2015

Cultural psychiatry in the Indian subcontinent

Guest editor: Raguram

  • Of syncretic traditions. Perspectives on cultural psychiatry in India –
    Editorial R. Raguram 1 – 2
  • Wellbeing in Indian psychology –
    Overview C. Shamasundar 3 – 15
    This paper proposes that Indian philosophy qualifies as a holistic psychology. It shows its scientific character by proposing a revised understanding of the scope of science. It describes the richness of many of its concepts in relation to mental health, and proposes that they can be usefully integrated into modern mental health theory, practice and research. Such assimilation will help the latter in many respects, for example by filling-up a few of its deficiencies and by expanding the scope of its application. Important areas of potential contribution of Indian psychology are the character of holism, scientific nature of spirituality, a revised understanding of the meaning of mental health, role and variants of coping-skills, the hitherto neglected concepts of ‘will-power’ and ideal love, the important role of values, and a potential for primary prevention. This article is a brief narrative of the above points.
  • Classification of serious mental illness according to Ayurveda –
    Overview M. Weiss 16 – 26
    Ayurveda is widely recognized as a Hindu system of medicine, but its formulation of mental illness is less well-known. This paper reviews concepts of mental illness with reference to principles of Ayurveda presented in the classical Sanskrit texts of the tradition. It discusses these concepts, their cultural contexts and relevance for cultural psychiatry. As a medical system with an elaborate theory, Ayurveda classifies mental disorders according to principles of an indigenous humoral pathophysiology, concerned with balance of vata (wind), pitta (bile), and kapha (phlegm). Other categories of mental disorder acknowledged by the tradition refer to spirits (bhuta or graha) identified with particular personalities and patterns of behaviour. An account of the signs, symptoms and meaning of various forms of serious mental illness (termed unmada), according to Ayurveda, provides a framework for examining the current influence of traditional cultural concepts and assessing cultural explanatory models of psychiatric illness. Doing so helps to explain how affected persons and others in their community understand and respond to this illness, including families, various practitioners who treat them and laypersons who collectively constitute the community context of mental illness. Recent attention to the value of a cultural formulation as an integral component of clinical assessment, which has been incorporated in the DSM-5, acknowledges the practical significance of clinicians’ awareness of the formal traditions that may influence the experience and meaning of mental illness, and expectations of treatment. It enables them to better understand and help their patients.
  • Culture and alcohol use in India –
    Review Article P. Murthy 27 – 39
    Both the use of alcohol and its proscription are known in ancient as well as in contemporary India. From early times, consumption was strongly influenced by social caste and class, and many religions proscribed its use. The availability of alcohol increased disproportionately following the advent of the East India Company and the early excise policies of the government. The early twentieth century witnessed a great demand for prohibition, but the excise revenues from alcohol sales soon largely reversed this trend. Liberalization and modernization have also been associated with an increase in alcohol consumption, which in turn has blurred social and religious distinctions to an extent. Alcohol use in India is still viewed from different lenses – as a public health problem, as a social scourge as well as a social necessity. In contemporary India, a cultural understanding of alcohol use and misuse and its health and societal implications necessitates its understanding both from a traditional, multi-religious, multi-cultural viewpoint, as well as in the context of a nation in rapid socio-cultural and economic transition.
  • Clinical fatigue and weakness as Neurasthenia Spectrum Disorders in India –
    Review Article V. Paralikar, M. Agashe, M. Weiss 40 – 50
    Medically unexplained clinically significant functional fatigue and weakness are core clinical symptoms of various phenomenologically defined overlapping syndromes, which include Chronic Fatigue Syndrome, Neurasthenia, Fibromyalgia, and others. Collectively, they may be regarded as Neurasthenia Spectrum Disorders (NSDs). Clinical challenges include lack of authoritative consensus criteria, vague and inconsistent clinical formulations, lack of diagnostic tests, absence of proven interventions to prevent a chronic course, and outcomes that are frequently unsatisfactory for patients and doctors. Public health challenges include poor clinical understanding of and management guidelines for the condition, stigma, reluctance to accept mental health referrals, and imposition of a burden on health systems. Consideration of culture-specific syndromes has influenced development of concepts of and motivated research on somatic distress, its psychological and social determinants, and the influence of changing societal and cultural forces. Clinical diagnoses are explanatory models of professionals. Perceived causes reflect dominant cultural orientations in the community. Social analysis of NSDs suggests they reflect predicaments of society and culture that manifest as clinical psychiatric and medical problems for which patients request treatment. An interdisciplinary perspective benefits from consideration of biological, social and cultural underpinnings that include background features of nutrition, disease status, housing, sanitation, gender, livelihood opportunities, and explanatory models of patients and doctors.
  • Cultural and social aspects of mental illness among the elderly –
    Review Article K. Shaji 51 – 54
    Health care of older people is related to their socio-cultural milieu. Families continue to be the major support for older people. However, social changes and consequent reduction in the availability of informal care resources like the traditional family, are putting pressure on home-based care in India. The treatment gap for geriatric mental health problems is huge. Dementia and depression are the two major mental health problems in the later years of life. Screening for cognitive impairment is difficult in these settings as illiteracy influences the individual’s performance on cognitive tests. The tests standardized elsewhere usually discriminate against illiterate people from rural societies, as they tend to perform poorly on these. Trained health workers can identify dementia cases in the community and support home-based care. Primary care doctors will have to be trained in identifying and managing depression and dementia. Provision of support to families and development of formal care services will help to meet the care needs of older people. It is incorrect to attribute near mythical strength to the abilities of families engaged in care; their distress is real and families need support to sustain care.