A tangled web: the intersection of psychiatric diagnostic systems and local illness categories in rural India
Sumeet Jain (University of Edinburgh)
Paper short abstract:
This ethnographic paper examines deployment of psychiatric diagnoses in rural northern India. I address two issues: 1) ‘use’ of psychiatric categories by professionals and lay people and 2) intersection between professional categories and local illness categories in clinical and community settings.
Paper long abstract:
In recent years, the 'global mental health' agenda has dominated academic and policy discussions of mental health in low income countries. One of the central 'technologies' of 'global mental health' interventions are diagnostic systems including the ICD and DSM. These are seen to provide a standardized and universal means of measuring psychiatric morbidity with consequent increase in 'access' to services. However, the perceived cultural invalidity of western diagnostic categories as applied in non-western settings forms the core of current critiques of GMH (Summerfield, 2008). This paper draws on ethnographic research from north India to examine deployment of international diagnostic systems in primary mental health care clinics. I address two issues: 1) the ways in which mental health professionals and patients & family members 'use' diagnostic systems for particular reasons and 2) the intersection between international diagnostic categories and local illness categories in clinical and community settings. The ethnographic data suggests a degree of fluidity on the ground, with both psychiatric diagnoses and local illness categories being defined both in relation and in opposition to each other. Usage of local and psychiatric categories is shaped by a range of factors including caste, gender and poverty. This fluidity has important implications for the operation of the community mental health service in this area, particularly issues of access and care which are central to the GMH agenda.
Ethnographic perspectives on 'global mental health'