By Dr Moitrayee Das, Saanya Verdia
The need for a culturally competent practice of psychology has become an important issue today. Continuous globalisation has led to an increase in the intercultural interactions between different communities. These interactions have led to the exchanging of cultural knowledge, ideas and forms of healing. Different forms of healing are becoming popular as different cultural and religious identities continue to mix, as the world increasingly becomes a melting pot (Sue et al, 2009).
As a result of intercultural interactions, patients from different cultural communities, along with the rise in alternative multicultural forms of healing have started knocking on psychologists’ door demanding a culturally equipped practice of psychology. This also led to the Diagnostic and Statistical Manual of Mental Disorders – the principal book of psychological practice, to come up with cultural notions of distress and disorders, thus, trying to inject multicultural sensitivity (American Psychiatric Association, 2013).
While the inclusion of cultural-bound syndromes in the DSM 5 is a step forward in creating a culturally incorporative space, western psychology still has a long way to go for it to become culturally competent. The inclusion of minority voices and communities belonging to different cultures in the western mental health narrative has become important more than ever and there is a lot of work that needs to be done in that area.
Spiritualistic, as well as religious healings, have always occupied an important part in the way psychology is practised in India. The notions of Westernised psychotherapy are ill-fitted with the Indian masses. The practice of therapy in the country has historically built itself on a religious framework. There also exists the hierarchical difference between the facilitator of therapy and the patient, which made an equal alliance between the therapist and patient impossible. Due to hegemonic differences, the patient also lacks the power to make decisions or have a say in their own treatment (Manickam, 2010).
With India having the three major religious-cultural medical systems – Unani, Siddha and Ayurveda, apart from the much less documented ethno medical practices of the indigenous and tribal communities, much of the healing practices in the country are rooted in spirituality and religion. In these practices, people with mental distress are often associated with otherworldly or astral causes, which lead to the linking of shame and fear with mental disorders.
The treatment of these conditions sometimes includes sending people to religious and spiritual shrines wherein the cause of the disorder – the unearthly spirit – is exorcised from the person’s body. Since psychological distress is considered deviant, there is a social stigma attached to people who suffer from distress or disorders (Janetius, 2011). Here, the terminology of normal is culturally different from what normal is understood as, by western psychology.
While dependency of the elderly and children are considered normal and desirable in India and other such collectivistic countries, the same is considered a sign of distress in individualistic cultures. Often in India, mental distress is explained by actions or attributing it to a physical medical symptom. Family and community are placed on a pedestal in India and sacrifices for them are considered virtues while the same may be considered vices in other cultures.
Along with this, hierarchical relationships such as the therapist-patient dyad is expected and encouraged, where the therapist becomes an adult or parental figure in the patient’s life (Venkatesan, 2016). With a religious as well as spiritual approach to psychotherapy in India, Western psychotherapy sans its cultural understanding and lack of multicultural competence may find it difficult to fit within the mental health narrative of the country.
However, an increased understanding of the importance of science and the rise in the scientific movement have impacted education globally. Therapeutic counselling that focuses on holistic progress, development and empirical data is being popularised in urban areas of the country (Janetius, 2011). The therapists in the urban centres have started employing Western psychotherapeutic practices while integrating local cultural and religious elements into their practice to suit the needs of their patients better. A part of this modification includes tailoring the lexical approach of the therapists as well as the process of the therapy with spiritual, religious and cultural underpinnings.
Since the community and family are of importance, these aspects were also brought into therapy. Due to increased globalisation, as the younger generations are interacting more across cultures, individualistic understandings and decision-makings in these generations are allowing for a change in the cultural and moral ethos of the collectivistic country – India which in turn is leading towards a behaviour change in the newer generation (Smoczynski, 2012).
Healings and Therapies
Increased awareness regarding the importance of cultural representation, and the slow, yet nonetheless, creation of spaces for minority voices has led to debates regarding diversity and inclusion in Western psychology. Fights for the inclusion of race, caste, gender and culturally diverse forms of healings and therapies have broken through the predominantly homogenous culture of the Westernised form of psychology (The Chicago School, 2021).
Along with this, recognition of indigenous narratives has been extremely important in making psychology a truly inclusive and collaborative space. Embracing indigenous narratives and acknowledging the communities’ relationship with nature as part of rehabilitation practices and therapy – recognising the cultural spaces that the therapist and clients belong to and using those culturally different spaces to foster a multicultural one – should be the goal of an inclusive psychotherapy programme (Tummala-Narra, 2015).
With Western psychology already on its way to achieving multicultural sensitivity, it is important for the psychological practices used in India to do the same. Being a land divided on the basis of caste-class, culture and religion, it is important for therapies and therapists to understand the indigenous communities’ realities and socio-cultural spaces to be able to operate in an inclusive way.
Apart from the major religious medical systems, it is imperative that therapists also school themselves and become aware of culture-specific indigenous knowledge and approach which they can integrate into their practice to ensure a truly inclusive psychological practice. Hence, the inclusion of cultural competence in the practice of psychology in Western as well as Indian psychotherapy and healing is imperative to accommodate the different communities that exist in these spaces.