Society, Culture and Psychopharmacology

Much has been written about the need to modify psychotherapeutic techniques to suit the cultural context of the Indian patient. Even the most ardent advocates of the need to make psychotherapy culturally relevant, often forget that similar modifications may also be necessary in the pharmacotherapy of psychiatric disorders. We often assume that a drug which is effective in one group of patients should be effective in the same way in patients elsewhere also. But clinical experience often shows that cultural factors influence compliance with response to drugs. It is often suggested that the main reason lor patients not following the drug prescriptions of doctors in developing countries like India, is because these medicatioas are expensive and the practitioners of modem medicine are not as accessible as the practitioners of indigenous methods of treatment. But one often comes across patients who avoid the primary health centre or hospital nearby and travel long distances to meet the practitioners of indigenous systems of medicine or magico-religious methods and spend a great deal of money on them. Even in situations where the drugs ae freely given and the patient lives close to the hospital, compliance with instructions about medication is often poor. This implies that factors other than cost or accessibility of psychiatric services play a part in determining whether a patient follows medical advice or not. Patients and their families' beliefs about the cause of the illiness is obviously a major I actor which influence compliance. A family which believes that the patient's psychotic symptoms are due to influence of evil spirits or witch craft will be unconvinced about the psychiatrists' ability to control the symptoms with medication md will feel comfortable if they try exorcism at li-' ast once. Popular concepts derived from indigenous systems of medicine regarding the effect of med-PSYCHOPHARMACOLOGY ication have a profound influence on compliance. Some drags and food stuff are believed to produce excessive "heat" while others are believed to have a "cooling" effect. Generally "heat" producing items are considered to have an adverse effect on health and many allopathic drugs, including most psychopharmacological agents, are included in this category and their long term use discouraged. While giving antipsychotics and antide-pressants as a single night time dose has several advantages, such a schedule also at times leads to the misunderstanding that these are "sleeping pills" which should not be taken for a long time lest the patients …