Abstract
Each culture influences the perceptions of illness and pathways to health care that its members follow. Non-biomedical beliefs about psychosis and treatment are reported from the developing world. This study explored people’s perceptions on psychosis to understand local perceptions of the condition. Focus group discussions were conducted with people who have relatives with psychosis (in five focus groups), with members of the general public (in four focus groups), and with patients who had recovered from psychosis (one group) in Vellore, South India. These discussions were recorded, transcribed and analyzed. Participants recognized psychosis as an illness category, and viewed indigenous healing methods as complementary to allopathic treatments. Multiple and apparently contradictory beliefs on different aspects of psychosis were often simultaneously held by participants. People in the community were more likely to express negative views about mental illness. Relatives of patients with psychosis wanted more support from mental health professionals and community in combating stigma against mental illness. Results of this study reveal the complex nature of illness perspectives among patients with psychosis, their relatives and community. Bio-medical and indigenous beliefs are simultaneously held by a significant number of people who often seek help from both modern and traditional health systems at the same time. The results indicate the need for better understanding of local perceptions of psychosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bhui KS, Bhugra D (2002) Explanatory models for mental distress: implications for clinical practice and research. Br J Psychiatr 181:6–7
Bryman A, Burgess R (eds) (1993) Analysing qualitative data. Routledge, London
Desjarlais R, Eisenberg L, Good B et al (1995) World mental health: problems and priorities in low-income countries. Oxford University Press, Oxford
Glasser BG, Strauss AL (1967) The discovery of grounded theory: strategies for qualitative research. Aldine, Chicago
Guba EG, Lincoln YS (1994) Competing paradigms in qualitative research. In: Denzin NK, Lincoln YS (eds) Handbook of qualitative research. Sage, London
Helman CG (1994) Culture, health and illness: an introduction for health professionals. Butterworth-Heinemann, London
Jacob KS (2001) Community care for people with mental disorders in developing countries: problems and possible solutions. Br J Psychiatr 178:296–298
Joel D, Sathyaseelan M, Jayakaran R, Vijayakumar C, Muthurathnam S, Jacob KS (2003) Explanatory models of psychosis among community health workers in South India. Acta Psychiatr Scand 108:66–69
Joseph A, Joseph KS, Kamaraj K (1991) Use of computers in primary health care. Int J Health Sci 2:93–101
Kapur RL (1979) The role of traditional healers in mental health care in rural India. Soc Sci Med 13B:27–31
Khan ME, Manderson L (1992) Focus groups in tropical research. Health Policy Plan 7:56–66
Kitzinger J (1995) Qualitative research. Introducing focus groups. Br Med J 311:299–302
Kleinman A (1980) Patients and healers in the context of culture: an exploration of the Borderland between anthropology, medicine, and psychiatry. University of California Press, Berkeley
Kleinman A (1988) Rethinking psychiatry: from cultural category to personal experience. The Free Press, New York
Leslie C (1976) The ambiguities of medical revivalism in modern India. In: Leslie C (ed) Asian medical systems. University of California Press, Berkeley
Leslie C (1980) Medical pluralism in world perspective. Soc Sci Med 14B(4):191–195
Lloyd KR, Jacob KS, Patel V, St Louis L, Bhugra D, Mann AH (1998) The development and use of the short explanatory model interview (SEMI) and its use among primary care attenders with common mental disorders: a preliminary report. Psychol Med 28:1231–1237
Patel V, Musara T, Butau T, Maramba P, Fuyane S (1995) Concepts of mental illness and medical pluralism in Harare. Psychol Med 25:485–493
Patel V (2000) Health systems research: a pragmatic method of meeting mental health needs in low income countries. In: Andrews G, Henderson S (eds) Unmet need in psychiatry. Cambridge University Press, Cambridge, pp 353–377
Patterson J (1990) There rest thy feet: the CHAD experience. Community Health Department, Christian Medical College, Vellore
Pope C, Ziebland S, Mays N (2000) Analysing qualitative data. In: Pople C, Mays N (eds) Qualitative research in health care. BMJ Books, London, pp 75–87
Raguram R, Venkateswaran A, Ramakrishna J, Weiss MG (2002) Traditional community resources for mental health: a report of temple healing from India. Br Med J 325:38–40
Saravanan B, Jacob KS, Bhugra D, Prince M, David AS (2004) Culture and insight––revisited. Br J Psychiatr 184:107–109
Shibre T, Negash A, Kullgren G, Kebede D, Alem A, Fekadu A (2001) Perception of stigma among family members of individuals with schizophrenia and major affective disorders in rural Ethiopia. Soc Psychiatry Psychiatr Epidemiol 36:299–303
Statistical Handbook of Tamil Nadu (2006) In: Tamil Nadu statistics at a glance. http://www.census.tn.nic.in
Thara R, Srinivasan TN (2000) How stigmatizing is schizophrenia in India? Int J Soc Psychiatr 46:135–141
World Health Organization (WHO) (1973) Report of the International Pilot Study of Schizophrenia (IPSS). WHO, Geneva
Zola IK (1973) Pathways to the doctor from person to patient. Soc Sci Med 7:677–684
Acknowledgments
The study was supported by a research grant from the Wellcome Trust, UK, including support for B Saravanan for full-time research. The authors acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) Specialist Biomedical Research Centre for Mental Health award to South London and Maudsley NHS Foundation Trust (SLaM) and the Institute of Psychiatry at King’s College London. We also thank Ms Joanna Murray, Senior Lecturer, Institute of Psychiatry, London, for her advice on analysis of data. Staff of Christian Medical College, Vellore, conducted the fieldwork (Drs RG Alex and AP Raj, and Mr Karunakaran). We are particularly grateful to all those who participated in the focus groups.
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
Case vignette
Mrs A is a 30-year-old housewife with three small children. Her husband does unskilled manual work. For the past 6 months she has stopped doing household work. She does not interact with the children or look after their needs. Her personal care is poor. She has been socially withdrawn and prefers to be alone. Her family has noticed that she smiles to herself and admits to hearing voices of strange people speaking to her. She is convinced that others will harm her. Her sleep is disturbed and her appetite is poor. Her in-laws live next door but are not supportive.
Rights and permissions
About this article
Cite this article
Saravanan, B., Jacob, K.S., Deepak, M.G. et al. Perceptions about psychosis and psychiatric services: a qualitative study from Vellore, India. Soc Psychiat Epidemiol 43, 231–238 (2008). https://doi.org/10.1007/s00127-007-0292-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-007-0292-y