The rhetoric of women and children's rights in Indian psychiatry

Abstract

Despite heavy patient caseloads and limited resources, psychiatric professionals of North Indian public teaching hospitals aspire to deliver psychosocial interventions along with pharmaceutical or biologic treatments. However, significant obstacles stand in the way of the success of these interventions. This paper discusses how the relative social and political status differences between elite professionals and their non-elite patients and patients’ families render problematic many of the psychosocial interventions employed. Data were collected in the form of observations of practitioner-patient-family attendant interactions at the Outpatient Department, and interviews with patients, patients’ family members, and psychiatric professionals at the Inpatient Department 2001–2004. Analysis found that many of the professionals’ verbal interventions attempted to promote egalitarian styles of communication and relating among patients’ family members. Psychiatrists perceived mental health problems as stemming from structural violence inherent in the North Indian institution of the family, which they described as organized hierarchically according to gender, age, and generation. One strategy evident in interventions deployed ‘traditional’ values, beliefs, and maxims irreverently in an attempt to re-order or level hierarchical differences. Another strategy invoked the concept of individual rights in an effort to empower weaker family members and enlighten powerful members regarding the destructive impact of relational styles predicated on inequality. Unfortunately, the professionals experienced their psychosocial interventions as unsuccessful. The paper suggests that rigid interactional norms across class statuses, an emphasis on liberal individual rights versus community rights, and a harsh exhortative style, contributed to the sense that the interventions alienated non-elite patients and family attendants.