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Psychiatric Demands Jump as India Battles Mental Illness

December 29, 2009 at 12:00 AM EST
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Mark Scheffler of GlobalPost looks at the ailing profession of psychiatry in India, where only a handful of doctors are equipped to handle the increasing demands of mental health there.
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MARK SCHEFFLER: This man has a problem. He’s convinced an evil spirit is trying to strangle him. So, he’s come to a town called Sonapah, about an hour-and-a-half outside Delhi. Here, on the grounds of a temple, he found someone he hopes can help him, a wild-eyed faith healer named Sadoran. Sadoran claims to be channeling deities that will expel the demon from the man’s life.

MAN: My mind is not working. Someone is trying to strangle me, to suffocate me.

MARK SCHEFFLER: For many Indians, places like these are all that’s available when it comes to solving what might otherwise be called a mental health problem.

In India, the chronic shortage of psychiatrists has become a glaring issue, even as the country makes great economic strides. By some counts, there are only 4,000 psychiatrists countrywide to treat Indians who suffer from depression or other mental illnesses.

Dr. Samir Parikh, the chief psychiatrist at Max Super Speciality Hospital in Delhi, sees 40 patients a day to keep up with demand.

DR. SAMIR PARIKH: So, based on WHO standard, we are almost 300 percent short of psychiatrists, based on the population-psychiatry ratio required. And most of these psychiatrists are in the more urban India.

So, what happens when you start going away from the urban to the rural areas? Since accessibility is not there, so stigma becomes more. And then all these voodoo things, and faith healers, and self-healing, kind of all those things start trickling in.

MARK SCHEFFLER: Beyond the issue of stigma, the poor often don’t have access to doctors. In more well-heeled enclaves, psychiatric treatment isn’t covered by insurance. And then there’s a simple matter of blaming not science, but the spirit world, for one’s mental state.

DR. AJAY PAL SINGH, psychiatrist, Max Super Specialty Hospital: Yes, it a sort of thing that something is predestined to you. If you’re not doing well, well, it may be the past sense that — your pain in this current life. It may be the past sense of a past life of your pain, or it could have been something you have done in a — you know, in your early youth, some — so, you’re paying — you’re getting a punishment for that.

MARK SCHEFFLER: To address the shortage of psychiatric care among the poor in Delhi, Dr. Nimesh Desai help runs a street clinic in a bustling, though deeply impoverished, part of the city.

Last year, he got the case-by-case legal authority to inject antipsychotic medicines here on the sidewalks into those who have no families and who are not mentally stable enough to give consent for themselves.

Shiv is one such person. Dr. Desai says he has shown signs of improvement in the four months he’s been receiving medication.

DR. NIMESH DESAI, head psychiatrist, Institute of Human Behavior and Allied Sciences: It is an experiment doing it on the street. We thought it’s a better idea to get treatment here, where people are, rather than getting people to the hospital.

That meaningful smile is such a reward, you know?

MARK SCHEFFLER: Psychiatry is gaining more credibility among India’s other medical professionals, who, for years, thought talk therapies and antidepressants didn’t work. That acceptance could eventually boost the ranks of practitioners here.

Meanwhile, traditional methods endure. Back at the temple, the faith healer seems to have helped Mahinder and Jalo, a couple that claims they’re no longer suffering from depression.

WOMAN: When we came to this place, we were helped by this man. We were treated.

MARK SCHEFFLER: While science may balk at calling this a cure, Dr. Parikh believes faith healing can be a legitimate form of therapy among a population that desperately needs help.

DR. SAMIR PARIKH: Make sure that the advances of mental health reach the common person. It’s not reaching the common person. Who is reaching the common person? The faith healer is reaching it.

So, integrate him in your system. But you don’t tell him that: “Listen, you’re foolish. I’m the great doctor. I have studied all these years. I understand these neurotransmitters and these brain chemistries, which you don’t understand. All you are talking about is some breathing exercises and some — some rituals and pujas.”

You integrate them.

MARK SCHEFFLER: But in places like Sonapah and throughout India, the goal of integrating local superstitions with big city medical practices seems every bit as elusive as the spirits that still haunt the unhealed.