As a group readings activity 6 of us had to read read 5 papers and discuss the papers among ourselves and present our reflections on these papers, one each presenting one paper. We named our team "Social Justice League" and I enjoyed every bit of working in this team!
The Chapter "The Last Resort, why patients with severe mental disorders go to therapeutic shrines in India" from the book Restoring Mental Health in India. Pluralistic Therapies and Concepts by Brigitte Sebastia was the paper I had to summarise what inequities has been discussed, what sources of inequities were discussed, the methodologies used, processes that led to inequities, any ethical issues related to the study etc.
I thought this paper was significant in several ways:
1. It is studied at a time (2001-02) that is way after the Mental Health Act was in practice (1987). Thus shows how the Act was being practiced and what was the access like for mental health services in that time.
2. It depicts the equities not just for the access to mental health among different communities but also the larger inequity in how much importance was given to mental health as a subject, specialty and practice as opposed to other health issues. And the stigma around it.
We have often heard and I myself have made this comment when I had a patient who had post-partum psychosis and the family wanted to take her to a temple to make her better. I remember how I had spent a long time explaining to them thinking it's their belief that is at fault and why they need to be treated in the hospital. But later we took the decision of sending her to the temple and asking her to return after that. She did return!
We use the words "misconceptions/blind believes" to accuse the patients. But this paper describes what they found when they studied with an open mind as to why people were going to a religious shrine for therapy instead of medical treatments. It's not always belief/faith. It describes how the families ran out of money trying to get "free" treatment in the public hospitals and thus went to the shrines as a last resort. It also describes how the conditions were at that time where medical institutions/ asylums kept the patients isolated from their families, doctors seldom explained what the problem and nature of treatment was, Electroconvulsive therapies (ECT) were used more than required and was traumatising for the patients. While the shrines too violated the human rights by tying the patients to trees because of the abnormal behaviour to prevent harm, they provided an environment where the families could be a support to the person with mental illness. The families also had the social support of other families going through similar crisis. So even though they weren't becoming better, they found that a better place to be in.
Further it explains how this existing system was utilised by an NGO and a psychiatrist visit and medication was incorporated into shrine, making it more humane and acceptable.
The ethical concern I got caught up with is how much can a researcher be just a witness to these especially when it comes to violation of human rights? When such a thing is witnessed, should the researcher act on it? When does the role of researcher end and actor start? Can a researcher act on it? Even if they do, how sustainable is that? I don't think there is single answer to these. But understanding one's inclinations, intentions and positions in this as a researcher and explicitly stating it is important. These are few discussions that happened with Dr Vandana Prasad from Public Health Resource Network as well.
The Chapter "The Last Resort, why patients with severe mental disorders go to therapeutic shrines in India" from the book Restoring Mental Health in India. Pluralistic Therapies and Concepts by Brigitte Sebastia was the paper I had to summarise what inequities has been discussed, what sources of inequities were discussed, the methodologies used, processes that led to inequities, any ethical issues related to the study etc.
I thought this paper was significant in several ways:
1. It is studied at a time (2001-02) that is way after the Mental Health Act was in practice (1987). Thus shows how the Act was being practiced and what was the access like for mental health services in that time.
2. It depicts the equities not just for the access to mental health among different communities but also the larger inequity in how much importance was given to mental health as a subject, specialty and practice as opposed to other health issues. And the stigma around it.
We have often heard and I myself have made this comment when I had a patient who had post-partum psychosis and the family wanted to take her to a temple to make her better. I remember how I had spent a long time explaining to them thinking it's their belief that is at fault and why they need to be treated in the hospital. But later we took the decision of sending her to the temple and asking her to return after that. She did return!
We use the words "misconceptions/blind believes" to accuse the patients. But this paper describes what they found when they studied with an open mind as to why people were going to a religious shrine for therapy instead of medical treatments. It's not always belief/faith. It describes how the families ran out of money trying to get "free" treatment in the public hospitals and thus went to the shrines as a last resort. It also describes how the conditions were at that time where medical institutions/ asylums kept the patients isolated from their families, doctors seldom explained what the problem and nature of treatment was, Electroconvulsive therapies (ECT) were used more than required and was traumatising for the patients. While the shrines too violated the human rights by tying the patients to trees because of the abnormal behaviour to prevent harm, they provided an environment where the families could be a support to the person with mental illness. The families also had the social support of other families going through similar crisis. So even though they weren't becoming better, they found that a better place to be in.
Further it explains how this existing system was utilised by an NGO and a psychiatrist visit and medication was incorporated into shrine, making it more humane and acceptable.
The ethical concern I got caught up with is how much can a researcher be just a witness to these especially when it comes to violation of human rights? When such a thing is witnessed, should the researcher act on it? When does the role of researcher end and actor start? Can a researcher act on it? Even if they do, how sustainable is that? I don't think there is single answer to these. But understanding one's inclinations, intentions and positions in this as a researcher and explicitly stating it is important. These are few discussions that happened with Dr Vandana Prasad from Public Health Resource Network as well.
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