Tag: psychiatry

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.

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