Indianizing Psychiatry - A Critique

By Das, Anindya; Rautela, Urvashi | Indian Journal of Psychiatry, April-June 2018 | Go to article overview

Indianizing Psychiatry - A Critique


Das, Anindya, Rautela, Urvashi, Indian Journal of Psychiatry


Byline: Anindya. Das, Urvashi. Rautela

The issue of culture in Indian psychiatry has endured increasing neglect with the burgeoning biological paradigm. This viewpoint debates and demystifies the connotation of 'culture' in mainstream psychiatry. As a template to infer dominant thinking in mainstream psychiatry about culture, DLN Murty Rao Oration in 2011, 'Indianizing Psychiatry - Is there a case enough?' by Avasthi (2011) (published in the Indian Journal of Psychiatry) has been used. Engaging a broad interdisciplinary view helps unravel the inherent biases in psychiatry and opens up space for analysis of the Indian psyche from a different philosophic tradition and ways of researching it. Effort here is to open up dialog with cultural psychiatry, make efforts to involve traditional and folk therapies, and use available theoretical and empirical resources within cultural psychiatry for a refined practice of psychiatry in India.

Introduction

Indianizing or indigenizing psychiatry is about realizing India's sociocultural realities. DLN Murty Rao Oration (2011) attempts bringing 'culture' to the fore in the context of psychiatric practice.[1] The oration titled in the form of a question 'Indianizing psychiatry - Is there a case enough?' (henceforth referred to as 'Indianizing psychiatry') attempts answering this in affirmative. We, on the other hand, use 'Indianizing psychiatry' as a template to infer and critique dominant thinking in mainstream psychiatry about culture. Critique here means an analysis that is in-depth, self-reflective, using concepts outside a single discipline to understand human interaction and intervention as a social phenomenon. Thus, we unpack the meaning of culture and attempt to provoke the readers to be self-reflective of their practice of psychiatry and engage a critical psychiatry perspective.

We beg not to assume any personal vendetta in this critique. We rather acknowledge and are in agreement with a more conceptually refined later paper on a similar theme [2] by the author of 'Indianizing psychiatry.' We attempt to further these refinements as well, through a critique.

We start with two guiding questions to give direction to the discussion. First, has the case been made enough to claim Indianization of psychiatry, and second, what rough shape that Indianized psychiatry will assume (in research, theory, and practice)? We have written a shorter response earlier,[3] but here we develop and expand those arguments for a more general purpose. Moreover, psychiatry as practiced in India today has turned too biological rather than truly biopsychosocial. Although early attempts in Indian psychiatry intended to integrate cultural understanding as evidenced in the works of Rao,[4],[5] Vahia et al .,[6],[7],[8],[9] Neki,[10],[11] Varma,[12] Satyanand,[13] Mahal,[14] and Varma,[15] but in the last two decades, this is not so.[16] On this account, the younger generation of psychiatrist needs to develop a critical view of psychiatry for a more nuanced practice.

We follow the broad structure of 'Indianizing psychiatry,' i.e., discuss the uniqueness of psychiatry from rest of medicine, elaborate on the idea of Indian psyche and unique coping styles, deliberate on the complexities of psychiatric categories, and show importance of culture in psychiatric services and therapeutics. We conclude proposing an epistemological shift for the integration of culture in psychiatric theory and practice.

Uniqueness of Psychiatry? and the 'rest of Medicine'

The psyche is 'intangible, effervescent, and indefinable,'[1] especially when meeting of minds through social exchange defines psychiatric diagnosis, treatment, and outcome. This is partly true for engagement with any of the following human condition: physical or mental illness and social or economic crisis. Thus, considering this line of thinking problem definition (diagnosis), solutions (treatment) and results/outcome are shaped by the communication skills, personality, sociocultural beliefs, and most importantly interpretations of those involved in these intimate or formal (social) exchanges. …

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