How do psychiatrists in India construct their professional identity? A critical literature review

Abstract

Psychiatric practice in India is marked by an increasing gulf between largely urban-based mental health professionals and a majority rural population. Based on the premise that any engagement is a mutually constructed humane process, an understanding of the culture of psychiatry including social process of local knowledge acquisition by trainee psychiatrists is critical. This paper reviews existing literature on training of psychiatrists in India, the cultural construction of their professional identities and autobiographical reflections. The results reveal a scarcity of research on how identities, knowledge, and values are constructed, contested, resisted, sustained, and operationalized through practice. This paper hypothesizes that psychiatric training and practice in India continues to operate chiefly in an instrumental fashion and bears a circular relationship between cultural, hierarchical training structures and patient–carer concerns. The absence of interpretative social science training generates a professional identity that predominantly focuses on the patient and his/her social world as the site of pathology. Infrequent and often superfluous critical cultural reflexivity gained through routine clinical practice further alienates professionals from patients, caregivers, and their own social landscapes. This results in a peculiar brand of theory and practice that is skewed toward a narrow understanding of what constitutes suffering. The authors argue that such omissions could be addressed through nuanced ethnographies on the professional development of psychiatrists during postgraduate training, including the political economies of their social institutions and local cultural landscapes. Further research will also help enhance culturally sensitive epistemology and shape locally responsive mental health training programs. This is critical for majority rural Indians who place their trust in State biomedical care.

Explanatory models of mental illness among family caregivers of persons in psychiatric rehabilitation services: A pilot study

“…The findings of this study have a range of implications for training and practice. Culturally grounded and locally responsive mental health training programmes can help trainees to accept and negotiate these disparities (Bayetti, Jadhav, & Deshpande, 2017) and cast a reflexive gaze on mental health systems and practices. Delivery of interventions and treatment sensitive to cultural knowledge, skills, practices, attitudes and policies while acknowledging individual variability and diverse experiences can have a positive impact on the interactions with patients and on outcomes (Baer, Singer, & Susser, 1997; Isaacs & Benjamin, 1991; James, 2006; Kleinman, 1978; Lo & Stacey, 2008; Sue et al, 1982).…”

Psychiatric practice: Some personal observations

“…Many felt that Indian psychiatrists are still a poor copy of Western psychiatrists. [ 8 ] Mainly, clinicians working in academic setups used the treatment guidelines;[ 9 ] others did not find them useful. Clinicians preferred guidelines that are concise and point wise.…”

The development of professional identity in clinical psychologists: A scoping review

“…There have been a number of reviews over the past decade synthesising the increasingly available empirical literature exploring a range of health care professional identities 2,5,7–15 . Much of the literature within these studies originates from the USA, Canada, the UK and Australia 2,7–10 .…”

“…Further, professional identities have a critical impact on political, social and health care advances and reforms 2 . Internationally, within health care services (including mental health care), there has been widespread criticism of paternalistic models of care and privileging biomedical views of recovery 3–5 . In this vein, current mental health system reforms demand person‐centred clinical care that promotes personal recovery: a radical shift in the way mental health services are delivered requiring an equally radical shift by mental health care professionals 5 .…”