'Diagnosis' and 'subjectivity' in community mental health in northern India
(University of Edinburgh)
Paper short abstract:
This paper examines the meaning and significance of ‘diagnosis’ and ‘subjectivity’ in community mental health in northern India. This paper argues that the identities of patients and clinicians as ‘subjects’ are de-emphasized in favour of stylized forms of interaction and idealized identities.
Paper long abstract:
This paper examines the meaning and significance of 'diagnosis' and 'subjectivity' in healing encounters in community mental health care in northern India. A central 'technology' of 'global mental health' interventions are diagnostic systems including the International Classification of Disease (ICD) and Diagnostic Statistical Manual (DSM). These are seen to provide a standardized and universal means of measuring psychiatric morbidity with consequent increase in 'access' to services. Drawing on ethnographic data, this paper argues that the identities of patients and clinicians as 'subjects' are de-emphasized in clinical encounters in favour of stylized forms of interaction and idealized identities. In these encounters, diagnosis is of limited value for clinicians and patients. Rather, the primary focus is on prescription and provision of medication. Patients and professionals construct 'ideal type' identities of the other in relation to medication. For patients and family members, the ideal psychiatrist is a provider of medication that will 'solve' a problem. For professionals, the ideal patient is 'compliant' to treatment. The actuality of practice is that neither the patient nor professional fulfils the ideal. This has important implications for the operation of community mental health services in this region, particularly issues of 'access to care' which is central to the 'global mental health' agenda.
Constructing diagnosis in 'mental health': the negotiation of categories, the encounter of subjectivities in South Asia