Women in psychiatry: A view from the Indian subcontinent

Comparing attitudes towards compulsory interventions in severe and persistent mental illness among psychiatrists in India and Switzerland

BACKGROUND

Psychiatrists face a major ethical challenge when deciding whether to make use of coercive measures in the treatment process of patients suffering from severe and persistent mental illness (SPMI). As India and Switzerland show major cultural, political and financial differences, it is hypothesized that attitudes towards coercive measures among Indian and Swiss psychiatrists will vary too. Exploring differences in attitudes between cultures strengthens the critical reflection on one's own stances and in consequence, on our way of action. Especially when it comes to situations involving power imbalances between patients and health practitioners, self-reflection is essential to prevent ethically inappropriate behavior.

METHODS

An online survey on aspects of care for patients with SPMI was sent to 3'056 members of the Indian Psychiatric Society between April and June 2020 and to 1'311 members of the Swiss Society for Psychiatry and Psychotherapy between February and March 2016. The respondents' answers were compared. This article deals with the questionnaire's items on autonomous decision making and the implementation of coercive measures in clinical practice. More precisely, participating psychiatrists were asked to rate the importance of patient's autonomy in general and their willingness to apply coercive measures regarding two specific case vignettes depicting a patient with schizophrenia and one with depression. The statistical analysis, namely descriptive data analysis and calculation of arithmetic means, Shapiro Wilks tests and Mann-Whitney U tests, was carried out using IBM SPSS Statistics version 27.

RESULTS

Answers were received from 206 psychiatrists in India and 457 psychiatrists in Switzerland. Indian participants tended to value autonomous decision making as slightly less important than Swiss participants (62.2% vs. 91%, p =.01). Regarding a case of severe and persistent depression, psychiatrists in the Indian group were on average more in favor of acting against the wishes of the patient (55% vs. 34.1%, p <.0001) as well as of accepting a temporary decrease in quality of life due to coercion (40% vs. 23%, p =.008). Answers concerning a case of schizophrenia revealed that Indian participants were more in favor of acting against the patient's wishes than Swiss participants (39% vs. 37%, p =.007), whereas the comparison whether to accept a temporary decrease in quality of life regarding this case showed no significant difference (p =.328).

CONCLUSIONS

The significant difference in attitudes towards coercive measures among Indian compared to Swiss psychiatrists found in this study might arise from a predominantly more collectivist society in India compared to Switzerland. Moreover, differences in financial resources, the organization of the health care system, and the historical background might have an influence. Continuous and critical reflection on one's own views and behavior is essential, especially if ethical principles and individual rights could be violated through a power imbalance, as in the case of coercive measures.

Associative stigma among mental health professionals in Singapore: a cross-sectional study

OBJECTIVES

(1) Investigate and explore whether different classes of associative stigma (the process by which a person experiences stigmatisation as a result of an association with another stigmatised person) could be identified using latent class analysis; (2) determine the sociodemographic and employment-related correlates of associative stigma and (3) examine the relationship between associative stigma and job satisfaction, among mental health professionals.

DESIGN

Cross-sectional online survey.

PARTICIPANTS

Doctors, nurses and allied health staff, working in Singapore.

METHODS

Staff (n=462) completed an online survey, which comprised 11 associative stigma items and also captured sociodemographic and job satisfaction-related information. Latent class analysis was used to classify associative stigma on patterns of observed categorical variables. Multinomial logistic regression was used to examine associations between sociodemographic and employment-related factors and the different classes, while multiple linear regression analyses were used to examine the relationship between associative stigma and job satisfaction.

RESULTS

The latent class analysis revealed that items formed a three-class model where the classes were classified as 'no/low associative stigma', 'moderate associative stigma' and 'high associative stigma'. 48.7%, 40.5% and 10.8% of the population comprised no/low, moderate and high associative stigma classes, respectively. Multinomial logistic regression showed that years of service and occupation were significantly associated with moderate associative stigma, while factors associated with high associative stigma were education, ethnicity and occupation. Multiple linear regression analyses revealed that high associative stigma was significantly associated with lower job satisfaction scores.

CONCLUSION

Associative stigma was not uncommon among mental health professionals and was associated with sociodemographic factors and poorer job satisfaction. Associative stigma has received comparatively little attention from empirical researchers and continued efforts to address this understudied yet important construct in conjunction with future efforts to dispel misconceptions related to mental illnesses are needed.

Women in psychiatry

Borrowing books was a privilege introduced for women by several academic institutions and libraries in England in the 19th century. Cambridge University accepted women on equal terms with men in 1948. Various objectors before that feared that higher education would have untoward effects on women's bodies and minds. The eminent 19th-century psychiatrist Henry Maudsley was convinced it would make them infertile (Robinson, 2009). Yet women played an important role in the founding of many Islamic educational institutions from the first millennium, and Christian religious orders fostered education for girls and women in Europe before the modern era.

Women in psychiatry

Borrowing books was a privilege introduced for women by several academic institutions and libraries in England in the 19th century. Cambridge University accepted women on equal terms with men in 1948. Various objectors before that feared that higher education would have untoward effects on women's bodies and minds. The eminent 19th-century psychiatrist Henry Maudsley was convinced it would make them infertile (Robinson, 2009). Yet women played an important role in the founding of many Islamic educational institutions from the first millennium, and Christian religious orders fostered education for girls and women in Europe before the modern era.

Women psychiatrists in India: A reflection of their contributions

The increasing number of women joining psychiatry is a relatively new phenomenon in the field of medicine. Keeping with the trends world over, the number of women psychiatrists in India has been on the rise over the last two to three decades. The authors searched various volumes of the Indian Journal of Psychiatry, recent membership directories of the Indian Psychiatric Society, website of the Medical Council of India and personal communications for contributions of the women psychiatrists in India. Women psychiatrists have a number of contributions to their credit in India. They have played important roles in the affairs of national professional organizations like the Indian Psychiatric Society and have contributed to the psychiatry education and research. However, they also suffer limitations because of the absence of adequate institutional support and policies looking into their specific needs.