Today we had a really wonderful discussion with Dr. Shah, the head psychiatrist and research director at Sumandeep Vidyapeeth. He explained to us the differences in general US vs. Indian healthcare and also the more subtle differences in US vs. Indian psychiatry. In India, 70% of medical facilities are private and 30% government-run. However, only 9% of the population has health insurance, so most are paying out of pocket for privatized, unsubsidized care. If they are lucky enough to get to a public health care facility – he told us about one psychiatric hospital in the state – the care, testing and medications are all free.
In terms of India-specific differences in the psychiatric field, one of the most influential forces is the huge stigma against mental illness and psychiatry – combating it, the primary cause of the MINDS Foundation. This social stigma interestingly affects the treatment availability, desire for treatment and even the manifestation of mental illness.
A unique aspect of mental illness in India is the higher than average levels of somatization, which is the physical manifestation of a mental problem. Interestingly, Dr. Shah explained to us this unique malady caused by cultural elements. Generally, women are twice as likely as men to develop some sort of depression. Dr. Shah explained that India (traditionally) is a village-based society, and in these villages, because of prescribed gender roles, women are rarely allowed to leave the home unless they need treatment for a physical malady. Apparently, subconsciously, women with depression realize that general symptoms like crying won’t allow them to get the same help as physical symptoms, so the disease manifests in that way instead.
Because of the stigma, people are very reluctant to seek psychiatric care, and more often visit doctors specializing in fields relevant to their symptoms, as opposed to their actual disease. For example, people suffering from anxiety will visit a cardiologist instead of a psychiatrist, because they want avoid any social ramifications that could come of being thought to have a mental illness. Related is the fact that many primary care doctors will not consider the possible psychological roots of a particular symptom, and will incorrectly treat it as a physical problem. We observed another psychiatrist talking to a young man about his wife’s severe seizures, asking careful specific questions about the frequency, duration and subtleties of her seizures. She was asking these questions to understand whether these seizures were caused by something physiological (diagnosis: epilepsy), or if these were “pseudo-convulsions,” resulting from psychological stress. She is very aware of the potential psychiatric roots of dieses, training under Dr. Shah, but many doctors in different fields aren’t trained with that same emphasis on the importance of mental status in physical disease. It’s understandable why patients are so reluctant to seek psychiatric care – many will have difficulty marrying or being accepted into other societal roles if they are suspected of suffering a mental illness.
Dr. Shah also said he believed that suicide rates were on the rise – attributing some of these cases to the fact that the younger generation has better access to technology, and therefore face fewer difficulties and frustration because of the easiness and convenience technology can bring to your life. When they get older and begin to have more difficult problems arise in their lives, they are less able to cope and overcome, having less experience doing this as they grew up. They are more frustrated and hopeless than older generations may have been confronting similar problems, and sometimes see suicide as the only escape.
Throughout the summer, the volunteers I’m working with and I will be conducting research in more rural villages and in city clinics, investigating differences in Indian healthcare. One group of students is looking into the roles of faith healers in more traditional Indian communities, and thinking about how their roles compare and could maybe be integrated into more modern medical practices. The other group, which I’ve asked to be in, will be looking at structural violence against women with mental illness and considering what cultural factors contribute to this problem. I’m excited to start understanding more deeply the roots of this devastating stigma and thinking about ways to combat it.