Bayetti Clement, Jadhav Sushrut, Deshpande Smita N
Division of Psychiatry, University College London, London WC1E 6BT, United Kingdom.
Department of Psychiatry, Centre of Excellence in Mental Health, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Indian J Psychiatry. 2017 Jan-Mar;59(1):27-38. doi: 10.4103/psychiatry.IndianJPsychiatry_16_17.
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.
印度的精神病学实践呈现出一种日益扩大的鸿沟，一方是主要集中在城市的心理健康专业人员，另一方是占多数的农村人口。基于任何接触都是一个相互构建的人道过程这一前提，理解精神病学文化，包括实习精神科医生获取当地知识的社会过程至关重要。本文回顾了印度精神科医生培训的现有文献、他们职业身份的文化构建以及自传式反思。结果显示，关于身份、知识和价值观如何通过实践得以构建、争论、抵制、维持和实施的研究匮乏。本文假设，印度的精神病学培训和实践主要仍以工具性方式运作，在文化、等级制培训结构与患者 - 护理者关切之间存在循环关系。缺乏解释性社会科学培训产生了一种主要关注患者及其社会世界作为病理场所的职业身份。通过常规临床实践获得的不频繁且往往多余的批判性文化反思，进一步使专业人员与患者、护理者以及他们自身的社会环境相疏离。这导致了一种独特的理论与实践模式，这种模式偏向于对痛苦构成的狭隘理解。作者认为，通过对精神科医生在研究生培训期间的专业发展进行细致入微的人种志研究可以解决这些疏漏，包括他们社会机构的政治经济情况和当地文化环境。进一步的研究也将有助于加强对文化敏感的认识论，并塑造适应当地情况的心理健康培训项目。这对于信任国家生物医学护理的大多数印度农村人口来说至关重要。
