Traditional concepts of mental disorder among Indian psychiatric patients: Preliminary report of work in progress

In a medically pluralistic setting a range of health care providers offer not only different forms of treatment, but different ways of understanding illness. Even within a single tradition, these concepts evolve over time. Chapters in the classical texts of Ayurveda describe varieties of severe mental disorder (unmada) arising from a particular humoral imbalance (dosa) or arising in association with specific demons and deities (bhuta) that produce distinct character changes and symptom patterns. Patients currently presenting for treatment of mental disorder may describe their illness with reference to these concepts, but they also rely on other indigenous traditional concepts such as astrology, karma, the effects of other humoral relationships, such as semen loss and so forth; or they may rely on ideas derived from cosmopolitan medicine or both. Patients presenting to allopathic psychiatric centers in India were studied to determine whether patterns of help seeking could be predicted from the conceptual model by which they understood their illness. We elicited explanatory models from patients and obtained a history of prior consultations to other types of healer. Preliminary findings were notable for the pervasiveness of prior use of folk healers and the prominence of somatic symptoms among patients presenting to these allopathic physicians. Hypotheses regarding the impact of explanatory models on patterns of medical help seeking require further study from a larger and more diverse data base.