Cultural shaping of illness: a longitudinal perspective on apparent depression

Culture, Empathy, and the Therapeutic Alliance

When the therapist and patient are from different cultures, there may be impediments to the development of empathy and a therapeutic alliance. South India culture provides an example of contrasting values and customs about which patients may be reluctant to discuss. The initial case history is of a South Indian who sought treatment in the United States. The remaining cases, drawn from a village in South India with which the author has had a 55-year history of research, illustrate cultural factors potentially inhibiting or facilitating the development of empathy and a therapeutic alliance.

Culture, Empathy, and the Therapeutic Alliance

When the therapist and patient are from different cultures, there may be impediments to the development of empathy and a therapeutic alliance. South India culture provides an example of contrasting values and customs about which patients may be reluctant to discuss. The initial case history is of a South Indian who sought treatment in the United States. The remaining cases, drawn from a village in South India with which the author has had a 55-year history of research, illustrate cultural factors potentially inhibiting or facilitating the development of empathy and a therapeutic alliance.

Women's Experiences and Perceptions of Depression in India: A Metaethnography

In India, social determinants of health, including poverty, domestic violence, and inadequate social support disproportionately affect women, leaving them more vulnerable to depression than men. We conducted a metaethnography to synthesize qualitative data from 13 studies (1987-2017) that explored women's experiences and perceptions of depression in India. We used a feminist standpoint to critically examine how gender shapes these experiences and perceptions. Indian women's experiences of depression were embedded in their social worlds. Women perceived interpersonal conflict, caregiving burden, domestic violence, financial insecurity, adverse reproductive events and widowhood as causes of depression. Women used cultural expressions to describe physical, emotional, and cognitive distress. The detrimental impact of discriminatory social conditions, gender inequalities, and traditional gender roles on Indian women's mental health highlights the need for gender-sensitive mental health research and practice that can attend to women's sociocultural context and promote values of gender equality and social justice.

A village possessed by "witches": a mixed-methods case-control study of possession and common mental disorders in rural Nepal

In Nepal, spirit possession is a common phenomenon occurring both in individuals and in groups. To identify the cultural contexts and psychosocial correlates of spirit possession, we conducted a mixed-method study in a village in central Nepal experiencing a cluster of spirit possession events. The study was carried out in three stages: (1) a pilot study consisting of informal interviews with possessed individuals, observations of the possession spells, and video recording of possession events; (2) a case-control study comparing the prevalence of symptoms of common mental disorders in women who had and had not experienced possession; and (3) a follow-up study with focus group discussions and in-depth interviews with possessed and non-possessed men and women, and key informants. Quantitative results indicated that possessed women reported higher rates of traumatic events and higher levels of symptoms of mental disorder compared to non-possessed women (Anxiety 68 vs. 18 %, Depression 41 vs. 19 %, and PTSD 27 vs. 0 %). However, qualitative interviews with possessed individuals, family members, and traditional healers indicated that they did not associate possession states with mental illness. Spirit possession was viewed as an affliction that provided a unique mode of communication between humans and spirits. As such, it functioned as an idiom of distress that allowed individuals to express suffering related to mental illness, socio-political violence, traumatic events, and the oppression of women. The study results clearly indicate that spirit possession is a multi-dimensional phenomenon that cannot be mapped onto any single psychiatric or psychological diagnostic category or construct. Clinical and public health efforts to address spirit possession must take the socio-cultural context and systemic dynamics into account to avoid creating iatrogenic illness, undermining coping strategies, and exacerbating underlying social problems.

The peripatetic cultural psychiatrist: reflections on a forty-five year longitudinal study of a South India village

This article presents one woman's odyssey, which began with a career in linguistics and later incorporated cultural psychiatry. While engaged in fieldwork as a linguist, studying the syntactic structure of Havyaka Kannada and dialectal accommodation among the castes in a South India village, I developed language skills and rapport with the village residents. Then I transferred my community-wide rapport to research on depression as a cultural psychiatrist. The articles I wrote on depression and its relationship to socialized passivity and endorsed assertiveness in progressive generations of South Indian women, illustrate the impact of change on mental health. The cultural background from my community-based longitudinal study of more than forty-five years has contributed to my understanding disorders in Indian patients living in a globalized world.