Mental Disorders and Systems of Medicine

I read Professor Somasundaram's article on "Psychiatric thoughts in Tamil Culture" with interest (Somasundaram,2002). Much of the debate on cul'ture and mental illness has emphasized the differences between cultures and systems of medicine (Kleinman,1980; Littlewood,1990). Anthropological orientations have employed cultural yardsticks and have argued against biomedical perspectives of mental disorders. However, the problems related to mental illness and its management facing mental health professionals across systems of medicine (i.e. western-international or regional) are similar (Jacob, 1999). These include: i). The heterogeneity within diagnostic categories, ii). The symptomatic nature of treatments and therapies, iii). The variability of response to specific treatments and iv). The inadequacy of individual systems of medicine to successfully manage all mental disorders. These common problems related to mental illness facing medicine across cultures suggests the following corollaries: i). Accepting the limitations of all clinical classification (i.e. international or regional); Regional concepts and classificiations, suggested by the new cross cultural psychiatry, would continue to have all the problems facing the current international classifications including heterogeneity within categories, problems with gold standards of diagnosis, category boundaries, syndrome thresholds and mixed presentations, ii). The use of eclectic approaches to treatment; The inadequacies of individual systems of medicine which do not address all aspects of the different mental disorders suggests the need for an eclectic approach to management. The inherent reductionistic nature of all classifications, the heterogeneity with in categories, the symptomatic nature of treatments and the variability of response mandates individualization of care. In addition, atypical clinical presentations, treatment resistance, poor outcome, and divergent patient beliefs pose formidable challenges . Such situations demand less rigid theoretical frameworks, an eclectic approach to care of mental illness utilizing both western-international and indigenous-regional concepts, categories, and therapies. Regional therapies including folk beliefs, religion, guru-chela relationship, yoga , and meditation, are currently employed by psychiatrists in their clinical practice. While indigenous psychological consturcts are easily incorporated, traditional physical therapies are seldom employed owing to the poor understanding of their active principles.