A cultural critique of community psychiatry in India

This article is the first comprehensive cultural critique of India's official community mental health policy and program. Data are based on a literature review of published papers, conference proceedings, analyses of official policy and popular media, interviews with key Indian mental health professionals, and fieldwork in Kanpur district, Uttar Pradesh (2004-2006). The authors demonstrate how three influences have shaped community psychiatry in India: a cultural asymmetry between health professionals and the wider society, psychiatry's search for both professional and social legitimacy, and WHO policies that have provided the overall direction to the development of services. Taken together, the consequences are that rural community voices have been edited out. The authors hypothesize that community psychiatry in India is a bureaucratic and culturally incongruent endeavor that increases the divide between psychiatry and local rural communities. Such a claim requires sustained ethnographic fieldwork to reveal the dynamics of the gap between community and professional experiences. The development of culturally sensitive psychiatric theory and clinical services is essential to improve the mental health of rural citizens who place their trust in India's biomedical network.