Our Problems: Our Solutions

Discussion on the unique characteristics of psychiatry in a non-Western country like India, often tend to be limited to culture-bound syndrome like Koro, possession state etc. It is, no doubt, important for us to be able to recognize these problems and render effective treatment to individuals suffering from them. It is also interesting to speculate on the cultural factors which contribute to the emergence of these phenomena and be aware of the local interpretations and traditional methods of dealing with them. However, the fact remains, that some of these syndromes are rarities even in our own country, while others which are widely prevalent, are seldom brought to psychiatric attention. The chances of an article on a rare culture-bound syndrome getting published in a foreign journal is much greater than that of a paper on a condition widely prevalent all over the world. Since we tend to value the appearance of a work in a foreign journal more than in an Indian one, the proclivity of our authors to report on rare but colorful syndromes gets reinforced. A survey of published work by Indian authors in foreign journals may give one an impression that psychiatric practice in India is centered around Dhat syndrome, Banamati sorcery and Koro. However the majority of patients seen both in psychiatric institutions and private practice in this country are those who suffer from disorders common all over the world and who can be diagnosed on the basis of criteria applicable in other cultures as well. Does this mean that the diagnostic and therapeutic approach of the psychiatrist in India need not be different from those of his Western counterpart? Findings of International Pilot Study on Schizophrenia and the study on the Determinants of Outcome of Severe Mental Disorder have shown that while psychiatric disorders seen in India are similar to those seen elsewhere, they bear a special cultural stamp with regard to their manifestations and outcome. Thus, it is the special responsibility of the psychiatrist in India to be able to maintain an international perspective, while having his feet firmly set in the social and cultural milieu of this land. How are we to maintain this balance? One of the basic needs is to be aware of the pathoplastic effect of cultural factors on the clinical features of psychiatric disorders. Current understanding about somatization is an example which proves this point. Somatization has been well recognized …