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L’hôpital en Asie du Sud

 | 
Clémence Jullien
, 
Bertrand Lefebvre
, 
Fabien Provost

Espaces hospitaliers : vers la complémentarité des soins ? / Hospital Spaces: Towards the Complementarity of Cares?

Mapping Mental Well-Being in India. Initial Reflections on the Role of Psychiatric Spaces

Cartographie du bien-être mental en Inde. Réflexions premières sur le rôle des espaces psychiatriques

Clément Bayetti, Sushrut Jadhav and Sumeet Jain

Abstract

This paper explores how two different sites—a psychiatric department and a community mental health programme embedded in a district hospital in India—construct their own peculiar understanding of mental well-being and recovery. Focusing initially on the nature of the discourse and practice emerging from a psychiatry department, this article demonstrates how members of the psychiatric profession in India are socialised into a conception of well-being narrowly defined by an absence of symptoms. It highlights how such notions emerge from the intersection existing between global paradigms such as “evidence-based medicine” and psychiatry’s “technological paradigm”. The authors argue that such conceptions of well-being can in turn be considered as both the articulation and operationalisation of a neoliberal capitalist ideology in which the hospital turns into a socially credited market where people’s “broken minds” can be fixed through the administration of psychotropic drugs, and through which recovery is narrowly conceptualised as paid employment. While such understanding may increasingly appears to fulfil the expectations of various social classes within Indian society by providing them a gateway to a form of global citizenship, this paper also shows how such notions feed into a state sponsored agenda of cost cutting public health care resources, thus impacting upon the well-being of both patients and professionals. This analysis also traces the ways in which this medicalised understanding of well-being evolves as these constructions of well-being diffuse out into wider society and become embedded into the national community mental health programme. In doing so, the paper explores ways in which such understanding may be reappropriated by people suffering from mental ill health and their communities, and the role that this plays in their personal and collective recovery.

Cet article explore la manière dont deux sites différents – un département de psychiatrie et un programme de santé mentale communautaire intégré dans un hôpital de quartier en Inde – construisent leur propre compréhension particulière du bien-être mental et du rétablissement. Se concentrant initialement sur la nature du discours et de la pratique émergeant d’un département de psychiatrie, cette étude montre comment les membres de la profession psychiatrique en Inde sont socialisés dans une conception du bien-être définie de manière étroite par une absence de symptômes. Elle souligne la façon dont de telles notions émergent de l’intersection existant entre des paradigmes mondiaux tels que la « médecine fondée sur des preuves » et le « paradigme technologique » de la psychiatrie. Les auteurs soutiennent que de telles conceptions du bien-être peuvent à leur tour être considérées à la fois comme l’articulation et l’opérationnalisation d’une idéologie capitaliste néolibérale dans laquelle l’hôpital se transforme en un marché socialement crédité où les « esprits brisés » des personnes peuvent être corrigés par l’administration de psychotropes, et à travers lequel la récupération est conceptuellement définie comme un emploi rémunéré. Bien qu’une telle compréhension puisse sembler de plus en plus répondre aux attentes des différentes classes sociales de la société indienne en leur fournissant une passerelle vers une forme de citoyenneté mondiale, le présent article montre également comment de telles notions s’inscrivent dans un programme de réduction des coûts parrainé par l’État, jouant ainsi sur le bien-être des patients et des professionnels. Cette analyse retrace également la manière dont cette conception médicalisée du bien-être évolue à mesure que ces constructions de bien-être se diffusent dans la société au sens large et s’enracinent dans le programme national de santé mentale communautaire. Ce faisant, l’article explore les moyens de réappropriation d’une telle compréhension chez les personnes souffrant de problèmes de santé mentale et leurs communautés, ainsi que le rôle que cela joue dans leur rétablissement personnel et collectif.

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Excerpt

Good mental health is an essential component of well-being (World Health Organization 2004). Across the world, Psychiatry plays an important role in managing people’s mental health, in term of promotion, prevention and treatment. However, in Lower and Middle Income Countries (LAMICs), the availability and access to mental health services and professionals are often poor, increasing the already substantial burden caused by poor mental health (Patel, Minas, Cohen et al. 2013). This is the case in India, where up to 90 % of people suffering from mental illness receive no form of treatment (WHO 2011), despite a relatively high prevalence of serious and common mental illnesses such as schizophrenia and depression (6.5 % and 15.1 %, respectively) (Grover, Dutt & Avasthi 2010; Thirunavukarasu & Thirunavukarasu 2010). This situation is in part caused by an acute shortage of mental health professionals, with approximately 4,000 psychiatrists available for the entire country (this is equivale...

Author(s)

He is Doctoral Student at the Division of Psychiatry, University College London (UCL), UK and an Adjunct Faculty at the Brown School, Washington University, St Louis, USA. His doctoral research explores the process through which psychiatry students in India acquire their professional identity and how this shapes clinical encounters and outcomes. His other research interests lie in the field of Global Mental Health and Medical Anthropology, with a focus on recovery, innovation in mental health services and the globalization of therapeutic culture. Previously, he has worked in the UK and India with third sector organization and NGO supporting people suffering from mental ill health, and he has collaborated closely with local and national authorities in the UK to develop and implement mental health policy and services.

He is street psychiatrist and clinician anthropologist in London, UK. He works as Senior Lecturer in Cross-cultural Psychiatry, University College London; Consultant Psychiatrist, Camden Homeless Outreach Services & Islington Mental Health Rehabilitation Services & Lead Clinician, Cultural Consultation Service, Camden and Islington Community Health and Social Care Trust. He is founding Editor, Anthropology & Medicine journal (Taylor & Francis, UK). Dr Jadhav’s current interests include mental health dimensions of marginal groups with a focus on South Asia. He has taught extensively on medical anthropology and cultural psychiatry programmes, at several national and international Universities. He currently supervises UCL doctoral and post-doctoral scholars conducting research on the cultural appropriateness of mental health theory and practice in low income nations with a specific focus on India. More recently, he is engaged in field testing cultural psychological therapy for Dalits in India.

He is Senior Lecturer in Social Work at The University of Edinburgh. He has degrees in Social Work (McGill), International Development (Toronto) and Cultural Psychiatry (University College London). His research aims to strengthen community mental health care in the global south drawing on inter-disciplinary perspectives. Current research examines contextually grounded mental health “innovations” in the global south; development of local approaches to “recovery” in northern India; the role of community health workers in delivery of mental health care in India and Nepal; and the relationships between mental health and forms of marginality and social exclusion in India.

© Éditions de l’École des hautes études en sciences sociales, 2019

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