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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 e 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.

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Estratto del testo

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...

Autori

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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