The rhetoric of women and children's rights in Indian psychiatry

Abstract

Despite heavy patient caseloads and limited resources, psychiatric professionals of North Indian public teaching hospitals aspire to deliver psychosocial interventions along with pharmaceutical or biologic treatments. However, significant obstacles stand in the way of the success of these interventions. This paper discusses how the relative social and political status differences between elite professionals and their non-elite patients and patients’ families render problematic many of the psychosocial interventions employed. Data were collected in the form of observations of practitioner-patient-family attendant interactions at the Outpatient Department, and interviews with patients, patients’ family members, and psychiatric professionals at the Inpatient Department 2001–2004. Analysis found that many of the professionals’ verbal interventions attempted to promote egalitarian styles of communication and relating among patients’ family members. Psychiatrists perceived mental health problems as stemming from structural violence inherent in the North Indian institution of the family, which they described as organized hierarchically according to gender, age, and generation. One strategy evident in interventions deployed ‘traditional’ values, beliefs, and maxims irreverently in an attempt to re-order or level hierarchical differences. Another strategy invoked the concept of individual rights in an effort to empower weaker family members and enlighten powerful members regarding the destructive impact of relational styles predicated on inequality. Unfortunately, the professionals experienced their psychosocial interventions as unsuccessful. The paper suggests that rigid interactional norms across class statuses, an emphasis on liberal individual rights versus community rights, and a harsh exhortative style, contributed to the sense that the interventions alienated non-elite patients and family attendants.

Keywords:

• India
• medical anthropology
• psychiatry
• communication
• social class

Acknowledgements

Field research was supported with a Junior Fellowship from the American Institute of Indian Studies and a Fulbright-Hays Doctoral Dissertation Research Award. Research with human subjects was approved by the University of Chicago's Institutional Review Board. Thanks to Julia Cassaniti, Thomas Blom Hansen, Tanya Luhrmann, and anonymous reviewers for their suggestions. Much gratitude is due to my Indian mentors, research subjects, and the institutions that allowed me to conduct research.

Conflict of interest: none.

Notes

1. Names and other crucial identifying characteristics of the professionals and patients have been changed in order to protect their confidentiality.

2. Data on the caste of patients who attended the clinic were not systematically collected for this study, since inquiries about caste in this context were sensitive. However, caste affiliation was sometimes apparent from surnames. Scholarly work on communication about caste in contemporary North India finds that upper caste persons refer to caste differences by using the binary categories ‘educated’ and ‘uneducated’ in which ‘educated’ referred to upper caste and ‘uneducated’ to lower caste (Frøystad 2005). Talk of patients and their families as educated or uneducated was very much a part of the professionals’ discourse.

3. Conversion disorder is a DSM-IV TR diagnostic category referring to a psychiatric disorder in which psychological factors account for symptoms that appear to be of a neurological, or general medical, condition (American Psychiatric Association 2000, 231–2).

4. Discussions regarding the rights of persons with mental illness were present on a national level, but were never mentioned by any professional in discussion with the researcher. See Addlakha (2008), Krishnakumar (2002) and Mudur (2002) for discussions regarding abusive custodial care of patients and the improper use of ECT.