Finding a fit: psychiatric pluralism in south India and its implications for WHO studies of mental disorder

This article examines reports of improvement and decline in short-term follow-up interviews and long-term recollections among patients in three forms of therapy for mental illness in south India: ayurvedic (indigenous) psychiatry, allopathic (western) psychiatry, and religious healing. Interviews indicate that patients of all three therapeutic systems showed improvement after follow-up assessments and that several patients had radically divergent experiences with each of the three therapies; each therapy was found by some to be helpful and by others to be ineffective. These findings suggest that a greater availability of distinct forms of therapy makes it more likely that an individual will find a therapy to which he or she responds well, an insight that helps interpret World Health Organization-sponsored studies which examined mental disorders in developed and developing country sites and found a better outcome for these disorders in developing country centers. Although several studies have attempted to account for this difference in outcome, none have done so by considering that the 'developing' country sites in the World Health Organization studies are all places that have a greater availability of diverse forms of therapy when compared with the 'developed' sites.