The early reports of the identification of genes for mental disorders among the Old Order Amish had raised our hopes for a cure from such suffering. The new and radical approach to psychiatric diagnosis introduced by the Diagnostic and Statistical Manual of Mental Disorders III, with its use of objective and behavioural criteria focused on increasing diagnostic reliability and identifying homogeneous sub-groups. The 1980s were an exciting time for psychiatry. It resulted in stigma, delayed help-seeking and discrimination.Īlthough an introductory seminar on anthropology shed a different light on cultural and social approaches to mental health, distress and illness, the discussion by senior faculty suggested a negative attitude to supernatural beliefs about causation and disdain for non-medical treatments and interventions, particularly for severe mental illnesses such as schizophrenia and bipolar disorders. The mental illness was shrouded in mystery and fear for diverse populations who presented for treatment. These issues came back into consciousness when I started training in psychiatry. Our training in medical school reinforced the belief that many local and cultural beliefs were unscientific and were an important reason for ill health, delayed help-seeking, poor outcomes, morbidity and mortality. Despite our superficial understanding of the complexities of life, we came away with idealism and a desire to educate people about scientific medical approaches, improve the lives of rural folk, reduce poverty and overcome cultural obstacles to health. The faculty and staff of the department of community health discussed many issues and their implications for health and disease. Many of us, 17-year-olds, from urban backgrounds found many cultural perspectives, customs and traditions difficult to comprehend. They seemed to affect all aspects of rural life. Belief in black magic, sin, punishment, karma, evil spirits, supernatural influences, dietary conventions and religious theories resulted in complex rules, modes of behaviour and ritualistic practice. The Community Orientation Programme involved household surveys, collecting nutrition and anthropometric data, studying water supply, sanitation, contraceptive usage, birth routines, immunization schedules, child-rearing practices, and eliciting caste information and its impact on discrimination. We, as a class, lived in a village, Kammasamudram, for two weeks during our first year of medical training, to understand and experience rural life. However, it was only when I joined medical school in 1976 that I was exposed to the range and diversity of cultural beliefs and practices. I heard about black magic and other supernatural systems of beliefs in my childhood.
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