illness experience and stigma. This report describes an approach following from the application of cultural epidemiological methods for identifying and measuring locally valid features of stigma in a scale for cultural study, cross-cultural comparisons, and for baseline and follow-up assessment to monitor stigma reduction programmes.

Read the article here.

The Cultural Origins of Western Depression

By Sushrut Jadhav

Focusing on the British cultural vocabulary of guilt, fatigue, energy, stress and depression; this paper argues that such vocabularies have their own unique histories and meanings; deeply embedded, in this instance, within “white British and western European” institutions. Predicated on a western epistemology, these constructs developed in response to prevailing concerns at different periods in western history; but are now assumed to be universal natural entities that await further scientific research and investigation. The cross-cultural validity of depression as a universal disorder is therefore dubious and needs an extensive re-examination.

Read the article here.

Unbearable suffering: mental health consequences of the October 2023 Israeli military assault on the Gaza Strip

By Hanna Kienzler, Gwyn Daniel, Weeam Hammoudeh, Rana Nashashibi, Yasser Abu-Jamei, and Rita Giacaman.

The onslaught on Gaza is leading to catastrophic psychological consequences which will not be limited to the short term and to those directly affected, but will have long-term, intergenerational effects.

This commentary argues that to understand trauma responses among Gazans, we need to go beyond individual illness and, instead, link the biomedical sphere with the political sphere through the concept of social suffering and, thereby, expose the socio-political conditions of life and the collective trauma-inducing nature of the Israeli military occupation and repression.

Addressing these complex trauma responses requires approaches that bring together the political, social and personal-level components of mental health with a focus on three factors: safety and allyship; the right to agency and acknowledgement, accountability and reparations.

Read the article here.

    Pills That Swallow Policy: Clinical Ethnography of a Community Mental Health Program in Northern India

    By Sumeet Jain and Sushrut Jadhav

    India’s National Mental Health Program (NMHP) was initiated in 1982 with the objective of promoting community participation and accessible mental health services. A key component involves central government calculation and funding for psychotropic medication. Based on clinical ethnography of a community psychiatry program in north India, this article traces the biosocial journey of psychotropic pills from the centre to the periphery. As the pill journeys from the Ministry of Health to the clinic, its symbolic meaning transforms from an emphasis on accessibility and participation to the administration of a discrete ‘treatment’. Instead of embodying participation and access, the pill achieves the opposite: silencing community voices, re-enforcing existing barriers to care, and relying on pharmacological solutions for psychosocial problems. The symbolic inscription of NMHP policies on the pill fail because they are undercut by more powerful meanings generated from local cultural contexts. An understanding of this process is critical for the development of training and policy that can more effectively address local mental health concerns in rural India.

    Read the article here.

    Bodies in Evidence: Race, Gender, and Science in Sexual Assault Adjudication

    By Heather R. Hlavka and Sameena Mulla

    For victims in sexual assault cases, trials rarely result in justice. Instead, the courts drag defendants, victims, and their friends and family through a confusing and protracted public spectacle. Along the way, forensic scientists, sexual assault nurse examiners, and police officers provide their insight and expertise, shaping the story that emerges for the judge and jury. These expert narratives intersect with the stories of victims, witnesses, and their communities to reproduce our cultural understandings of sexual violence, but too often this process results in reinscribing racial, gendered, and class inequalities.

    Bodies in Evidence draws on observations of over 680 court appearances in Milwaukee County’s felony sexual assault courts, as well as interviews with judges, attorneys, forensic scientists, jurors, sexual assault nurse examiners, and victim advocates. It shows how forensic science helps to propagate public misunderstandings of sexual violence by bestowing an aura of authority to race and gender stereotypes and inequalities. Expert testimony reinforces the idea that sexual assault is physically and emotionally recognisable and always leaves material evidence. The court’s reliance on the presence of forensic evidence infuses these very familiar stereotypes and myths about sexual assault with new scientific authority.

    Read the book here.

    Palestinians’ mental and physical Health. An interview with Rita Giacaman.

    By Sélima Kebaïli

    While mental health is usually assessed using objective health indicators, these measurements fail to address the intricate impact of persistent violence on Palestinians’ lives.

    Rita Giacaman is the founder of and a professor at the Institute of Community and Public Health at Birzeit University. She has chronicled the effects of Israeli military occupation on the life and health of Palestinians under occupation focusing on the impact of chronic war-like conditions and exposure to violence on the health and wellbeing of Palestinians. Her focus lies also on the psychological and social well-being of adolescents, aiming to create methods for implementing health and welfare programmes in prolonged violent conditions.

    Read the text interview here.

    Towards decolonising research methods training: the development of a locally responsive online learning course on research methods for mental health in war and conflict for researchers and practitioners in the Gaza Strip

    By Nancy Tamimi, Hanna Kienzler, Weeam Hammoudeh, Hala Khalawi, Mathias Regent and Rita Giacaman

    Background

    Concerns exist that online learning directed at non-Western settings to strengthen research capacity imposes Western-centric epistemology, provides unidirectional transfer of knowledge, and neglects local paradigms and expertise. We argue that a plurality of voices, histories and epistemologies are essential to strengthen research capacity. We share our experience developing and teaching an online course for mental health professionals and researchers in the Gaza Strip.

    Methods

    Birzeit University and King’s College London developed and delivered the course equally, focusing on the intersection between qualitative research methods, mental health and conflict, and addressing local research needs. We incorporated local case studies and expertise, encouraged interaction in English and Arabic, and stimulated critique of Western theories. Seventeen participated, 12 completed the pre-course questionnaire, 15 completed the post-course questionnaire and four undertook semi-structured interviews.

    Results

    Our pre-course survey showed participants most needed coding and qualitative data analysis skills. Post-course findings showed improved qualitative research skills. Most agreed the course was comprehensive and well delivered, with relevant case studies. Three themes were identified: (1) the course was locally contextualised and met students’ needs; (2) the course fostered dialogic and multi-directional learning and (3) suggestions for improvements. Several participants wanted some topics in greater depth and further specialised training. A few suggested the course be in Arabic.

    Conclusion

    Fostering multi-directional learning is key for non-Western knowledge, epistemologies, and languages to gain prominence in Western academia. A social transformation would see local researchers and educators engage with and use local methods and paradigms in mental health in war and conflict.

    Read more here.

    The Wretched of the Earth

    By Frantz Fanon

    Written at the height of the Algerian war for independence from French colonial rule and first published in 1961, Frantz Fanon’s classic text has provided inspiration for anti-colonial movements ever since, analysing the role of class, race, national culture and violence in the struggle for freedom. With power and anger, Fanon makes clear the economic and psychological degradation inflicted by imperialism. It was Fanon, himself a psychotherapist, who exposed the connection between colonial war and mental disease, who showed how the fight for freedom must be combined with building a national culture, and who showed the way ahead, through revolutionary violence, to socialism.

    Read more here.

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